Lifting the cloud of depression
Don’t be afraid to ask for help. Prompt attention will help ease the severity of symptoms.
by Robert Mayfield, M.D.
Chronic —long lasting and difficult to eradicate. Illness—an unhealthy condition of body or mind. Put these two words together and their displeasure to the ear is magnified. Their effects on the soul can be devastating.
Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of people with a serious medical condition have symptoms of depression.
After all, chronic illness is characterized by dramatic life changes, changes in one’s own abilities to carry out day-to-day tasks, possibly inhibiting the ability to work and earn a living. Chronic illness may keep an individual from doing the things that they normally enjoy. These limitations on activity imposed by an illness lead to the gradual withdrawal from rewarding activities.1 Isolation from social interactions can compound the problem and often there is fear over what the future holds.
Risk of depression is related to the severity of the illness and prior history. For conditions such as heart attack and stroke, having depression can even affect the outcomes of the disease with earlier mortality rates and disease complications. Depression is associated with a poorer prognosis and more rapid progression of chronic illness. Similarly, depression worsens the symptoms of chronic illness such as fatigue and pain.
For these reasons it is imperative to recognize the signs and symptoms of depression and seek treatment sooner rather than later. Too often, the mistake is made of attributing the symptoms to the disease, or looking at them as “normal” or “expected.” While there is a normal grief process associated with the diagnosis of a chronic illness, it should be temporary and not prolonged. Although there needs to be sufficient time to mourn loss and to be angry and sad regarding impairments caused by chronic illness, if symptoms last three months or more, treatment becomes mandatory.
It is important to recognize the following signs and symptoms:
1. Sleeplessness that is often manifested by waking early in the morning with an inability to fall back asleep. This is often the initial symptom that heralds impending depression.
2. A loss of interest in normal activities that used to be pleasurable. While it may be likely that abilities can be limited by chronic illness, a complete lack of desire to engage in what used to be fun is a good measure of depression.
3. Feelings of guilt or worthlessness may be present and magnified by a diagnosis of chronic illness.
4. A loss of energy and constant feeling of fatigue that goes beyond just feeling tired. Some describe it as a “black hole.”
5. An inability to concentrate or focus on tasks is frequently present.
6. Changes in appetite occur that can either be increased or decreased depending upon the individual.
7. Movements can become slow and labored to the point it feels like an effort to even speak.
8. Thoughts of harming oneself or suicide may be present.
If any number of these symptoms is present, prompt attention is critical, especially if there are thoughts of harming oneself. Enough stress cannot be placed on the fact that there is help for these symptoms. Patients need to be proactive in their care as the presence of chronic illness may reduce the likelihood of a health care provider recognizing and treating depression. The provider may be more focused on the illness and reluctant to spend time on other issues in what is likely a limited appointment time. Due to these circumstances, it is important for a patient to feel comfortable with their doctor and be able to share anything with them. Having an open and honest dialogue ensures better diagnosis and decision making. As the National Institutes of Health reports, “Recognition and treatment are crucial; depression worsens the course of a chronic disease.”2
Recently, researchers at the University of Virginia School of Medicine found that the brain is connected to our lymphatic system, a component of our immune system.3 While the researchers are more intent on the effects of the immune process on the brain such as in Alzheimer’s disease, one could hypothesize that this is evidence of the mind’s effects on the body. Perhaps depression can lower our immune response. As discussed, depression worsens symptoms of chronic illness like pain and fatigue. Getting prompt and appropriate treatment will lessen the severity of symptoms experienced.
There are many good treatments for depression and medication is often necessary. It is important not to view adding a medication to what is likely an already complex regimen as defeat. Such fears and perceptions may discourage a patient from seeking the help they need. Once again, treatment can improve quality of life and alleviate some of the symptoms of disease.
Further interventions such as “talk therapy” and group support can help. Evaluate your support circle and enlist the help of those closest to you. Reaching out to others and avoiding isolation is essential in a return to your normal self. There are many support groups for those with chronic illness and communication with others with similar experiences helps. Also, one should strive to be as active as possible. A program of simple exercise or even yoga offers some relief. It is important to have dreams and re-establish realistic goals — have something to look forward to.
If this article resonates with you, it is important to seek treatment. If you feel as if you are in crisis, there are many services available to you such as 1-800-273-TALK. Here you can be connected to a trained counselor in your area and the number is available 24 hours a day. Finally and most importantly, remember to take good care of yourself and simply aspire to do the best that you can. In essence, that is all we can ask of ourselves as human beings.
1. A prospective population-based cohort study of the effects of disablement and social milieu on the onset and maintenance of late-life depression.
The Gospel Oak Project VII.Prince MJ, Harwood RH, Thomas A, Mann AHPsychol Med. 1998 Mar; 28(2):337-50.
2. West J Med. 2001 Nov; 175(5): 292–293.; PMCID: PMC1071593; Treating depression in patients with chronic disease; Gregory E Simon
3. http://www.news.virginia.edu/content/researchers-find-textbook-altering-link-between-brain-immune-system
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