Low mood & anxiety

Living with secondary breast cancer can be extremely overwhelming and many women experience feelings of great sadness, grief or anger as they come to terms with the uncertainty brought by this diagnosis. Continuous, ongoing treatment is often mentally as well as physically exhausting. Some women also feel emotionally drained with what is often described as ‘fighting a battle’ that they feel they cannot ‘win’, given their cancer is not curable and treatment is indefinite. Living with so much uncertainty can also leave women feeling anxious and fearful.

In this section

Sadness

Whilst these emotions are entirely natural and understandable, they can be difficult and frightening to deal with alone. Sadness and low mood are very common in secondary breast cancer. It can be extremely challenging to maintain a positive front in the face of uncertainty, fear and loss. Feeling sad is not a sign of weakness or failure. Don’t be afraid to talk about your sadness and other emotions with your doctors, nurse, family and friends. Your health professionals will be able to offer advice and support and your family and friends may be able to help by simply listening and being a supportive shoulder to cry on, if you feel this is what you need. By voicing your worries, you may find that the emotions you are feeling become more manageable and you feel less alone or helpless.

Periods of sadness experienced during cancer may be frequent but should pass. When sadness or low mood is experienced over a long period of time, for several weeks or more, this may be depression.

Depression

Some people find that feelings of sadness experienced when living with cancer do not improve over time, or even worsen. If these feelings last for two weeks or more, and you are finding it hard to find enjoyment or feel good about anything, you may be experiencing depression.

Depression is a medical illness which requires treatment (just like having a physical condition, for example a chest infection or heart condition).

Symptoms of depression include:

  • Loss of enjoyment and interest in doing everyday things or seeing people
  • Feeling sad all of the time
  • Loss of interest in your appearance
  • Loss of appetite
  • Difficulty getting to sleep
  • Waking up very early in the morning
  • Feeling guilty or hopeless
  • Difficulty concentrating

These are just some of the symptoms experienced in depression and everyone will experience it differently, meaning it can be difficult to recognise. Some of these symptoms can also be caused by the secondary breast cancer itself or your treatment. If you think you might have depression, the first step is to speak to your cancer doctor, nurse or GP.

Treatment

It is important to remember that depression is very common and is not a sign of weakness, failure or an inability to cope. Letting your doctor or nurse know how you are feeling means that they can help you to find the most appropriate help for you. There are lots of different things that can be done to treat depression and to help you to feel better and more like yourself.

You may be asked to fill in a questionnaire by your doctor which asks about the feelings and symptoms you are experiencing. Depending on the results of this questionnaire and the symptoms you have described, your doctor will be able to advise you on the best form of treatment or support, whether it be self-help, medications or talking therapies.

Things you can do to help yourself

Whether you are suffering from a relatively mild or a more severe depression, there are lots of things you can do to help support your own mental well-being and to improve your mood.  

Be kind to yourself and try not to do too much at once. When dealing with depression, it can be difficult to find the energy or motivation to get going, especially when you are also managing cancer treatment and side effects.

  • Keep active
  • Eat a healthy, well-balanced diet
  • Get plenty of sleep
  • Try some relaxation & mindfulness
  • Connect with family & friends
  • Take time to do the things you enjoy and plan things to look forward to

St John’s wort is a herbal remedy which some people take to treat mental health problems. However, this is not recommended as it can interfere with a range of other medications including cancer treatment. This can make them less effective. Please speak to your doctor or breast cancer nurse if you are considering taking this herbal remedy.

Please also see our sections on Healthy living and Psychological well-being for further information on mental health & well-being.

Medications

Your doctor may decide that a medication known as an anti-depressant is the best treatment to improve your mood. There are lots of different types of anti-depressants. Some commonly known ones include Amitriptyline, Sertraline and Fluoxetine (Prozac). Different anti-depressants work best for different people, so you may need to try a few before you find the one that suits you best. It may take a little while for you to notice an effect; symptoms usually start to improve after around 4-6 weeks. They are not addictive drugs and doctors recommend continuing to take them for at least 6 months, even if you are feeling better.

It is important that you take these medication as directed and do not exceed the maximum dose. If you feel that they are not working or you do not want to take them any longer, please speak to your doctor or nurse before you stop taking them.

Just as with any medication, anti-depressants may cause some side-effects. These will vary depending on the antidepressant and the individual but your doctor or nurse will be able to talk you through these before you begin taking them. There will also be a leaflet that comes with the box of medications which will list all the possible side effects. Not everyone will experience these side effects; some people may experience only a few or none at all.

The charity, Mind, have a range of information about anti-depressants on their website.

Psychological therapies (non-drug treatment)

Counselling and psychotherapy, also known as talking therapies, are forms of psychological treatment that help people to manage and overcome psychological and emotional difficulties through recognising and exploring their feelings and finding strategies to cope with them.

