Chronic Illness

Chronic Illness and Mental Health: Recognizing and Treating Depression

Chronic illnesses such as cancer, heart disease, or diabetes may make you more likely to have or develop a mental health condition.

It is common to feel sad or discouraged after having a heart attack, receiving a cancer diagnosis, or when trying to manage a chronic condition such as pain. You may be facing new limits on what you can do and may feel stressed or concerned about treatment outcomes and the future. It may be hard to adapt to a new reality and to cope with the changes and ongoing treatment that come with the diagnosis. Favorite activities, such as hiking or gardening, may be harder to do.

Temporary feelings of sadness are expected, but if these and other symptoms last longer than a couple of weeks, you may have depression. Depression affects your ability to carry on with daily life and to enjoy family, friends, work, and leisure. The health effects of depression go beyond mood: Depression is a serious medical illness with many symptoms, including physical ones. Some symptoms of depression include:

Persistent sad, anxious, or "empty" mood
Feeling hopeless or pessimistic
Feeling irritable, easily frustrated‚ or restless
Feeling guilty, worthless, or helpless
Loss of interest or pleasure in hobbies and activities
Decreased energy, fatigue, or feeling "slowed down"
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Changes in appetite or weight
Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
Suicide attempts or thoughts of death or suicide

The same factors that increase the risk of depression in otherwise healthy people also raise the risk in people with other medical illnesses, particularly if those illnesses are chronic (long-lasting or persistent). These risk factors include a personal or family history of depression or family members who have died by suicide.

However, some risk factors for depression are directly related to having another illness. For example, conditions such as Parkinson's disease and stroke cause changes in the brain. In some cases, these changes may have a direct role in depression. Illness-related anxiety and stress also can trigger symptoms of depression.

Depression is common among people who have chronic illnesses such as:

Alzheimer's disease
Autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and psoriasis
Cancer
Coronary heart disease
Diabetes
Epilepsy
HIV/AIDS
Hypothyroidism
Multiple sclerosis
Parkinson's disease
Stroke
Some people may experience symptoms of depression after being diagnosed with a medical illness. Those symptoms may decrease as they adjust to or treat the other condition. Certain medications used to treat the illness also can trigger depression.

Research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses. They may have more difficulty adapting to their medical condition, and they may have higher medical costs than those who do not have both depression and a medical illness. Symptoms of depression may continue even as a person’s physical health improves.

A collaborative care approach that includes both mental and physical health care can improve overall health. Research has shown that treating depression and chronic illness together can help people better manage both their depression and their chronic disease.