When depression travels with a chronic medical condition, you’ll need these coping strategies:
“Mens sana in corpore sano.”
That’s how the ancient Roman poet Juvenal defined life’s greatest virtues: A sound mind in a healthy body.
What about the opposite? For many people, depressive symptoms and chronic physical disorders go hand in hand—and science is puzzling over why.
More than a dozen medical conditions have a notable overlap with depression. The list includes asthma, cancer, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, and high blood pressure.
Illnesses characterized by chronic pain seem especially linked with depression. A third of people with arthritis also have depression. Ditto for fibromyalgia. A startling 85 percent of those with lupus report depressive symptoms.
(In medicine that’s known as co-morbidity: the simultaneous occurrence of two chronic disorders, whether medical or psychiatric.)
The double challenge of coping with both medical and psychiatric issues can feel overwhelming. People who’ve been through it recommend learning all you can about both conditions, employing every professional and self-help resource at your disposal, and keeping all your practitioners fully informed and working in concert.
“You need to think outside the box and work with doctors who also think outside the box,” says Bonnie of Randolph, New Jersey. “And if you do not feel a physician is helping you, find someone who does.”
Bonnie lives with major depressive disorder and fibromyalgia, a chronic medical disorder with no clear cause and no cure. Fibromyalgia is characterized by widespread pain in joints and muscles, fatigue, sleep and mood issues, and problems with memory and focus.
At 41, Bonnie aches like an elderly woman. She wills herself up and out of bed every morning and distracts herself with daily tasks, even when she’s in pain or a mental fog. If she doesn’t, she might sink into lethargy.
If she overdoes it, she’ll face disabling exhaustion—though she counts herself lucky because she’s not fatigued all the time. Depressive episodes don’t seem to affect her physical condition, she says, but fibromyalgia flare-ups do worsen her depression.
Bonnie believes personal empowerment makes all the difference for her. She sees her doctors regularly and takes psychiatric medications that target her depressive symptoms, which include feelings of hopelessness and worthlessness, exacerbated anxiety, and loss of appetite.
Chiropractic treatments, a water exercise class, and physical and occupational therapy help a lot with her bodily symptoms, and that has benefits for her mood. She participates in support groups, continues to educate herself, and follows all the coping recommendations.
“I try to push myself as much as I can,” she says.
At her best, Bonnie was able to participate in a 5K race after a training regimen of walking and running.
“That was huge for me,” she says. “Being successful at something I never saw possible was an amazing feeling … a ‘high’ for me.”
Ailments of mind and body connect in complicated ways, and different mechanisms may be at work in different situations. To further muddy the waters, physical complaints like bodily pain, gastrointestinal disturbances, fatigue, trouble sleeping, headaches and backaches are common to both depression and a number of medical conditions.
In some cases, people who seek help for physical woes actually have what’s known as “masked depression.” Physicians will prescribe the usual medical treatments, but see little improvement. Once the root cause is recognized, however, the physical or “somatic” symptoms respond to treatments for depression.
In people with Huntington’s disease, Parkinson’s disease and certain other conditions, depressive symptoms are considered to be complications of the underlying physical illness. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference for psychiatric diagnoses in North America, includes a category for “depressive disorder due to another medical condition.”
A number of chronic illnesses that have a strong association with depression travel an interesting two-way street. Studies show that people who have had heart attacks are at higher risk of developing depression; likewise, people diagnosed with depression face an elevated chance of developing cardiovascular disease. People with diabetes face a 50 percent increased risk of getting depression; people with psychiatric disorders are twice as likely to have diabetes as someone in the general population.
Scott of Minneapolis, who was diagnosed with Type 1 diabetes at age 5, wishes he’d known more about the interplay between depression and diabetes way earlier in the history of his own mood issues. His wife encouraged him to seek help from a therapist when he became increasingly irritable in his mid-20s.
Scott, now 40, recalls that it took six months to a year before he found relief from depression through medication. In the meantime, his depressive symptoms made it harder to stay on top of the frequent blood sugar checks, regular exercise, and nutritious meals required to maintain his physical health.
