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% to 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.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/4/2013...#9288