  
|  |
|
| Depression and physical illness |
|
|
Written by Dr Alan Thomas, lecturer and honorary specialist registrar in psychiatry
|
 |
 |
| Feelings of guilt and self-blame are a sign of depression in
the physically ill |
|
|
Mood changes and depressive illnesses are more common in people
suffering from physical illnesses than in people who are well. Although a
person can develop depression in association with almost any physical illness,
some diseases are more likely to lead to
depression than
others. Depression in these conditions can be expected to respond to the same
treatments (medication and
psychosocial treatments) as any other depressive illness, and so help should be
sought and treatment given for the depression, irrespective of its cause.
Some physical illnesses, particularly heart disease and other
conditions that affect the blood supply, are more likely to occur in people
with depression. It is not simply that physical illnesses can lead to
depression - the opposite occurs too. This makes the recognition and treatment
of depression all the more urgent.
Physical illnesses in which depression is common
Below are some of the more common conditions in which depression
is likely to occur.
Diseases of the nervous system
-
Parkinson's disease.
About 40 per cent of those with Parkinson's disease will suffer from an
episode of depression. It is often missed because some of the symptoms of
Parkinson's disease are similar to those of depression. For example, slow
movements and reduced speech occur in both depression and Parkinson's
disease. It seems likely that the increased occurrence of depression in
Parkinson's disease results from both the direct effects of the disease on
the brain and the impact of the condition on the sufferer's everyday life.
-
Dementia. People with
dementia suffer from more depressive symptoms and more depressive illnesses
than other people. The difficulty these people have in communicating their
distress means the depression can be missed and not treated. The development of
features such as a loss of interaction and interest in others and a sense of
gloominess may mean that a depressive illness is developing and help should be
sought.
-
Multiple sclerosis.
Depression is more common in this condition, too. It is not clear how much of
the depression arises from the effects of the disease on the brain and how much
results through the consequences of the disability.
Vascular diseases (diseases of the blood vessels)
-
Heart disease. Depression is more common in
people with heart disease. It is increased in those suffering from angina
(chest pain triggered by thickening of the arteries), and is two to three times
more common in people after a heart attack (your doctor may refer to this as a
myocardial infarction or MI). Depression in such circumstances also leads to
problems for people recovering from a heart attack, making them more at risk of
another heart attack. In addition, they may have more difficulty returning to
work and more general disability.
-
Stroke (cerebrovascular
accident). Similarly, depression is much more common in people after a
stroke and is probably increased in people having 'ministrokes' too
(your doctor may refer to these as transient ischaemic attacks or TIAs). Again,
those who suffer depression tend to have a more severe and prolonged illness
than those with no depression.
-
Hypertension (high blood
pressure). Studies have shown this also leads to increased rates of
depression.
Endocrine disorders
-
Hypothyroidism (decreased
metabolism). Low levels of thyroid hormones can lead to depression,
which may be very severe. However, unlike the conditions mentioned above,
treatment of the hypothyroidism itself (with thyroxine to replace the missing
hormone) can also treat the depression.
-
Cushing's syndrome.
This is a rare disease caused by an excess of certain steroid hormones that can
lead to severe depression. Like hypothyroidism, treatment of the underlying
physical illness can be very effective in helping to treat the depression too.
Prescribed medication
-
Certain types of medication are associated with increased
rates of depression, for example calcium channel blockers (eg nifedipine,
nimodipine, verapamil), beta-blockers (eg propranolol, atenolol, metoprolol),
corticosteroids (eg dexamethasone, hydrocortisone) and levodopa (eg madopar,
sinemet). If depressive symptoms develop after taking a new medicine, then
advice should be sought from a doctor about whether to try an alternative.
How do you recognise depression in such physical illnesses?
It is important to be aware of the possibility of depression,
especially when a person is suffering from one of illnesses mentioned. The
difficulty is that some of the key symptoms in depression are very common in
these conditions, eg disturbed sleep, poor appetite and tiredness.
This makes these symptoms less helpful for doctors when making
the diagnosis of depression. Furthermore, sadness is common following diagnosis
of an illness as the sufferer comes to terms with their condition, but a
prolonged 'low' mood with frequent weeping is likely to indicate
depression has developed.
A physically ill person displaying the following symptoms may in
fact be depressed.
-
Persistent sadness that does not lift with happy
experiences.
-
Lack of interest in activities and pastimes that are normally
enjoyed.
-
Loss of interest in sex.
-
A loss of interest in friends and socialising.
-
Feelings of guilt and self-blame.
-
Marked pessimism about the future.
-
Suicidal thoughts and talk of wishing one were dead.
What causes depression in people with physical illnesses?
Just as the cause or causes of depression in people with no
physical illness are often not clear, so it is with those who also have a
physical illness.
There is good evidence that some of the above illnesses directly
affect the parts of the brain and the chemical systems that control our mood
and behaviour. For example, vascular diseases (those affecting the blood
vessels) and Parkinson's disease damage important areas of the brain,
making people vulnerable to depression and perhaps triggering the illness.
Endocrine conditions directly interact with, and upset,
important chemical systems governing mood and other features of depressive
illness.
However, the psychological and social impacts of the illness are
also very important. Suddenly losing function in a limb after a stroke, or
struggling to walk after a heart attack, can lead to a number of social
consequences - being unable to return to work, having to give up certain
hobbies, etc. Such losses may trigger a depressive illness.
At the same time, these losses affect the sufferer's
self-esteem and their
roles at home and work may be changed, too. These factors may all contribute to
the development of depression.
What should you do if someone is depressed and physically ill?
-
Try to encourage the person to talk about their feelings and
difficulties, because support from friends and family is important and not to
be underestimated.
-
However, if depression is suspected then you should seek help,
usually through the family doctor (GP).
-
The
treatment of depression in somebody
who is physically ill may include talking therapies and/or antidepressants.
-
Support groups for the specific physical illnesses can be
sources of information and understanding.
|
|
|
Last updated 05.01.2005
|
 |
|
|
 |
| |      |
|
