Given the common side effects of ADT, such as hot flashes, sexual dysfunction, weight gain and fatigue, it’s no surprise that men on ADT are at increased risk of depression and anxiety. But how are their psychological problems being addressed by the doctors who treat them?
Here is a nice retrospective study using data from a Medicare insurance database in the USA, which explores that question.
The authors looked at the association between prostate cancer patients known to be on ADT and whether they were receiving any treatment for depression or anxiety subsequent to starting ADT. The study focused on men starting treatment for psychological distress in the year or two after starting on ADT. Thus, men who were treated for psychological problems prior to starting ADT were excluded from the study.
The sample of men who received an incident diagnosis of anxiety and depression after starting ADT was just under 4,000. More than half of them were diagnosed with depression and almost a third diagnosed with anxiety. Some received a diagnosis of both anxiety and depression.
For many men on ADT, those numbers will not be surprising. But the paper gets more interesting from there on, when the authors explore what the men were getting in the way of treatment for their psychological distress.
Here are some choice quotes from the paper:
“Nearly half (48%) [of the men] did not receive psychotherapy or pharmacological treatment despite being diagnosed [with anxiety or depression]”.
“A quarter of the men (25.9%) diagnosed with depression or anxiety who received a treatment were started on a benzodiazepine as their first therapy“.
Men who were offered a benzodiazepine were given a prescription with a median supply of 105 days, which suggests that they were offered a long-term prescription. This contrasts with the fact that:
“Because of their potential for dependence and abuse, clinical practice guidelines for the management of anxiety disorders have outlined benzodiazepines to be…limited to short-term use during crisis.”
Furthermore, benzodiazepines have been associated with “cognitive impairment, falls, and fractures. Notably, men receiving ADT are already at higher risk for these specific adverse events.”
Benzodiazepines are a class of drugs that are generally prescribed for treatment of anxiety. Since the dominant diagnosis in this study was depression and not anxiety, many patients may actually have been prescribed a benzodiazepine medication inappropriately. Also of note, only 0.3% of men were offered psychotherapy and 33% received an anti-depressant medication.
As the authors concluded, it certainly seems to be the case that: “Men with prostate cancer who develop depression or anxiety after starting ADT are potentially not receiving adequate mental health care.”
Importantly, this study highlights a need to better understand why this gap in mental health care exists and how it can be addressed. Cancer centres around the world are increasingly offering free or low-cost mental health resources, though access to these resources may be difficult for men who live in certain regions. Online mental health support, like group programs and virtual counselling, may be a helpful option for some. The bottom line is: it’s important to reach out to a health care provider if you notice changes in mood or mental wellbeing.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/35298660/
Reference:
Tsao PA, Ross RD, Bohnert ASB, Mukherjee B, Caram MEV. Depression, Anxiety, and Patterns of Mental Health Care Among Men With Prostate Cancer Receiving Androgen Deprivation Therapy. Oncologist. 2022 Mar 17:oyab033. doi: 10.1093/oncolo/oyab033. Epub ahead of print. PMID: 35298660.