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Dealing With Chronic Illnesses And Depression
For millions of people, chronic illnesses and depression are facts of life. A chronic illness is a condition that lasts for a very long time and usually cannot be cured completely, although some illnesses can be controlled or managed through lifestyle (diet and exercise) and certain medications. Examples of chronic illnesses include diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis.
Many people with these illnesses become depressed. In fact, depression is one of the most common complications of chronic illness. It's estimated that up to one-third of people with a serious medical condition have symptoms of depression.
It's not hard to see the cause-and-effect relationship between chronic illness and depression. Serious illness can cause tremendous life changes and limit your mobility and independence. A chronic illness can make it impossible to do the things you enjoy, and it can eat away at your self-confidence and a sense of hope in the future. No surprise, then, that people with chronic illness often feel despair and sadness. In some cases, the physical effects of the condition itself or the side effects of medication lead to depression, too.
Although any illness can trigger depressed feelings, the risk of chronic illness and depression gets higher with the severity of the illness and the level of life disruption it causes. The risk of depression is generally 10-25% for women and 5-12% for men. However, people with a chronic illness face a much higher risk -- between 25-33%. Risk is especially high in someone who has a history of depression.
Depression caused by chronic disease often makes the condition worse, especially if the illness causes pain and fatigue or it limits a person's ability to interact with others. Depression can intensify pain, as well as fatigue and sluggishness. The combination of chronic illness and depression might lead you to isolate yourself, which is likely to make the depression even worse.
Research on chronic illnesses and depression indicates that depression rates are high among patients with chronic conditions:
People with a chronic illness as well as their family members often overlook the symptoms of depression. They assume that feeling sad is normal for someone struggling with disease. Symptoms of depression are also often masked by other medical problems. The symptoms get treated, but not the underlying depression. When you have both a chronic illness and depression, you need to treat both at the same time.
Depression is treated much the same way for someone who is chronically ill as someone who isn't. Early diagnosis and treatment can ease distress along with the risk of complications and suicide. Many times, depression treatment can improve your overall medical condition, a better quality of life, and a greater likelihood of sticking to a long-term treatment plan.
When depressive symptoms are related to the physical illness or the side effects of medication, your doctor may need to adjust or change your treatment. When the depression is a separate problem, it can be treated on its own. More than 80% of people with depression can be treated successfully with medicine, psychotherapy, or a combination of both. Antidepressant drugs usually take effect within a matter of weeks. You should work closely with your doctor or psychiatrist to find the most effective medication.
Depression, disability, and chronic illness form a vicious cycle. Chronic medical conditions can bring on bouts of depression, which, in turn, get in the way of successful treatment of the disease.
Living with a chronic illness is a challenge, and it's normal to feel grief and sadness as you come to grips with your condition and its implications. But if these feelings don't go away, or you are having trouble sleeping or eating, or you've lost interest in the activities you normally enjoy, seek help.
To avoid depression:
Connection Between Chronic Pain, Mental Health Demands Whole-person Care
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Key takeaways:A recent study published in JAMA Network Open underscores a critical yet often overlooked reality: Chronic pain and depression frequently go hand-in-hand.
Nearly four in 10 adults living with chronic pain, defined as pain lasting more than 3 months, also struggle with depression or anxiety. As clinicians, we have seen this connection for years. It is great to have more data reinforcing the well-established overlap between these conditions.
Recognizing that the concurrence of depression and pain is the rule rather than the exception allows us to advocate for a more holistic, personalized care plan for each patient.
This reminds us that treating pain isn't just about medications or procedures. It also is about supporting mental health. A team-based approach that looks at both the physical and emotional sides of pain can make a real difference in helping patients feel better overall.
When people live with daily pain, it can take a toll not just on their bodies but also on their emotional well-being. Chronic pain significantly raises the risk for developing depression.
In fact, the American Psychiatric Association estimates that about 12 million Americans live with both chronic pain and anxiety or depression. Likewise, untreated depression can intensify the perception of pain. When these conditions co-occur, they often reinforce one another, creating a negative cycle that can be very difficult to break.
More personalized careUnfortunately, our current health care system can feel very fragmented and often lacks the seamless infrastructure needed for patients to receive holistic, multidisciplinary care. Patients often report feeling tossed between primary care, psychiatry and various specialties such as rheumatology, neurology and orthopedics based on their ailments.
