Breast cancer: The impact of depression and its treatment

Abstract

A series of difficult life adjustments is initiated the moment a woman receives her diagnosis of breast cancer, arguably one of the most challenging of life stressors. (Table presented) Elevated rates of major depression are observed in women with breast cancer. This disorder of the CNS interferes with a woman's capacity for problem solving and self-care, impairs her compliance with the antineoplastic regimen, adversely affects her quality of life, and is associated with diminished survival. Depressive symptoms in cancer patients are thought to be induced by pathophysiologic mechanisms such as elevations of proinflammatory cytokines and HPA axis hyperactivity. The acute perturbation of gonadal steroid production by chemotherapy can be conceptualized as being analogous to the perimenopause, the maturational phase in which women are especially susceptible to major depression. Antidepressant treatment reduces the incidence of hot flashes and has been shown to improve depressive symptoms in women with breast cancer suffering from comorbid major depression. With documented effectiveness in amelioration of depressive symptoms (and improvement in quality of life) of breast cancer survivors, group psychotherapy also provides education, techniques to reduce some of the adverse effects of chemotherapy, and improvement in pain control. Further understanding of the molecular pathways by which antineoplastic therapeutic regimens induce depressive symptoms and related symptoms of fatigue and cognition dysfunction can only catalyze the development of neuroprotective strategies to prevent mood syndromes in women with breast cancer. Whether group psychotherapy alone and/or in combination with antidepressant treatment enhances a woman's compliance with oncologic treatment, and thereby improves her survival, will undoubtedly be elucidated in the next decade [85]. © Springer-Verlag Berlin Heidelberg 2006.