The following excerpt is taken from Chapter
12 of Colon & Rectal Cancer: A Comprehensive Guide for
Patients & Families by Lorraine Johnston, copyright 2000 by
O'Reilly & Associates, Inc. For book orders/information, call
(800) 998-9938. Permission is granted to print and distribute this
excerpt for noncommercial use as long as the above source is
included. The information in this article is meant to educate and
should not be used as an alternative for professional medical care.
What can we do?
If fear is not very useful in dealing with cancer, and anxiety and
depression pose risks for long-term health problems, what reactions and
responses deal effectively with cancer-related stress? And if stress is not
linked conclusively to the inception or growth of tumors, and may in fact
shrink tumors in some cases, why attempt to reduce the stress that is
associated with the cancer experience?
First, most people prefer feeling good to feeling bad. Stress reduction
techniques can help you feel better.
Second, increased levels of stress clearly are tied to the worsening of
certain illnesses such as upper respiratory infections. If you've decided on a
course of chemotherapy or radiation therapy, your immune system may be
compromised for a few days or a week during each cycle. It's best to avoid
infections, and to minimize those that may arise, during these troughs. Stress
reduction techniques may help you keep secondary health problems at a minimum
while undergoing anticancer therapy.
Third, high levels of stress for long periods of time can contribute to the
development of high blood pressure, gastric ulcers, migraine headaches, certain
autoimmune diseases, and other stress-related illnesses.
Fourth, stress may upset the balance you're trying to maintain between
constipation and diarrhea.
Behavioral and medical ways to interrupt the worry cycle are discussed
Stress reduction techniques
An article of this length cannot do justice to the history of theories of
stress and stress reduction, and the ways of life that arose to accomplish
this. Nonetheless, stress reduction has always been of interest to humans
albeit under different names, and has received close scrutiny in the twentieth
century after the chemical link between stress and hormones was delineated.
Thus, various ways to reduce stress have been discovered or rediscovered.
Listed below in alphabetic order are techniques that many have found useful
for reducing stress. Not all of these will work for any one person; in fact,
it's possible that none of these will work for you during particularly
stressful times such as during periodic checkups, or if you have a symptom that
causes fear of relapse. It is hoped, though, that the following ideas will help
you discover your own ways to unwind.
Acupuncture is a versatile way to reduce stress and pain, and is
particularly good at relieving certain kinds of pain.
The ancient Chinese mapped the flow of energy in our bodies through pathways
called meridians. These pathways are thought by Western medicine to be
neuroelectric, although there continues to be discussion about the exact nature
of these meridians. Eastern medicine believes that the stalled or misdirected
flow of energy through these meridians accounts for most of the imbalances that
occur within our bodies, and that these imbalances cause illness, and can be
detected in twelve pulses.
The central nervous system produces hormones for which receptors exist on
the surfaces of white blood cells. Recent gains in knowledge regarding this
interaction of the central nervous system and the immune system may explain
more fully some of acupuncture's mode of action.
An experienced acupuncturist will spend at least an hour taking a
comprehensive medical and emotional history; will use few needles, perhaps no
more than six; may prefer Japanese to Chinese needles because they're thinner;
and will be skilled at using the needles in a way that is not perceptible, or
The needles come in packets for single use only. You'll be able to see your
practitioner opening these packets, which is reassuring if you have
well-justified doubts about the reuse of needles. All body surfaces on which
needles are used are cleaned first with rubbing alcohol.
If you have asthma or hyper-reactive airway, tell the practitioner. Certain
acupuncture treatments call for the burning of an herb called moxa that may
irritate your breathing. When moxa is used, only a sensation of warmth is felt
on the skin.
Shoes should come off last and go on first. The easiest and most regrettable
way to find a tiny, thin, lost acupuncture needle on the floor is with your
It's becoming increasingly common for health insurance companies to pay for
part or most of acupuncture treatment, although they generally pay less for
psychological diagnoses such as stress than they do for medical diagnoses such
as migraine or endometriosis.
In some states, an acupuncture practice must be supervised by a medical
doctor. Verify the licensing and credentials of your practitioner with your
state health department.
