Coping with Mental and Physical Aspects of Chronic Illness

senior person's hand on caneOne day you woke up not knowing that after that day, things were going to be different in your life. Something that you suspected to be true or something that came out of nowhere took a prominent role in your life. That was the day that you were diagnosed with a chronic health condition.

A doctor probably discussed your specific information and told you what your treatment options were. Whether it felt like a kick in the stomach, a tidal wave of fear, or just total numbness, there was probably some emotional reaction going on. This may or may not get addressed at that time.

Since that day, life has been filled with doctor appointments, tests, treatment options, and lots of questions that don’t necessarily have answers. Is it any wonder that a person may be dealing with anxiety or depression on top of all that? Unfortunately, the medical community has not always given the emotional impact enough attention when addressing initial treatment plans after a medical diagnosis. It’s been expected that a person will address the medical treatments, yet there is minimal regard to the emotional and life impact after a diagnosis. Luckily, things are changing.

In this day and age of healthcare, we encourage people to be active parts of their treatment team. This means more than just taking the provider’s suggestions. This includes implementing the treatments, keeping track of symptoms, managing side effects, and exploring complimentary treatment options that best fit for you. This requires a lot of insight, understanding, involvement, monitoring, and juggling, all while not feeling your best. However difficult, it is worth it for your health and care management in the long run.

Depression and Chronic Health Issues

Depression and/or anxiety often accompany a chronic health condition, and the causes for this are varied and still being researched. No one reason will fit all. Along with the adjustment and any major life transition comes a grieving process, during which many people ask “what could have been?” or “what should have been?”

Some individuals may be genetically predisposed to the condition you or a loved one have been diagnosed with. It should be of note that many medications used to treat chronic illness may have a potential side effect of depression or anxiety. Research is currently being conducted to see if inflammation in the body plays a role by impacting the other body systems.

Some major medical issues co-occurring with depression or anxiety include:

  • Seizures: 30-50% of those with a seizure conditions have psychiatric symptoms at some point during the course of their illness.
  • Parkinson’s disease: Major depression in patients with Parkinson’s is estimated to be 40%; anxiety occurs in 25% of people with Parkinson’s.
  • Multiple sclerosis (MS): 25-50% of people with MS experience symptoms of major depression after onset of the disease.
  • Diabetes: Depression is estimated to occur in 12% to 18% of people with diabetes.
  • Coronary heart disease (CHD): Depression affects between 15% and 23% of people with CHD.
  • Depression also may occur with other serious medical illnesses such as stroke, cancer, and HIV/AIDS.

People who have depression along with a medical illness tend to have more severe symptoms of both depression and the health condition, making it more difficult to adapt to their medical condition, and raising more medical costs than for those who do not have co-existing depression. Treating the depression can help improve the outcome of treating the co-occurring illness. Just because statistics may point to co-occurring depression does not mean that it depression inevitable or that you can’t do anything about its occurrence to manage it. One thing is clear: this is not caused by a weakness in character or a personal failure.

Talking to Medical Professionals

So what can one do in order to improve the quality of care and odds of being physically and mentally healthy despite a disease? Learning how to effectively discuss how you feel with your health care providers goes a long way. Doctors tend to speak the language of symptoms, location of occurrence, and frequency of such. Learning how to speak to them in their language with less vagueness can help to address problems early on. Stating “I’m in pain” is only telling the start of what they need to know. Let them know what the pain feels like—shooting? throbbing? radiating?—how frequently it occurs, and if there are any triggers. This will help them evaluate your situation with greater accuracy.

Rather than stating “I’m depressed,” try to communicate specifically what you’re feeling—whether you’re sad, lacking motivation or appetite, or having a difficult time falling and staying asleep. This will compile a more thorough picture for them to evaluate, and they can make referrals more easily. It can feel very rushed when you’re face to face with the doctor. You may forget what it was you wanted to address if you leave it to memory, so be prepared and write it out beforehand.

If a provider doesn’t ask you directly about your mood or how you are handling the impact of being diagnosed with a chronic illness, bring it up to them. If it is having an impact on your mental health or daily functioning it is important enough to address, especially early on. This advise goes for any physical or mental health issue, no matter how embarrassed you may feel. If it is impacting your quality of life then it is important to discuss. There is a lot of crossover between the various systems in the body; their emotional impact and origin may be rooted in a metabolic change or something else. Standard practice is to examine the medical or physiological nature of symptoms in addition to addressing the psychological. The majority of things are best addressed in the earlier rather than the later stages.

Lastly, being open to addressing your mental health can also go a long way. Many people see therapists or psychiatrists for what are considered major mental health issues, but others seek out and are open to treatment in order to gain understanding about how to best cope with situations, gain support for issues they are dealing with, and prevent further progression of what is currently manageable. Gaining an awareness of how your mental health and physical health have an interplay and addressing both can help you be your own best health manager, as well as help you live a life not totally consumed by health issues.

References:

  1. Linda Chuang, MD. Mental Disorders Secondary to Medical Conditions. Medscape Reference Drugs, Diseases, and Procedures. Updated March 15, 2012 http://emedline.medscape.com/article/294131-overview
  2. Katon, W. State of the Art: Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience. Vol 13 . No. 1 . 2011 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181964/pdf/DialoguesClinNeurosci-13-7.pdf
  3. Cassano, P., Fava, M. Depression and public health, an overview. Journal of Psychosomatic Research, 2002; 53:849–857.
  4. Katon, W., Ciechanowski, P. Impact of major depression on chronic medical illness. Journal of Psychosomatic Research, 2002; 53:859–863.

