Millions of people suffer from chronic physical illness, including almost half the population of the United States. Chronic illness accounts for 76% of physician visits and 91% of prescriptions filled as well as 81% of hospital admissions. Among people with chronic illness, approximately a third also suffer from depression, a rate far higher than in the general population. Most commonly, the physical illness presents before the onset of depression, but people with mental illnesses like major depressive disorder and bipolar disorder also suffer from chronic illnesses and at a higher rate than the general population. Because of this, it’s important to discuss the nature and treatment of depression in chronic illness.
A chronic illness is a condition that lasts for several weeks, months or years. These illnesses can be treated, but not cured. They are generally controlled by lifestyle changes and medication. However, people with chronic illness often suffer from symptoms despite treatment.
Some examples of chronic illnesses include:
- Heart disease
- Crohn’s disease
- Multiple sclerosis
It is common for people with these and other chronic illnesses to become depressed. Those that have experienced depression in the past are especially susceptible. There are different reasons people become depressed with a chronic illness.
Depression may immediately follow the diagnosis just as a reaction to knowing the illness will need a lifetime of treatment. Some chronic illnesses can drastically change a person’s lifestyle and independence. This type of depression may ease as a person gets used to their diagnosis and treatment.
Some physical conditions can also cause depression. This is most common in cases of diseases that involve the endocrine and central nervous systems. Examples of endocrine disorders include Cushing’s disease, thyroid disease, and adrenal insufficiency. Nervous system disorders can include Parkinson’s disease, degenerative disease, and chronic pain.
Another cause for depression in chronic disease is the medications used to treat those disorders. Steroids, beta-blockers, NSAIDs and metoclopramide are all medications that have been shown to have depressive side effects.
When dealing with a chronic illness, it’s important for patients and their doctors to be on the lookout for symptoms of depression as they are often overlooked. Symptoms of depression include:
- Feeling sad, irritable, empty, or hopeless
- Losing interest in activities, hobbies, or relationships
- Changes in appetite and/or weight
- Insomnia, sleeping too much, or waking up early
- Fatigue or lack of energy
- Problems concentrating or making decisions
- Thoughts of death or suicide
Treating depression with a chronic illness is basically the same as treating depression alone. Treatment for depression can go alongside treatments for chronic illness. Most people respond to treatments like medication, psychotherapy or both. Becoming educated about depression can also help. For those who already have depression or bipolar disorder, current treatments may need to be adjusted.
It’s important to keep all of your doctors informed on all medications and treatments you are receiving so that there are limited drug interactions or contraindications. It’s also important to monitor any breakthrough symptoms or side effects. Being open and honest with your caregivers will help make living with a chronic illness easier.
Image credit: Vinay Shivakumar