Biofeedback is a way to relearn how to relax, usually monitored by a
psychiatrist or psychologist.
During initial biofeedback sessions, sticky sensors are attached to various
muscle groups on the part of your body that seems tense or is in pain, and a
graph of muscle tension is displayed on a screen that is similar to a home
computer screen. Relaxation tapes or the guiding voice of a therapist are used
to establish a calm atmosphere.
When you have relaxed these muscle groups, you can tell you've succeeded
because the indicators on the screen have changed.
After a few sessions with the sensors and the screen, you no longer need
them for echoing success, and you switch to doing relaxation exercises on your
own. It is important to rehearse this stage of independence over and over with
a therapist so that soon you can do the exercises independently in any
As with acupuncture, it's becoming increasingly common for health insurance
companies to pay for part or most of biofeedback treatment, although they
generally pay less for psychological diagnoses such as stress headache than
they do for medical diagnoses such as migraine.
Counseling sessions with a mediator or therapist who is experienced in
cancer survivorship issues have proven very helpful to many people. Three
randomized studies, including Dr. David Spiegel's work with breast cancer
survivors, have shown increased survival among melanoma, colorectal cancer, and
breast cancer survivors who received counseling.
Counselors might be a psychiatrist, a psychologist with a PhD or a master's
degree, or a licensed social worker. Some insurance companies pay a larger
percentage of the cost for sessions with a psychiatrist or psychologist, but
often social workers charge less to begin with.
Group counseling or support with other cancer survivors is a wonderful way
to reduce stress. The group generates camaraderie, reduces feelings of
isolation, offers practical as well as sympathetic support, and can become the
source of many new friendships.
See Support groups for more information.
Modest regular exercise is a wonderful, well-documented way to reduce stress
as well as improve overall health. Exercise also generates endorphins, the
body's natural opiates, which reduce pain and ease depression.
Be careful, though, not to be too strenuous, for very strenuous exercise,
such as training for a marathon, can lower white blood cell counts for about 24
to 48 hours. Do only what feels good, stopping before the point of exhaustion.
Check first with your oncologist before starting a new exercise regimen,
especially if you have had radiation therapy in the chest area. This treatment,
if given in high doses, entails a risk of cardiac damage. The same is true for
very high doses of 5-FU.
Of all social support factors that appear to contribute to the positive
outcome of an illness, including cancer, the support of family or very close
friends appears to be highest. This effect has been shown most clearly in
studies of white males recovering from heart conditions. The beneficial effect
is less clear when other illnesses, females, and members of non-white ethnic
groups are studied.
I am blessed to have a wonderful supportive family with the most positive
outlook. That is the advice my surgeon gave me, "Surround yourself with
positive people, just walk away from the negative ones, they'll only drag you
Most people are both blessed and cursed with family. Cancer survivors report
family members who range from saintly, indispensable soulmates to those
seemingly hatched by Fate as an example of how not to behave. Nonetheless, at
times, there's something uniquely comforting about being surrounded by those
who resemble you, share your body language and your mother tongue, regardless
of their inclination, or lack of inclination, to offer support. If nothing
else, the less helpful ones can unintentionally provide wry entertainment.
Occasionally people have family members who need more support than the
cancer survivor does, or who are tooth-grindingly insensitive to what they're
going through. And once in a while, stories surface about family members who
actually blame the cancer survivor, or family "rivals" such as a
daughter-in-law, for the cancer.
Don't berate yourself if you find you frequently need a vacation from family
members who put themselves first at all costs. Often these unhealthy imbalances
in family dynamics were present all along, but remained subtle and bearable
until the cancer experience highlighted them.
Few other stress reducers are as good as having sympathetic, listening
When friends offer to help, don't be too noble to say yes. Keep in mind that
often they don't know quite what to say when they learn of your cancer,
especially at first, so they may prefer to act instead.
