If you live with myeloproliferative neoplasms (MPNs), you may experience depression, anxiety, or stress related to your condition. Although occasionally feeling “down” or “blue” is common, clinical depression is a mood disorder that can cause feelings of sadness, anger, and hopelessness that impact your daily quality of life.

MPNs are a group of blood cancers characterized by abnormal development of stem cells in the bone marrow. There are three main types of MPNs: polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF).

Getting the necessary support from your doctors, family, and friends is key to alleviating your depression. Importantly, you and your loved ones must understand the cause of your depression — as well as the treatments available.

The Prevalence of Depression in MPNs

Depression is common for people living with MPNs and other blood cancers. The mood disorder affects 15 percent to 25 percent of people living with cancer, according to the National Cancer Institute. That estimate is three times higher than rates of depression in the general population.

Anxiety as a comorbidity of MPNs (a simultaneous additional disease) is also common. Researchers have found two-thirds of people living with cancer and depression also have anxiety.

What Causes Depression in People With MPNs?

Understanding the causes and risk factors of depression associated with MPNs may help you spot the early warning signs and take steps with your doctor to manage it. Your risk factors can vary according to your experience with MPNs and your biology. For example, if you have relatives who have depression, you are at higher risk of having it.

The following are some of the causes and risk factors for depression in people with MPNs and other blood cancers.

Chronic Stress

According to a paper in the journal Oncology Letters, individuals with cancers like MPNs face chronic stress — including tough prognosises and uncertainty about their health and its impact on their relationships, finances, or work. This stress can lead to depression.

The paper mentions the following as risks for developing depression:

• Poor coping strategies
• History of mental illness
• Limited communication with doctors

However, an optimistic outlook and emotional support from friends and family are both protective factors.

Inflammation

Research suggests that certain biological components may cause depression in people with cancer. For example, tissue damage from certain treatments — such as chemotherapy, radiotherapy, and surgery — can lead to the production of pro-inflammatory substances. In turn, these substances can influence certain neurotransmitters, chemicals in the brain that effect mood. Anything that changes these chemical levels can contribute to depression.

Disease Progression

The severity of your depression can vary over the course of your disease. It’s usually at its highest around the time of diagnosis, when you first experience the strong emotions that come with a significant life change.

Conversely, rates of depression in cancer survivors have been shown to drop to the level of the general population — 4 percent — five years following diagnosis.

Pain

Individuals with high levels of pain may be more likely to experience depression than those with low levels of pain. In one study, depression was observed in 33 percent of people with high levels of pain, but in just 13 percent of those with low levels.

Cancer Medications

Certain medications have been found to be associated with depressive symptoms. One such medication, Haldol (Haloperidol) — sometimes used to treat nausea caused by chemotherapy — has been found to reduce the transmission of dopamine in the brain and has been linked to the development of depression-like symptoms.

For similar reasons, immunotherapy medications used to treat some cancers — such as Multiferon (Interferon alfa) — have also been found to cause depression in as many as 50 percent of individuals with cancer.

Treating Depression From MPNs

Depression can significantly affect your everyday life. Fortunately, it’s treatable.

Although speaking up when you feel depressed may feel hard, sharing your feelings and experiences with your loved ones and doctors is a great first step toward finding the right treatment.

People react differently to the various treatments for depression. Below are some of the most commonly used options. As always, it’s important to discuss these options with your health care team to find and develop an effective treatment plan for your depression.

Psychotherapy

Psychological support may improve your well-being and recovery from depression. Close engagement with counselors has been shown to significantly improve depressive symptoms.

One form of cognitive-behavioral therapy (CBT), called adjuvant psychological therapy (APT), is designed specifically for individuals with cancer who are experiencing depression. APT is based on the notion that depression can stem from an individual’s personal relationship with their cancer and how they manage it. This problem-focused approach involves altering a person’s perception of their cancer and improving their skills for coping with emotional challenges. Ultimately, the goal is to learn to challenge negative behaviors and promote positive emotions.

Medication

People diagnosed with cancer-related depression have been shown to respond to antidepressants. Classes of antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and others. Each class takes a different approach to treating depression.

When discussing antidepressants with your doctor, be sure to talk about your options, potential side effects, and any other medications and treatments you’re receiving.

Lifestyle Changes

Practicing self-care and making positive changes in your daily life may help supplement your depression-treatment plan.

Communication

Maintaining open, honest communication with your doctor, family, and friends is one of the best ways to stay on top of your progress and monitor how you are feeling on a regular basis.

Sticking To Your Treatment Plans

Although navigating treatments for depression on top of those for MPNs may be difficult, you should follow the treatment plan you and your doctor have chosen. Skipping therapy sessions, appointments, or medication doses — even if you’re feeling well — may cause the symptoms of depression to return or lead to withdrawal-like symptoms.

Although you may not feel better immediately after starting treatment for depression, keep in mind seeing improvement takes time.

Understanding Warning Signs

Understanding your unique depression warning signs — thoughts, feelings, or behaviors that indicate you’re experiencing depression — will help equip you to recognize when you may need to reach out to your doctor or support system. If you’re comfortable doing so, you may also want to tell your family and friends about these warning signs so that they understand what to look out for in case your depression worsens.

Additionally, working with your therapist or doctor to learn what triggers your depressive symptoms can help you come up with a plan together for coping if your symptoms do worsen.

Keeping Healthy Habits

You can improve your emotional well-being by taking care of your physical and mental health, including eating a healthy diet, getting enough sleep, and exercising regularly (to your comfort level). Physical activity triggers the release of “feel-good” chemicals and can help you deal with stress. Moreover, sleeping well can help regulate your mood.

In fact, over time, insufficient sleep can increase your risk of developing depression. If you’re having difficulty sleeping, talk to your doctor about ways to help you get a better night’s sleep.

Find Support and Understanding

A cancer diagnosis and the emotional challenges it brings can be overwhelming — so you’re not alone if MPN takes a toll on your mental health, too. Fortunately, a strong social support network, beyond family and friends, can help you process your experiences with MPN and fight back against depression.

By joining myMPNteam, the social network and online support group for those living with MPNs, you gain access to others who understand the challenges of living with these rare blood cancers.

How are you managing depression caused by MPNs? Share your thoughts below or start a conversation on myMPNteam.