Chronic Illness and Mental Health: Recognizing and Treating Depression

Chronic illnesses such as cancer, heart disease, or diabetes may make you more likely to have or develop a mental health condition.

It is common to feel sad or discouraged after having a heart attack, receiving a cancer diagnosis, or when trying to manage a chronic condition such as pain. You may be facing new limits on what you can do and may feel stressed or concerned about treatment outcomes and the future. It may be hard to adapt to a new reality and to cope with the changes and ongoing treatment that come with the diagnosis. Favorite activities, such as hiking or gardening, may be harder to do.

Temporary feelings of sadness are expected, but if these and other symptoms last longer than a couple of weeks, you may have depression. Depression affects your ability to carry on with daily life and to enjoy family, friends, work, and leisure. The health effects of depression go beyond mood: Depression is a serious medical illness with many symptoms, including physical ones. Some symptoms of depression include:

• Persistent sad, anxious, or “empty” mood
• Feeling hopeless or pessimistic
• Feeling irritable, easily frustrated‚ or restless
• Feeling guilty, worthless, or helpless
• Loss of interest or pleasure in hobbies and activities
• Decreased energy, fatigue, or feeling “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Changes in appetite or weight
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
• Suicide attempts or thoughts of death or suicide

Remember: Depression is treatable—even if you have another medical illness or condition..

People with other chronic medical conditions are at higher risk of depression.

The same factors that increase the risk of depression in otherwise healthy people also raise the risk in people with other medical illnesses, particularly if those illnesses are chronic (long-lasting or persistent). These risk factors include a personal or family history of depression or family members who have died by suicide.

However, some risk factors for depression are directly related to having another illness. For example, conditions such as Parkinson’s disease and stroke cause changes in the brain. In some cases, these changes may have a direct role in depression. Illness-related anxiety and stress also can trigger symptoms of depression.

Depression is common among people who have chronic illnesses such as:

• Alzheimer’s disease
• Autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and psoriasis
• Cancer
• Coronary heart disease
• Diabetes
• Epilepsy
• HIV/AIDS
• Hypothyroidism
• Multiple sclerosis
• Parkinson’s disease
• Stroke

Some people may experience symptoms of depression after being diagnosed with a medical illness. Those symptoms may decrease as they adjust to or treat the other condition. Certain medications used to treat the illness also can trigger depression.

Research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses. They may have more difficulty adapting to their medical condition, and they may have higher medical costs than those who do not have both depression and a medical illness. Symptoms of depression may continue even as a person’s physical health improves.

A collaborative care approach that includes both mental and physical health care can improve overall health. Research has shown that treating depression and chronic illness together can help people better manage both their depression and their chronic disease.

Children and Adolescents with Chronic Illnesses

Children and adolescents with chronic illnesses often face more challenges than their healthy peers in navigating adolescence. Chronic illnesses can affect physical, cognitive, social, and emotional development, and they can take a toll on parents and siblings. These limitations put children and adolescents at higher risk than their healthy peers of developing a mental illness.

Children and adolescents with chronic illnesses experience many forms of stress. Parents and health care providers should be on the lookout for signs of depression, anxiety, and adjustment disorders (a group of conditions that can occur when someone has difficulty coping with a stressful life event) in young people and their families.

People with depression are at higher risk for other medical conditions.

It may come as no surprise that adults with a medical illness are more likely to experience depression. The reverse is also true: People of all ages with depression are at higher risk of developing certain physical illnesses.

People with depression have an increased risk of cardiovascular disease, diabetes, stroke, pain, and Alzheimer’s disease, for example. Research also suggests that people with depression may be at higher risk for osteoporosis. The reasons are not yet clear. One factor with some of these illnesses is that many people with depression may have less access to good medical care. They may have a more challenging time caring for their health—for example, seeking care, taking prescribed medication, eating well, and exercising.

Scientists also are exploring whether physiological changes seen in depression may play a role in increasing the risk of physical illness. In people with depression, scientists have found changes in the way several different systems in the body function that could have an impact on physical health, including:

• 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

There is some evidence that these changes, seen in depression, may raise the risk of other medical illnesses. It also is clear that depression has a negative effect on mental health and everyday life.

Depression is treatable even when another illness is present.

Depression is a common complication of chronic illness, but it does not have to be a normal part of having a chronic illness. Effective treatment for depression is available and can help even if you have another medical illness or condition.

If you or a loved one think you have depression, it is important to tell your health care provider and explore treatment options. You also should inform your health care provider about all your current treatments or medications for your chronic illness or depression (including prescribed medications and dietary supplements). Sharing information can help avoid problems with multiple medicines interfering with each other. It also helps your health care provider stay informed about your overall health and treatment issues.

Recovery from depression takes time, but treatment can improve your quality of life even if you have a medical illness.

Treating depression with medication, psychotherapy (also called “talk therapy”), or a combination of the two also may help improve the physical symptoms of a chronic illness or reduce the risk of future problems. Likewise, treating the chronic illness and getting symptoms under control can help improve symptoms of depression.

Depression affects each individual differently. There is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best. 

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Talking to Your Health Care Provider About Your Mental Health

Communicating well with your doctor or health care provider can improve your care and help you both make good choices about your health.