The journey isn't over yet, but I have so many delightful friends to help me
along the way. I have to say I have never been happier in my life. I have
learned not to sweat the small stuff, to embrace life and enjoy every minute of
If they're good listeners, let them know if you do, or do not, feel like
talking about cancer today--and that tomorrow might be different. Undoubtedly
there will be days when reducing stress means talking about cancer, and other
days when one more word about cancer will make you want to run for cover. Try
to sense or ask if they feel like listening, too.
Far too many cancer survivors report that friends, even very good friends,
disappear when cancer appears. These friends are speechless, sad, frightened,
or guilty that they're healthy--never mind that perhaps we're much more sad and
frightened than they are.
Each of us has to decide on a way to handle this abandonment that meshes
with our system of ethics. Many cancer survivors say that they just don't need
additional sources of sadness and stress in their life, and they move on to
find new friends, often in cancer support groups. Other cancer survivors try to
keep their old friends by never talking about cancer. Bear in mind, though,
that for those who are very fearful about cancer, just being around someone
with cancer might be frightening.
If you have healthy friends who have remained a presence in spite of
cancer--lawn-mowing, grocery-buying, baby-sitting friends, friends who have
listened to you when you're scared, or friends who have just spent time with
you if talking about cancer is not your style, you're very lucky. Show them
that you're glad they're around. The harmony that results is a guaranteed
Take solace, too, in the goodwill of those you may never meet. The daffodils
that appear in hospitals during the American Cancer Society's Daffodil Days in
March, for instance, are from someone who wants you to feel better.
Not surprisingly, a book such as this supports the belief that gaining
knowledge about your cancer, and thus gaining some control over your cancer
experience, is an excellent coping mechanism. Learning about your illness and
your options has been proven to reduce anxiety and stress, and may be the
crucial factor in your illness and its outcome. Not only can obtaining a
correct diagnosis and learning about new, more effective treatments result in
sound choices, but animal studies have shown that those who perceive that they
have a means to escape stressful situations maintain higher white blood cell
counts than those who perceive otherwise. Bear in mind as well that, while our
doctors often must master information about a broad variety of cancers, or are
immersed deeply in their own research projects, we have the luxury of going
narrow and deep, learning a great deal about our own illness.
If your doctor seems unreceptive about things you've learned, seek a second
opinion or consider changing doctors. An excellent book on this topic,
Working with Your
Doctor, by Nancy Keene, is available.
Worthy of mention is the observation that some doctors react badly to the
idea that their patients find information on the Internet, because the
information available on the Net ranges from abysmal to superb. If you use the
Internet to research your illness avoid using the word "Internet"
when discussing your findings with your oncologist. Instead, use terminology
that credits the sources on which your findings are based: Medline, the PDQ
database of the National Cancer Institute, Cancerlit, certain reputable medical
journals, and so on.
As a form of healthy denial and, in some cases, a form of exercise, hobbies
are an excellent stress reducer. Immersed in an activity you enjoy, you're
likely to forget cancer, breathe and laugh more easily, and feel capable.
Hobbies are especially important for reducing the stress that may be linked to
the lowered self-esteem of those who are temporarily or permanently unable to
return to work.
In his book Anatomy of an Illness as Perceived by the Patient,
Norman Cousins says we should take humor seriously. Cousins was diagnosed in
1964 with ankylosing spondylitis, a degenerative disease of the connective
tissue that causes disability and pain. He undertook to improve or cure his
condition by focusing on positive, happy thinking, and he believes he
Funny friends, books, and movies are good ways to forget about cancer for a
while, and can invoke some of the healthy bodily changes that come about when
we laugh and relax. Two studies have found that mirthful laughter reduces blood
levels of the hormones associated with stress.
Sue Browne shares a way she and her sisters used humor and distraction to
ease her husband's worry while he was hospitalized:
To help ease some of the stress of this nightmare and hopefully cheer Steve up
a bit, my sisters and I put on a little performance for him. Since he is an
avid fisherman, we each picked out a fishing hat and made up our own words to,
"Row, Row, Row Your Boat," singing it in a round harmony. The poor
guy had to hold his pillow tight to his stomach to laugh--we about busted his
stitches wide open! We even made the surly old man in the bed next to him smile
for a brief second.
