Chronic Illness and Depression
What is a chronic illness?
A chronic illness is one that lasts for a very long time and usually cannot
be cured completely. Examples of chronic illnesses include diabetes, heart
disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis.
Many of these conditions can be improved through diet, exercise, and healthy
living, in addition to medication.
Why is depression common in people who have a chronic illness?
Depression is one of the most common complications of chronic illness. It is
estimated that up to one-third of individuals with a serious medical condition
experience symptoms of depression. People diagnosed with chronic illnesses must
adjust to the demands of the illness as well as to its treatment. The illness
may affect a person’s mobility and independence, and change the way a person
lives, sees him- or herself, and/or relates to others. These requirements can be
stressful and cause a certain amount of despair or sadness that is normal.
In some cases, having a chronic illness can trigger clinically significant
depression, a potentially serious but treatable illness itself. The challenge
for the doctor and the patient is to decide whether symptoms of depression are
just a normal reaction to the stress of having a chronic medical condition, or
so intense or disabling that they require additional specific antidepressant
treatment.
Which long-term illnesses lead to depression?
Any chronic condition can trigger depression, but the risk increases with
the severity of the illness and how much disruption it causes in one’s life.
Depression caused by chronic illness can in turn aggravate the illness,
causing a vicious cycle to develop. Depression is especially likely to occur
when the illness is associated with pain, disability, or social isolation.
Depression in turn can intensify pain, fatigue, and the self-doubt that can lead
to avoidance of others.
The rate for depression occurring with other medical illnesses is quite high:
Heart attack: 40%-65%
Coronary artery disease (without heart attack): 18%-20%
Parkinson’s disease: 40%
Multiple sclerosis: 40%
Stroke: 10%-27%
Cancer: 25%
Diabetes: 25%
What are the symptoms of depression?
Patients and their family members often overlook the symptoms of depression,
assuming that feeling depressed is normal for someone struggling with a serious,
chronic illness. Symptoms of depression such as fatigue, poor appetite, impaired
concentration, and insomnia are also common features of chronic medical
conditions, adding to the difficulty of deciding whether they are due to
depression or to the underlying illness. When depression is present, it is
extremely important to treat both the depression and the chronic medical illness
at the same time.
Common symptoms of depression include:
Depressed mood or loss of interest or pleasure in daily activities
Significant weight loss or weight gain
Sleep disturbances -- sleeping too much or not able to sleep
Problems with concentration
Apathy (lack of feeling or emotion)
Feelings of worthlessness or guilt
Fatigue or loss of energy
Repeated thoughts of death or suicide
What can be done to treat depression?
Early diagnosis and treatment for depression can reduce distress as well as
the risk of suicide when it exists. Those with a chronic medical condition who
get treatment for co-existing depression often experience an improvement in
their overall medical condition, achieve a better quality of life, and find it
easier to follow through with their treatment plan.
Sometimes improved treatment of the chronic medical condition will alleviate
the symptoms of depression that it caused. When this is the case, specific
treatment for depression is unnecessary. Some medications can cause depression;
in these cases, the best thing to do is reduce or eliminate the offending agent.
However, when depression becomes a separate problem, it should be treated on its
own.
The success of antidepressant treatment – like any other treatment – cannot
be guaranteed, but the majority of individuals treated for depression will
recover. Recovery is often more rapid and complete when both antidepressant
medication and psychotherapy ("talk therapy") are combined. Many antidepressant
medicines are available to treat depression. How these drugs work is not fully
understood, but they affect brain chemicals that are believed to be involved in
depression.
Psychotherapy, or "therapy" for short, actually refers to a variety of
techniques used to treat depression. Psychotherapy involves talking to a
licensed professional who helps the depressed person:
Focus on the behaviors, emotions, and ideas that contribute to his or her
depression.
Understand and identify the life problems or events--such as a major
illness, a death in the family, the loss of a job, or a divorce--that
contribute to depression and help them understand which aspects of those
problems they may be able to solve or improve.
Regain a sense of control and pleasure in life.
Tips for coping with chronic illness
Depression, disability, and chronic illness form a vicious circle. Chronic
illness can bring on bouts of depression, which, in turn, can lead to a rundown
physical condition that interferes with successful treatment of the chronic
condition.
The following are some tips to help you better cope with a chronic illness:
Learn how to live with the physical effects of the illness.
Learn how to deal with the treatments.
Make sure there is clear communication with your doctors.
Try to maintain emotional balance to cope with negative feelings.
Try to maintain confidence and a positive self-image.
Get help as soon as symptoms of depression appear.
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Copyright 1995-2007 The Cleveland Clinic Foundation. All rights reserved
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