Medically Ill and Depression

Medically ill and Depression someone should always be assessed as soon as possible because of the links between depression and other medical causes. See your General Practitioner first. Here are some simple facts:

• It can be hard to properly diagnose depression in someone who is medically ill.
• Medical illness can trigger depression, either psychologically or physically.
• Some medical illnesses greatly increase the chance of developing depression. 
• Some medications can induce depression.
• Depression may itself increase the risk of developing certain medical conditions, such as heart attack.
• Depression can prolong the recovery from certain medical illness.

DIAGNOSING DEPRESSION IN SOMEONE MEDICALLY ILL

Diagnosing depression in people who are medically ill can be quite complicated. This is because the standard ways of assessing depression frequently assess things such as fatigue, loss of interest and lack of energy, and, as having a medical illness is often associated with feeling this way, there is the obvious risk of non-depressed people being falsely diagnosed as having ‘depression’.

Research is being conducted in re-examining the link between depression and cardiac disease, seeking to better understand the links between the two illnesses.

If you think you or a family member who is medically ill may have depression it is best to seek professional help. Not only can depression prolong the recovery of the medical illness but the depression could be an indicator of other medical issues that may warrant proper assessment and treatment.

MEDICAL ILLNESS CAN TRIGGER DEPRESSION

Psychological factors

A significant percentage of people experiencing physical illness are likely to experience a range of stress and distress symptoms, including anxiety and depression, reflecting the ‘impact’ of the physical illness.

In the initial phase of a physical illness, depression is far less common than symptoms such as anxiety and stress (e.g. what is going on, is it dangerous, is it temporary or likely to persist, does it threaten my life or not?). Depression is more likely to occur at a later stage of the illness process, particularly when some ‘loss’ is experienced. The ‘loss’ could be a loss of functioning, of ongoing good health and even the threat to life.

Physical factors

Medical illness can itself bring on depression or cause it to appear in the form of new physical symptoms or sensations. Put simply, it is thought that stress and depression might lower a person’s tolerance threshold so that they begin to observe physical sensations and feelings they didn’t notice before.

The other explanation is that certain illnesses ( e.g. Parkinson’s Disease, stroke, cancers of the pancreas and the lung, disordered thyroid function ) strikingly increase the chance of developing a depression. There are various physiological mechanisms at play here.

DEPRESSION INCREASES RISK TO SOME MEDICAL ILLNESSES

In recent years, we have become aware that depression may significantly increase the chance of certain medical conditions developing, and also influence their outcome. Probably the best example involves a link with heart attacks. A number of longitudinal studies have followed adults over decades and established that those who had experienced a depressive episode are at higher risk of heart attack (and with a worse outcome) than those not having had a clinical depressive episode.

THE IMPACT OF MEDICATIONS

Many medications used to treat physical conditions may induce depression. Examples are some blood pressure tablets and hormone replacement therapy medications.

A further link between medical illness and depression is currently attracting increasing research interest and clinical attention. This involves the capacity of various antidepressant drugs to influence the disease process. For example, a number of studies have shown that, for those who have diabetes mellitus, some antidepressant drug classes may influence plasma insulin and glucose levels.

Further, increasing attention is being given to defining the potential for worrying drug-drug interactions, as these may have a large number of major consequences, including inducing depression.

If you are taking medications and think you may be depressed, it would be wise to see your doctor. Let him or her know what medications you are taking so he or she can assess whether any of those medications may be inducing depression.

DEPRESSION CAN HAMPER RECOVERY

With certain medical conditions, such as heart attack, being depressed around that time means that recovery can be hampered. While best established for cardiovascular disease and stroke, having a depressive disorder at the same time as having a medical illness can mean that it is more difficult to recover properly and that the risk may persist for more than two years after the illness episode.