The humor we have been able to share also has a lot to do with our faith.
Friends ask us how we can be so calm and joke around about this, and we just
tell them that humor has replaced the anger and fear that would be there in its
place. We used to always tell our kids, "You can do this hard, or you can
do this easy," meaning that you have choices in how you deal with life's
situations. Keeping busy also helps especially when you are waiting for the
The back-rubs and neck-rubs given to you by loved ones will release
endorphins that reduce pain and depression.
The lymphatic strokes practiced by massage therapists, on the other hand,
are location-specific and utilize a lot of pressure. Always check with your
doctor before having deep massage therapy, because massage may hasten the
spread of colorectal cancer through lymphatic vessels.
Your doctor may determine that professional therapeutic massage of certain
parts of the body, those that appear unaffected by colorectal cancer, is
Massage therapy is licensed by some states, and recognized by a national
organization, the American Massage Therapy Association (AMTA). In some states,
massage therapy can be performed only under the supervision of a doctor, nurse,
physical therapist, or chiropractor. Your local phone book will list the
nearest chapter of the AMTA for verifying your practitioner's credentials, or
you can contact the national office at (847) 864-0123 or
Meditation is a way to interrupt negative, cyclic thinking by focusing on
one soothing word or peaceful scene. Those who practice meditation regularly
eventually are able to lower their blood pressure and levels of stress
hormones. These reductions persist beyond the end of the meditation session,
and sometimes well beyond.
Lowering of blood pressure is beneficial for those who have cardiac or
vascular damage following radiation therapies.
One study has shown that those who meditate have higher levels of melatonin
in their urine, and another study has shown that higher levels of melatonin are
found naturally in those with certain cancers. The significance of higher
levels of naturally produced melatonin, or melatonin supplements, on colorectal
cancer survivors is not fully understood, but a few studies have shown that
melatonin can increase the growth of myeloma cells in the test tube. (Myeloma
is a cancer of the blood and bone marrow related to leukemia.)
Owing to this unquantified risk, the FDA requires a warning on melatonin
dietary supplements made or distributed in the US about possible health risks
for those with white blood cell disorders such as ulcerative colitis or Crohn's
It is likely that naturally elevated levels of melatonin associated with
meditation do not have an undesirable effect on tumor growth, and that only the
higher doses associated with dietary supplements do. It is also possible that
all relaxation efforts, not just meditation, increase urinary levels of
melatonin, and that future studies will demonstrate this--or that blood levels,
not urinary levels, are significant for an effect on cancer. Clearly, more
research on melatonin's effects on the colorectal cancers is needed, but it's
not likely that meditation will harm you.
Denial is a healthy coping mechanism as long as is doesn't cause us to
neglect the care we need for cancer. Some healthy ways to take a mini-vacation
from cancer are:
- Drive to work along a prettier route.
- Schedule day trips away from daily stress.
- Buy your favorite author's latest hardcover edition instead of waiting for
the paperback or library version.
- Grant yourself permission not to worry for one hour, one day, one week, and
- Take a nap on your lunch hour.
- Buy a pair of wild golf pants, or lipstick that "isn't your
color" and wear it anyway.
- Spend all day Saturday in your bathrobe reading old New Yorker
- Write a limerick and mail it anonymously to a friend.
- Odd as it may sound, you might enjoy celebrating the parts of your body
that still work. Most of them still do work, of course, and rejoicing in this
and using our bodies may have healing effects as yet unknown to medicine.
One of the highlights of my day is to gaze out the patio window at my lovely
flowers, hummingbirds, butterflies, and many birds and squirrels. God has
created such a beautiful world for us, we often forget to stop and savor
Dr. Albert Schweitzer once said that he couldn't imagine life without music
or cats. Schweitzer was an extremely productive, altruistic, humorous man who
lived and worked in a difficult setting well into old age. He was a strong
believer in the doctor within each of us, and thought of himself as only the
facilitator of his patients' own healing processes.
