ORIGINAL ARTICLE Managing Anxiety and Depression During Treatment David Spiegel,* and Michelle B. Riba † *Department of Psychiatry, Stanford School of Medicine, Stanford, California; † Department of Psychiatry, University of Michigan, Ann Arbor, Michigan n Abstract: Here, we review the prevalence and treatment of anxiety and depression among patients with breast cancer. Cancer-related symptoms include similarities to responses to traumatic stress. Well-developed screening devices for identi- fying and tracking psychiatric comorbidity are discussed. Basic principles of psychopharmacology, and individual and group psychotherapy are presented. Finally, effects of effective treatment of anxiety and depression on quality of life and overall survival are reviewed. n Key Words: breast cancer, anxiety, depression, psychopharmacology, psychotherapy, outcome, survival A nxiety and depression are the most common psychiatric disorders, and may be induced or exacerbated by the diagnosis and treatment of breast cancer. These comorbid illnesses affect quality of life, adherence to treatment, social support, and survival time. Effective coping with the disease involves deal- ing with its direct and indirect effects. Facing breast cancer and its consequences requires acknowledging and managing strong but inevitable emotions that can interfere with medical care (1), family and vocational engagement, sleep, diet, and exercise (2). A high prevalence of psychiatric and psychological problems affect patients and families before, during, and after cancer care and treatment. While many would like to maintain a positive view of the diagnosis and treatment for cancer, for many a diagnosis of breast cancer constitutes a trauma analo- gous to experiencing a physical assault, accident, or natural disaster. Many patients remember the date and time they received their cancer diagnosis, exactly where it was discussed, who said it, the specific words that were used, and how they felt. These life-altering, life-changing moments are, psychologically riveting. In the initial period of diagnosis and treatment, the term acute stress disorder or posttraumatic stress disorder (PTSD) may best describe the psychological problems that occur (3). In one study of breast cancer patients after treatment, 5–10% met diagnostic criteria for PTSD, (4) and the symptoms changed little over the ensuing year (5). Such patients experience intrusive thoughts, disbelief, avoidance, inability to sleep, fears, and physiological hyperarousal. Their lives change suddenly from the mundane routine of work or family activities, to a string of doctors’ appointments, receiv- ing life-altering news and data in technical language, making appointments for surgery, blood draws, che- motherapy, and radiotherapy. As patients move through the stages of cancer care, the trauma response may persist from acute stress to a more chronic PTSD (6–8). Even cessation of acute treatment can be fraught with anxiety about recur- rence and withdrawal of active medical support. Yet many patients and their families also experience what has been called posttraumatic growth, an altered per- spective on what matters in life that comes from fac- ing and dealing with major life stressors (9). This ability to come to terms with the implications of the disease and enhance relating to others, appreciation of life, and spiritual change occurs in a substantial pro- portion of cancer patients (10,11) and in some cases predicts better long-term adjustment (12). SCREENING FOR PSYCHOLOGICAL PROBLEMS In 1997 the National Comprehensive Cancer Net- work published the Distress Management Guidelines, Address correspondence and reprint requests to: David Spiegel, MD, Professor of Psychiatry & Behavioral Sciences, Jack, Lulu & Sam Willson Professor, Department of Psychiatry, Stanford School of Medicine, Room 2325, 401 Quarry Rd., Stanford, CA 93405, USA, or e-mail: dspiegel@ stanford.edu DOI: 10.1111/tbj.12355 © 2014 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 1, 2015 97–103