Doctors need to manage depression in chronic illness

© Rob Marmion – 123RF.com

"The risk of depression in individuals considered to be healthy, is usually 10% to 25% for women and 5% to 12% for men, but those with chronic illnesses face a much higher risk - between 25% to 33%. Research shows that 40% to 65% of heart-attack patients, 40% of Parkinson's patients, 25% of cancer patients and 30% to 54% of patients with chronic pain syndrome develop depression.

"It can be difficult to identify depression in the chronically ill, but diagnosis and treatment are essential. Symptoms such as troublesome sleep, diminished appetite and lack of energy may already exist because of the illness. So too, treatment for a medical condition may equally affect the patient's mood, as may the disease itself.

"In order to make the correct diagnosis, it may be helpful to assess the patient's risk factors for depression, such as whether they have a history of depression or pain. Other risk factors may also include undesirable social and environmental circumstances, such as unemployment, financial strain or a lack of emotional support.

"Despite these difficulties, it is essential to diagnose and treat depression in patients with chronic conditions. Even mild depression may reduce a person's motivation to gain access to medical care and to follow treatment plans.

The process of diagnosis is often just as complex as the treatment. Selecting an appropriate antidepressant requires careful assessment of the risks and benefits, since antidepressant drugs may aggravate the patient's medical condition. However, many antidepressant drugs are effective in people who are medically ill.

"The optimal treatment of depression in patients with chronic conditions also involves using a combination of cognitive and supportive psychotherapies. It can be a shock for patients to learn that they've been diagnosed with a chronic illness but when healthcare professionals help patients to understand their illness and how to take care of themselves, the better they will be able to cope emotionally and otherwise."

Advice to doctors

She offers the following advice to doctors:

1. Consider patients' individual circumstances, beliefs and value system before recommending a treatment regime. Medication prescribed should ideally cause as little further disruption to the patients' quality of life as possible.
   
2. Help manage patients' expectations by adjusting their goal-setting. If they can't manage as much as they used to, they shouldn't be hard on themselves. They need to learn to set reachable goals while keeping their individual situation in mind. Help them manage life in their new reality.
   
3. Don't let patients withdraw themselves from others. Isolation only leads to depression and it is easy for patients to isolate themselves when they are feeling low. Encourage them to ask for help and to remain socially active.
   
4. Monitor patients during each visit. If their symptoms worsen, recommend psychotherapy, which will further assist in determining the severity of their mood disorder.
   
5. Alternatively, they can contact Pharma Dynamics' toll-free helpline on 0800 205 026, which is manned by trained counsellors who are on call from 8am to 8pm, seven days a week, to help them through the process.