Music can lower stress and enhance emotions. You can experiment with music
to see which type suits your needs at different times. Some people find the
relaxing or soul-thrilling effects of classical music best; others find that
loud pop or rock music numbs pain, and that its relatively simple, repetitive
rhythms and singable melodies interrupt incessant worries. Still others enjoy
rediscovering the ethnic music they may have abandoned in the past. Listening
to a type of music we've never heard before, such as the Australian didjeridu
or Tibetan chord-singing, might distract us from the worries of cancer.
Singing can release cares from your soul, and may realign anxious breathing.
Singing out loud in the car when you're alone, like screaming, can lower
Classes in dance for people of all ages and both genders are available in
many community centers. If you feel that you need greater control in your life,
ballet's discipline, controlled breathing, and classic beauty may make you feel
better. If, on the other hand, you feel there's too much control in your life,
jazz dance or aerobics may allow you to set free some inhibitions. Flamenco
might help you rediscover the sexuality that may have gone to sleep when you
heard the word "cancer." Yoga, t'ai chi (an Asian discipline), and
Feldenkrais movement, all of which span the disciplines of exercise and dance,
are fine ways to stretch and relax.
In general, the diet that is recommended for those without cancer--a diet
high in vegetables, fruit and grains--remains the best diet for those with
cancer, although those who are losing weight, suffering from loss of appetite,
or recently recovering from colon surgery should consult their oncologists
before substituting vegetables for meat.
A few nutritional factors seem to have some effect on mood:
- A diet high in animal protein has been linked to anxiety and panic attacks.
Other studies have found that certain flavonoids, compounds found in plant but
not animal tissue, are similar to Valium in their relaxing action. This might
mean that it's not reducing meat intake, but increasing vegetable intake, that
lowers anxious episodes in some people. If you're suffering from severe anxiety
symptoms related to your cancer diagnosis, you might try modifying your diet to
contain more vegetables and grains--but check first with your oncologist.
- Drinking milk at bedtime, or eating turkey for dinner are known to help
with relaxation. These foods are high in tryptophan, an amino acid that aids
sleep. Tryptophan is used by the body to make serotonin, a neurotransmitter
that affects mood and is the target of many of the newer antidepressants.
- Low blood levels of zinc have been correlated to treatment-resistant
depression, and to an increase in the undesirable immune system inflammatory
response sometimes seen in depressive patients.
- Cachexia, the weight loss experienced by some cancer patients, has been
linked to depression, which is thought to be triggered by nutritional deficits,
or by the tumor's commandeering of dietary substances otherwise needed for the
manufacture of brain neurotransmitters.
Always verify a change in diet first with your oncologist.
You may find that your pets, considered family members by some, are a unique
solace to you through the cancer experience. Animals seem to have a knack for
knowing when we need help, and they don't care if we smell funny or if our hair
is missing. They don't become instantly bashful because of our diagnosis, and
they aren't afraid they'll catch cancer from us. How many humans will sit by us
for an hour in the bathroom while we're sick, as our dogs will? And who's
funnier than the cat who thinks the bathtub filling with water must be a sign
from the gods? Or the puppy who barks at the wig on the dresser?
Positive thinking and visualization have been shown to increase immune
system function in some studies. Oddly, one study has shown that when cancer
survivors visualize an immune system attack on the tumor, using attack images
that are incorrect according to what is known today about immune system
function, immune system parameters still improve. This may reflect the
"taking charge" phenomenon: the belief that you can escape stress
tends to lessen the effect of stress on the immune system.
Visualization can be used as described above, to attempt to direct inner
forces against the cancer, or to relax by calling to mind pleasant experiences,
places or dreams. Initially it might be useful to practice visualization in a
quiet, relaxed atmosphere, but eventually you can do it anywhere.
As a form of escapism, reading is a good way to reduce stress.
As a means of learning more about your illness, reading may make you feel
more stressed temporarily, but this may be offset by long stretches of peace of
mind after you're able to make better medical decisions based on what you've
learned by reading.
If you have a personal computer, reading from and writing to the various
cancer discussion groups on the Internet can provide a cathartic outlet for
See Support groups.
This technique is similar to Biofeedback, described earlier, and
incorporates visualization techniques, described previously under Positive
thinking and visualization.
