Consider these statistics:
- Nearly 50 percent of asthma patients have symptoms of depression.
- At least 40 percent of people with Parkinson’s disease experience depression, and anxiety is often reported.
- 45 percent to 65 percent of people who have had a heart attack live with depression.
- The lifetime risk for depression in people with multiple sclerosis (MS) is 40 percent to 60 percent.
- Nearly 30 percent of stroke patients develop depression.
A 2009 study published in Archives of Gerontology and Geriatrics confirms that “when pain is severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes. Similarly, depression in patients with pain is associated with more complaints and greater functional impairment.” The study goes on to explain that there is growing evidence that “depression and pain share genetic factors, biological pathways, and neurotransmitters. Thus, the most promising area of future research is elucidating the neurobiological alterations in pain pathways that intersect with those involved in depression.”
This is important to know since, according to research published by the Robert Wood Johnson Foundation, the number of people with chronic illnesses will increase 37 percent, or 46 million people, between 2000 and 2030. That means those of us who are predisposed to depressive episodes to begin with would be wise to familiarize ourselves with those illnesses that are most often associated with depression and can exacerbate our symptoms. The following 10 are a good start.
1. Parkinson’s Disease
The National Parkinson Foundation’s Parkinson’s Outcomes Project, the largest clinical study of Parkinson’s disease ever conducted, shows that depression is the most important factor influencing the health status of people with Parkinson’s. According to the study: “A clear finding from our study is that, taken together, mood, depression, and anxiety, have the greatest effect on quality of life, even more than the motor impairments commonly associated with the disease. Further, our analysis found that QII [quality improvement initiative] participants who receive care from clinics with the most active approach to psychological counseling report the lowest rates of depression.”
2. Heart Disease
Depression is three times more common in people after a heart attack than in the general public, with 15 to 20 percent of heart attack victims qualifying for a diagnosis of major depression disorder and many others experiencing depression symptoms. “Depression after a heart attack is bad not only because of the accompanying emotional distress and suffering,” says Redford B. Williams, MD, professor of psychiatry at Duke University Medical Center in Durham, North Carolina, “it also increases one’s risk of having another heart attack or dying over the ensuing months and years.” People with heart disease who are depressed tend to have more cardiac symptoms than those who are not depressed. Depression and anxiety affect heart rhythms, increase blood pressure, elevate insulin and cholesterol levels, and raise levels of stress hormones.
Nearly 30 percent of stroke patients develop depression, either in the early or in the late stages after a stroke, according to a study published in the medical journalNeuropsychiatric Disease and Treatment. It is so common that the Diagnostic and Statistical Manual (DSM)-5 categorizes “post-stroke depression” as a mood disorder (due to a general medical condition, i.e., stroke). Stroke causes physical damage to the brain, affecting brain cells that monitor mood and mental function. It’s also a frightening experience that can cause trauma. Although depression may affect functional recovery and quality of life after stroke, it is often ignored. In fact, only a minority of patients are diagnosed and even fewer are treated in the common clinical practice.
Up to 40 percent of people with Alzheimer’s disease may also experience severe depression according to the Alzheimer’s Association. In fact, a new study published in the journal Neurology found that for people who develop Alzheimer’s disease, depression and other “noncognitive” changes can happen before any of the hallmark symptoms like memory and thinking problems associated with the disease. Another report in the British Journal of Psychiatry found that depressed older adults (over the age of 50) were more than twice as likely to develop vascular dementia and 65 percent more likely to develop Alzheimer’s disease than people who weren’t depressed. It can be difficult to distinguish depression in persons with dementia because the symptoms are similar: a lack of interest in hobbies and activities, difficulty communicating, weight loss, and difficulty sleeping.
High blood pressure can impact depression; however, it is more likely that depression affects high blood pressure. Stress hormone levels are raised during depressive episodes, which, in turn, elevates blood pressure. Acute stress and severe depression will elevate blood pressure to the point where damage to blood vessels is caused.
I was shocked to find out how many people in my depression communities, Project Beyond Blue and Group Beyond Blue, have diabetes. In a 2010 study published in the Archives of Internal Medicine, it was determined that the diabetes-depression relation is, in fact, “bidirectional,” meaning that just as people with diabetes have a higher risk for developing depression than those without the condition, people who have depression are more likely to develop diabetes, at least type 2 diabetes. “We can say that the two conditions are linked to each other and are both the causes and the consequences of each other,” says the study’s senior author, Frank Hu, MD, PhD, professor of nutrition and epidemiology at Harvard School of Public Health.
The prevalence of mood disorders among persons with cancer can vary depending on the type of cancer and its clinical stage. In an older 1983 study published in theJournal of the American Medical Association, 47 percent of the patients were diagnosed with a kind of psychiatric disorder — most of them adjustment disorders. However, a more recent study published in the journal Cancer shows that 53.7 of people with terminal cancer were diagnosed with a psychiatric disorder: delirium, dementia, adjustment disorders, major depression, or generalized anxiety disorder.
8. Multiple Sclerosis
Depression is the most frequent psychiatric diagnosis in people with MS, according to a study published in the Journal of Rehabilitation Research & Development. The lifetime risk for depression in people with MS ranges from 40 to 60 percent. Depression could be a result of the disease process, since MS damages the myelin and nerve fibers deep within the brain — areas involved in emotional expression and control. Depression may also be associated with changes that occur in the immune and neuroendocrine systems. According to the study, “the etiology of depression is multifactorial and likely associated with psychosocial stress, focal demyelinating lesions, and immune dysfunction.”
I was surprised to learn that nearly 50 percent of people with asthma may experience clinically significant depressive symptoms. The stress involved in having this particular illness and the disruptive symptoms seem to be what contribute most to psychiatric diagnoses. For example, those who experience dyspnea and nighttime awakening are at increased risk for major depression according to a study published in the Medical Journal of Australia. Asthma has also been associated with anxiety in a study of children and adolescents. In general, the depression and anxiety is worse among persons whose asthma is difficult to control: 87.5 percent of people with frequent asthma attacks experienced mood disruptions, compared to 25 percent of people with less frequent attacks, according to other research.
A study from the Centers for Disease Control and Prevention published in the journal Arthritis Care & Research indicates that one third of Americans aged 45 years and older with arthritis have either anxiety or depression. Interestingly enough, anxiety was almost twice as common as depression. Most people who had depression (85 percent) also had anxiety. But only half (50 percent) of the people who had anxiety also had depression. The study suggests that everyone with arthritis may be at risk for mood disruptions, and that screening all adults with arthritis for anxiety and depression is more important than ever, especially since the results found that only 50 percent of those with anxiety and depression sought help in the past year.