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Support > Living Well with Lymphoma

Last updated: 05/13/2015

TOPICS

Clinical Trials | Counseling | Exercise | In the News | Feelings | Meditation | Signs of Stress and Depression
Tips for dealing with Anxiety and Grief 

Depression and Anxiety Screening Quiz | Self Blame? |
Recommended Reading and Resources
 Medications and Antidepressants | Research News

TOPIC SEARCH: PubMed

Anxiety, depression, and even panic attacks may result from your reaction to the diagnosis of lymphoma, or from the effects of the disease or treatment.  

It is very important to inform your doctor or nurse regarding your feelings and how your mood or fatigue is impacting your quality of life and ability to function. 

Men may be particularly susceptible to keeping such feelings
to themselves.  Caregivers are also vulnerable to depression and anxiety. 

Individuals prone to sadness or depression may be more vulnerable to depression when diagnosed with a cancer (or another stressor), and should communicate to our doctors regarding this tendency. 

We need to give ourselves time to adjust to new challenges.  It's important also to note that even very advanced lymphoma can be treated effectively and some types are often cured.  See for details Encouragement

Feelings

The diagnosis of cancer and setbacks in treatment can sometimes trigger the following strong feelings and emotions:

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Shock, and disbelief

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Paralyzing fear and anxiety of the future

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A preoccupation with the word "cancer"

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A heightened awareness to any physical aches and pains

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Grief for what is thought to be the loss of your life goals and plans.

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Concern about the unspoken and yet obvious reactions of others who know of your diagnosis

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Becoming overwhelmed by the enormity of decisions to be made, some of which must be made very quickly

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Feelings that this is unfair to yourself and to your loved ones

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Confusion and lack of control and feelings of uncertainty

Signs of Stress and Depression

It is normal and makes sense to feel sad, angry and depressed following a diagnosis of a cancer, or other life altering events.  However, when the signs of depression are overwhelming and persistent, lasting many  weeks or months, indicates a need to seek professional help ... noting there are many effective therapies for such feelings.  
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Anger, anxiousness, or anxiety, and denial of same
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Feelings that are persistent, which diminish your quality of life and ability to function:
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something bad is going to happen, or feeling empty
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guilt,  sadness, worthlessness, and/or helplessness/or pessimism
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fear of losing control
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Decrease in sociability
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Poor eating habits - overeating or appetite loss 
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Physical symptoms that are persistent, which diminish your quality of life and ability to function:
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fatigue and exhaustion  
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aches or pains, headaches, cramps, 
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digestive problems that do not ease even with treatment 
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Postponing or missing medical appointments
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Loss of interest in hobbies and activities that once interested you (including sex)
See also Sexual side effects PAL
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Nervousness and restlessness - tense feelings, trembling and shaking
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Sleep problems (insomnia, early-morning wakefulness, or excessive sleeping) 
Comparing Sleep medications Consumer reports
Health Now:
Insomnia: A Guide for People with Chronic Illness  -Webcast http://bit.ly/8tvD8e

 
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Thinking or problem solving deficits - inability to organize or prioritize
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Thoughts of suicide or suicide attempts 

  

Are you Depressed or Anxious?

Test yourself:
  
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NYU Depression Screening Test
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PsychCentral: Anxiety Screening Quiz  
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PsychCentral: Depression Screening Quiz

Tips for dealing with anxiety and grief

Tips for relieving anxiety by Dr. Himle (Cognitive therapy) 
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Make a list of blessing in your life on an index card - 
what you have to be thankful for.   Read it often.

This simple step will help you to avoid focusing exclusively on the negative.

Which is not the same as telling yourself that everything is great.

What is the truth about your life, is not one thing. 

The list is not a fantasy, these are real aspects of your life.  

Cancer does not take everything from you, even if the future is unsure.
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"Your activities are as important as your thoughts. "

Becoming motionless for days would make anyone miserable, 
even without the diagnosis of a cancer.

We are not built to feel good doing nothing.  