Research shows that even one night of missed sleep lowers levels of natural
killer (NK) white blood cells that attack tumors. Although NK counts recover
quickly once sleep is restored, persistent lack of sleep is an opportunity for
Animal research on the artificial shifting of the phases of light and
darkness shows that the immune system is depressed by the shifting. Fish that
occupy parts of the ocean that receive low light in winter experience an
additional breeding cycle if artificial light is increased, and simultaneously
their white blood cell counts decrease.
Being kissed, hugged, and patted by people who love you causes endorphins to
be released within the central nervous system. Endorphins are natural opiates
produced by our bodies, capable of reducing pain and depression, and producing
feelings of well-being.
Hugging, kissing, snuggling, and giggling with a child who has cancer has
been shown in several nursing studies to lower the child's pain and anxiety
Hugging and kissing your partner can be enjoyable and healthy, even if
you're feeling too tired at the moment to enjoy all of the sexual activities
you enjoyed before diagnosis.
Your religious beliefs may provide comfort when little else is making sense.
Some people find that their spiritual beliefs sustain them in spite of a
seemingly arbitrary infliction of suffering, either because their religion
provides answers for the question of human suffering, or owing to theological
beliefs they have developed independently.
I am 48 years old--too young to have this disease. I know I cannot control the
cancer. I can just fight it, but that's me. There are times when I need my
faith to carry me through. We are all different, and we find what we need--and
maybe that's a doctor telling us everything will be all right ( just like our
moms used to when we were little).
Other cancer survivors, however, experience a crisis of faith after their
cancer diagnosis. They find it difficult, for instance, to reconcile the
emergence of a seemingly undeserved, life-threatening illness with their belief
in a kind, nonpunitive deity.
On a more human level, the support that fellow church or temple members
furnish to those who need help is clearly an asset in stress reduction. Support
might take the form of emotional support (cards, calls, hugs, visits), prayer,
practical support (drives to and from the doctor, or casseroles for supper), or
financial support for someone who is underinsured.
The May 1995 issue of the Journal of the American Medical
Association contains an article showing a correlation between religious
practice and prayer and increased good health. At least one other study has
shown that a person who is prayed for improves when ill, even if he or she is
not aware that prayers are being said.
Sue Browne describes her reliance on faith to keep her and her husband on an
Without our faith, I don't believe that we would be at peace with all that this
disease has thrown at us. You go through lessons in humility you never would
have had to go through, or at least not until you were very old and senile. As
a relatively young man, Steve has been poked, prodded, and shaved by
good-looking, young-sweetie nurses, had his wastes monitored, and his hair fall
out. We pray all these are "costs" for his survival.
For some of us, support groups can be the difference, literally, between
life and death. The opportunity to exchange information with those who have
already weathered colorectal cancer can provide you with everything from
emotional support to knowing when to question your treatment and seek medical
help elsewhere. Support groups are an immeasurably useful way to do this,
bringing together a variety of skills, sometimes including medical and legal
Moreover, Dr. David Spiegel's work with breast cancer survivors shows longer
survival among those who are part of support groups, a serendipitous finding
from a study intending to highlight other aspects of survival.
Support groups are offered locally in many areas by organizations such as
the American Cancer Society, the Wellness Community, or local hospitals.
If you have Internet access, support groups are also available on the
In the 1930s, marine biologist Sir Alister Hardy noted that humans have
features in common with water mammals, features not found in any other
primates, such as a subcutaneous layer of body fat, hair that grows in one
direction to reduce water resistance, a protective dive reflex within the
respiratory system, a nose that blocks water during a dive, residual webbed
toes, and fully webbed toes in 7 percent of humans. He argues that we humans
may have spent a period of our evolution in water.
