We are often focused on the impact that cancer has on our physical health. But the diagnosis of cancer, the disease itself, the treatments, and the side effects of treatment also can have a tremendous impact on our mental and emotional health. Sometimes, the mental and emotional symptoms may outlast the physical symptoms.
For years, some of the effects of cancer and its treatment – such as chemo-brain and scanxiety – were given short shrift by health care providers. Fortunately, many leading institutions now are employing an integrative approach when treating patients. As the days of winter drag on, it is an appropriate time to examine the “winter blues.”
Seasonal affective disorder or “SAD” is a mood disorder associated with depression and is most frequently experienced by individuals during the winter months. Approximately half a million people will experience SAD every winter between September and April, according to Dr. Janine E. Gauthier, Director Clinical Services, Cancer Integrative Medicine Program, and Director of Psychosocial Services, Rush University Medical Center. Typically the symptoms include mood changes, lethargy, sleep problems, social problems, overeating and sexual difficulties (low libido, decreased interest).
Many people – not only cancer survivors and patients – experience the “winter blues,” a milder form of SAD that actually impacts many more people. “Feelings of sadness, anxiety and loss are more prevalent among cancer patients during the winter months,” says Katherine Puckett, PhD, MS, MSW, LCSW, national director of mind-body medicine at Cancer Treatment Centers of America. “Negative thoughts left unchallenged can become a longer lasting problem and can easily impact treatment outcomes.”
Dr. Gauthier tells us that some of the causes of SAD include a shift in our “biological internal clocks” or what is termed circadian rhythms due to changing sunlight patterns. The sleep hormone, melatonin, secreted by the pineal gland in the brain, also has been linked to SAD. Melatonin is produced at increased levels in the dark and thus may increase as the days get shorter. It is important to assess whether and to what extent the patient’s depressive symptoms are linked primarily to their cancer or whether in the past they experienced these symptoms with the changing seasons, adds Dr. Gauthier.
“The mind and body are intricately connected,” notes Dr. Puckett. “By offering programs that help reduce stress and incorporate supportive therapy into a care plan, we can aid the body’s natural mechanisms to fight disease, help combat depression, address pain and help patients remain optimistic and strong as they battle cancer.”
According to Dr. Gauthier, “phototherapy or bright light therapy has been shown to decrease the secretion of melatonin in breast cancer patients.” For the winter blues (milder symptoms) spending time outdoors during the day or arranging home and workplaces to receive more sunlight can provide some relief of symptoms.” According to the National Mental Health Association, spending an hour walking in the winter sunlight was as effective as two and a half hours under bright artificial light. If phototherapy does not work for a patient, an antidepressant medication may be considered. But these medicines often come with unwanted side effects and not everyone tolerates antidepressant medications.
The accompanying video is the second part of an interview we conducted with Dr. Gauthier a couple of years ago on the role of integrative medicine in treating cancer patients. Here is a link to a more detailed radio interview of Dr. Gauthier. http://www.blogtalkradio.com/battling-and-beating-cancer/2010/07/14/coping-with-the-psychological-social-aspects-of-ca
David Blain, a 73-year man diagnosed with prostrate cancer in 2006, points out “everyone living in the mid-west goes through the winter blues, but when you are diagnosed with cancer it accentuates it.” Mr. Blain knows first hand that cancer is "emotionally devastating as well as physically devastating." He says that more patients should take advantage of acupuncture, massage, counseling, and other integrative approaches. Mr. Blain and his wife help patients on a volunteer basis by speaking to them and offering sage advice. He properly points out the importance of having a good caregiver - which in his case was his wife - and to be sure to look after the physical and emotion health of the caregiver.
This is no time to be SAD. Spring is just around the corner. But in the meantime, talk to your physician about taking the appropriate steps to remedy the winter blues.