Depression and Chronic Illness: Which Comes First?
Which comes first—depression or chronic illness? While the connection works both ways, one thing's for sure: treatment can make a difference.
Jennifer was 26 years old when her doctor diagnosed her with high blood pressure. It wasn't until she learned that she also suffered from polycystic ovary syndrome that she began her slide into depression. Like many other people with chronic illnesses, she hid her depression from her doctor, even as she underwent fertility treatments and a high-risk pregnancy.
"It's so hard to deal with a chronic illness," says Jennifer, now 29. "Many people are afraid to admit that they need help."
After the birth of her son, she broke down and told her doctor of her depressive symptoms—her self-imposed isolation from others, withdrawal from relationships, sleeplessness, and feelings of hopelessness. He helped her understand that like her other chronic conditions, her depression was not her fault. She began taking an antidepressant, and her outlook improved.
"It has helped tremendously," she explains. "I needed it to keep things in perspective for me, which it did."
When Illness Triggers Depression
When faced with a potentially life-changing diagnosis of a chronic condition, it can be easy for depression to set in.
When someone is diagnosed with an illness, it is not uncommon to feel helpless or alone. Depression is easy to overlook in part because some of its symptoms, like fatigue or change in energy levels, mimic those of some chronic illnesses.
When Depression Leads to Illness
In cases like Jennifer's, it's pretty clear that the illness led to depression. But for scores of others with conditions like heart disease and diabetes, the connection can be the reverse.
People with a history of depression are at least 3 times more likely to suffer from heart attacks than their non-depressed peers, making depression as important a risk factor as high cholesterol or family history of heart disease.
Depression is also associated with type 2 diabetes. Links between depression and these illnesses likely work on different levels. Depression could have a behavioral component, such as having different eating or exercising habits. It can also affect the body in how the immune system works or how the blood clots.
The Diagnosis Dilemma
There may be some people who suffer from depression, but go undiagnosed. It may be the result of a minimalization of depression that stems from the people themselves. It may seem like a natural part the illness, preventing them from realizing they have depression as well.
For many chronically ill patients who are depressed, it's a Catch-22. Their depression saps their energy, leaving them withdrawn and less likely to actively seek help from their healthcare providers.
Family and friends can play an important role in helping bring depression to light in people with ongoing health problems. Often times it takes an outsider to realize there is more going on with someone they are close to.
Luckily, doctors are becoming more aware of the importance of screening for depression, and incorporating it into how they approach their patients. Looking for signs of depression is as easy as asking a few questions. How the person answers them can indicate that there may be a problem.
Depression's Devastating Effects
No matter when depression strikes, if it accompanies some chronic illnesses, the effects can be serious:
- Diabetes —Depressed people with diabetes may not take their medications as diligently. This will lead to more problems controlling their blood sugar, which in turn leaves them more susceptible to serious complications.
- Heart disease —People with heart disease who are also depressed might stop paying as much attention to their diets, thereby putting themselves at greater risk for heart attacks. People with heart disease who suffer from depression are 3-4 times more likely to die within 6 months of their attack than people who do not get depressed.
- Asthma —A psychological study of people with asthma showed that those who recorded more mental signs of depression, like feelings of helplessness or worthlessness, also suffered more from their asthma.
Although not all chronic diseases are as closely related to depression as diabetes, heart disease, and asthma, the way depression worsens symptoms makes it a particularly dangerous risk factor.
Treatment for Depression
The complex cause-and-effect relationships between depression and chronic illness may never be completely understood, though studies are aimed at pinpointing specific risk factors and discovering optimal treatments. In the meantime, the doctors say that raising awareness of the prevalence of depression in people with chronic illness may help more of them receive appropriate treatment, whether it's psychotherapy, an antidepressant, or some combination of the two.
Already, doctors have seen that successful treatment of co-occurrences of depression shows promising benefits. This doesn't surprise Jennifer, who continues to manage her depression daily. After taking control of her depression, she has been better able to accept and deal with her other chronic illnesses. She thinks it's unfortunate that depression is not better understood and its treatment more accepted by the general public. "Depression is a medical condition, just like other conditions," she explains. "It's okay to ask for help."
Symptoms of Depression
Doctors and their patients should look for the following symptoms as clues of depression, especially in the presence of other medical conditions:
- Persistent feelings of sadness, anxiety, or emptiness
- Feeling guilty, worthless, or helpless
- Loss of interest in hobbies and activities
- Loss of interest in sex
- Feeling tired
- Trouble concentrating, remembering, or making decisions
- Trouble sleeping, waking up too early, or oversleeping
- Eating more or less than usual
- Weight gain or weight loss
- Thoughts of death or suicide with or without suicide attempts
- Restlessness or irritability
- Physical symptoms that defy standard diagnosis and do not respond well to medical treatments
If you have a chronic illness, and you have any of these symptoms, talk to your doctor. Depression is highly treatable and it will help you better cope with managing your other illness.
American Psychological Association
Mental Health America
Canadian Psychiatric Association
Canadian Psychological Association
Chronic illness & mental healh. National Institute of Mental Health website. Available at: https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml. Updated 2011. Accessed September 27, 2017.
Co-occurring disorders and depression. National Mental Health Association website. Available at: http://www.mentalhealthamerica.net/conditions/co-occurring-disorders-and-depression. Accessed September 27, 2017.
Gan Y, Gong Y, Tong X. Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2014;14:371.
Major depressive disorder (MDD). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116638/Major-depressive-disorder-MDD. Updated July 19, 2017. Accessed September 27, 2017.
Lomper K, Chudiak A, Uchmanowicz I, Rosińczuk J, Jankowska-Polanska B. Effects of depression and anxiety on asthma-related quality of life. Pneumonol Alergol Pol. 2016;84(4):212-221.
Last reviewed September 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 11/27/2013