Anxiety and depression in women with breast cancer

Anxiety and depression are the two most prevalent psychiatric presentations among women with breast cancer. If left untreated, anxiety and depression can have serious psychological, medical and health service utilisation consequences. These include reduced likelihood of accepting, tolerating and adhering to recommended treatments, and increased toxicities and severity of medical symptoms that, in turn, can increase healthcare costs and reduce quality of life. Risk factors for anxiety and depression in women with breast cancer include: a past history of anxiety or depressive disorder; younger age at diagnosis (<50 years); poor social support; burdensome somatic symptoms; currently undergoing active cancer treatment; specific drug treatments; and body image distress. Interventions for depression and anxiety in breast cancer have typically comprised a) pharmacological treatments, with citalopram, venlafaxine and mirtazapine being safe antidepressants to treat both anxiety and depression; and b) psychotherapy, with cognitivebehavioural therapy considered the current gold-standard treatment for primary breast cancer, and supportive-expressive approaches more appropriate to women with advanced disease. However, distress continues to be under-screened and under-treated. In order to increase the reach of our services, more tiered and systematic approaches to screening, and a stepped care approach to delivering treatments are required.