Research Findings and Resources for MPN-Related Depression

Experiencing Depression Related to MPN Symptoms? You Are Not Alone

Nearly a quarter of patients with a myeloproliferative neoplasm (MPN) reported significant symptoms of depression as part of an international study sponsored by the Mayo Clinic Survey Research Center in Rochester, Minnesota.

The internet-based questionnaire was designed to evaluate fatigue and mood symptoms in patients with an MPN. During the study, patients completed the Patient Health Questionnaire-2 (PHQ-2) to identify who is at high risk of depression. A PHQ-2 score of three or higher was considered a depression marker. The study was published in the journal Cancer Medicine.

When to Seek Professional Help

According to the American Society of Clinical Oncology, you should talk to a doctor if you experience the following symptoms, especially if they last two weeks or longer.

Mood Symptoms

• Feeling down

• Feeling sad

• Feeling hopeless

• Feeling irritable

• Feeling numb

• Feeling worthless

Behavioral Symptoms

• Loss of interest in activities that you used to enjoy

• Frequent crying

• Withdrawal from friends or family

• Loss of motivation to do daily activities

Cognitive Symptoms

• Trouble focusing

• Difficulty making decisions

• Memory problems

• Negative thoughts. In extreme situations, these may include thoughts that life is not worth living or thoughts of hurting yourself.

Of the 1,344 respondents, 23 percent reported a PHQ-2 score of three or higher, meaning they were at risk of depression. The proportion of patients who were at risk for depression was similar across essential thrombocythemia (ET), myelofibrosis (MF) and polycythemia vera (PV). In addition, the risk was not associated with MPN treatment, but with worsening symptoms, including fatigue, pruritus (itching) and night sweats.

“Depression for MPN patients is due to more than just the psychological stress of a worrisome diagnosis,” the authors of the study wrote. “The lifetime of uncontrolled symptom burden and disease features have been demonstrated to impair significant social, role and physical functioning. Additionally, environmental factors such as financial stressors can significantly contribute to depression.”

In another international study, 90 percent of patients experienced MPN-related symptoms. The most frequent and severe symptom was fatigue. Sixty percent reported “some level of depression” in the previous month, and one in five indicated that depression had a high impact on them. Approximately 10 percent of patients were prescribed antidepressants to help manage their condition.

“…patients with MPNs have severe disease burden, reduced QOL (quality of life), and impaired productivity, regardless of geographic location,” the authors wrote. “Findings from our study suggest that managing disease burden in patients with MPNs is crucial to minimize disease impact on patient daily lives.”

In the recent Mayo Clinic study, patients who were more at risk for depression (PHQ-2 score of three or higher) also reported more physical symptoms (i.e., dizziness, abdominal pain, numbness, cough, bone pain), the worst fatigue and the worst overall quality of life. They were more likely to smoke, take prescription pain medicine, antidepressants or anxiety medications, and experience fatigue throughout the day. They were also more likely to manage tiredness by setting priorities, postponing non-essential activities and napping.

Patients who were less at risk for depression (PHQ-2 score of two or lower) were more likely to use exercise and volunteering to cope and feel tired only in the evening.

Emotional Support and Preventative Care

Mental well‐being is critical to living a healthy and active life, the investigators note. Research has shown that increased stress or emotional distress is associated with increased cancer incidence and mortality.

The authors suggest that addressing the severity of MPN symptoms may improve depression. In contrast, they note that treating depression may help reduce the impact of MPNs on patients’ quality of life, as emotional distress can exacerbate physical symptoms.

In conclusion, the researchers say healthcare providers should routinely screen patients for depression and prescribe treatment if necessary. In addition, yoga, mindfulness and Acceptance and Commitment Therapy (ACT) can promote stress reduction and alleviate depressive symptoms.

If you are experiencing symptoms of depression, you are not alone. Several organizations can provide emotional support, including MPN Connect, the MPN Research Foundation, MPN Advocacy and Education International and CancerCare.