Chronic illness affects a great many of the patients I see, and a large share of them are also dealing with depression, whether or not anyone has named it that. A chronic illness is one that either lasts a very long time or can’t be cured outright — conditions like diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis. Many of these can be managed successfully with medication, other treatments, or lifestyle changes, but the ongoing worry over flare-ups, progression, and future limitations takes a real toll on mood.
It’s estimated that about one-third of people living with a chronic illness also experience depression. Medication side effects and the physical burden of the illness itself both play a role in that overlap.
Do certain illnesses raise the risk more than others
Any illness can be associated with depression, but the risk climbs as the illness becomes more chronic, and higher still as it becomes more severe — especially for someone who already has a history of depression. In my experience, people managing chronic pain or recovering from a heart attack carry the highest risk, followed closely by those living with multiple sclerosis, Parkinson’s disease, cancer, or diabetes.
Symptoms that are easy to miss
Family members often miss the signs of depression in someone with an ongoing illness because they assume sadness is simply part of being sick. Sometimes patients themselves don’t recognize what they’re experiencing as depression — the illness, or its medications, can mask or mimic the same symptoms.
- Loss of appetite
- Insomnia
- Overwhelming fatigue
- Loss of interest in sex
- Taking no pleasure in life
- Feelings of shame, guilt, or inadequacy
- Severe mood swings
- Difficulty bonding with loved ones
- Withdrawal from friends, family, and social contact
- Thoughts of harming yourself or others
If you, or someone you love, has a chronic illness and is showing most of these signs, it’s worth having it evaluated by a mental health provider.
How depression affects the underlying illness
Depression keeps patients from getting the most out of life despite their illness, and it can place their physical health at further risk — causing them to forget medications, miss appointments, skip treatments, or abandon a healthy routine altogether. Heart disease illustrates this well: patients with heart disease have a higher likelihood of depression than otherwise healthy people, and depression itself is closely linked with angina and heart attacks, raising the risk of heart disease or worsening its symptoms.
On the other side of that same coin, once depression is treated, many patients find that their overall medical condition improves, their quality of life is better, and they’re more likely to stay with their long-term treatment plan.
What helps
Talking with your doctor is the starting point — if a current medication seems to be contributing to depression, there may be alternatives, and if chronic pain is part of the picture, pain management options are worth discussing directly. Learning about your condition restores some sense of control. Antidepressant medications can improve mood and, since they act on some of the same chemical pathways as pain receptors, may help with chronic pain as well. Psychological counseling helps patients get at the roots of their depression and build coping skills, and cognitive therapy in particular can help patients use their own thinking to manage chronic pain.
Stress-reduction efforts — exercise as your condition allows, meditation, yoga, journaling — also make a difference. Exercise releases endorphins and helps maintain fitness, which lowers the risk of further physical setbacks. And staying connected to a support team, rather than becoming isolated, matters as much as any of the above; your physician can also point you toward support groups specific to your condition.
Chronic illness is hard enough without depression layered on top of it. If that combination sounds like where you are, treating the depression is often what makes the rest of your care manageable again.