Anxiety and depression after breast cancer: The predictive role of monoamine levels

Eur J Oncol Nurs. 2021 Jun;52:101953. doi: 10.1016/j.ejon.2021.101953. Epub 2021 Mar 26.


Purpose: Despite the fact that the prevalence of anxiety and depression in breast cancer survivors is higher than in the general female population, the psychobiological substrate of this phenomenon has yet to be elucidated. We aimed to examine the predictive role of peripheral dopamine (DA), noradrenaline (NA), serotonin (5-HT) and kynurenine (KYN) in anxiety and depression among breast cancer survivors.

Method: We evaluated 107 women using the Hospital Anxiety and Depression Scale, and monoamine levels were analyzed via high-performance liquid chromatography.

Results: High KYN levels predicted both disorders, while low NA and DA predicted anxiety and depressive symptoms, respectively. A negative conditional effect of 5-HT was found for anxiety and depression among younger women only, while being both middle-aged and younger influenced the negative conditional effect of DA on depression.

Conclusion: Monoamine variations may render breast cancer survivors more vulnerable to anxiety and depression, with young women being especially vulnerable to the detrimental effect of low DA and 5-HT. Assessing subclinical psychobiological markers allows mental health nurses to identify vulnerable survivors prior to the onset of anxiety and depression, and to adjust nursing interventions accordingly.

Keywords: Age; Anxiety; Breast cancer survivors; Depression; Monoamines.

MeSH terms

  • Anxiety / epidemiology
  • Anxiety / etiology
  • Anxiety Disorders
  • Breast Neoplasms* / complications
  • Depression* / diagnosis
  • Depression* / epidemiology
  • Depression* / etiology
  • Female
  • Humans
  • Middle Aged
  • Survivors