A psychiatrist explains how the condition can be triggered after the all clear
By Dr Andy Zamar, Consultant Psychiatrist
Dr Andy Zamar is a Medical Director and Consultant Psychiatrist at The London Psychiatry Centre.
A staggering one in two people in the UK will get cancer at some point in their lives so it’s little wonder there is a tremendous focus on support for cancer patients once they have been diagnosed and are undergoing treatment. But what about afterwards? What happens when a patient has been given the all-clear from cancer?
I know from my own personal experience as a psychiatrist that those who have had cancer and have recovered, can suffer Post Traumatic Stress Disorder (PTSD) due to the traumatic nature of the experience and its impact on them and their loved ones.
PTSD symptoms have been found in 80% of women after breast cancer diagnosis according to recent research. That’s why I believe it’s time to acknowledge that those who have been diagnosed with cancer should be screened for PTSD as a matter of course.
What is PTSD?
PTSD is a mental health problem that can occur when someone has witnessed, experienced or even learned about a life-threatening or traumatic event occurring to themselves or a loved one.
It affects people of all ages, and between 25-30% of those experiencing a traumatic event will develop PTSD. Although many people associate it with war, this condition is also seen in patients who have suffered serious illnesses, like cancer, and can occur any time during or after treatment – weeks, months, even years later.
Whilst cancer itself does not cause PTSD, it may trigger the condition. The life-threatening nature of cancer means that people are not only frightened about what is going to happen to them but also about the unknown. When faced with a cancer diagnosis our first thought focusses on the medical aspect of the disease: How severe, what treatments are available and the prognosis. The psychological aspect of the disease can be a secondary concern. I would encourage all of us to recognise that the impact of cancer is psychological as well as physical.
Getty Fausto Serafini / EyeEm
I would also advise we pay attention to the mental health aspects of those sufferers who have had a cancer diagnosis and those who have had successful treatment but still live with worry or fear. Anyone diagnosed with cancer may feel apprehensive because they don’t know how they are going to get on with chemotherapy, radiotherapy or surgery – or if these treatments will improve their condition. Even though these are all things that are explained to patients with cancer, living with it is very different to hearing about it.
PTSD can be triggered by any cancer or treatment related to a traumatic event like having lost a breast, a testicle, or having colostomy or tracheostomy. These significant changes mean adjusting to a more challenging lifestyle and can affect confidence, self-esteem, daily routine – every aspect of life. PTSD can have a significant impact on daily life and adjusting to these changes is what can trigger PTSD. The sudden removal of encouragement from the support network after someone has been given the all clear from cancer, could also act as a trigger.
Those suffering with it often experience depressive symptoms like low self-esteem and confidence issues, and can become irritable. When reminded of the traumatic event – perhaps at their annual post-cancer check-up – they may feel anxious and upset, physically tense, sweat more, and even try to avoid their check-ups and further treatments in some cases.
What are the symptoms of PTSD?
Symptoms of PTSD can include nightmares and disturbing flashbacks. The person may jump when they hear a noise, actively avoid reminders, feel withdrawn and isolate themselves – both physically and emotionally. PTSD is often misdiagnosed as depression because it is common for patients to also experience depressive symptoms which can be extensive. It is often this that is picked up on by healthcare providers.
It is important to screen for the presence of PTSD in the cancer survivor population, particularly those with depressive symptoms.
Treatment for PTSD
The National Institute for Health Care Excellence (NICE), the body that provides guidelines for recognition and treatment of medical, surgical and psychiatric conditions in the UK, advises not to use antidepressants for treatment of PTSD unless there are significant depressive symptoms – which often there are. In this instance, depression should be treated first, and once the depressive symptoms are managed then PTSD can be treated.
Repetitive Transcranial Magnetic Stimulation (rTMS) may be the most appropriate treatment for depressive symptoms for various reasons. Antidepressants have many side effects, withdrawal symptoms, and achieve full recovery in around 30% of cases only. Those who do not find antidepressants helpful will often find it difficult to come off the medication. rTMS is an effective, drug-free, non-invasive and pain-free treatment for depression. rTMS uses magnetic pulses to stimulate areas of the brain that regulate mood. Side effects are minimal and treatment results are also impressive. Of 44 centres in the US and Australia that have published rTMS treatment results for treatment-resistant depression, the remission rate is 29%. At The London Psychiatry Centre, the remission rate is more than 60%.
Once the depression has improved, there are two options for treatment of PTSD, which are both equally effective. The first is trauma-focussed CBT (TF-CBT), which helps patients to identify and cope with thoughts, behaviours and emotions. The second isEye Movement Desensitisation and Reprocessing (EMDR), a highly regarded treatment which helps to change the way the traumatic memories are reacted to despite them remaining stored in the brain, thus making them easier to manage.
If you are concerned you may be experiencing PTSD post-cancer, such as irritability, despondency, feeling ashamed or isolated, having trouble sleeping, getting upset by reminders or get unduly tense or worried around your annual cancer check-up, visit your GP or a mental health professional.