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Depression
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Depression Co-occurring With General Medical Disorders

Clinical depression commonly co-occurs with general medical illnesses, though it often goes undetected and untreated. In fact, while the rate of major depression among persons in the community is estimated to be between two to four percent, among primary care patients it is between five and ten percent and among medical inpatients it is between ten and fourteen percent. And an additional two to three times as many persons in these groups experience depressive symptoms. Research suggests that recognition and treatment of co-occurring depression may improve the outcome of the medical condition, enhance quality of life, and reduce the degree of pain and disability experienced by the medical patient.

What Is Depression

Clinical depression is a common and highly treatable illness affecting over 17 million American adults-- with or without a co-occurring condition-- each year. Unfortunately, nearly two thirds of them do not get treatment, in part, because the effects of depression are not understood to be symptoms of an illness. With proper treatment, however, nearly 80% of those with depressive illness can feel better, and most within a matter of weeks.

Depression: A Whole Body Illness

Depression affects mood, thought, body, and behavior. For some, it occurs in one or more relatively severe episodes, known as major depression. Others have ongoing, less severe but also debilitating symptoms, known as dysthymia. And still others have bipolar disorder (also known as manic depressive illness), where episodes of terrible "lows" alternate with excessive "highs".

Symptoms of Depression and Mania:

Depression
Persistent sad, anxious, or "empty" mood Feeling helpless, guilty, or worthless Hopeless or pessimistic feelings Loss of pleasure in usual activities Decreased energy Loss of memory or concentration Restlessness, Irritability or restlessness Sleep disturbances Loss of or increase in appetite Thoughts of death

Mania
Extreme irritability & distractibility Excessive "high" or euphoric feelings Sustained period of unusual behavior Increased energy, activity, rapid talking & thinking, agitation Decreased sleep Unrealistic belief in one's own abilities Poor judgment Increased sex drive Substance abuse Provocative or obnoxious behavior Denial of problem

If five or more symptoms last for two weeks or longer, or are severe enough to interfere with normal functioning, an evaluation for clinical depression by a qualified health or mental health professional is recommended.

Accurate Diagnosis Is Important

Since some symptoms are common to both depression and certain medical disorders, accurate diagnosis is critical to developing an effective plan for treatment. For example, symptoms of depression such as weight loss, sleep disturbances, and low energy, may also occur in diabetes, thyroid disorders, some neurologic disorders, heart disease, cancer, and stroke. Other depressive symptoms, such as loss of interest or memory, also occur early in the course of disorders such as Parkinson's and Alzheimer's disease. In addition, achiness or fatigue may be present in many other conditions. In such cases, careful assessment of an individual's emotional state, and personal and family histories can help determine if one or two illnesses are present.

Other Diagnostic Concerns

The relationship of clinical depression to a medical illness can be varied. Depression can occur as the biological result of a condition such as an underactive thyroid, or can be the side-effect of one or a combination of medications, including over-the-counter medications. In such cases, the depression may be relieved by a change in dosage or type of treatment(s). On the other hand, it is not unusual for a traumatic diagnosis, such as cancer, to trigger a period of depressive symptomatology including sadness, poor concentration, anxiety, or withdrawal. Careful monitoring of the length and severity of depressive symptoms can determine if clinical depression is an additional diagnosis.

A Message of Hope: Depression Is Treatable

When depressive illness is a co-occurring condition, it should be treated. With treatment, up to 80% of those with depression can show improvement, usually in a matter of weeks. Common interventions include a range of antidepressant medications, focused short-term psychotherapy, or a combination of the two. In addition, in special circumstances, electro-convulsive therapy (ECT), a safe and effective treatment, may be considered as an option. Which treatment is recommended depends on the severity of the depression, the type of co-occurring illness and its treatment, and, to some degree, on individual preference. In addition, maximizing the treatment of the medical disorder may also help to diminish the depressive symptoms.

Treatment of Depression Has Added Benefits

Treatment of depression can improve a patient's overall quality of life in several ways. It may enhance the ability to follow the treatment regimen for the co-occurring medical condition, decreasing complications and improving the eventual outcome. In addition, effective management of depression can lessen the degree to which the patient is irritable, demanding, or experiences overall problems in functioning, any of which may contribute to slower or more difficult recovery, and greater stress and disability from the medical condition. Finally, controlling the depression will often improve the cognitive symptoms that are a part of some illnesses.

The Path to Healing

Whether or not it co-occurs with medical illness, overcoming depression requires recognition of symptoms, and evaluation and treatment by a qualified health or mental health professional. Success involves a partnership with a health care provider so that an individual's concerns can be addressed. Negative thinking is a part of the depression that will fade as symptoms resolve. Family and friends can help by encouraging the depressed person to seek or remain in treatment, and by offering emotional support. In addition, the following may be helpful adjuncts to treatment: support groups, mild exercise or hobbies, reading self-help materials.

From Depression: Awareness, Recognition, and Treatment (D/ART),
National Institute of Mental Health.
Rockville, Maryland.

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