By Amy Norton, Medical Tribune News Service
While it's common for cancer patients to go through bouts of
depression, some women with breast cancer may be at particular risk
for major depression due to their cancer treatment, research
suggests.
Breast-cancer treatment often causes women's estrogen levels to
drop sharply, and this hormonal upset can bring on symptoms of
clinical depression, according to researchers at Massachusetts
General Hospital in Boston.
Following 21 breast-cancer patients over two years, researchers
led by Dr. Laura Sheingold Duffy, a psychiatrist, found that eight
(38 percent) developed major depression within six months of
beginning treatment with chemotherapy or the drug tamoxifen.
``Many women have menopausal symptoms like hot flashes and
insomnia,'' said study co-author Dr. Donna Greenberg, a professor
of psychiatry at Harvard Medical School. ``Some go beyond that and
develop what a psychiatrist would recognize as clinical
depression.''
Her team's findings appear in the current issue of the journal
Psychosomatics.
Clinical depression, Greenberg explained, differs from the
episodes of depression that cancer patients commonly face in that
patients lose the ability to feel pleasure or to take interest in
the things they normally would.
Through years of treating emotional symptoms in women with
breast cancer, Greenberg said, she and Duffy noticed an association
between these problems and menopausal-like symptoms.
Many women who develop breast cancer in their 30s or 40s go
through early menopause due to the effects of chemotherapy on the
ovaries.
Older breast-cancer patients who've gone through menopause can
also experience hormonal fluctuations due to treatment, according
to Greenberg. For instance, women who go on estrogen-replacement
therapy (ERT) after menopause must discontinue it if they develop
cancer since ERT can promote breast tumors. And tamoxifen, an
anti-estrogen drug for breast cancer, can bring on menopausal
symptoms.
In periodic interviews with the study subjects, the Boston
researchers found that among the 15 who had not gone through
menopause before cancer treatment, 14 stopped menstruating or
developed hot flashes within six months of beginning therapy. They
determined that four were clinically depressed, as were four of six
postmenopausal women.
These findings, the researchers reported, suggest that cancer
specialists closely monitor signs of depression in women who are
likely to become estrogen deficient during treatment.
That breast-cancer patients become depressed is no secret to the
oncologists who treat them, said Dr. John Carpenter, a professor of
medicine at the University of Alabama at Birmingham Comprehensive
Cancer Center.
Carpenter estimated that one-quarter of the breast-cancer
patients he sees suffer emotional problems that require attention.
That usually means short-term treatment with an antidepressant, a
highly effective strategy, according to Carpenter.
``There are only a few who really get into trouble and need a
referral to a psychologist or psychiatrist,'' he said.
The breast-cancer specialist questioned whether the study
subjects suffered clinical depression. He said that he saw no
evidence that the women had anything beyond common depressive
symptoms -- an ``important problem'' that he said the study brings
out.
Carpenter did note that it's ``reasonable'' that estrogen
deficiency is connected to depressive symptoms in breast-cancer
patients. He pointed out that antidepressants can sometimes ease
premenstrual syndrome, suggesting a link between menstrual symptoms
and those of depression.
In the Boston study, three of the eight women with depression
fully recovered after treatment with antidepressants. One improved
with psychotherapy and two with no treatment. That treatment met
with success is an important finding, according to Greenberg.
``Patients have mental anguish,'' she said, ``but it can be
treated.''
