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Depression, Anxiety, and Leukemia

Posted on May 20, 2021
Medically reviewed by
Todd Gersten, M.D.
Article written by
Anastasia Climan, RDN, CDN

People living with leukemia commonly face mental-health-related symptoms, such as depression and anxiety. In fact, it’s estimated that 1 in every 4 people with cancer has clinical depression and about 15 percent of people with cancer have both anxiety and depression.

Leukemia is a type of blood cancer in which blood stem cells develop abnormally and excessively in the bone marrow. Leukemia causes symptoms when abnormal white blood cells begin to crowd out healthy blood cells and spread. Along with physical symptoms — such as pain, fatigue, and shortness of breath — people living with leukemia can also experience psychological symptoms like depression or anxiety.

Symptoms of depression may include:

  • Difficulty focusing or making decisions
  • Feeling hopeless or empty
  • Loss of interest in activities previously enjoyed
  • Mood swings
  • Sleep changes
  • Thoughts of self-harm or suicide
  • Tiredness
  • Weight loss or gain

Anxiety symptoms include:

  • Nervousness, restlessness, or tension
  • A sense of impending danger
  • Increased heart rate
  • Rapid breathing
  • Trouble sleeping

After a cancer diagnosis, it’s crucial to have a plan for your mental and emotional well-being. Here are some of the challenges and treatment options for dealing with the psychological aspects of leukemia.

Causes of Mental Health Issues With Leukemia

If you have a recent cancer diagnosis or have been undergoing treatment, there are several common reasons that you may feel depressed or anxious.

Lack of Activity

Most people with cancer experience fatigue. Whether it’s from the cancer itself or the side effects of treatment, leukemia can make it difficult to do the things you used to enjoy. As energy levels become depleted, it’s only natural to cut back on exercise.

Sometimes the extra rest is exactly what your body needs. But sometimes, missing out on mood-boosting endorphins can perpetuate a downward spiral of depression.

Financial Burdens

The financial toll of leukemia can be another significant contributor to depression and anxiety. The combination of medical bills piling up and the need to cut back at work can make it seem impossible to get ahead.

Social Withdrawal

Depression may lead you to withdraw socially at a time when you need support from loved ones more than ever. You may worry about how others will respond to your diagnosis and find it easier to keep your distance — but a lack of social support can lead to mental and emotional issues.

Uncertainty

The uncertainty that comes with a cancer diagnosis is a common driver of anxiety. Not knowing what to expect from your next test result or experiencing an unexpected change in your course of treatment can leave you feeling out of control and stressed.

This sentiment is echoed by members of MyLeukemiaTeam. One member shared that changes in their test results left them “more terrified than ever.” “Does this mean I will never go into remission? I feel like I keep getting bad news, and nothing seems to be going well. I am so scared,” they wrote.

Fear of the unknown breeds greater anxiety levels that may manifest in a variety of ways, including:

  • Phobias
  • Sleep disturbances
  • Panic attacks
  • Appetite changes

Finding a way to manage anxiety can vastly improve your quality of life with leukemia.

Anxiety and Depression in Children and Young Adults With Leukemia

Several factors make living with leukemia particularly difficult for younger people. Cancer treatments can disrupt normal developmental experiences, including school and social activities. Younger people also haven’t had as much life experience to gain the tools necessary to navigate difficult emotions.

Survivors of childhood leukemia may experience life differently than their peers and siblings, even after entering remission. Studies show higher rates of depression and anxiety, lower quality of life, and negative self-image in younger people with leukemia. Parents may be nervous about allowing children with a history of leukemia to participate in social activities, making it harder for kids to connect with friends.

These effects seem to subside after the first five years of recovery, however. Ultimately, children who experience leukemia generally appear to end up with stronger coping skills than those who haven’t had leukemia. Finding age-appropriate interventions can help young people with leukemia avoid depression and bring a greater sense of meaning to their lives as they go through treatment and adjust back to their usual routines.

