Hester Hill Schnipper Photo courtesy of Beth Israel Deaconess Medical Center

MOST PEOPLE DIAGNOSED WITH CANCER experience some level of anxiety and grief. However, with an estimated one in five U.S. adults living with a mental illness, many people with cancer will also have preexisting mental health conditions.

People living with conditions such as depression, anxiety or bipolar disease often take drugs like antidepressants, anti-anxiety medications, stimulants or antipsychotics. They may regularly see a psychiatrist or counselor. Thus, the mere thought of more doctors’ appointments and cancer treatments that might interact with their current drug regimen can be a significant source of stress.

By being completely honest and forthcoming with oncology providers, people who have mental health issues and cancer can get help to manage both health conditions. The following tips can help to set a foundation for support:

1) Expect that news of your cancer diagnosis and necessary treatments could exacerbate preexisting mental health issues. You may feel more depressed or anxious than your baseline. While this can be part of normal adjustment, speak up if your symptoms interfere with your ability to function or to adhere to your cancer treatment regimen.

2) Ask to connect with your hospital’s behavioral health or oncology social work professional at the start of your treatment or as soon as possible. It can help to have someone who can help you process the experience. That person, with your permission, can also communicate regularly with your psychiatrist or counselor, if needed.

3) Tell your oncologist if you are taking medications for your mental health condition. If your medication list is complex, ask for a referral to a psychiatrist who is trained in psycho-oncology and is well versed in potential interactions between cancer drugs and mental health drugs. Many cancer centers have staff with this expertise; others can refer you to someone in the community.

4) Some cancer drugs interact with psychiatric medications and vice versa. For example, many women with estrogen receptor-positive breast cancer are prescribed a type of hormone therapy called tamoxifen, which reduces the chance of cancer coming back after treatment. However, some antidepressants, such as Prozac (fluoxetine) and Paxil (paroxetine), can inhibit an enzyme that is broken down by tamoxifen, which would make treatment less effective. You may need to switch to a different antidepressant or cancer drug.

5) Fatigue is a frequent companion of both depression and cancer treatment. Psychiatrists can prescribe drugs that are safe to use during treatment and can increase energy.

6) Enlist the help of your existing mental health support community and explore additional resources to ease the months of cancer treatment. If you have been attending a support group or day program, try to keep going to meetings. If you are already receiving mental health support, continue your relationship with your therapist, who should also speak occasionally with someone on your cancer care team.

7) Keep in mind how much you’ve already overcome as you approach this new challenge. Rely on the tools you’ve learned along the way and be open to asking for help.

Hester Hill Schnipper, a licensed independent clinical social worker, is a breast cancer survivor who served as the manager of oncology social work at Beth Israel Deaconess Medical Center in Boston.