It is common for people with cancer to experience distress associated with their diagnosis, treatment, and after-effects of treatment. The National Comprehensive Cancer Network (NCCN) defines ‘distress’ as: “A multifactorial unpleasant emotional experience of a psychological, social and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment.” Distress can be coming from many things, including depression, anxiety, fatigue, or pain.
The risk of depression may be up to 2-3 times higher in people with cancer than in the general population. In addition, symptoms of anxiety may also occur in up to 22 percent of people with cancer. When people with cancer suffer from symptoms of depression and anxiety, they may have lower treatment success, therefore, it is very important that these symptoms be adequately treated.
While non-medication modalities like psychotherapy, exercise, and spiritual practices are often very beneficial for these forms of distress, many people may also be prescribed medications to help minimize symptoms. Antidepressant medications (see table below) can be helpful treating distress and may be the first choice options recommended by healthcare providers. All of these antidepressants can be helpful for depression and anxiety. The SNRIs and TCAs are classes of medications that may be helpful for some types of pain experienced by patients with cancer.
Certain factors can affect the success and tolerability of antidepressant medications for people with cancer or who are survivors of cancer. It is important to keep these six things in mind whether you are new to antidepressant therapy or have been taking an antidepressant for a while.
Benefits may not be apparent right away. Most people don’t experience improvements in depression, anxiety or pain symptoms for at least a couple of weeks. The average time it takes to see improvements is 4-6 weeks. It can take as long as 12 weeks for benefits to be noticeable.
Antidepressants should be taken every day. Antidepressants don’t work as well if they are taken irregularly. Taking an Antidepressant some days and not on other days can also increase the risk for side effects.
You may feel worse before you feel better. Unfortunately, antidepressants can cause side effects such as increased anxiety, stomach upset, insomnia or drowsiness. These effects can make depression or anxiety feel worse. Fortunately, these side effects usually go away within 1-2 weeks. Your doctor or pharmacist can often suggest strategies to manage these side effects while they are problematic.
Some antidepressants can interact with other medications that patients with cancer may be taking. It is very important to inform your doctor and your pharmacist about all medications you take (even over-the-counter medications and supplements) so that they can assess any interactions.
The length of time to keep taking an antidepressant can vary widely. All patients who start taking an antidepressant should clarify the recommended length of therapy with their healthcare provider. It may be necessary to continue taking the antidepressant long after the distress-related symptoms have resolved.
If one antidepressant didn’t work, there is a very good chance that an alternate one will. Even though many antidepressants are in the same family, they can still have very different effects for an individual person. Don’t give up hope if one antidepressant doesn’t work for you. There are many options that may work better.