A cancer diagnosis is a life-altering experience. It creates uncertainty and a fear of the unknown. This holds especially true for people battling breast cancer. The disease can be painful and the course of treatment, uncomfortable. If you’ve been diagnosed with breast cancer, it’s natural to feel sadness and uncertainty along with a wide range of other complex emotions. Sometimes the feelings that accompany a cancer diagnosis can be overwhelming and persistent, leading to a secondary diagnosis of clinical depression. In fact, close to 50% of people diagnosed with breast cancer experience depression and its cousin, anxiety. While depression is treatable under the care and direction of a doctor, it presents a unique problem for those currently undergoing breast cancer treatment.
The Challenge of Treating Depression and Breast Cancer Concurrently
Clinical depression is an entirely different condition from “feeling sad.” Sadness arises in response to external factors; it is short-lived and responsive. Depression, on the other hand, is a long-term condition marked by a lack of energy, restlessness, irritability, a loss of interest in normal activities, changing sleep patterns, lapses in concentration, and in some cases more severe symptoms, such as suicidal thoughts or ideation.
Doctors normally use antidepressant medications as a frontline intervention for patients diagnosed with clinical depression. Common antidepressants fall into a few main categories. Those categories include:
- Selective serotonin reuptake inhibitors (SSRI)
- Selective norepinephrine reuptake inhibitors (SNRI)
- Tricyclic antidepressants (TCA)
- Monoamine oxidase inhibitors (MAOIs)
SSRIs and SNRIs are by far the most commonly prescribed alternatives. You might recognize medications brands such as Paxil, Prozac, Celexa, Zoloft, or Lexapro. Each of these medications falls into either the SSRI or SNRI category. However, attempting to treat breast cancer patients with these particular medications presents a problem for those who are estrogen receptive positive (ER Positive): key chemical components in many SSRIs interfere with the effectiveness of one of breast cancer’s main treatment methods.
A anti-estrogen medication called Tamoxifen is used to mitigate the risk of relapse in breast cancer patients who’ve undergone surgery or chemotherapy. It is also used as a preventative for people who are at high risk for developing breast cancer in the first place. Tamoxifen is a SERM, which stands for selective estrogen receptor modulator. Tamoxifen use prevents recurrent cancer by up to 50% in women who’ve already undergone menopause.
In order to be effective, however, Tamoxifen must be metabolized by the CYP2D6 liver enzyme. The problem with SSRIs occurs because many SSRIs act as CYP2D6 inhibitors, essentially blocking that metabolization from happening. A Breast Cancer Research study found that patients who took both Tamoxifen and an SSRI experienced a 27% increase in the likelihood of recurrent breast cancer and, ultimately, mortality. In this study, the SSRIs being taken prevented the SERMs from having a positive effect on the cancer patient’s body. Therefore, taking an antidepressant during post-chemotherapy cancer treatment must be done in careful consultation with your doctor.
Knowing this, physicians generally avoid prescribing known CYP2D6-inhibitors to current, former, and potential breast cancer patients. There are medication options which are less likely to conflict with breast cancer treatment. But what if the prescribed medications don’t do enough? Or don’t do anything? Or the side effects you experience simply make the medications unusable? Fortunately, there are options that may augment or even replace the need for medications.
Effective Depression Treatment Alternative: TMS Therapy
When antidepressants aren’t enough or aren’t good options, there is still an effective medical option available: TMS therapy.
TMS stands for transcranial magnetic stimulation. TMS therapy is an FDA-approved treatment method that’s performed by a licensed psychiatrist. The process is noninvasive, with no systemic side effects (no weight gain, no loss of libido) and patients are able to drive immediately following the procedure.
The technique itself is simple. The patient sits comfortably upright while a magnetic coil is placed over the front of their head. The gentle magnetic currents help the brain’s prefrontal cortex release key chemicals, such as serotonin and dopamine, that help combat the chemical imbalances that cause long-term depression. Most patients experience few — if any — side effects, and the time constraints of treatment are minimal. The patient can expect to engage in the TMS therapy 5 times a week at 18 minutes per treatment for 6 weeks. After that, only a yearly checkup is required. That makes TMS therapy the perfect option for many patients who are already dealing with the difficult task of breast cancer treatment and recovery.
Holistic Methods to Help Combat Depression
Whether or not you are being treated with medication and/or TMS therapy, there are a few other holistic methods you can use to help mitigate your depressive symptoms. Some of those techniques include:
- Increasing your level of exercise
- Meditation, prayer, and spirituality
- Eating a healthy diet
- Avoiding alcohol
- Seeking formal therapy options
Many of these options can effectively reduce depressive symptoms, especially when they are used in conjunction with one another, TMS therapy, and/or medication. The main idea is to begin addressing everyday issues that contribute to long-term depression. If holistic lifestyle changes on their own are not enough to help you manage your depression, it may be a good idea to discuss the benefits of medication and/or TMS therapy with your physician.
Prime Behavioral Health specializes in administering TMS therapy to patients of all types, including those battling breast cancer and suffering from depressive symptoms concurrently. We can also help determine what other methods may help with combatting your depression. To find out more about TMS therapy, contact Prime Behavioral Health today.