Ask: What can I do that can give me some sense of accomplishment? 

Stay busy with rewarding activities (your hobbies or occupation)

"Depression has a lot of trouble finding a moving target, 
it's outstanding at hitting a stationary one."

Activity pacing ... avoid over-extending yourself

It can take creativity to be active when dealing with effects 
of the cancer or treatment, but usually we can find a way to do something.

-  Such as: walking in a nice place, a diary, breathing exercises,  writing, art, needlework
step outside yourself and others ...
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Regular exercise (walking, yoga, gardening) is an effective way to relieve 
anxiety and depression

Test your belief that you can't do something.  
Try it. Begin it.  In small steps first.

Try to harvest what you are best at, what gives you satisfaction or a sense of accomplishment, even if in a more limited capacity.
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Remain social and connected.  Maintain your relationships.

Crawling into an isolation hole is a huge risk.  Try to avoid it.

It's true that some people will not know what to say.

Don't expect everyone to be perfect about it.

Some of our friends will be better than others relating to us with our 
new circumstance, but most will be fine, and it will get better.  
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Work on your bucket list.
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Regarding a poor prognosis - contemplating our mortality:

It might sound strange, but it's important to think beyond the event: 
Can I cope with being dead?  

... For those who are not spiritual:
   Consider your experience in sleep or before you were born.

It will be hard for my family?  
But families often prove to be very resilient - 
will find their strength when they need to.


Clinical Research:

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The ASCO Post:
Researchers Discuss Pilot Study on Hallucinogenic Therapies for Cancer Anxiety http://bit.ly/1J7nTwN 

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Other sources for tips:

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Tips on managing anxiety Cancer.net
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NCI Facing Forward: Life After Cancer Treatment Cancer.gov | PDF 
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Caregiver Stress: How to identify and suggestions for relieving PAL
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National Institute of Mental Health NIMH.nih.gov  
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Post-traumatic stress (PTS) outcomes in NHL survivors. ncbi.nlm.nih.gov 
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About Post Traumatic Stress Disorder medicinenet.com 
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The Emotional Impact of a Cancer Diagnosis Cancer.org 
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Dealing with Grief Mercer.edu
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Encouragement PAL
lymphomas are highly treatable, sometimes curable
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Mapping the Emotional Journey (Through Cancer)  
(Excellent coping skills and tips)
 
Direct Download http://bit.ly/1HMoYL 

(Buffering may take a few minutes when downloading directly) 

Dr. Joseph Himle, PhD, Director, Psychosocial Programs, 
University of Michigan Depression Center

Attitude and Self Blame?
 

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Facts and Myths about Attitude and Cancer cansa.co.za 
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Health Care Proxy? When the patient needs help making decisions
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The Road Back to Health: 
Coping With the Emotional Side of Cancer, by Neil A., Ph.D. Fiore (Amazon Book)
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THE TYRANNY OF POSITIVE THINKING PDF

I got really depressed when people said I should think positive. I thought, 
"If that's what I have to do to survive, I'm never going to make it."

 


Counseling Resources

Sorrow 
By Abraham Lincoln
 
In this sad world of ours, sorrow comes to all, and it often comes with bitter agony.

Perfect relief is not possible,
except with time.
You cannot now believe that you will ever feel better.
But this is not true.

You are sure to be happy again.
Knowing this, truly believing it,
will make you less miserable now.
I have had enough experience to make this statement.
 

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On Counseling

A mental health professional can help if what you are feeling is an "adjustment disorder, an "adjustment reaction," clinical depression, or an anxiety disorder. 

Based on this assessment, different treatment options may be recommended. These might include just counseling, a brief course of medication to help through the initial difficult time, or a longer course of medication, or a combination of medications and therapy.

If you are experiencing a lot of stress, please do not consider it a sign of weakness to reach out for this kind of help.  Therapy and/or medications may help you weather through this difficult time. 

If you've experienced episodes of depression or anxiety prior to your cancer diagnosis, this may be a particularly vulnerable time for you to experience a recurrent episode. 

