How Mental Health Medications Are Used in Cancer Care 

May is Mental Health Awareness Month. This month, HealthTree is addressing the vital role of mental health treatments in cancer recovery. Our goal is to break the taboos surrounding psychiatric support. In this article, you will learn how certain medications and therapies can significantly improve your quality of life.

Receiving a cancer diagnosis can be an overwhelming experience that may bring up feelings of fear and uncertainty. These emotions are a valid response to a major life event. Coping with cancer can make existing mental health challenges worse. It can also bring up new symptoms of depression and/or anxiety. Some cancers and their treatments can also affect how you think, act, and feel. This makes treating your mental wellness just as important as treating the cancer itself.

Anxiety, depression, sleep disorders, and physical pain are the primary reasons a person with cancer might visit a mental health professional. This is more common than you may think. Research suggests that psychiatric disorders affect as many as 30% to 40% of people diagnosed with cancer. By identifying and treating these conditions early, you can improve your ability to make medical decisions and even support your immune system’s ability to recover.

Understanding the different types of mental health medications

Managing mental health during cancer treatment often involves a combination of therapy and medication to regulate emotional and physical symptoms. According to the National Institute of Mental Health (NIMH), these treatments fall into several main groups, each targeting specific chemicals in the brain to improve how you feel and function.

Antidepressants

Primarily used for depression and anxiety, but can also help with chronic pain and sleep issues. They typically take 4 to 8 weeks to reach full effect.

The First Line: SSRIs like citalopram and sertraline are generally better-tolerated options. If you are taking tamoxifen avoid fluoxetine and [aroxetine as they prevent tamoxifen from working correctly.

Sertraline, citalopram, escitalopram, venlafaxine.

Anti-Anxiety Medications

Help reduce physical and emotional symptoms of panic, extreme fear, or worry.

Often used for short-term relief. Must be tapered carefully to avoid withdrawal symptoms.

Benzodiazepines (Alprazolam, Lorazepam) and buspirone.

Stimulants

Increase alertness and energy. Used in cancer care to manage severe fatigue or "chemobrain".

May be used in treatment or end-of-life care but require monitoring for agitation.

Methylphenidate (Ritalin) and modafinil.

Antipsychotics

Used to manage symptoms like hallucinations, severe agitation, or delirium. They can also be used to reduce nausea and vomiting. 

Myelosuppression risk: Avoid clozapine due to the risk of dangerously lowering blood counts when mixed with certain chemotherapies. If you have a heart condition called Long QT syndrome, combining these with tamoxifen requires heart rhythm monitoring.

Haloperidol, quetiapine, olanzapine, risperidone.

Mood Stabilizers

Used to reduce the severity of mood disturbances and keep emotions steady.

Dosing adjustments are often needed when medications like imatinib are introduced or removed.

Lithium and valproates.

 

Some people may hesitate to start these medications. However, clinical guidelines emphasize that treating mental health is a vital part of your overall recovery plan. These medications can help treat negative feelings and painful symptoms, improving your overall quality of life.

How do I know if I need to start taking medication for mental health problems? 

Many people with cancer will not need to go on medication for mental health challenges. For some, they can be managed with mindfulness, talk therapy, and other treatments. But for others, those techniques don’t make the symptoms better. 

To know if you need a medication, you should first ask your primary care physician, your oncologist or a psychiatrist. Psychiatrists are medical specialists who treat and prevent mental, emotional, and behavioral disorders. They can prescribe medication, order lab tests, and use therapies to treat conditions like depression and anxiety. 

A therapist is a mental health professional who studies human behavior, emotions, and cognitive processes to diagnose and treat mental health issues, typically using talk therapy.  A psychologist can also help and they use evidence-based techniques, such as talk therapy and psychological evaluations, to diagnose and treat mental health conditions, behavioral issues, and help people cope with life challenges. But they do not possess the medical background to monitor or prescribe mental health medications.  Some psychologists have additional training and qualifications to prescribe, however it is recommended that you verify with your health team for possible interactions with your current treatment. 

Because cancer treatments and mental health medications are processed through the same systems in your body, it is essential to follow the "start low and go slow" principle. This means starting at a very small dose and gradually increasing it under medical supervision to ensure your body tolerates the treatment well. It is important that your psychiatrist know what medications you are taking as part of your cancer care. It is also important to tell your oncology team before you start any new mental health treatment. This can help avoid potential interactions and to ensure your care is coordinated and safe.

Are there over-the-counter (OTC) medications for mental health? 

Traditional psychiatric medications are the primary way to manage some chemical imbalances that may be causing mental health symptoms. However, many patients turn to over-the-counter (OTC)  supplements to support relaxation, stress, and sleep. It is important to approach these options with the same scientific care as your cancer treatments. Keep in mind that while these natural options can be helpful, they can also interfere with how your body processes other medications. Read more on how to safely incorporate natural supplements.

