Selected Podcast

Depression and Cancer Treatment for Women

Cancer diagnosis and treatment bring myriad other conditions like insomnia, fatigue and cognitive decline. These can lead to mood or anxiety disorders. Dr. David Silver discusses cancer diagnosis and depression in women.
Depression and Cancer Treatment for Women
David Silver, MD
Dr. Silver completed a fellowship in Gyn Oncology at Roswell Park Cancer Institute in Buffalo and his ob-gyn residency at The Union Memorial Hospital in Baltimore. He completed a psychiatry residency at the University of Pennsylvania. To broaden his training, he also obtained a Master’s in Business Administration (Healthcare) at DeSales University in the Lehigh Valley. He earned his medical degree at Thomas Jefferson University’s Sydney Kimmel Medical College in Philadelphia.

Board-certified in Obstetrics & Gynecology and in Gynecologic Oncology, Dr. Silver pursued a busy clinical and academic career in Gynecologic Oncology at institutions including Yale University, Eastern Virginia Medical College, Thomas Jefferson University, University Medical Center of Nevada, and St. Luke’s University Health System.

In his spare time, Dr. Silver enjoys spending time with his family and drawing, especially architectural drawing.

Introduction: Another edition of The Healthier You Podcast from UPMC Pinnacle

Bill Klaproth: Behavioral symptoms such as depression are a common side effect of women going through cancer treatment. These symptoms cause serious disruption in a patient's quality of life and may persist for years following treatment. Here to talk with us about cancer treatment for women and depression is Dr. David Silver, a Gynecologic Oncologist and Women's Behavioral Health expert at UPMC Pinnacle. Dr. Silver, thank you for your time. So when it comes to women and cancer treatment, can you give us a brief run down of the types of behavioral issues or conditions a woman might face?

Dr. Silver: Sure. The most common symptom that a woman faces when undergoing cancer diagnosis and treatment is fatigue, but they also have insomnia. They have perceived or real cognitive decline, whether it's related to stress or to their treatments. And all of those things can relate to subsequent mood and anxiety for them.

Host: So a cancer diagnosis has a huge impact on a person. We all know this, the stress of the diagnosis, the treatment, the behavioral issues that you just mentioned and you just said can lead to anxiety and depression. Let's focus on that for a minute. Can you talk about depression and women with cancer?

Dr. Silver: About, 25 to 50% of women who have cancer diagnoses do have depressive symptoms, if not full blown depressive conditioned or diagnosis. These things kind of creep up slowly, are frequently not reported because kind of diagnosis, and when they do affect a woman who's being treated for cancer oftentimes result in problems with completing treatments for their cancer diagnosis. And it does also relate to a decrease outcomes for their cancer treatment.

Host: So this is really an important issue then. And you just said the symptoms creep up slowly and a lot of times are not reported. So what are the signs and symptoms of someone with depression? What should we be looking out for?

Dr. Silver: Yeah. Yeah, so the main two things that a person depression should report is, of course a depressed mood is the first, and the second one is kind of a loss of interest in the things that they're normally interested in doing. Hobbies, being social with friends, whatever it is for that particular patient or person. The loss of interest is an important part of depression. And then there are vegetative symptoms that we talk about and those include things like disturbed sleep or change in sleep. Disturbed appetite, meaning either an increase in appetite or a decrease in their appetite. Disturbance in their concentration or attention, not able to read a magazine article without going back over it and over and over cause they just can't get the idea. Then of course, one of the most important symptoms that we want to screen for is the possibility that the patient has suicidal ideation.

Host: Well, these are really, really important things to know, so a depressed mood, loss of interest, disturbed sleep, change in appetite, either way, cognitive changes and as you say, suicidal thoughts. If someone recognizes these symptoms in themselves or in a loved one, what is the next step?

Dr. Silver: Yeah, I think the next step is to report them to your Doctor. If, of course it's a loved one, is to encourage the patient to report or maybe accompany the patient to the Doctor's visit so that the doctor can be made aware of these important changes. Because as I said, not only are these symptoms, these mood symptoms, very important to a patient's quality of life and life, but they're also very important to the oncologist treatment and ability the patient. So it's a very important time in a patient who has cancer to be very willing to communicate these things.

Host: That is absolutely true. So when it comes to treatment, how do you generally treat a cancer patient who is depressed?

Dr. Silver: Yeah, so in general there are two forms of treatment and the first is psychotherapy, which is talk therapy, in which case there are several different methods of psychotherapies that are useful for mood disorders and anxiety disorders that can be facilitated either by a psychiatrist or a therapist. And then the other mode of treatment is medication. Frequently we use antidepressants that are very well tolerated for patients with these conditions.

Host: And at UPMC Pinnacle, you specialize in this type of treatment. In fact, can you talk about the new services at UPMC Pinnacle, which will officially open in December that will focus solely on women and behavioral and mental health issues?

Dr. Silver: Yeah, so Nazanin Silver, my wife and I are starting a practice, the women's behavioral health specialists at UPMC Pinnacle. And as part of that, we are treating women with cancer who have behavioral health issues. But the broader look of our practice will be that we will treat women with behavioral health issues throughout their reproductive life cycle and the transitions that occur in that life cycle. So to be more specific, I'm talking about mood and behavioral issues that relate to the menstrual cycle, mood and behavioral symptoms that relate to pregnancy, and with that also infertility, pregnancy loss, and mood and behavioral, and also cognitive symptoms that come with perimenopause and menopause. So in those hormonal transitions in a woman's life, we know that there are increased vulnerabilities for those types of diagnoses, and we will be focused solely on the these populations of patients to get them through these difficult times.

Host: And speaking of focus, unlike other psychiatric practices, UPMC Pinnacle will concentrate solely on women's behavioral health issues. Is that right, Dr. Silver?

Dr. Silver: That's correct. My wife and I are both boarded in OB GYN subspecialties. I myself am boarded in gynecologic oncology. My wife Nazanin is boarded uro gynecology and we are now retrained in psychiatry for the purpose of opening up a practice such as this that will focus specifically on women.

Host: And in general, what types of services will you offer?

Dr. Silver: So like we mentioned before, there are basically two modes of treatment. They will include psychotherapy and medication management. We will have the two of us, a psychiatrist and in addition we will have two therapists within our practice and we will be able to take care of the full spectrum of treatment options related to the problems that we've mentioned.

Host: And Dr. Silver, why should a woman choose UPMC Pinnacle for their behavioral health issues?

Dr. Silver: I think we kind of shed some light on that. It's a unique practice that we have focused on women's behavioral health. And although women's behavioral health is becoming a more a recognized subspecialty within psychiatry, there are probably no other practices where there are providers who are well versed and trained in both OB GYN, OB GYN subspecialties and psychiatry as we have here. And I think that gives us some unique insights on the kind of the physiology of a woman's reproductive system and how it relates to the way the brain works and how that affects the emotion and cognition. So I think we have a unique situation here and we are really excited to get started in helping the community.

Host: And as you said earlier, a full spectrum of women's health is what you specialize in Dr. Silver, thank you for your time. For more information on women's behavioral health issues, please visit, that's I'm Bill Klaproth. Thanks for listening.