Monday, April 14, 2014
Depression in People with Chronic Illnesses
Depression is one of the most common – and potentially dangerous -- complications of every chronic illness. According to depression specialist Arthur Rifkin, M.D., a psychiatrist at Albert Einstein Medical Center in New York, the most common misconception about depression and chronic illness is that it's understandable to become depressed when faced with a chronic illness. It is understandable -- but only during the initial adjustment period that should not last for more than a few months.
Depression is one of the most common – and potentially dangerous -- complications of every chronic illness. According to one survey, it is particularly common in those with recent heart attacks (45%), hospitalized cancer patients (42%), recent stroke survivors (40%), and people with multiple sclerosis (40%), Parkinson's disease (40%), and diabetes (33%). According to depression specialist Arthur Rifkin, M.D., a psychiatrist at Albert Einstein Medical Center in New York, the most common misconception about depression and chronic illness is that it's understandable to become depressed when faced with a chronic illness. It is understandable -- but only during the initial adjustment period that should not last for more than a few months. Beyond that, persistent depression should be treated as a separate illness. For centuries, physicians have noticed that chronic disease and depression frequently go hand-in-hand.
As early as 1684, Dr. Thomas Willis wrote of the "sadness, or long sorrow" that accompanies many chronic illnesses. Today we know that the link between depression and chronic illness is a two-way street. Chronic illnesses are depressing. And the depression they cause often exacerbates the illness. Many surveys show how depressing it is to have a chronic illness. In the general population, the lifetime risk of depression is 10% to 25% for women and 5% to 12% for men. However, the prevalence of depression in those with chronic illnesses is much higher -- 25% to 33%. Any chronic condition can trigger depression, but risk increases in direct proportion to the severity of the illness and the life disruption it causes. A broken leg that makes you miss a family reunion is a drag. But a car accident that leaves you paraplegic can be severely depressing. Risk of depression also increases with the possible complications of a chronic illness. For example, diabetes can cause so many complications -- among them, heart disease, blindness, kidney failure, and sex problems -- that even people who are in control of diabetes have an unusually high rate of depression.
In addition, the depression caused by chronic illnesses often aggravates the illness, especially if the condition causes pain, fatigue, or disruption of social life. Depression makes pain hurt more. It causes fatigue and lethargy that can exacerbate the loss of energy of many chronic conditions. And depression aggravates social disruption because it tends to make people withdraw into social isolation. Depression's aggravation of chronic illness can be fatal. Duke University researchers tested 730 men and women for depression several times over a period of 27 years. Compared with participants who were not depressed,
those who had major depressive episodes were 59% more likely to die of all causes, and 71% more likely to succumb to heart attack. Furthermore, the presence of chronic illness may affect the dosing requirements of antidepressants. It may also place people at a greater risk for having side effects. It is very important that the dose of the drug is adjusted accordingly.
Finally, depression impairs the immune system, which can hurt the body's efforts to combat chronic illness. In one study, 42 young adults had blood tests that evaluated their immune function. Half were depressed, half were not. Compared with the normal participants, the depressed group showed significant immune impairment. You may have to live with your chronic illness. But you don't have to live with depression. Depression is treatable. One frequent benefit of getting your depression treated is that, once your mood has brightened, your chronic illness often becomes easier to endure and manage. We, at New Hope Behavioral Health are ready to help 24 hrs a day and 7 days a week.
Give us a call at 573-860-1601(02). Hope is just a phone call away.
Barefoot, J.C. and M. Scholl. "Symptoms of Depression, Acute Myocardial Infarction, and Total Mortality in a Community Sample," Circulation (1996) 93:1976.
Rifkin, A. "Depression in Physically Ill Patients," Postgraduate Medicine (9-92) 147-154.
Schleifer, S.J., et al. "Immunity in Young Adults with Major Depressive Disorder," American Journal of Psychiatry (1996) 153:477.