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Mind–Body Medicine for Treating Depression: Using the Mind to Alter the Body’s Response to Stress | Alternative and Complementary Therapies

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see also p 332 Recognition and treatment are crucial; depression worsens the course of a chronic illness
Chronic medical illness is consistently associated with an increased prevalence of depressive symptoms and disorders., In some cases, depression appears to result from specific biologic effects of chronic medical illness. Examples of this relationship include central nervous system disorders-such as Parkinson's disease, cerebrovascular disease, or multiple sclerosis-as well as endocrine disorders-such as hypothyroidism. In other cases, the association between depression and chronic medical illness appears to be mediated by behavioral mechanisms; the limitations on activity imposed by the illness lead to gradual withdrawal from rewarding activities. Why should primary care physicians be alert to the possibility of depression in their patients with chronic disease? Why do they sometimes miss it? And what can they do to manage this distressing mental health problem?

Depression significantly increases the overall burden of illness in patients with chronic medical conditions. Compared with those without depression, medical outpatients with depressive symptoms or disorders experienced decrements in quality of life and had almost twice as many days of restricted activity or missed work because of illness. Similarly, depression is associated with a 50% to 100% increase in health services use and costs.

Depression has also been linked to increased disease-related morbidity and mortality. Results of population-based studies have shown a modest association between depression and all-cause mortality and a stronger association between depression and mortality resulting from cardiovascular disease. Depression is clearly associated with a poorer prognosis and more rapid progression of chronic illnesses, including ischemic heart disease and diabetes. Here as well, the interaction between depression and chronic medical illness may be mediated by either biologic or behavioral mechanisms. For example, depression may affect the course of ischemic heart disease through increased platelet activation or of diabetes through decreased glucose tolerance. It may also affect these diseases by decreasing treatment adherence and physical activity and by increasing tobacco and alcohol use.

The presence of a chronic medical illness may reduce the likelihood that physicians or other health care providers recognize or treat depression. The demands of chronic illness management may crowd concerns of depression out of the visit agenda. Providers may also not look beyond a chronic medical illness to explain nonspecific symptoms, such as fatigue or poor concentration. Even when they recognize symptoms of depression, they may defer treatment, believing that "anyone would be depressed" in such a situation.

Yet, somatic symptoms often reflect a combination of medical and psychological factors, and the presence of a clear medical explanation for these symptoms does not rule out depression as a contributing factor. Patients should receive appropriate treatment regardless of whether there is an obvious medical or psychological precipitant to their depression.

Because the symptoms of depression-such as fatigue or changes in appetite-may overlap with manifestations of the medical illness, using standard screening tools or diagnostic criteria for depression in patients with chronic disease may lead to overdiagnosis of depression. This concern has led to the development of depression measures, such as the Geriatric Depression Scale, that include fewer somatic symptoms. However, it seems that underdiagnosis of depression is a more important problem than is overdiagnosis. Concern about the accuracy of screening or diagnostic measures should not interfere with efforts to improve access to appropriate treatment.

So what is the appropriate treatment? First, consider whether a medical problem or medication is causing the depressive symptoms; treating the problem or changing the medication may alleviate the symptoms. Chronic illnesses known to mimic depression include sleep apnea, thyroid disorders, and Cushing's syndrome. Among medical outpatients, however, the prevalence of major depression (6%-10%) is greater than that of "medical mimics" of depression. Exhaustive efforts to rule out medical disorders can delay needed treatment and reinforce the stigmatization of depression as something less than a "real" illness.

Second, recognize that randomized trials have shown the efficacy of both pharmacologic,, and psychosocial treatments of depression across a range of chronic medical conditions. Effective treatment of depression reduces depressive symptoms and improves daily functioning. Treating depression has also been shown to have a positive effect on biologic indicators of disease severity or progression, such as the level of glycosylated hemoglobin in diabetes or platelet activation in ischemic heart disease. Given the clear benefits of recognizing and treating depression, all those who care for people with chronic medical illness should consider identification and treatment of depression a clinical priority.

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Treating depression in patients with chronic disease

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see also p 332 Recognition and treatment are crucial; depression worsens the course of a chronic illness Chronic medical illness is consistently associated with an increased prevalence of depressive symptoms and disorders., In some cases, depression appears to result from specific biologic effects of chronic medical illness.

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Depression:
Depression Caused by Chronic Illness

A chronic illness is an illness that lasts for a very long time and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, and certain medicines. Examples of chronic illnesses include diabetes, heart disease , arthritis, kidney disease, HIV / AIDS, lupus, and multiple sclerosis.

Why is Depression Common in People With a Chronic Illness?

People diagnosed with chronic illnesses must adjust to the demands of the illness itself, as well as to the treatments for their condition. The illness may affect a person's mobility and independence, and change the way a person lives, sees him or herself, and/or relates to others. For these reasons, a certain amount of despair and sadness is normal. In some cases, a chronic illness may actually cause depression. .

Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression. Depression and illness may occur together because the physical changes associated with the illness trigger the depression, the individual has a psychological reaction to the hardships posed by the illness, or simply as a coincidence.
Which Long-Term Illnesses Can Lead to Depression?
Any chronic condition can trigger depression, but the risk increases with the severity of the illness and the level of life disruption it causes. The risk of getting depression is generally 10-25% for women and 5-12% for men. However, those with chronic illnesses face a much higher risk -- between 25-33%.

Depression caused by chronic illness often aggravates the illness, especially if the illness causes pain, fatigue, or disrupts your social life. Depression can intensify pain. It causes fatigue and sluggishness that can worsen the loss of energy associated with these conditions. Depression also tends to make people withdraw into social isolation.

