Millions of people worldwide are diagnosed with chronic illnesses every year — conditions such as arthritis, diabetes, lupus and multiple sclerosis, which can last for a long time and, although they can be controlled, they may not be cured. Chronic illnesses change your life and involve not only cost but also lifestyle changes that are often hard to accept.
For many people diagnosed with a chronic illness, depression is a reality. In fact, it is estimated that up to one-third of people with a serious medical condition experience symptoms of depression.
Depression can also aggravate the diagnosed condition but depression can be treated — and it should be.
It is not hard to understand the relationship between chronic illness and depression. “When we’re young, we take our health for granted,” says Johannesburg-based psychologist Colinda Linde. “Chronic illness means getting sick and being told it’s not going away. We lose control of the thing we thought we could rely on and that’s really scary.”
Serious illnesses may cause immense changes in lifestyle and limit a person’s mobility and independence, making it impossible to do the things he or she wants or used to do. This can undermine self-confidence and hope. “It’s not surprising that people who have been diagnosed with a chronic illness often experience despair, sadness and anger,” says Linde.
The risk of depression increases with the severity of the illness and the level of disruption it causes to the patient. Although 10% to 25% of women and 5% to 12% of men are generally at risk of depression, those with chronic illnesses face a much higher risk — between 25% to 33%. Research shows that 40% to 65% of heart-attack patients, 40% of Parkinson’s patients, 25% of cancer patients and 30% to 54% of patients with chronic pain syndrome develop depression.
Symptoms are overlooked
In people with chronic illnesses the symptoms of depression are often overlooked by both the patients and their loved ones, because they assume that feeling sad is normal for someone struggling with a chronic disease. In addition, symptoms of depression are often masked by other medical problems that are symptomatically treated, yet the underlying depression is not.
Depression can aggravate the chronic condition. It can intensify pain and fatigue and cause people to isolate themselves even further. The treatment of depression in people with chronic illness is similar to treating depression in other people.
“Early diagnosis and treatment is important to reduce the distress people feel and to help them adjust to their diagnosis,” says Cassey Chambers of the South African Depression and Anxiety Group (Sadag). “Treatment of depression can also help improve the person’s overall health and make it more likely that they comply with their treatment regime,” says Chambers.
Sadag’s helplines get many calls from patients who feel depressed as the result of a diagnosis or medical treatment. “Medication side effects can sometimes cause depressive symptoms, in which case they may need to be adjusted or changed,” says Linde.
Vicious cycle
Depression, disability and chronic illness form a vicious cycle: chronic conditions may bring on bouts of depression, which in turn interfere with the successful treatment of the chronic illness. But more than 80% of people with depression are treated successfully with medication, or psychotherapy, or a combination of both.
Living with a chronic illness is an enormous challenge. Periods of grief and sadness are to be expected. Your diagnosis, the loss of your health, changes in appearance, mobility or independence, pain and fatigue, the illness itself or the medication you’re on as well as the social pressure to appear OK can all trigger grief and depression.
“It’s not necessarily depression if you’re adjusting to a major loss [such as the] diagnosis of a chronic illness. Grief needs time to be processed. Allow yourself that time to mourn, to be angry and sad about what you’ve lost,” says Linde. If the depressive feelings persist, or you find that you’ve lost interest in things you used to enjoy, it’s important to seek help. Depression makes people feel exhausted, worthless and hopeless. With treatment, negative thinking fades. Take time to accept your new reality. If you don’t, grief morphs into depression and that can make physical illness even worse.
For more information contact the South African Depression and Anxiety Group helpline: 011Â 262Â 6396 or go to www.sadag.org