From the Guidelines
Managing depression, anxiety, insomnia, and fatigue requires a comprehensive approach. The most effective strategy is to prioritize treatment of depressive symptoms, and consider a unified protocol combining cognitive behavior therapy (CBT) for depression and anxiety 1.
Key Interventions
- CBT: Has been shown to result in significant reductions in depressive and anxiety symptoms, and can be delivered face-to-face or by telephone 1.
- Exercise: Provides a moderate to large reduction in depression and may offer a reduction in anxiety, with a large effect in favor of exercise compared to usual care for both depression and anxiety 1.
- Mindfulness-based interventions: Demonstrate statistically significant improvements in both depression and anxiety compared to usual care, with a reduction in the severity of depression and anxiety in both the short term and medium term 1.
- Medications: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), and anti-anxiety drugs, such as benzodiazepines, can be beneficial in the treatment of depression and anxiety in adult patients with cancer 1.
- Psychostimulant drugs: Can help in the management of fatigue 1.
Assessment and Treatment
- Evaluate contributing factors: Assess pain, emotional distress, sleep disturbance, anemia, nutrition, activity level, alcohol/substance abuse, medication side effects, and other comorbidities to identify treatable contributing factors to fatigue 1.
- Address sleep disturbances: Sleep disturbances are prevalent in 30% to 75% of patients with cancer, and can range from hypersomnia to insomnia 1.
- Consider psychotherapy: Psychotherapy with or without an anxiolytic or an antidepressant is recommended for the treatment of anxiety, after eliminating medical causes 1.
Important Considerations
- Suicide risk: Patients with mood and adjustment disorders can develop suicidal tendencies, and safety measures should be implemented for comorbidity 1.
- Comorbidities: Fatigue and depression have been documented as concurrent symptoms in cancer patients, and assessment of pain along with emotional distress and institution of effective treatment are essential 1.
From the Research
Management of Depression, Anxiety, Insomnia, and Fatigue
- Depression, anxiety, insomnia, and fatigue are common comorbidities that can have a significant impact on an individual's quality of life 2, 3, 4, 5, 6
- Treatment of these conditions often requires a multifaceted approach, incorporating pharmacological and non-pharmacological interventions 2, 4, 5, 6
Pharmacological Interventions
- Sedating antidepressants, such as mirtazapine, nefazodone, or tricyclic antidepressants, may be effective in managing insomnia and depression 2
- Benzodiazepines, eszopiclone, zaleplon, and zolpidem are commonly used to treat insomnia, but their use should be carefully considered due to potential side effects 2
- Atypical antipsychotic agents, such as quetiapine or olanzapine, may be used to manage agitation and sleep disturbances in some cases 2
Non-Pharmacological Interventions
- Cognitive-behavioral therapy (CBT) and mindfulness-based interventions (MBI) have been shown to be effective in managing depression, anxiety, and insomnia 3, 4, 5, 6
- Exercise and physical activity have also been found to have a positive impact on symptoms of depression, anxiety, and fatigue 4
- Mindfulness meditation, in particular, has been found to improve depression and anxiety symptoms in adults with sleep disturbances, with effects being driven by improvements in pre-sleep arousal 6
Lifestyle Changes
- Establishing a consistent sleep schedule and creating a relaxing sleep environment can help improve sleep quality and reduce symptoms of insomnia 2
- Engaging in regular exercise and physical activity can help reduce symptoms of depression, anxiety, and fatigue 4
- Practicing stress-reducing techniques, such as meditation or deep breathing, can help manage stress and anxiety 3, 5, 6