Costs of Untreated Mental Health

There are deep costs associated with neglecting the emotional aspects of leukemia. During periods of depression, life goals like progressing through school, holding down a job, and maintaining social relationships become increasingly challenging. Lowered productivity leads to poor finances, while social isolation fuels downward trends in mental health.

Don’t underestimate the impact of anxiety and depression on your overall health — research shows a clear correlation between mental and physical health. Anxiety and depression may lead to poor medication compliance, higher stress levels, and worse outcomes for leukemia treatment.

Depression has been identified as an independent risk factor for cancer mortality. Researchers have identified an increased mortality rate of 26 percent for those with depressive symptoms and a 39 percent hike for those with major depression.

Fortunately, it is possible to get help. When undergoing leukemia care, it’s essential to take extra steps to check in with yourself and ensure that you’re getting the emotional support you need. Feeling anxious or depressed about your condition is normal at times, but it doesn’t have to be long term or debilitating. With a proactive approach, you can discover tools to address these issues head on.

Treatment for Anxiety and Depression

Depression and anxiety are medical conditions, just like leukemia. While temporary periods of sadness may be unavoidable at times, clinical depression can become a barrier to treating leukemia and healing your body. Through mental health treatment, you can find ways to move past the mood issues holding you back from living life to fullest.

Psychotherapy and Support Groups

Therapy from a qualified provider (such as a social worker, psychologist, nurse, or psychiatrist) can make a big difference in your ability to cope with anxiety and depression during leukemia treatment. Talk to your insurance carrier about coverage for services, or ask your oncology health care team for low-cost support in person or online.

Look for resources like:

  • Cognitive behavioral therapy (CBT)
  • Educational classes and workshops
  • Group programs led by cancer survivors
  • Individual counseling or coaching
  • Spiritual support groups

Couples or family counseling can help you build positive relationship dynamics, even with the added stress of leukemia. If you’re having trouble discussing your health with your family or spouse, you may benefit from this type of more formal and guided program.

Support groups specific to leukemia or for people with different forms of cancer may be found through:

  • Doctors' offices
  • Community centers
  • Senior centers
  • Libraries
  • YMCAs
  • Religious organizations

If you can’t find support groups in your area, the internet has opened up endless opportunities to connect with others who can relate to your experience.

You can find plenty of social support on MyLeukemiaTeam. One member shared, “No matter where you are in the process, hang in there and trust the process. You may ask yourself at times, ‘Why am I going through this?’ Things will get better. There are smiles down that road. Just know you are stronger than you ever thought you were.”

Medications

Various antidepressant medications are available to help manage mental health issues, including:

  • Monoamine oxidase inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)

Newer medications are also sometimes prescribed, including:

  • Agomelatine
  • Bupropion
  • Mirtazapine
  • Reboxetine

Your doctor can help you decide if medication is necessary. Some antidepressants offer additional benefits during leukemia treatment, such as increasing appetite or improving sleep. If antidepressants are right for you, your doctor will prescribe a medication carefully based on your tolerance, any other treatments you're on (to avoid interactions), and your current symptoms.

Physical Activity

Studies show that exercise helps reduce depression and anxiety for adults undergoing induction therapy for acute leukemia. Although intense physical activity may not be appropriate or beneficial, light exercise — like walking and stretching — can help:

  • Maintain your mobility
  • Reduce aches and pains
  • Improve your mental outlook

The support of a structured program with a physical therapist or trainer provides added benefits during leukemia treatment, including:

  • Better sleep
  • Less fatigue
  • Lower levels of anxiety and depression

When To Get Emergency Help

If depression or anxiety progresses to a severe level, it’s wise to seek treatment right away. Some significant causes for concern include:

  • Inability to eat or sleep for multiple consecutive days
  • Preoccupation with death
  • Restlessness, difficulty breathing, or sweating (signs of a panic attack)
  • Suicidal thoughts

Your cancer treatment center should be able to refer you to the appropriate resources. Call 911 if you’re concerned about your immediate health and safety.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. More than 8,300 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Is life with leukemia causing you symptoms of anxiety or depression? What advice do you have for others? Share your experience in the comments below, or start a conversation by posting on MyLeukemiaTeam.

All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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