Psychological support

By Vanessa Marais

Updated January 14, 2025

The relation between acute myeloid leukemia and mood disorders

Cancer impacts various aspects of life, including relationships, social networks, work or school, finances, and overall quality of life. Based on the diagnosis and subsequent treatment plan, it may be necessary to adapt to immediate changes and adjust future plans while also coping with the threat on life expectancy. This can bring up difficult emotions, including loss, grief, sadness, hopelessness, isolation, depression, fear, anxiety, anger, and guilt. 

With the intensive treatments and their potential side effects, medical complications, prolonged hospitalizations, and uncertainty regarding outcomes and prognosis, patients with acute myeloid leukemia often experience psychiatric disorders, such as major depression, anxiety, and post-traumatic stress reaction.

Survivors of childhood leukemia may experience life differently compared with their peers and siblings, even after entering remission. Studies show higher rates of depression and anxiety, lower quality of life, and negative self-image in younger people with leukemia. 

AML treatment and psychological conditions

Chemotherapy

Depression

Patients with acute myeloid leukemia receiving intensive chemotherapy deal with many psychological and physical challenges, which can cause emotional distress, including feelings of depression and anxiety. Induction chemotherapy, in particular, is a stressful period due to unfamiliarity of the treatment, uncertainty of the results, and decreased health-related quality of life. It is normal to feel depressed after a diagnosis with acute myeloid leukemia, but if your low mood persists and interferes with your day-to-day activities, you may be experiencing clinical depression, which may require active psychological treatment.

Symptoms of depression include changes in appetite, sleep disturbances, fatigue, decreased concentration and short-term memory, reduced libido, feeling discouraged, loss of interest in people and activities, feelings of guilt, helplessness, worthlessness and irritability, negative thoughts about oneself and the future, and, in severe cases, suicidal thoughts.

Depression is a common medical condition triggered by the shock of an acute myeloid leukemia diagnosis and the side-effects of treatment and does not mean that you cannot cope. If you think you might be depressed, reach out to your healthcare team. Depression can be effectively treated with medication and psychotherapies, such as cognitive behavioural therapy and emotional supportive therapy. 

Anxiety

The uncertainty and unpredictability of acute myeloid leukemia and treatment side effects can lead to anxiety. It is normal to be worried about the success and outcome of treatment, and the possibility of the cancer returning. 

However, if this “normal” anxiety becomes difficult to manage or begins to interfere with your quality of life and daily functioning, talk to your healthcare team about referral for medication and psychotherapy.

Fatigue

Fatigue is one of the most common consequences of acute myeloid leukemia treatment, impacting physical, emotional, and cognitive abilities, and often disrupting daily functioning. Effective self-management includes acknowledging and understanding your acute myeloid leukemia-related fatigue, conserving energy, being kind to yourself, setting realistic expectations, and practicing self-compassion. Conscious self-management of your fatigue can help you feel more in control and enhance your sense of well-being.

Stem cell transplant

Undergoing a stem cell transplant can make you susceptible to various forms of emotional distress. It is beneficial to be prepared by your healthcare team for the psychological challenges of the transplant process, such as strict isolation, severe physical side effects, and increased dependence.

Anxiety

Anxiety is commonly heightened before undergoing a transplant, with concerns about how your body will respond to the procedure, quality of life during recovery while in isolation, and your ability to manage potential complications, especially if you are far away from your home and social support. If anxiety becomes overwhelming, it can jeopardize your ability to fully engage in your treatment and routine follow-up, and you may need additional support to understand and manage your anxiety. 

Post-traumatic stress reaction

The hospitalization and acute recovery following a stem cell transplant, which differs from other cancer treatments, can be traumatic and may lead to post-traumatic stress reaction. This can result in reliving the cancer and treatment experiences, with nightmares, flashbacks, or persistent thoughts about the procedure.

Depression

Depression is common at all stages of the transplantation process and can interfere with recovery from the procedure.

Persistence of anxiety, depression, and symptoms such as fatigue and sleep disturbances can strongly affect clinical progress, potentially contributing to increased morbidity and mortality following stem cell transplantation, and therefore requires active attention from healthcare providers.

Strategies to help adjust and manage your emotions

• An acute myeloid leukemia diagnosis is often unexpected and may feel overwhelming. You will need time to adjust to the biological and psychological changes experienced during the treatment. It is important to understand that everyone processes emotions in their own way and that you do not have to be positive all the time. Be kind to yourself as you navigate these changes. 
• It is important to talk about your fear and anxiety. Open communication with your healthcare team, as well as with your family and loved ones, can provide support. Hiding your feelings to protect others or because you fear that they may not understand can lead to isolation and loneliness. 
• If uncertainty and anxiety are impacting your daily life, consider speaking with a psychologist who can help you cope with this trauma on a deeper level. 
• Set yourself realistic goals to help your recovery process and lean on the support of others. With resilience, time, and good support, you can adapt to this enormous change in your life.
• Engage in physical exercise, when approved by your healthcare team, to help release your pent-up tension and refocus on something constructive. 
• Practice relaxation and breathing exercises to calm the mind and release muscle tension.
• Participate in activities that you enjoy to help you to stay in the present moment.
• Prioritize your activities and evaluate whether they all need to be done on the same day. Avoid overdoing things, even on good days.

Benefits of seeing a psychologist during and after treatment

There is scientific evidence supporting the benefits of incorporating psychological care into standard acute myeloid leukemia treatment. Clinical depression and anxiety can be successfully treated with medication and psychotherapy, with the primary aim of enhancing your quality of life by helping you achieve optimum functioning within the limits imposed by cancer. This can help you to endure your treatment better, improve your survival outlook, and assist in adapting to your “new normal” during and after treatment. Talking to a specialized therapist can provide you with tools to help identify and cope with your emotions in a healthy way.

In summary, the three most dynamic coping strategies are:

• Emotional support
• Acceptance
• Active coping

After treatment: In limbo

The transition after treatment is a major adjustment, requiring time to adapt to physical changes, regain self-confidence, face the challenges of returning to “normal” life, and managing others’ expectations. It is normal to experience feelings of depression and anxiety, often accompanied by uncertainty about the future and fear of recurrence. It is also natural to grieve for the losses and to feel sad about the impact that acute myeloid leukemia has had on you and your loved ones.

Acknowledging your emotions and reaching out to your healthcare team and a psychologist can help you cope with difficult or conflicting feelings during this transition. While your family and friends might expect you to feel back to normal once your treatment ends, your body and emotions need time to recover and work through all that has happened. Rather than trying to go back to“normal”,this time is about discovering your“new normal”. Your outlook on life may change because of acute myeloid leukemia, and you may be required to make difficult adjustments. Continue to seek support from those close to you.

Support for caregivers

Due to the nature of the illness, patients with acute myeloid leukemia often rely heavily on their family members. Consequently, caregivers face the pressure of managing these additional responsibilities alongside their daily routine and work commitments and may experience emotional strain, psychological challenges, and burnout. Caregivers can benefit from seeing a psychologist to better understand their emotional experience on their journey and learn how to “survive” it. 

Conclusion

Living with acute myeloid leukemia significantly impacts mental health, often leading to depression, anxiety, or both. The psychological burden on patients and their caregivers can be alleviated through a multidisciplinary approach that provides support at all stages of treatment and beyond.