If you can find a mental health professional experienced in oncology issues in your area, they may prove more helpful than one who does not have a specialty in this area. 

If you do opt to go for counseling, trust your gut in choosing a therapist that feels right for you. If the first one doesn't click, it is worth trying another to see if you can find a better match." 

You may do better with non-drug treatment (particularly for anxiety), and in many cases for depressive symptoms as well. 

Here are some resources for counseling.
 

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Call Cancer.gov 18003328615
to  ask for help locating supporting services in your area
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The American Cancer Society on Psychosocial support ACS
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Art and Science of Forgiveness Frederic Luskin, Ph.D.
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Emotional, Psychological and Spiritual Cancer Support Links - Cancerlinks.com 
Cancer Appearance, Support and Spirituality
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Encouragement PAL
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National Institute of Mental Health brochure on 
Symptoms of Depression and its treatments NIMH.nih.gov   (fixed)
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Psychosocial Support Program CancerSupportivCare.com
Comprehensive, source of many articles above


Anti-anxiety Medications and Antidepressants

 

There are different anti-anxiety medications and antidepressants with varied effects and side effects from which your physician may choose or recommend based on your individual health issues. 

Medications may be needed if your anxiety and depression is severe or persists. Please do not hesitate to inform your doctor or nurse regarding your feelings and how your mood or fatigue is impacting your quality of life and ability to function.  

But you will need a qualified physician to make such medical decisions and follow up to determine if the medications need to be adjusted or changed, depending on how effective they are.  

Benzodiazapines (eg. ativan, xanax, valium etc) are often used to treat anxiety.  These may be particularly helpful in the initial period of adjustment to a lymphoma diagnosis. Some times these also are used to help patients with insomnia although there are other drugs sold specifically for insomnia (eg. Ambien, Lunesta etc).

In addition to helping to alleviate depression, antidepressants also may be effective treatments for anxiety and panic. Some doctors may prefer to use antidepressants instead of anti-anxiety medications / benzodiazapines (eg. xanax, ativan, valium etc) because they do not have the same type of addictive potential. 

Some antidepressants may be used to treat hot flashes and menopausal symptoms http://www.webmd.com/menopause/antidepressants-for-hot-flashes

Some older antidepressants may be used in doses lower than that used to treat depression to help treat insomnia (eg Trazedone) or pain (eg Amitriptaline)

Vivian writes:

"All antidepressant classes have delays in the antidepressant effects of two weeks or more, although the sedating antidepressants may foster improved sleep more immediately." 

As with any treatment there is considerable individual variability in patient's response to these agents - some folks are helped readily, others are not; some have bad side effects and others don't. Because of this, patients should not expect an immediate "cure" or resolution of their depression and may need to try different medications, doses or combinations for optimal effects.

Linda writes:

Regarding SSRI's (a type of medication) for both depression and anxiety disorders?

The SSRI's (eg proxac zoloft etc) often are prescribed for depression and/or anxiety disorders. Sometimes the docs will give a benzodiazapine like Ativan until the SSRI kicks in --it can take 4-6 weeks for SSRIs to work. Any of the SSRI's can have a "discontinuation syndrome," and it is best not to stop them on your own, but to taper them under a doc's guidance.

I think the SSRI's all work fairly similarly, but side effect profiles may be a bit different- some may be more activating or sedating etc-- the doc may chose one for a person based on this, or the MD may just have a personal preference regarding the one he/she choses to start with first.

Any of the SSRI's can have some side effects during the first week or so--eg upset tummy etc, and or slightly increased anxiety. Generally these symptoms will subside after a week or two, so patients often are asked to ride it through. Rather than start at a standard dose some docs will have the patient start at a lower dose, say half, to acclimate, and then gradually build up when these types of side effects happen. However it will probably take longer for the meds to kick in as it takes a month + for full effectiveness at full dose.

