Coping with a chronic illness can have an impact on millions of people and sometimes the weight of that burden can be depressing.
I am Marley Hall and here with me now to focus on this double-barrel issue is psychiatrist, Dr. Thomas Schwartz.
Now, Dr. Schwartz, do you find that it's very often that chronic illness occurs concurrently with depression?
I think it can and it does. Sometimes it's a one-two punch. You develop the medical problem and then the depression follows.
What are some of the more prevalent conditions that you see co-occurring with depression?
From medical point of view, heart disease is one of maybe the key things that's been in the literature. People that have heart attacks, who are also depressed,
end up having more heart attacks and they are more lethal. Certainly, developing a cancer is a horrible thing and depression tends to travel with that.
Some of the other very difficult neurological illnesses like Lou Gehrig's disease or ALS, multiple sclerosis; these are very tough chronic debilitating conditions.
We see many of these people struggle with depression as well.
Now, do you think that co-occurring depression is often overlooked?
I think sometimes it is. I think some illnesses, doctors and clinicians might say well, if you have cancer and your life is threatened, you should be sad, you should have grief.
But again, if you are stuck in grief and sadness for several weeks, it likely is more than just the blues; it's more than just a reaction to your diagnosis.
Now, what are some of the warning signs that one should look for?
Well, I think the standard depression symptoms are there; sadness, loss of interest, poor concentration, appetite change, low energy, fatigue problems.
Certainly, anytime you see suicidal thinking, extreme guilt, worthlessness or poor self-esteem, that's not a normal process of being medically ill.
So, when you get more towards those psychological symptoms in depression. That should be a wakeup call, I think, to the patient and to the clinicians involved.
Now should you treat the illness and the depression separately.
I think ideally you treat both simultaneously. And I think as the medications for depression have become safer and more commonly used, many non-psychiatrist have become very good.
Family practice doctors probably prescribe 70% of the anti-depressants in the U.S. Some people aren't good at both and then you need two doctors or two clinicians.
But yes I think treating both at the same time make a lot of sense.
How does the co-occurring depression affect the underlying illness?
If you think about depression where it causes us to be unmotivated. We're not very good at concentrating, keeping our medication straight or our diet straight,
typically depression causes other medical illnesses to do worse. Your diabetes won't be as well-controlled; neither will your high blood pressure.
So I would say almost all the time to have a depression probably puts the medical illness at even more risk.
To what extent does treating the depression help you get better?
Well, I think successful treatment of depression, if it alleviates all the symptoms what you have been talking about, should help your medical condition.
The simple idea is you will be more motivated to take care of yourself, take your medications and all of those things.
So I do think the downstream effects are very important. So treating the depression should also improve the medical condition or at least slow down its progression.
How can someone with a long-term illness avoid being depressed?
What I advise patients with chronic medical problems is to try to get out of the victim's stance. My illness is beating me up, this will never get better.
I think you really try to turn people into being more assertive; goal-oriented. They should know their illness,
do some of their own work, get on the Internet, talk to their doctor, be their own advocate.
If you can treat somebody who is sad, down and out, motivated with low self-esteem, if you can fix those symptoms, then you have a chance to be a better fighter for their medical illness.
As always Dr. Shwartz, we appreciate your time and helpful information. For more information and other useful resources please join us on WebMD's Depression TV.