The rate for depression occurring with other medical illnesses is quite high:
What Are the Symptoms of Depression in People with Chronic Illness?
Patients and their family members often overlook the symptoms of depression, assuming that feeling depressed is normal for someone struggling with a serious, chronic illness. Symptoms of depression are also frequently masked by the other medical conditions, resulting in treatment for the symptoms -- but not the underlying cause of the symptoms -- the depression. It is extremely important to treat both forms of illness at the same time.
What Can Be Done to Treat Depression in People With Chronic Disease?
Treatment of depression in people with chronic disease is similar to that offered to other people with depression. Early diagnosis and treatment for depression can reduce distress, as well as the risk of complications and suicide. People who get treatment for depression that occurs at the same time as a chronic disease often experience an improvement in their overall medical condition, a better quality of life, and are more easily able to stick to their treatment plans.

If the depressive symptoms are related to the physical illness or side effects of medicine, treatment may just need to be adjusted or changed. If the depression is a separate problem, it can be treated on its own. More than 80% of people with depression can be treated successfully with medicine, psychotherapy, or a combination of both. Treatment with antidepressant drugs can start to work within a few weeks.
Tips For Coping With Chronic Illness
Depression, disability, and chronic illness form a vicious cycle. Chronic illness can bring on bouts of depression, which, in turn, can lead to a run-down physical condition that interferes with successful treatment of the chronic condition.

Following are some tips to help you better cope with a chronic illness:

Learn how to live with the physical effects of the illness.

Learn how to deal with the treatments.

Make sure there is clear communication with your doctors.

Try to maintain emotional balance to cope with negative feelings.

Try to maintain confidence and a positive self-image.

Get help as soon as symptoms of depression appear.

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health fact medical  medicine medications tips tools diseases conditions wellness mens womens

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A chronic illness is an illness that lasts for a very long time and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, and certain medicines. Examples of chronic illnesses include diabetes, heart disease , arthritis, kidney disease, HIV / AIDS, lupus, and multiple sclerosis.

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National Institute of Mental Health (NIMH)

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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:

People with other chronic medical conditions are at higher risk of depression.

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.

Children and Adolescents With Chronic Illnesses

Children and adolescents with chronic illnesses often face more challenges than their healthy peers in navigating adolescence. Chronic illnesses can affect physical, cognitive, social, and emotional development, and they can take a toll on parents and siblings. These limitations put children and adolescents at higher risk than their healthy peers of developing a mental illness.

Children and adolescents with chronic illnesses experience many forms of stress. Parents and health care providers should be on the lookout for signs of depression, anxiety, and adjustment disorders (a group of conditions that can occur when someone has difficulty coping with a stressful life event) in young people and their families.

People with depression are at higher risk for other medical conditions.

It may come as no surprise that adults with a medical illness are more likely to experience depression. The reverse is also true: People of all ages with depression are at higher risk of developing certain physical illnesses.

People with depression have an increased risk of cardiovascular disease, diabetes, stroke, pain, and Alzheimer's disease, for example. Research also suggests that people with depression may be at higher risk for osteoporosis. The reasons are not yet clear. One factor with some of these illnesses is that many people with depression may have less access to good medical care. They may have a more challenging time caring for their health-for example, seeking care, taking prescribed medication, eating well, and exercising.

Scientists also are exploring whether physiological changes seen in depression may play a role in increasing the risk of physical illness. In people with depression, scientists have found changes in the way several different systems in the body function that could have an impact on physical health, including:

Increased inflammation

Changes in the control of heart rate and blood circulation

Abnormalities in stress hormones

Metabolic changes such as those seen in people at risk for diabetes

There is some evidence that these changes, seen in depression, may raise the risk of other medical illnesses. It also is clear that depression has a negative effect on mental health and everyday life.

Depression is treatable even when another illness is present.

Depression is a common complication of chronic illness, but it does not have to be a normal part of having a chronic illness. Effective treatment for depression is available and can help even if you have another medical illness or condition.

If you or a loved one think you have depression, it is important to tell your health care provider and explore treatment options. You also should inform your health care provider about all your current treatments or medications for your chronic illness or depression (including prescribed medications and dietary supplements). Sharing information can help avoid problems with multiple medicines interfering with each other. It also helps your health care provider stay informed about your overall health and treatment issues.

Recovery from depression takes time, but treatment can improve your quality of life even if you have a medical illness.

Treating depression with medication, psychotherapy (also called "talk therapy"), or a combination of the two also may help improve the physical symptoms of a chronic illness or reduce the risk of future problems. Likewise, treating the chronic illness and getting symptoms under control can help improve symptoms of depression.

Depression affects each individual differently. There is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best. You can learn more about the different types of depression treatment-including psychotherapy, medication, and brain stimulation therapies-on NIMH's depression webpage. Visit the Food and Drug Administration (FDA) website for the latest information on medication approvals, warnings, and patient information guides.

Participating in Clinical Research

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so others may receive better help in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH's clinical trials webpage.

Finding Help

Behavioral Health Treatment Services Locator

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator , an online resource for locating mental health treatment facilities and programs in your state. For additional resources, visit NIMH's Help for Mental Illnesses webpage.

Talking to Your Health Care Provider About Your Mental Health

Communicating well with your doctor or health care provider can improve your care and help you both make good choices about your health. Read NIMH's Tips for Talking With Your Health Care Provider to help prepare for and get the most out of your visit. For additional resources, including questions to ask your doctor, visit the Agency for Healthcare Research and Quality website .

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( en español )

ClinicalTrials.gov ( en español )

U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. 21-MH-8015

Revised 2021

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Chronic Illness and Mental Health: Recognizing and Treating Depression

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This brochure provides information about depression and mental health for people living with chronic illnesses, including children and adolescents. It discusses symptoms, risk factors, treatment options, and presents resources to find help for yourself or someone else.