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Chronic Illness and Depression
http://www.cchs.net/health/health-info/docs/2200/2282.asp?index=9288
What is a chronic illness?
A chronic illness is one that lasts for a very long time and
usually cannot be cured completely. 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 is estimated that up to one-third of individuals
with a serious medical condition experience symptoms of
depression. People diagnosed with chronic illnesses must adjust
to the demands of the illness as well as to its treatment. The
illness may affect a person’s mobility and independence, and
change the way a person lives, sees him- or herself, and/or
relates to others. These requirements can be stressful and cause
a certain amount of despair or sadness that is normal.
In some cases, having a chronic illness can trigger clinically
significant depression, a potentially serious but treatable
illness itself. The challenge for the doctor and the patient is
to decide whether symptoms of depression are just a normal
reaction to the stress of having a chronic medical condition, or
so intense or disabling that they require additional specific
antidepressant treatment.
Which long-term illnesses lead to depression?
Any chronic condition can trigger depression, but the risk
increases with the severity of the illness and how much
disruption it causes in one’s life.
Depression caused by chronic illness can in turn aggravate the
illness, causing a vicious cycle to develop. Depression is
especially likely to occur when the illness is associated with
pain, disability, or social isolation. Depression in turn can
intensify pain, fatigue, and the self-doubt that can lead to
avoidance of others.
The rate for depression occurring with other medical illnesses
is quite high:
• Heart attack: 40%-65%
• Coronary artery disease (without heart attack): 18%-20%
• Parkinson’s disease: 40%
• Multiple sclerosis: 40%
• Stroke: 10%-27%
• Cancer: 25%
• Diabetes: 25%
What are the symptoms of depression?
Patients and their family members often 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, impaired
concentration, and insomnia are also common features of chronic
medical conditions, adding to the difficulty of deciding whether
they are due to depression or to the underlying illness. When
depression is present, it is extremely important to treat both
the depression and the chronic medical illness at the same time.
Common symptoms of depression include:
• Depressed mood or loss of interest or pleasure in daily
activities
• Significant 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
• Repeated thoughts of death or suicide
What can be done to treat depression?
Early diagnosis and treatment for depression can reduce distress
as well as the risk of suicide when it exists. Those with a
chronic medical condition who get treatment for co-existing
depression often experience an improvement in their overall
medical condition, achieve a better quality of life, and find it
easier to follow through with their treatment plan.
Sometimes improved treatment of the chronic medical condition
will alleviate the symptoms of depression that it caused. When
this is the case, specific treatment for depression is
unnecessary. Some medications can cause depression; in these
cases, the best thing to do is reduce or eliminate the offending
agent. However, when depression becomes a separate problem, it
should be treated on its own.
The success of antidepressant treatment – like any other
treatment – cannot be guaranteed, but the majority of
individuals treated for depression will recover. Recovery is
often more rapid and complete when both antidepressant
medication and psychotherapy ("talk therapy") are combined. Many
antidepressant medicines are available to treat depression. How
these drugs work is not 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
his or her 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.
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