Chronic Illness and Depression

What is a chronic illness?

A chronic illness is one that lasts for a long time and usually can’t be completely cured. 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’s estimated that up to one-third of individuals with a serious medical condition have symptoms of depression.

People who have chronic illnesses must adjust to both the illness and its treatment. The illness may affect a person’s mobility (ability to move) and independence, and change the way they live, see themselves and/or relate to others. These changes can be stressful and cause a certain amount of despair or sadness, which is normal.

In some cases, having a chronic illness can trigger what’s known as clinically significant depression, itself a potentially serious but treatable illness. The doctor and patient must decide whether symptoms of depression are just a normal reaction to the stress of having a chronic medical condition — or are so intense or disabling that they require additional treatment with an antidepressant.

What are the symptoms of depression?

Common symptoms of depression include:

• Depressed mood and/or loss of interest or pleasure in daily activities.
• 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.
• Thoughts of death or suicide.

People can 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, reduced concentration and insomnia are also common features of chronic medical conditions. This makes it hard to decide if these symptoms are due to depression or to the underlying illness.

When a patient has a chronic medical illness and is also depressed, it’s extremely important to treat both the depression and the medical illness at the same time.

Which long-term illnesses lead to depression?

Any chronic condition can trigger depression, but the risk increases if the illness is more severe and causes more disruption in the patient’s life.

Depression caused by chronic illness can aggravate the illness, causing a vicious cycle to develop. Depression is especially likely to occur when the illness causes pain, disability or social isolation. Depression in turn can intensify pain, fatigue, and the self-doubt that can lead the person to avoid other people.

The rates for depression that occurs with other medical illnesses is quite high:

• Heart attack: 40% to 65%.
• Coronary artery disease (without heart attack): 18% to 20%.
• Parkinson’s disease: 40%.
• Multiple sclerosis: 40%.
• Stroke: 10% to 27%.
• Cancer: 25%.
• Diabetes: 25%.

How can depression be treated?

Early diagnosis and treatment for depression can reduce distress, as well as any risk of suicide. People with a chronic medical condition who get treatment for co-existing depression often have an improvement in their overall medical condition, achieve a better quality of life and find it easier to follow their treatment plan.

In some cases, improved treatment of the chronic medical condition will relieve the symptoms of depression that it caused. If so, specific treatment for depression may be unnecessary. Some medications can cause depression. In these cases, the best thing to do is reduce or eliminate that particular medication. However, when depression becomes a separate problem, it should be treated on its own.

The success of antidepressant treatment – like any other treatment – can’t be guaranteed, but most people who are treated for depression will recover. Recovery is often quicker and more complete when both antidepressant medication and psychotherapy (talk therapy) are combined. Many antidepressant medicines are available to treat depression. How these drugs work isn’t 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 their 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.