Anthropologists may settle this point eventually, but for our immediate use,
it means that, for some of us, water is a wonderful way to relax. A good swim
or a warm tub with salts and a good book can make you briefly more than just
Discuss swimming or bathing first with your oncologist if you have an
ostomy. Some water activities might entail a risk of introducing bacteria at
If you have an urge to write, you'll be encouraged to know that those who
write very honestly and emotionally about their frightening, negative
experiences increase the function of their white blood cells. Writing can be in
a range of formats. You can write for yourself in a journal, write letters to
friends, write letters for your children to be read when they're older, or
write email to cancer discussion groups on the Internet.
Stress associated with cancer responds well to anti-anxiety and
antidepressant medication. Research has shown, though, that these medications
are most effective when used in combination with counseling and behavior
There are many drugs to choose from to ease anxiety or depression, or to aid
sleep. The newer drugs available today have fewer side effects, and are less
likely to be addictive than drugs used just a few years ago.
All medications prescribed by any physician, including a psychiatrist,
should be reviewed first by your oncologist for their effect on your digestive
Anti-anxiety drugs (anxiolytics) fall broadly into two groups, the
fast-acting drugs and the slower-acting drugs. The fast-acting benzodiazepine
drugs such as Valium, Ativan, or Xanax are potentially addictive, and can cause
rebound anxiety when they're stopped. The newer anti-anxiety drugs such as
Buspar (buspirone) cross the boundary between anti-anxiety and antidepressive
drugs, are not addictive, and can be stopped abruptly with no ill effect. They
take two to three weeks to work.
The mood change following use of the older anti-anxiety drugs in the Valium
family is pronounced and rapid, similar to the effect of alcohol. It's unwise
to drive or operate heavy machinery when using drugs in the benzodiazepine
The mood change following use of newer anti-anxiety drugs such as Buspar is
more subtle and gradual, and sleepiness, if present, is less pronounced than
with the benzodiazepines.
The anti-anxiety drug Ativan, a benzodiazepine, is often used just prior to
chemotherapy to control nausea.
The availability of today's more effective, safer antidepressants is a
blessing for those coping with cancer. Unlike the antidepressants of a few
years ago, which caused sleepiness, weight gain or other undesirable side
effects, today's antidepressant medications are far safer and less disruptive
of weight and sleep patterns.
Some of the newer antidepressants can cause restlessness and insomnia for
the first two or three weeks they are used. You might discuss with your doctor
the temporary use of a sleeping pill until your body has adjusted to the
Antidepressants are also good pain relievers, although their mechanism as
such is not entirely clear.
Improvement in mood is gradual with most of the antidepressants used today,
changing slowly over a few weeks or months. The fullest effect is gained if the
drugs are used continuously for months. Always check with your doctor before
stopping an antidepressant lest gains in improved mood be lost.
The best source for antidepressant medication is a psychiatrist. This
specialist is the one most likely to be familiar with all antidepressants and
their side effects, and can rotate you through several until the best one for
you is apparent.
Sleep medications range from the very mildest, including over-the-counter
antihistamines and Tylenol, to the stronger medications necessary for those
using prednisone, or those coping with moderate to severe anxiety.
The anti-anxiety drugs in the benzodiazepine family, such as Ativan, are
also used as sleep aids. See "Anti-anxiety medication," earlier in
this article, for cautions about these drugs.
One of the newest sleeping pills available is Ambien, a drug that aids those
who have trouble falling asleep. It's cleared very rapidly from the body, so
it's less useful for those having trouble staying asleep. When Ambien first was
approved by the FDA, it was marketed as a nonaddictive sleeping pill, but
post-market experience has shown that, for at least some people, it may be
Drugs prescribed for severe pain, such as codeine and morphine, also induce
Some people use melatonin, a substance marketed as a food supplement, to aid
sleep. Melatonin has been shown to increase the quantity of white blood cells.
This is a risky phenomenon for a person with a gastrointestinal cancer linked
to an autoimmune disorder such as ulcerative colitis, because the white blood
cells increased by melatonin or another immune-system enhancer could stimulate
undesirable gastrointestinal activity. Accordingly, the FDA requires a warning
on melatonin dietary supplements made or distributed in the US about possible
health risks for those with white blood cell disorders. Always consult your
oncologist before using any drug, whether prescription, nonprescription, or a
"natural remedy" marketed as a food supplement.