As a psychologist who's worked a fair bit with depression and panic disorder, I think often a combo of meds and psychotherapy is most helpful. A therapist can teach relaxation methods, as well as cognitive strategies for reducing depression, anxiety and panic.  ~ Linda (advisor to PAL)
 


Exercise

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TOPIC SEARCH: PubMed

Getting regular exercise, such as walking, can help to ward off depression and fight anxiety.  Simple and effective, it also contributes to good health. 

See our Resource on Exercise Lymphomation.org

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Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000 Sep-Oct;62(5):633-8. PMID: 11020092


Meditation (mindfulness)

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Life is fragile and temporary. Techniques that bring you in contact with the present moment and awareness of what is around you can help to relieve tension and anxiety Mindfulness activities can be a way to reduce unproductive worry -- about what we cannot change or about about what might happen to us or a loved one in the future.  

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Guided Imagery / Visualization Uses with the Cancer Patron
By Cheryl Warren, M.S.L.S. ValleyCare Health Library, Pleasanton, CA
Cancerlib
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Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer. 1999 Apr;80(1-2):262-8. PMID: 10390006  PubMed


Research News

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In the News:

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What Are Benzodiazepines? What Are The Risks Of Benzodiazepines? 

Anjou: Article discusses benzodiazepines, medications used for anxiety, sleep and some may be used as anticonvulsants
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AACR: Risk of Infection-Related Cancers after the Loss of a Child:
A Follow-up Study in Sweden http://bit.ly/V3BH2z

showing that severe anxiety is not associated with the risk of acquiring lymphoma.
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Post-traumatic stress (PTS) outcomes in NHL survivors. ncbi.nlm.nih.gov 
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About Post Traumatic Stress Disorder http://www.medicinenet.com 

"Posttraumatic stress disorder (PTSD) is an emotional illness that develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal). "
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Angels and bolters:
a field guide to the wildlife of cancer Karen Ritchie M.D.
 
This article describes how some people try to help or bolt when you are diagnosed with cancer.
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Importance of Psychosocial Support for Cancer Patients Recognized;New Partnership Will Share Resources and Information NIH.gov

Recommended Reading and Resources

 

 
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WebMD:
Anxiety and Cancer Patients http://bit.ly/10ZAR6X
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NCI:
Adjustment to Cancer: Anxiety and Distress (PDQ) http://1.usa.gov/10ZC6Tv
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NCCN:
Depression symptoms after cancer treatment video http://bit.ly/15KNmHg
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NCCN:
Post Traumatic Stress Disorder http://1.usa.gov/18Xt5SS
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The Group Room: ONS 2010: Post-Traumatic Stress Disorder in Cancer Patients http://bit.ly/1b5F2ma
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Mayo Clinic:
Cancer survivors: Managing your emotions after cancer treatment http://bit.ly/qT2QlJ
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MSKCC:
Video of Dr. Jimmie Holland discussing anxiety after treatment http://bit.ly/17pS28Q

Recommended self help books:
 
1) The Feeling Good Handbook David Burns, M.D.
2) When Panic Attacks David Burns, M.D.
 
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5 rules for living well with a chronic illness  http://bit.ly/k6uect

"When someone outside the circle asks you the same question, lie.

Say, Im fine! and change the subject. Too often they cant handle the truth and
they suck any energy you have taking care of them. If someone asks if they can help,
say yes. Accepting help is a gift to them. Trust that someday you will be on the giving end."
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What Not to Say to a Depressed Person
By Therese J. Borchard http://bit.ly/alzxrY
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8 Survival Tips for the Spouse (or significant other) of a Terminally Ill Person http://bit.ly/fcy1wl
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Health Now:
Insomnia: A Guide for People with Chronic Illness  -Webcast http://bit.ly/8tvD8e
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Depression MedlinePlus
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Depression Guide WebMd
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Depression and anxiety in oncology: the oncologist's perspective. 
J Clin Psychiatry. 2001;62 Suppl 8:52-5; discussion 56-7. PMID: 12108823 PubMed

 

 

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Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright 2004,  All Rights Reserved.