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Citation
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Markowitz JC, Hellerstein DJ, Falabella G, Lan M, Levenson J, Crew KD, Hershman DL. Gen. Hosp. Psychiatry 2023; 83: 117-122. |
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Abstract
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Background
Breast cancer, a major life stressor, increases the risk of a major depressive episode. Prevalence of MDD is at least 11% among patients with breast cancer [1], versus <4% in the general population [2]. A review of sixty studies found “compelling evidence” that breast cancer survivors face increased rates of depression, anxiety, and suicide [3]. Beyond pain and suffering, patients with breast cancer experience potential loss of healthy body image, fertility, and even life. Surgery ...
Psychopharmaphobia
One explanation for reluctance to take antidepressant medication is an understandable desire of somatically-sensitized patients to avoid previous physical symptoms like those arising from breast cancer or its treatment. Although study patients have not met DSM posttraumatic stress disorder (PTSD) criteria, their hypervigilance to medication side effects resembles the hypervigilance of traumatized patients with PTSD. In decades of conducting antidepressant treatment trials with non-medically ill...
Responding to psychopharmaphobia
Medication fears aside, pharmacotherapy already faced disadvantages in this trial. Serotonin reuptake inhibitors are ubiquitous in medical practice, whereas evidence-based antidepressant psychotherapy can be harder to find. It thus seemed likely that patients interested in study enrollment would favor IPT, potentially skewing treatment preference. Based on the McHugh et al. review [15], we expected to enroll patients with two psychotherapy-leaning preference factors beyond our control ..
Discussion
Prospective patients for a study comparing two distinctly different treatments are showing unusual wariness of standard antidepressant pharmacotherapy despite its typically mild adverse effects. This finding might be partly an artifact of our research design, which presents patients a seeming choice between psychotherapy and medication, then randomly assigns treatment. No historical comparison exists, this being the first trial to compare the two modalities for depressed patients with breast ...
Language: en |