Under Pressure

THE effect of chronic illness on the mind can sometimes be as devastating as the toll it takes on the body.

Depression is two to three times more common in people with a long-term physical health problem like heart disease, cancer, arthritis or diabetes - and feeling mentally wretched isn’t the only consequence.

Studies show that people with both cancer and depression are up to 39% more likely to die than people with cancer alone. And those suffering heart disease and depression have an increased risk of death following a heart attack.

It can work the other way too - psychiatrists point out that stress hormones released during a bout of depression can increase the risk of heart attacks and diabetes. Experts warn that if depression isn’t treated, maintaining recovery for a physical problem is more difficult, and relapses more common. An estimated 20% of people with chronic physical problems will develop the mental illness, which can lead to a variety of serious consequences, impacting their ability to care for themselves, take medication, and even their will to live.

The physical signs that somebody may be suffering, like weight loss and fatigue, can often be misinterpreted and either linked to an existing physical complaint, seen as a side-effect of treatment, or dismissed as a natural response.

People struggling with mental health problems tend to have poorer physical health than others, and higher rates of long-term diseases - sometimes because of higher levels of smoking, obesity and lack of exercise.

Poorer health could be linked to the attitudes of health care workers, who may not take a depressed person’s other physical complaints seriously.

Psychiatrist Professor Chris Thompson, chief medical officer of The Priory Group, stresses that depression accounts for a huge amount of the disability associated with conditions like diabetes and rheumatoid arthritis, and says developing it after being diagnosed with a disabling disease is “completely under-standable”.

But, he points out that depression may also help lead to physical illness, citing a study by the American psychiatrist Dr Greg Simon, which found people with the psychological disorder were much more likely to develop chronic physical illnesses in the next five to 10 years.

“In other words, when you get depressed for a long period, stress responses start to happen that leave you vulnerable to developing chronic illnesses,” explains Thompson.

These responses include higher levels of the stress hormone cortisol, which can increase the risk of heart attack and affect glucose tolerance.

“That means if you’re on the edge of having diabetes, you could get pushed over into actually having it,” he says.

Thompson says if people get depressed and don’t do anything about it their physical health is at risk. But depressed people with another long-term condition may not feel motivated enough to get help.

He stresses: “Don’t ignore it because it’s due to a physical illness. If you’re not motivated and you don’t think you’ve got much of a future, that’s probably coming from the depression. Don’t let that influence you getting treatment for the physical illness as well - that’s a double whammy. You need treat-ment for both, and you may need a friend to tell you to do it. That can be crucial.”

SPOTTING THE SIGNS

If you have experienced four or more of the following symptoms nearly every day for over two weeks, you should seek help:

¦ Tiredness and loss of energy

¦ Persistent sadness

¦ Loss of self-confidence and self-esteem

¦ Difficulty concentrating

¦ Inability to enjoy things that are usually pleasurable or interesting

¦ Undue feelings of guilt or worthlessness

¦ Feelings of helplessness and hopelessness

¦ Sleeping problems

¦ Avoiding other people

¦ Finding it hard to function at work/school

¦ Loss of appetite

¦ Loss of sex drive and/or sexual problems

¦ Physical aches and pains

¦ Thinking about suicide and death

¦ Self-harm