Melatonin is a hormone our body naturally produces during the sleep cycle. There are many melatonin supplements, from gummies to flavored beverages. While generally considered safe for short-term use (up to 3 months), it should still be used under medical supervision as it can work similarly to certain sedatives. 

Other supplements  like magnesium and L-theanine are often used to promote a sense of relaxation and support the balance of the nervous system. Magnesium helps calm the nervous system by boosting GABA, a natural brain chemical that promotes relaxation. Similarly, L-theanine, an amino acid often found in tea, can increase alpha brain waves associated with a relaxed mental state without causing drowsiness.

Plants that can help you relax

Botanical options like ashwagandha and valerian root are frequently used to manage long-term stress and improve the quality of sleep. 

Ashwagandha is an "adaptogen" that may help lower cortisol, the body's primary stress hormone. However, these are processed in the liver by the same enzymes as many anticancer medications. Taking them can cause your cancer medication to build up to toxic levels or be flushed out too quickly to work. For example, ashwagandha should not be combined with sedatives like benzodiazepines as it can cause excessive drowsiness, and it may also interfere with thyroid medications or immunosuppressants.

For immediate relief of procedural anxiety, such as before a scan or biopsy, there is high-quality evidence that lavender inhalation (aromatherapy) is a safe and effective tool. Lavender contains terpenes that may have a calming effect on receptors in the brain. Similarly, chamomile is a widely used and gentle supportive care option for calming mild anxiety. It contains a chemical called apigenin that binds to receptors in the brain to create a calming effect similar to some anti-anxiety medications. However, even gentle herbs like chamomile can interact with certain drugs, such as the blood thinner warfarin.

The key to using any of these supports safely is professional screening. Before adding any supplement or herb to your routine, always consult your oncology team or a pharmacist. They can check your specific anticancer drug profile to ensure these natural supports work with your treatment rather than against it.

Mental health medications to improve cancer patients’ outcomes

The way we look at mental health medication is changing rapidly. For a long time, they were seen only as a way to manage mood or sleep. However, recent research has found that many psychiatric medications may directly inhibit the growth of cancer cells. Research has identified several ways these medications might help cancer patients by interfering with cell signaling and metabolic pathways.

One of the most important findings is how these medications work alongside standard treatments to create "synergy." This means they can team up with chemotherapy and radiotherapy to help overcome treatment resistance in tumors. This synergy is especially valuable during the periods between active treatment sessions, as these psychiatric medications may help maintain an inhibitory effect on the tumor while your body rests. While further research is needed to create exact clinical guidelines, current evidence suggests that addressing both mental health and cancer simultaneously provides significant value to patients.

What are other non-pharmacological ways to help you reduce anxiety and depression symptoms?

Evidence-based integrative oncology offers several non-drug therapies that can significantly improve emotional well-being throughout the cancer journey. 

Mindfulness-based interventions (MBIs), such as mindfulness-based stress reduction, are highly recommended during and after active treatment to manage both anxiety and depression symptoms. 

Yoga is also valuable for improving emotional balance, with specific evidence supporting its use for reducing psychological distress. 

Music therapy and relaxation techniques have proven effective for stress felt during diagnostic tests or procedures. Additionally, for those in the post-treatment phase, practices such as Tai-chi, Qigong, and acupuncture are recommended to help restore mental and physical resilience. 

Medications are meant to help you recover your health. Mental health medications do, too

This is why managing the dual challenge of a cancer diagnosis and mental health concerns requires a shift in perspective. By addressing your emotional needs, you are engaging in a vital and legitimate part of your treatment plan and your overall health. As emerging research suggests, psychiatric care may even serve as a potentially anticancer component of your recovery by inhibiting tumor growth and supporting the effectiveness of traditional therapies.

To ensure this integrated care is safe and effective, bridging "communication gaps" between your medical teams is essential. To make this easier, you can use digital tools like HealthTree allows you to maintain one master medication list that both your psychiatrist and oncologist can review simultaneously. 

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This transparency prevents high-risk "drug-to-drug collisions" and ensures that your healthcare team is working from the same data. By taking an active role in coordinating your care and prioritizing your mental resilience, you can improve your overall health and quality of life.

Explore more mental health resources for cancer patients and caregivers 

Read more related articles: 

• What is Polypharmacy? Managing Your Medications When You Have Cancer
• How To Safely Incorporate Complementary Medicine in Cancer Care
• Better Sleep With Cancer: Understanding Sleep Problems and How to Rest Better
• How Cancer Impacts Sexual Health 
• Breaking the Stigma: Debunking Mental Health Myths
• Mental Wellness for Blood Cancer Patients: Grounding Technique
• How Can Antidepressants Aid Cancer Care?

Sources: 

• The Future of Oncology in Psychiatric Medications
• NIH Mental Health Medications
• Antidepressants and other psychiatric medications in cancer care
• Management of psychiatric disorders in patients with cancer
• Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults Cancer: Society for Integrative Oncology–ASCO Guideline
• 14 Over-the-Counter (OTC) Natural Remedies for Anxiety