Recognizing Depression in Patients with Chronic Illness
Research data shows a higher prevalence of depressive symptoms with chronic illness, with estimates ranging from 9.3% to 25%.
While there are many reasons a patient may develop depression, one explanation is that patients with chronic diseases face incredible challenges and disruptions to their daily activities.
Another reason for the increased risk of depression is medication side effects which may trigger feelings of depression.
Watch the Video: Recognizing Depression in Patients with Chronic Illness
The Importance of Staying Vigilant
Managing a chronic disease is a heavy burden for physicians who must constantly be on the lookout for new or worsening symptoms and medication side effects, not to mention treatment compliance.
With so many variables to consider, it’s easy to overlook signs of depression or attribute nonspecific symptoms such as fatigue, changes in appetite, and poor concentration as an inevitable part of the disease.
Treating depression positively affects biologic disease progression and severity indicators and can significantly improve the patient’s daily functioning.
Because treating depression in chronically ill patients offers such clear benefits, it’s of the utmost importance for physicians and other healthcare providers to say vigilant and identify early signs of depression.
What Are the Symptoms of Depression?
Depression can take many forms. Below are some common symptoms to look out for:
- Loss of interest or pleasure in daily or leisure activities
- Persistent feelings of sadness or anxiety
- Apathy – Feeling emotionally empty
- Persistent feelings of hopelessness
- Feeling guilty, worthless, helpless, or being a burden
- Behavioral changes – Irritability, restlessness, frustration
- Difficulty remembering, making decisions
- Thoughts of death or suicide
Watching Out for Overlapping Symptoms
Many chronic disease symptoms can also be depression symptoms, including:
- Changes in sleep patterns (sleeping too much or not being able to sleep)
- Decreased energy, fatigue
- Aches, pains, digestive problems
- Changes in appetite – unplanned weight loss or weight gain
- Difficulty concentrating
When physicians notice these signs or patients express concerns about these symptoms, it’s crucial to evaluate the situation and check for other signs of depression.
Screening for Depression
Although screening for depression is not typically part of chronic disease management, it may be beneficial to incorporate a more comprehensive view of a patient’s well-being.
The United States Preventive Task Force (USPSTF) recommends depression screenings for most adult patients.
Among the recommended screening instruments, we have:
- The Patient Health Questionnaire (PHQ)
- The Hospital Anxiety and Depression Scales in adults
- The Geriatric Depression Scale for older patients
A positive screening result requires additional assessment to determine the severity of depression and evaluate the risk for other mental health problems, including anxiety.
As a physician, if you suspect one of your patients may be experiencing depression, please consider referring them to a qualified healthcare provider.
Treatment Options for Patients
Evidence shows that treatment with tumor necrosis factor (TNF) inhibitors may reduce the risk of depression in patients with chronic pain, including those with Rheumatoid Arthritis (RA).
When disease symptoms are at the center of the patient’s depression, biologic infusion therapy should be considered to improve the patient’s quality of life.
Additionally, psychiatric or psychological therapy, antidepressant medications, and joining a support group should all be considered.