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • gemma

    gemma

    June 19th, 2014 at 1:24 PM

    I think that my mom is depressed since she found out that she has MS.
    She has not been like herself since that day and it is almost like she has lost the will to try to fight this.
    What can I do to help her? I think that she thinks that I am being critical of her when I try to offer up suggestions or try to talk to get her mind off of it for a while.
    I know that this has been a life changing diagnosis for her, it has been for all of us but we want to help and all she does is shut us out.

  • Karen Bernardes LCSW

    Karen Bernardes LCSW

    June 20th, 2014 at 10:23 AM

    Hi Gemma,
    I’m sorry to hear that your Mom is struggling. It’s saddens me to hear when someone is struggling more than they have to under already very difficult circumstances. I would recommend sharing this article with your mother and others in the family to gain a better understanding of the ‘normalcy’ of what she’s experiencing. When we are depressed it’s a very isolating event and can feel like you’re the only one who’s ever felt this way even if the person doesn’t have a negative bias towards depression or other mental health symptomology. If she is on a standard course of medications they may be contributing to her depression as it is in the side effect profile for MS drugs. Talk therapy may be a great place for her to address the emotional impact of her symptoms and to address the grieving that may come with her major health condition. If that is not suffice the therapist or the neurologist will likely address it through medications which are effective in managing depression and can allow her to be in a better emotional postion to address her issues in talk therapy. Meds alone are often not all a person needs as it will address the neurochemical issues but not the person as a whole and all that comes with a major life change. There are some great resources out there for increased support for both Mom and your family. I’d recommend the local MS Society chapter. Lastly, if Mom is willing to talk with a therapist I’d recommend GoodTherapy.org as a starting point and using the option of Chronic Illness/Chronic Pain in her search to find a good fit.

  • Isaac

    Isaac

    June 19th, 2014 at 2:06 PM

    Sometimes it is easier to understand the maladies that we can see, the physical ones, far better than we understand the ones that cause you to hurt on the inside. No one can see and understand that kind of pain unless they have experienced it for themselves and when they haven’t there is a tendency to just want to dismiss whatever it is that the other people could be feeling. It is a wake up call for many to really pay attention to what others are feeling and imagine how you would feel if this was something that you were dealing with personally. If you can do that and put yourself in their shoes then it may be easier to understand that pain that they are going through.

  • Karen Bernardes LCSW

    Karen Bernardes LCSW

    June 20th, 2014 at 10:32 AM

    I agree 110%. Anyone who has ever experienced pain or have an illness where they look healthy on the outside but struggle on the inside would also agree.

  • Katrina

    Katrina

    June 19th, 2014 at 10:41 PM

    Thank you for that great step by step approach! These are things that medical doctors don’t seem to walk you through or warn you of so when it happens its even worse because you think something is wrong with you only. Its very alienating. So thank you for writing this!

  • Karen Bernardes LCSW

    Karen Bernardes LCSW

    June 20th, 2014 at 10:29 AM

    Your very welcome and thank you for your feedback. I hope to help to change this part of the culture and be a resource for those who are going through this process. As a positive of the Affordable Care Act medical providers are being strongly encouraged to address the issues of mental health along with the physical so I hope the future will hold much hope and decreased struggling for many. In my work I’ve always found that the sooner emotional health is addressed the easier it is to address everything else that comes with the struggle of life changing events. Everything just becomes so much harder of a hurdle when dealing with depression or anxiety.

  • bonnie s.

    bonnie s.

    June 20th, 2014 at 4:14 AM

    Many medical providers don’t take the time with their patients, even the chronically ill ones, that they probably should.

    They are rushed, they have a lot of people to see, and most of them lack the bedside manner that one needs at a time like this. It is important to have all of your questions for him or her written down so that you don’t forget and feel rushed through your appointments.

    Even if they are giving you the best medical care, are they giving you the best care overall that hits on everything that you are experiencing? If not it is ok to ask for a referral to someone else who may can help to fill in some of the gaps.

  • Karen Bernardes LCSW

    Karen Bernardes LCSW

    June 20th, 2014 at 10:30 AM

    Exactly

  • jen

    jen

    June 21st, 2014 at 5:57 AM

    It is too bad that many people also start going through depression when they are diagnosed with another illness because this has to feel like they have been given a doubl whammy, so there is even more of that feelling of why is this happening to me?
    There will never be any easy answers to this, we have to look at it as things happen for a reason, and some reasons we may never know. It is not our job to even pretend to know them.
    What we can do, though, is try to help this person through it all, help them when they need it and back off some when they don’t/ Meddling where we are not wanted will not help things.

  • Stefanie

    Stefanie

    June 23rd, 2014 at 4:16 AM

    I really do think that things are changing a lot more in the medical community than what some are giving credit for. There are a whole lot more providers today who look at health from a holistic stance instead of only inside the small little box in which they have been practicing . They know now that this is not only going to impact your physical health but I think that more and more understand that there are going to be other situations too that will need to be addressed. They see that if you work on healing the whole person instead of simply this one aspect of the person then the likelihood that the patient is going to show more improvement is substantial. This has become a rallying cry of sorts for many in the medical community and I am positive that there are many patients who are now benefiting from this school of thought.

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