By MARY-CATHERINE SEGOTA, Psy.D
Dealing with sudden medical events such as a heart attack or stroke, or a chronic medical condition such as diabetes, cancer, or chronic pain, can evoke feelings of sadness or worry. Illness-related stress or anxiety can trigger symptoms of depression. Patients may be worried about treatment, the treatment outcome, or their future. They may have difficulty adjusting to the treatment, or the lifestyle limitations that these conditions may cause. These feelings of sadness or worry, if not addressed, may lead to clinical depression which is a serious medical illness. Research indicates that individuals diagnosed with chronic medical conditions are at a higher risk for developing depression. It is imperative that both formal and informal depression screening is integrated into medical care on the outset of treatment and on an ongoing basis.
Symptoms of depression include:
- Aches, pains, headaches, or digestive problems without a clear physical cause that do not ease even with treatment
- Persistent sad, anxious, or "empty" mood
- Feeling hopeless or pessimistic
- Feeling guilty, worthless, or helpless
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue, or feeling "slowed down"
- Feeling irritable, easily frustrated‚ or restless
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Changes in appetite or weight
- Suicide attempts, thoughts of death or suicide
Having certain medical conditions places patients in a high-risk category for developing depression. For example, conditions that cause structural changes in the brain, such as Parkinson's disease and stroke, may play a direct role in the development of the symptoms of depression. Individuals with hypothyroidism experience symptoms also associated with depression, including fatigue, sluggishness, trouble concentrating, and increased need for sleep. Individuals with hyperthyroidism can experience unusual nervousness, which is also related to anxiety. Patients learning how to deal with the dietary modifications associated with diabetes, and ongoing monitoring of blood sugar levels may experience distress related to the lifestyle changes.
Depression is common among people who have chronic illnesses such as:
- Alzheimer's disease
- Autoimmune diseases, (systemic lupus erythematosus, rheumatoid arthritis, psoriasis)
- Coronary heart disease
- Multiple sclerosis
- Parkinson's disease
Certain medications used to treat medical illnesses also can trigger depression, including betablockers, corticosteroids, benzodiazepines, stimulants, anticonvulsants, proton pump inhibitors, H2 blockers, statins and other cholesterol-lowering drugs, anticholinergic drugs, medications for Parkinson’s, acne, pain, allergies, thyroid regulation, hormone regulating medication, and antibiotics.
While patients with chronic medical conditions are at higher risk for developing clinical depression, the reverse is also true. Patients who experience chronic clinical depression are at higher risk for developing other medical conditions. An increased risk of cardiovascular disease, diabetes, stroke, pain, osteoporosis, and Alzheimer's disease, has been associated with patients with clinical depression.
Many patients with depression may have difficulty caring for themselves and their health, following through with doctor’s appointments, and being compliant with treatment. Depression interferes with a patient’s ability to practice good wellness through proper diet and exercising, and related symptoms such as lack of interest or motivation may prevent them from gaining access to good medical care.
In research studying the mind-body connection, researchers are investigating the role of the physiological changes associated with depression on the risk of developing physical illnesses. In patients experiencing depression, research has identified changes in the way different systems in the body function. The changes in these systems and bodily function that could impact physical health include:
- Increased inflammation
- Changes in the control of heart rate and blood circulation
- Abnormalities in stress hormones
- Metabolic changes such as those seen in people at risk for diabetes
While it is common to experience symptoms of depression after being diagnosed with a medical illness, these symptoms may decrease as the patient adjusts to the diagnosis, or treatment of the condition occurs. Research suggests that patients who have depression AND another medical illness tend to have more severe symptoms of both illnesses. When patients experience both depression and another medical condition, they may have more difficulty adjusting to their medical condition. Additionally, they may have higher medical costs than those who do not have both depression and a medical illness. Physical symptoms such as chronic pain may be prolonged or reported at higher rates in those patients who are also experiencing depression, as well as poorer treatment compliance in many medical conditions such as diabetes. Even as a patient’s physical health improves, symptoms of depression may continue.
The good news is, depression is treatable, even when the clinical picture is complicated by another medical condition. In primary care, initial and ongoing assessment of depression is critical. Collaboration with mental health specialists in order to address the physical and mental conditions simultaneously presents the opportunity for better outcomes of both conditions and a greater improvement in overall health. Treating depression and a chronic medical illness together can help patients better manage both their depression and their medical condition.
Why is depression difficult to recognize? Patients don’t always disclose symptoms of depression. Additionally, symptoms of medical conditions are often similar to those experienced in depression. A thorough assessment, as well as ongoing education about the symptoms and treatment options will help demystify the topic for patients that are resistant to disclosing mental health difficulties. Research indicates that treatment is best through a combination of treatment approaches, including medication and different psychotherapeutic approaches. Depression affects every patient differently. It may take different medication trials and therapeutic interventions to find the combination of treatment that works best. Treatment may improve the physical symptoms related to chronic medical illness and reduce the risk of future medical problems, and treating medical illness and improving physical symptoms will help improve the symptoms of depression. Recovery from depression takes time, and patients need continued re-evaluation and support throughout the process. Collaboration with a mental or behavioral health provider will help identify patients that may be experiencing depression, and ultimately improve patient physical and mental health outcomes.
With a doctorate in clinical psychology and over 20 years of experience in the field, Dr. Mary-Catherine Segota has conducted university-based behavioral medicine research, acted as a consultant to professionals and organizations, and worked with a diverse number of psychological and medical conditions. By identifying unique needs, the source of distress, and what’s perpetuating the problem, she will help develop the tools to overcome seemingly insurmountable circumstances. Visit www.CounselingResourceServices.com