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Depression and Chronic Illness: Which Comes First?


Which comes first—depression or chronic illness? While the connection works both ways, one thing's for sure: treatment can make a difference.

Jennifer was 26 years old when her doctor diagnosed her with high blood pressure. It wasn't until she learned that she also suffered from polycystic ovary syndrome that she began her slide into depression. Like many other people with chronic illnesses, she hid her depression from her doctor, even as she underwent fertility treatments and a high-risk pregnancy.

"It's so hard to deal with a chronic illness," says Jennifer, now 29. "Many people are afraid to admit that they need help."

After the birth of her son, she broke down and told her doctor of her depressive symptoms—her self-imposed isolation from others, withdrawal from relationships, sleeplessness, and feelings of hopelessness. He helped her understand that like her other chronic conditions, her depression was not her fault. She began taking an antidepressant, and her outlook improved.

"It has helped tremendously," she explains. "I needed it to keep things in perspective for me, which it did."

When Illness Triggers Depression

When faced with a potentially life-changing diagnosis of a chronic condition, it can be easy for depression to set in.

When someone is diagnosed with an illness, it is not uncommon to feel helpless or alone. Depression is easy to overlook in part because some of its symptoms, like fatigue or change in energy levels, mimic those of some chronic illnesses.

When Depression Leads to Illness

In cases like Jennifer's, it's pretty clear that the illness led to depression. But for scores of others with conditions like heart disease and diabetes, the connection can be the reverse.

People with a history of depression are at least three times more likely to suffer from heart attacks than their non-depressed peers, making depression as important a risk factor as high cholesterol or family history of heart disease.

Depression is also associated with type 2 diabetes. Links between depression and these illnesses likely work on different levels.Depression could have a behavioral component, such as having different eating or exercising habits. It can also affect the body in how the immune system works or how the blood clots.

The Diagnosis Dilemma

There may be some people who suffer from depression, but go undiagnosed. It may be the result of a minimalization of depression that stems from the people themselves. It may seem like a natural part of having the illness, allowing them to not realize they have depression as well.

For many chronically ill patients who are depressed, it's a Catch-22. Their depression saps their energy, leaving them withdrawn and less likely to actively seek help from their healthcare providers.

Family and friends can play an important role in helping bring depression to light in people with ongoing health problems. Often times it takes an outsider to realize there is more going on with someone they are close to.

Luckily, doctors are becoming more aware of the importance of screening for depression, and incorporating it into their daily routines. Looking for signs of depression as easy as asking a few questions. How the person answers can indicate there may be a problem.

Depression's Devastating Effects

No matter when depression strikes, if it accompanies some chronic illnesses, the ramifications can be serious:

  • Diabetes—Depressed people with diabetes may not take their medications as diligently. This will lead to more problems controlling their blood sugar, which in turn leaves them more susceptible to serious complications.
  • Heart disease—People with heart disease who are also depressed might stop paying as much attention to their diets, thereby putting themselves at greater risk for heart attacks. People with heart disease that suffer from depression during the early days of their recoveries are more likely to die within a year of their attack than people who do not get depressed.
  • Asthma—A psychological study of people with asthma showed that those who recorded more mental signs of depression, like feelings of helplessness or worthlessness, also suffered more from their asthma.

Although not all chronic diseases are as closely related to depression as diabetes, heart disease, and asthma, the way depression exacerbates symptoms makes it a particularly dangerous risk factor.

Treatment for Depression

The complex cause-and-effect relationships between depression and chronic illness may never be completely understood, though studies are aimed at pinpointing specific risk factors and discovering optimal treatments. In the meantime, the doctors say that raising awareness of the prevalence of depression in people with chronic illness may help more of them receive appropriate treatment, whether it's psychotherapy, an antidepressant, or some combination of the two.

Already, doctors have seen that successful treatment of co-occurrences of depression shows promising benefits. This doesn't surprise Jennifer, who continues to manage her depression daily. After taking control of her depression, she has been better able to accept and deal with her other chronic illnesses. She thinks it's unfortunate that depression is not better understood and its treatment more accepted by the general public. "Depression is a medical condition, just like other conditions," she explains. "It's okay to ask for help."

Symptoms of Depression

Doctors and their patients should look for the following symptoms as clues of depression, especially in the presence of other medical conditions:

  • Persistent feelings of sadness, anxiety, or emptiness
  • Hopelessness
  • Feeling guilty, worthless, or helpless
  • Loss of interest in hobbies and activities
  • Loss of interest in sex
  • Feeling tired
  • Trouble concentrating, remembering, or making decisions
  • Trouble sleeping, waking up too early, or oversleeping
  • Eating more or less than usual
  • Weight gain or weight loss
  • Thoughts of death or suicide with or without suicide attempts
  • Restlessness or irritability
  • Physical symptoms that defy standard diagnosis and do not respond well to medical treatments

If you have a chronic illness, and you have any of these symptoms, talk to your doctor. Depression is highly treatable and it will help you better cope with managing your other illness.

RESOURCES:

American Psychological Association
http://www.apa.org

Mental Health America
http://www.mentalhealthamerica.net

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org

Canadian Psychological Association
http://www.cpa.ca

References:

Chronic illness and depression fact sheet. National Alliance on Mental Illness website. Available at: http://www.nami.org/Content/NavigationMenu/Mental_Illnesses/Depression/Depression_and_Chronic_Illness_Fact_Sheet.htm. Updated October 2009. Accessed November 27, 2013.

Co-occurring disorders and depression. National Mental Health Association website. Available at: http://www.nmha.org/conditions/co-occurring-disorders-and-depression. Accessed November 27, 2013.

Depression. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 31, 2013. Accessed November 27, 2013.

Depression and cancer. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/depression-and-cancer/index.shtml. Accessed November 27, 2013.

Detre KM. Coronary bypass surgery improves heart attack survival in people with diabetes. N Engl J Med. 2000;342:33-43.

Mancuso CA, Peterson MG, Charlson ME. Effects of depressive symptoms on health-related quality of life in asthma patients. J Gen Intern Med. 2000;15:301-310.

Pratt LA, Ford DE, Crum RM, et al. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Circulation. 1996;94:3124-9.



Last reviewed November 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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