More than half of Americans live with at least one chronic illness. Heart disease, cancer, arthritis, thyroid disease- these are only a few examples. Chronic illnesses can be treated, but there is no cure, so patients only have the option to continue through life dealing with the illness and whatever comes along with it. It involves constant scrutiny from others, constant doctors appointments, trying new treatments when previous ones fail and dealing with the side-effects of those treatments. This is the same process patients with mental illnesses must face, and about 20% of Americans live with mental illness. Oftentimes, the two overlap.
I have my own list of chronic illnesses. My medicine cabinet is full of prescription bottles with multiple prescriptions for a couple of those. As far as my allergies/asthma and hypothyroidism are concerned, they are under control and don’t have that much of an impact day-to-day. Thankfully. On the other hand, my bipolar disorder requires daily maintenance and awareness of how I’m doing. In addition to all of this fun, I have a rare gastric disorder that completely changes how I function. I have periods of relief that can last for months at a time, but when it flares for the rest of the time, it gets ugly. The symptoms don’t ever fully go away, they just lessen. Nausea, vomiting, severe stomach pain and fatigue are constantly affecting me and my quality of life pretty much plummets, especially when combined with my bipolar symptoms.
Depression is, unsurprisingly, incredibly common in those with chronic physical illnesses. Even those who have no history of mental illness are at risk for developing depression, and the stronger the physical symptoms or the number of symptoms is directly proportional to severity of the depressive symptoms.
It’s incredibly frustrating to deal with physical symptoms. They don’t just affect your body. They affect your work. They affect your social life. They affect your family. Everything is touched. That’s enough to bring anybody down, especially since many chronic illnesses can leave you fatigued on their own, not to mention the fatigue induced by trying to live as normally as possible.
There are also physical changes to your body during illness that can contribute to mood changes. Chronic disorders don’t just trigger stressful feelings, they also cause physical stress on the body. When the body is stressed, it releases hormones and neurotransmitters that help the body deal with the stress so that it can return to normal and balance out. This is called allostasis. The amount of work the body has to do to maintain allostasis is called the “allostatic load,” and the heavier the allostatic load, the harder it is on the body in addition to the damage caused by the disorder itself. As the body’s stress response continues, antibodies and chemicals intended to fight off the infection are produced. This, in turn, produces inflammation that affect areas of the brain that control mood.
So, you have the frustration of life in general when living with the disease, but then your body adds insult to injury by affecting your brain and causing even more depressive symptoms. These depressive symptoms (e.g. low energy, poor appetite, weight loss) can also mimic symptoms of the disorder itself, so it’s easy for a physician to overlook them or discount them completely.
This problem is exacerbated by the fact that even physicians can stigmatize patients with mental illnesses. Even if the stigma is absent, it can be incredibly difficult to coordinate medical and psychiatric care. Patients with mental illnesses are more likely to have problems finding treatment in general, not to mention having an entire team of physicians to manage holistic care. Because of this, we also have lower success rates in many areas of life, including medical, employment and social factors.
The lesson in this is that, as patients, we must absolutely be our own advocates. We cannot rely on “the system” to make sure that we’re receiving optimal care. It doesn’t matter if your primary care physician is great and your psychiatrist is great, they need to be able to work together to come up with the best treatment in your particular situation, not a generic, out-of-the book treatment. There are side-effects for all treatments and those side-effects could impact any part of both physical and psychological symptoms. This is especially important to note if you have a severe mental illness such as bipolar disorder or schizophrenia since major mood swings can be triggered.
Your responsibility is to make sure that you are communicating all of your symptoms to all members of your treatment team. Don’t only tell a specialist symptoms that you think pertain to their specialty. Telling your gastroenterologist about your nausea but not mentioning the fact that the constant nausea is worsening your depression is not doing you any favors. Similarly, not telling your psychiatrist about your gastrointestinal problems will also hurt your outcome, especially if your treatment for your mental illness causes gastrointestinal problems. Tell everyone everything, and make sure they hear you.
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