Depression also made it harder to get himself a psychotherapist, much less one he clicked with, one who could provide sympathetic guidance on coping with his double disorders.
“I went to a number of therapists, but they did not appreciate how much work was involved in managing diabetes,” says Scott.
He has found the most compelling encouragement comes from others who are facing similar challenges.
“You realize that other people are wrestling with the same things and it brings a sense of normalcy back into your life,” he says.
He joined peer support groups and connected with people through the Internet. He now pays it forward as a blogger and social media advocate.
He might advise someone to “recognize that feeling emotional when your blood sugars are higher is not your fault.” And especially, “Don’t be afraid to ask for help.”
Patti of Tennessee, trades information and encouragement with peers in her online support groups. What helps her the most, though, is the sense of mission she gets from her Christian faith and her efforts to educate others about both depression and lupus.
“I think God has a plan and a purpose for me, and that is getting my story out there,” she says.
Patti, 49, has been living with depression since childhood and sought counseling in her early 20s. Increasingly troubled by physical issues such as severe pain, fatigue, fever, and sensitivity to light, she was diagnosed with lupus (technically systemic lupus erythematosus, or SLE) at age 28.
She takes medications that tamp down her various psychiatric and medical symptoms. By definition, however, chronic conditions have no decisive remedy. Science is seeking answers, but in the meantime, everyday coping strategies remain vital for both halves of the equation.
“You can’t treat chronic pain with just drugs,” explains Catherine Cahill, PhD, a University of California-Irvine researcher who explores the juncture of chronic pain and mood disorders.
“A positive attitude plus activities such as movement therapy, pet therapy, tai chi, acupuncture, and even dance are beneficial. … And you need a support group because family doesn’t want to hear about your chronic pain all the time.”
Patti lives with her son, who is a registered nurse, and speaks appreciatively of all the support he provides. It’s hard for her to get out and around, so she spends most of her time in the home they share.
Feeling isolated and discouraged about the future can become fuel for depressive episodes. Patti has church friends who will call to make sure she’s not languishing in bed—her “safe haven” when she’s depressed.
Reaching out to friends is on her list of coping tools. She also recommends using relaxation techniques to relieve stress. She does deep breathing exercises when she needs to relax.
“And treat yourself occasionally to something special like a total body massage or bubble bath,” adds Patti, who finds massage especially good for her bodily ills.
“Above all, take one day at a time.”
Talk therapy for the body
Basic lifestyle strategies for recovery from depression—a nutritious diet, healthy sleep, judicious physical activity, and tools to cope with stress—are also bedrock recommendations for managing conditions like diabetes, high blood pressure and heart disease.
Well, tit for tat: The principles of cognitive behavioral therapy, which are quite effective for depression, have a role to play in handling the day-to-day difficulties of living with a chronic illness. Research suggests CBT can lead to better outcomes for diabetes, arthritis, and chronic pain.
Which leads us to Chris Williams, a professor of psychosocial psychiatry at the University of Glasgow in Scotland.
Williams popularized CBT in a series of booklets called “Live Life to the Full.” The Canadian Mental Health Association’s division in British Columbia uses his framework in its Bounce Back program, originally developed to help people living with mild to moderate depression and another chronic illness. CMHA Ontario adopted Bounce Back last year.
Williams looks beyond emotional distress to physical debility in Reclaim Your Life from Illness, Disability, Pain or Fatigue. Some of his tips:
- Think of yourself as bigger and more important than your illness. Avoid checking constantly for aches and pains.
- List things you enjoy (walking in the park, spending time with a child), then do more of them. • Learn to pace yourself in achieving realistic targets (for example, completing one errand rather than a whole list). Break down tasks into small parts you can do at different times.
- Appreciate and enjoy what you can achieve rather than ruminating about what you can’t. Try to grumble less.
- Reconnect with others. Perform a small kindness for another person every day or call up friends or family.
Find out more: “5 Reasons Why Depression is Linked to Chronic Diseases”
Printed as “Pain in body, Pain in mind,” Winter 2016
via Esperanza – Hope To Cope
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