This can be disorienting and isolating, especially when communication among clinicians is limited. Too often, the burden falls on the patient to connect the dots and communicate their story across multiple touchpoints. As one can imagine, these patients do not have the energy or capacity to do so in many circumstances.
There is hope, however! Data, research and ongoing commitment in the field have provided valuable insights and tools that enable clinicians to personalize care, break down barriers and pave the way for breakthroughs in treatment.
The findings from the JAMA Network Open study help advocate for more cohesive care, bringing together treatment for physical and mental health in meaningful ways. This can take form in different ways based on patient and needs.
One example can include implementing regular standard screenings for patients with chronic pain for depression, particularly in primary care and pain management settings. Likewise, mental health clinicians should be trained to recognize the physical toll of depression, including its impact on pain perception and sensory input.
Rethinking treatmentAs more than half of U.S. Residents face limited access to mental health care, it is time to reconsider how we offer support. Treating mental health can't be reduced to a single solution, and focusing only on physical symptoms is just half the equation.
True health care addresses both the mind and body and does so with a full range of tools, not just one. That is why it is critical to explore evidence-based interventions that go beyond conventional methods, especially for individuals who have not found relief through standard treatments.
One solution many clinicians are adding to their toolbox is transcranial magnetic stimulation (TMS), a noninvasive treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation and pain. There is evidence that TMS is a safe and effective treatment for people dealing with chronic pain and depression.
Research shows TMS can help ease symptoms of both conditions, particularly when applied to the dorsolateral prefrontal cortex, although the level of relief may vary from person to person.
However, the presence of severe pain may reduce the likelihood of achieving a full antidepressant response, and certain pain subtypes such as low back pain may predict lower response rates.
Among the different TMS treatments, Deep TMS (BrainsWay) has been shown to yield higher response rates for treatment-resistant depression patients, leading to better long-term results.
What's more is that TMS treatment can be used in combination with other therapies, including antidepressants, psychotherapy, or emerging options like ketamine, offering a more comprehensive, individualized path to recovery.
Breaking down barriersWhile the results of the JAMA Network Open study do not come as a surprise to many in the field, they do sharpen understanding and reinforce that chronic pain and depression are deeply intertwined. Patients do not benefit when these symptoms are treated in silos.
It also is important to emphasize the need for further studies to clarify long-term outcomes and optimal protocols. Overall, TMS is considered a viable and safe treatment option for patients with both chronic pain and depression, with the potential for clinically meaningful improvements in both domains.
Events such as Mental Health Awareness Month in May give us a platform to reexamine how we approach these issues in our practices and propel us to continue expanding access to treatments that address the intricate connection between mental and physical health.
Depression deserves to be taken seriously, especially when it exists alongside chronic pain, compounding its impact. By raising awareness and embracing the right tools, like innovative therapies and integrated care approaches, we can disrupt this cycle and empower people to reclaim their quality of life.
References: For more information: Sources/DisclosuresCollapse Source: Expert SubmissionDisclosures: Richard A. Bermudes, MD, is the chief medical officer of BrainsWay. He also is an associate physician with the department of psychiatry and behavioral sciences, University of California Davis. He can be reached at psych@healio.Com. Bermudes reports employment as chief medical officer of BrainsWay.
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Combinations Of Chronic, Physical Illnesses Up The Risk Of Subsequent Depression
HealthDay News — Certain groups of physical multimorbidity may be associated with a higher risk of subsequent depression, according to a study published online May 13 in Communications Medicine.
Lauren Nicole DeLong, from the University of Edinburgh in the United Kingdom, and colleagues investigated associations between physical multimorbidity and subsequent depression. Analysis included 142,005 participants (aged 37 to 73) with at least one chronic physical condition identified from the U.K. Biobank.
The researchers found that one group, which included people experiencing the highest rates of physical illness, also showed the highest risk of developing depression. People with both heart disease and diabetes were at high risk of depression, as were those with chronic lung conditions like asthma or chronic obstructive pulmonary disease. In both men and women, liver and bowel conditions had noticeable links to depression. Women with joint and bone conditions were particularly affected with depression, but this pattern was not as prominent among men. In the highest-risk groups, roughly one in 12 people developed depression over the next 10 years versus about one in 25 people without physical conditions.
"Health care often treats physical and mental health as completely different things, but this study shows that we need to get better at anticipating and managing depression in people with physical illness," coauthor Bruce Guthrie, M.B., B.Chir., Ph.D., also from the University of Edinburgh, said in a statement.
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