- Chronic Illness and Depression: Causes, Symptoms, Treatment
- Why is depression common in people who have a chronic illness?
- What are the symptoms of depression?
- Which long-term illnesses lead to depression?
- How can depression be treated?
- Tips for coping with chronic illness
- Depression and Anxiety
- What Causes Depression?
- Who Gets Depression?
- What Are the Treatments for Depression?
- Depression and Suicide: Getting Help in a Crisis
- Additional Resources
Chronic Illness and Depression: Causes, Symptoms, Treatment
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 ly 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 – 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.
Depression and Anxiety
Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:1
- Feeling sad or anxious often or all the time
- Not wanting to do activities that used to be fun
- Feeling irritable‚ easily frustrated‚ or restless
- Having trouble falling asleep or staying asleep
- Waking up too early or sleeping too much
- Eating more or less than usual or having no appetite
- Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
- Having trouble concentrating, remembering details, or making decisions
- Feeling tired‚ even after sleeping well
- Feeling guilty, worthless, or helpless
- Thinking about suicide or hurting yourself
The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.
What Causes Depression?
The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental, and psychological factors.2 Everyone is different‚ but the following factors may increase a person’s chances of becoming depressed:1
- Having blood relatives who have had depression
- Experiencing traumatic or stressful events, such as physical or sexual abuse, the death of a loved one, or financial problems
- Going through a major life change‚ even if it was planned
- Having a medical problem, such as cancer, stroke, or chronic pain
- Taking certain medications. Talk to your doctor if you have questions about whether your medications might be making you feel depressed.
- Using alcohol or drugs
Who Gets Depression?
In general‚ about 1 every 6 adults will have depression at some time in their life.3 Depression affects about 16 million American adults every year.4 Anyone can get depressed, and depression can happen at any age and in any type of person.
Many people who experience depression also have other mental health conditions.1,5 Anxiety disorders often go hand in hand with depression. People who have anxiety disorders struggle with intense and uncontrollable feelings of anxiety, fear, worry, and/or panic.1 These feelings can interfere with daily activities and may last for a long time.
Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.6 About 3 every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.
6 Why smokers are more ly than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause‚ smoking is not a treatment for depression or anxiety.
Getting help for your depression and anxiety and quitting smoking is the best way to feel better.
What Are the Treatments for Depression?
Many helpful treatments for depression are available. Treatment for depression can help reduce symptoms and shorten how long the depression lasts. Treatment can include getting therapy and/or taking medications. Your doctor or a qualified mental health professional can help you determine what treatment is best for you.
- Therapy. Many people benefit from psychotherapy—also called therapy or counseling.7,8 Most therapy lasts for a short time and focuses on thoughts‚ feelings‚ and issues that are happening in your life now. In some cases‚ understanding your past can help‚ but finding ways to address what is happening in your life now can help you cope and prepare you for challenges in the future.With therapy, you’ll work with your therapist to learn skills to help you cope with life, change behaviors that are causing problems‚ and find solutions. Do not feel shy or embarrassed about talking openly and honestly about your feelings and concerns. This is an important part of getting better.Some common goals of therapy include:
- Getting healthier
- Quitting smoking and stopping drug and alcohol use
- Overcoming fears or insecurities
- Coping with stress
- Making sense of past painful events
- Identifying things that worsen your depression
- Having better relationships with family and friends
- Understanding why something bothers you and creating a plan to deal with it
- Medication. Many people with depression find that taking prescribed medications called antidepressants can help improve their mood and coping skills. Talk to your doctor about whether they are right for you. If your doctor writes you a prescription for an antidepressant‚ ask exactly how you should take the medication. If you are already using nicotine replacement therapy or another medication to help you quit smoking, be sure to let your doctor know. Several antidepressant medications are available‚ so you and your doctor have options to choose from. Sometimes it takes several tries to find the best medication and the right dose for you, so be patient. Also be aware of the following important information:
- When taking these medications‚ it is important to follow the instructions on how much to take. Some people start to feel better a few days after starting the medication‚ but it can take up to 4 weeks to feel the most benefit. Antidepressants work well and are safe for most people‚ but it is still important to talk with your doctor if you have side effects. Side effects usually do not get in the way of daily life‚ and they often go away as your body adjusts to the medication.
- Don’t stop taking an antidepressant without first talking to your doctor. Stopping your medicine suddenly can cause symptoms or worsen depression. Work with your doctor to safely adjust how much you take.
- Some antidepressants may cause risks during pregnancy. Talk with your doctor if you are pregnant or might be pregnant, or if you are planning to become pregnant.
- Antidepressants cannot solve all of your problems. If you notice that your mood is getting worse or if you have thoughts about hurting yourself‚ it is important to call your doctor right away.
Quitting smoking will not interfere with your mental health treatment or make your depression worse. In fact, research shows that quitting smoking can actually improve your mental health in the long run.9,10,11
Depression and Suicide: Getting Help in a Crisis
Some people who are depressed may think about hurting themselves or committing suicide (taking their own life). If you or someone you know is having thoughts about hurting themselves or committing suicide‚ please seek immediate help. The following resources can help:
If you are a smoker and dealing with depression or anxiety, consider the following resources:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Editionexternal icon. Arlington, VA: American Psychiatric Publishing, 2013 [accessed 2018 Mar 22].
- Belmaker RH, Agam G. Major Depressive Disorderexternal icon. New England Journal of Medicine 2008;358:355–68 [accessed 2018 Mar 22].
- Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replicationexternal icon. Archives of General Psychiatry 2005;62(6):593-602 [accessed 2018 Mar 22].
- Substance Abuse and Mental Health Services Administration.
Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings pdf icon[PDF – 2.37MB]external icon. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2014 [accessed 2018 Mar 22].
- Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ.
Age Differences in the Prevalence and Co-Morbidity of DSM-IV Major Depressive Episodes: Results From the WHO World Mental Health Survey Initiativeexternal icon. Depression and Anxiety 2010;27(4):351–64 [accessed 2018 Mar 22].
- Centers for Disease Control and Prevention.
Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years with Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62(05):81–7 [accessed 2018 Mar 22].
- American Psychiatric Association. Practice Guidelines for the Treatment of Patients With Major Depressive Disorder, Third Edition pdf icon[PDF – 1.
64MB]external icon. Arlington, VA: American Psychiatric Publishing, 2010 [accessed 2018 Mar 22].
- Davidson JRT. Major Depressive Disorder Treatment Guidelines in America and Europeexternal icon. Journal of Clinical Psychiatry 2010;71(Suppl E1):e04 [accessed 2018 Mar 22].
- Tidey JW, Miller ME.
Smoking Cessation and Reduction in People With Chronic Mental Illnessexternal icon. BMJ 2015; doi:http://dx.doi.org/10.1136/bmj.h4065 [accessed 2018 Mar 22].
- Evins AE, Cather C, Laffer A. Treatment of Tobacco Use Disorders in Smokers With Serious Mental Illness: Toward Clinical Best Practicesexternal icon.
Harvard Review of Psychiatry 2015;23(2):90–8 [accessed 2018 Mar 22].
- Hitsman B, Moss TG, Montoya ID, George TP. Treatment of Tobacco Dependence in Mental Health and Addictive Disordersexternal icon. Canadian Journal of Psychiatry 2009;54(6):368–78 [accessed 2018 Mar 22].