A combination of both anti-depressants and psychological therapy can work very well for serious depression as the two forms of treatment complement one another to give a long lasting effect.

Please see our section on Psychological well-being for further information on a range of talking therapies.

Clinical psycho-oncology services

Some hospitals have a dedicated Clinical Psycho-Oncology Service where patients can be referred to see clinical psychologists on site. These professionals are specialists in psychological support for people living with cancer. Ask your doctor if there is such a service at your hospital and whether this would be an appropriate option for you.  

Worsening low mood

For some people, the emotions they are experiencing can become so overwhelming that they no longer feel able to cope with them. This can lead to suicidal thoughts and feelings.

They may feel as though there is no way out and that they are a burden to their loved ones or that no one can help them. This is not true.

If you begin to feel this way or have any thoughts about hurting yourself or others, or any other thoughts or feelings which are worrying you, it is very important that you speak to someone you trust. This might be your doctor, nurse, GP, a family member or a friend.

If you feel unable to speak to someone you know, the Samaritans have a 24 hour confidential helpline (116 123) where anyone in an emotional crisis can access support. You can also get help by going to your local A&E department.

Anxiety

Anxiety is a very natural response to a cancer diagnosis and to dealing with ongoing uncertainty. It is often experienced alongside low mood and depression. For women living with secondary breast cancer, lots of different questions and unknowns can cause anxiety; will my cancer spread further? Is my treatment working? How long will my treatment work for? How many other treatment options do I have? Will I cope with the side effects? How long do I have? What will happen to my family?

Anxiety can be a very different experience for different people. For some, it is a constant feeling of worry or unease, making it difficult to concentrate or to focus on day to day life, whilst for others, it can progress to extreme fear and panic attacks.

Physical symptoms of anxiety can include;
  • Heart pounding (heart palpitations)
  • Feeling of tightness in the chest
  • Feeling faint or dizzy
  • Shortness of breath
  • Sweating
  • Dry mouth
  • Trembling
  • Pins & needles
  • Nausea (feeling sick)
  • Diarrhoea
  • Tiredness
  • Restlessness

These symptoms are caused by adrenaline, the hormone which is released when we encounter fear or stressful situations, initiating the ‘fight or flight’ response. Essentially, this means our body goes into overdrive to protect us from ‘danger’. When we continually encounter stressful situations, such as repeated hospital appointments, treatments, side effects and worries about the future, the body does not have time to rest and return to normal. This can lead to persistent feelings of anxiety, worry and loss of control.  

Panic attacks happen when anxiety progresses to intense fear or stress.

Symptoms of a panic attack can include;

  • Breathing too quickly
  • Pounding heart (heart palpitations)
  • Trembling or shaking
  • Feeling sick (nausea)

Speak to your cancer doctor, breast cancer nurse of GP if you are suffering from panic attacks as there are lots of things they can advise to help you.

Treatment

Where anxiety is extreme and severely impacting day to day life, doctors are able to prescribe medications. These can help you to feel calmer and more in control. Commonly prescribed medications include Diazepam, Lorazepam and Clonazepam. It is important that these are taken as prescribed and that you do not exceed the maximum dose. These are very useful for helping to relieve symptoms of anxiety in the shorter term. However, to manage anxiety in the longer-term, the underlying causes must be addressed. Please speak to your cancer doctor, breast cancer nurse or GP to discuss how best to manage and overcome anxiety in your situation.

Non-drug treatments

Just as with depression and low mood, psychological therapies such as cognitive behavioural therapy (CBT) can help you to learn techniques to better manage and address the underlying worries and emotions causing you to feel anxious. Other complementary therapies can also help to relieve anxiety through promoting relaxation, self-awareness and mindfulness.

Please see our sections on Complementary therapies and Psychological well-being for further information and guidance.

Tips for dealing with anxiety

There are lots of simple things you can do to help you to deal with fear and feelings of anxiety.

Voice your feelings. Sharing how you are feeling with family, friends or health professionals can help you to process and rationalise your fears and worries. If you don’t feel ready to voice them, writing them down can also help. Simply expressing your concerns can help you to feel less alone or helpless.

Look after yourself. ‘Self-care’ is very important for your mental health and well-being. This means getting plenty of sleep and eating well. Regular, gentle exercise can also help to relieve symptoms of anxiety

Try and find time to relax. Learning relaxation techniques and breathing exercises can help you to manage the physical symptoms of anxiety, as well as dealing with your worries and emotions. Some people find massage therapy can also help to promote relaxation and calmness, relieving anxiety.

Distract yourself. Distracting and occupying your mind can really help to relieve anxiety by temporarily taking your mind away from the things that are worrying or troubling you. Reading a book, watching  a favourite TV show, going for a walk, planning an activity to look forward to or catching up with a friend or loved one can all help to break the cycle of worrying thoughts that may be going around in your head.

Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.

Sources

Page last updated: April 2020