Depression rates among Americans continue to rise. In general, major depressive disorder (MDD) impacts just over eight percent of Americans. But there is truly a crisis of depression among patients living with a chronic illness.
Prevalence depends on the disease. Individuals with diabetes, for example, are 2-3 times more likely to be diagnosed with depression than average. Among cancer patients, about 14 percent live with depression as measured by diagnostic interviews. When self-reported, it’s even higher–up to 27 percent. About half of Parkinson’s patients also report having clinically relevant depressive symptoms. The same is true for 11 percent of Alzheimer’s patients.
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Beyond the Disease
The relationship between long-term illness and depression is complex. For one thing, living with chronic illness is inherently difficult. It affects a patient’s life in countless ways—from causing physical pain, to changing relationships, to limiting career potential.
“They have to go to doctor’s appointments instead of doing the things they usually enjoy, ” David Prescott told Psychiatrist.com. “Chronic illness impacts one’s ability to live and the trajectory of what they hoped their life would be.” Prescott is a professor and the chair of social science and humanities at Husson University in Maine.
Prescott explained that patients often feel like they spend more time seeking treatment rather than living their lives. “You don’t do as much socializing or do as many things that you enjoy because you just don’t have as much energy and endurance as you might if you didn’t have the chronic illness. That starts them down a path that eventually leads them to feel isolated and depressed,” he said.
But the general discomfort and loneliness that accompany many enduring health challenges is not the only—or even the primary—factor driving this comorbidity, according to Meghan Beier, an assistant professor at Johns Hopkins Medicine in Maryland.
“One of the misconceptions is that everybody would feel this way because it’s hard to live with a condition that impacts your life, and so they don’t think about the ways that the disease itself or the medications that they might be on could be impacting moods,” she explained to Psychiatrist.com.
Body Affects Mind
As Beier noted, the physical symptoms that accompany an ailment can directly impact the psyche. For example, up to 50 percent of patients with autoimmune disorders such as multiple sclerosis and rheumatoid arthritis meet the criteria for a depressive episode at some point. She attributed this to “an inflammatory process that seems to kick off depression symptoms.”
Psychological problems also seem to be a particular problem for people with health conditions that directly affect the brain, such as a stroke or spinal cord injury. Certain treatments and medications may contribute to this, at least in part. For example, anti-inflammatory medications like corticosteroids have been linked to suicidal thoughts, depression, and even manic episodes. Parkinson’s drugs like Sinemet can also cause or worsen depression.
However, Beier noted that psychological symptoms among brain injury patients are often acute. They ultimately stabilize as the individual adjusts to their new reality.
“Their brain is directly impacted by the pathology of the diagnosis, and so that injury or insult to the brain can have a direct impact on how one is able to manage their emotions,” she said.
Misinterpreted Symptoms
For a variety of reasons, individuals with a persistent medical condition tend to be underdiagnosed and undertreated for depression and other mental illnesses. Somatic symptoms of depression, like appetite changes, lethargy, and sleep disorders often fly under the radar because they mirror common manifestations of the primary condition.
“Somebody might meet criteria for depression, but their doctors are attributing it to the medical condition itself,” Beier said. For this reason, it’s vital that physicians help patients access well-being resources by asking the right questions and actively listening to their needs. Ideally, an intervention will aim to improve not just physical symptoms but also emotional well-being.
Help Makes a Difference
Clinicians can adapt cognitive behavioral therapy (CBT) to meet the unique challenges of patients with chronic illnesses, such as coping with chronic pain or fatigue. Mindfulness-based treatments are useful too, because they help a patient become more aware of their thoughts and feelings, reducing stress and depressive symptoms. Integrated care models, recommended for conditions like diabetes or heart disease, combine mental health services with primary care.
Providers should also closely monitor medication reactions to ensure they don’t exacerbate depression. Prescott emphasized that seeking psychological care can make a difference in someone’s mental outlook even if their primary disease isn’t curable. “I think one of the misconceptions is that treatment won’t help,” he said. “It probably won’t do everything you want—I’m not smart enough to make your pain go away—but I can help you live a whole lot better life.”
