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Breast cancers progress
From The Medical Tribune
Researchers suggest that 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.
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.” and her team’s findings appear in an 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.”
Also published in the July-August issue of Psychosomatics June 30, 1999 | |
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