The diagnosis of a chronic illness has a huge emotional impact on patients and their families. It may be hard for them to accept the fact that an incurable disease will influence the rest of their lives. At first, a lack of knowledge about the disease can create even more anxiety. As information is acquired and supportive care begins, people slowly adjust.

The mental and emotional distress of chronic illness varies by disease. Some diseases cause changes in appearance like weight gain or rash. Other diseases affect the ability to walk, drive, swallow or speak. Some illnesses alter a patient's ability to work. Parenting, marriage, finances, social activities, recreation and education can also be affected. Any of these changes may cause fear, anxiety, stress, low self-esteem or depression.

Depression has been called "a normal reaction to an abnormal situation." As such, depression is a common complication of every chronic illness. Doctors have known for centuries that depression often occurs with chronic illness. People with chronic illnesses have a 25-33% chance of getting depressed. For those without chronic illnesses, the chances are much less--10-25% for women and 5-12% for men.

There are several reasons: First, depression is part of the way human beings grieve their losses. "Reactive" depression is a normal response to the news that one has a chronic illness. The losses that result from chronic illness vary from person to person, but everyone grieves. Reactive depression is part of adjusting to the new lifestyle imposed by chronic illness. Reactive depression is temporary. It lasts only a few weeks or months. Usually no medical treatment is needed.

Second, there may be physical causes for depression. Some diseases may themselves cause depression. For example, diseases that destroy the myelin covering of nerves may affect the nerves in the brain, producing depression. Depression can also result from deficiencies in the brain chemicals, serotonin and norepinephrine. In addition, some people may also inherit a genetic tendency toward depression.

Third, depression may be a side effect of drugs taken to treat a chronic illness. (A doctor may be able to adjust drugs to provide relief.)

Fourth, social factors like poverty, abuse, or violence may increase the chances that some chronically ill people will get depressed. (Psychotherapy may help.) Finally, depression can sometimes result from a combination of physical, emotional and social factors.

Regardless of the cause, depression that occurs with chronic illness should be taken seriously. Medication should always be considered if depression lasts more than a few weeks. It is always important to discuss depression with a doctor or counselor. Even when it is related to a chronic condition, depression is usually treated as a separate illness. The good news is that depression is a very treatable illness. Over 80 percent of depressed people improve when treated. Depression may be treated with medication, psychotherapy, or both.

Treating depression is very important. Left untreated, it can worsen many chronic diseases. For example, social support is a vital part of coping with a chronic disease. Depressed people withdraw from others. Isolation can increase depression, making it harder to cope. Depression can also increase one's awareness of pain. It increases fatigue, which can make some chronic conditions worse. It also hinders the immune system in its fight against illness. Many people find that when depression is successfully treated, it is easier to manage their disease. They have the energy to take better care of themselves. They also feel more like being around other people.

One of the best ways to combat the mental and emotional distress of chronic illness is to join a support group. Support groups provide peer to peer help in a caring atmosphere. In a support group, patients enjoy a sense of community that is not found anywhere else. Members exchange practical tips and share experiences and feelings. Support groups offer many benefits, including:

Ongoing acceptance and support

A safe place to talk openly about problems and feelings

Social interaction, which reduces feelings of isolation

Positive role models for success in various areas, in spite of the illness

A place to give and receive encouragement

Resources and tips for coping

A place to ask questions

References

First published October 17, 2001
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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