Depression is often triggered or worsened by some traumatic or stressful event. Few things in life are more traumatic and stressful than receiving a diagnosis of a serious, chronic or potentially terminal illness. Take cancer. Upon receiving a diagnosis of cancer, 40 percent of patients experience significant distress, which can include panic attacks, depression and post-traumatic stress disorder, according to the Anxiety and Depression Association of America.
Or take a chronic and potentially debilitating disease like diabetes or rheumatoid arthritis. Those patients are six times more likely to develop depression than people without these illnesses, the ADAA reports. Indeed, anyone facing a lifetime of chronic pain, cardiac or respiratory disease, and other such health issues may experience increased levels of depression and anxiety. “The possibility and probability of someone suffering a serious disease and getting depressed is pretty high,” says Michael D. Yapko, a clinical psychologist, author and lecturer on depression. “It is never something someone will be indifferent to, especially when facing death.”
[See: Am I Just Sad — or Actually Depressed?]
Dr. Michelle Riba has made a career out of helping such people. A professor in the department of psychiatry at the University of Michigan, she is also director of the PsychOncology Program at the University of Michigan Comprehensive Cancer Center and director of the university’s psychosomatic medicine fellowship. Psycho-oncology is a fairly new subspecialty that deals expressly with the mental health of cancer patients. Psychosomatic medicine works with other types of diseases — but, she adds quickly, “No one likes the name ‘psychosomatic medicine,’ because it sounds like a made-up disease, so we are in the process of changing it to ‘consultation-liaison psychiatry.'”
Whatever it’s called, this branch of mental health care plays an ever more important role in depression treatment. As more people are diagnosed with serious illness, due to an aging population and more precise diagnostics, and are forced to face their own mortality or to live with a lifelong disease, these providers are offering a critically valuable service. “It is important to treat [mental health issues] because it impacts on the ability of the patient to adhere to treatments, to make decisions and to have a good quality of life,” Riba says.
When to Seek Help
It’s both normal and understandable that someone with a serious disease would feel depressed to some degree. But that shouldn’t have a dramatic, deleterious effect on daily functioning, Riba says. “It is not normal to have major depression. We want to look at the range of this and how it impacts on quality of life, and decide when we want to intervene.”
Patients themselves are justifiably worried about their psychological health. “While their doctors are focused on their physical well-being, many patients become highly concerned with their own mental well-being,” the ADAA notes. “Patients want to find as much joy and meaning as possible given their difficult circumstances. They realize from hard experience that just following the doctor’s orders or reading up on stress management does not automatically lead to feeling well.”
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
The ADAA says the following symptoms should prompt patients or their caregivers to seek out professional mental health care:
— Anxiety attacks about upcoming treatments or prognosis.
— Avoiding treatment because of extreme anxiety or sadness.
— Chronic nightmares or negative thoughts about the diagnosis or its treatment.
— Sleep disruption from stress.
— Thoughts of suicide because life seems worthless or the pain is too great.
— Feeling unable to talk about your feelings with others.
— Avoiding socializing because of your illness.
— Feeling shame or blaming yourself about your condition.
— Losing pleasure from formerly enjoyable activities.
Treatments May Be Different
Specialists in psycho-oncology have screening guidelines to evaluate all cancer patients for stress and depression and to recommend treatment, based in part on a landmark 2008 report from the Institute of Medicine called “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.”
And those treatments may be different for patients with another coinciding disease. “Take for example a woman with stage 4 breast cancer,” Riba says. “She may have a lot of overlapping symptoms. She may lose weight from cancer treatments or gain weight on steroids, she may have trouble sleeping, be in pain, worried about the future, unable to function, and may feel guilty about it all. These are cardinal symptoms for being depressed even without breast cancer. Sometimes it is difficult to tease out what is related to the medical condition and treatment, and what is related to depression or anxiety.”
To do so, she learns about any past history of depression, and works with the patient’s oncologist and pharmacist to coordinate care, especially with antidepressant medications that may interfere with other medications, such as tamoxifen, a common breast cancer medication, or blood thinners for cardiovascular disease, which may have adverse interactions with depression meds.
Psychotherapy is also recommended for the patient and his or her family and caregivers. “There is a tendency with a terminal diagnosis to ruminate about what life means, to ask cosmic questions that are simply not possible to answer,” Yapko says. “Rumination is one of the most powerful driving forces of both depression and anxiety.” Therapy, he says, can offer a different perspective to such questions and reduce the anxiety they provoke. “You want to be reflective, but there has to be a limit in how many times you ask the question. Research on rumination is so valuable in recognizing that there is an upper limit to how much thinking is good for you until it turns bad for you.”
[See: How to Find the Right Mental Health Professional for You.]
If physical health deteriorates, Riba and her colleagues may even make house calls and work with visiting nurses or hospice and palliative care providers to help manage treatment. She says that most major cancer centers around the country are ready to help patients find mental health care; if there are none nearby, the National Comprehensive Cancer Network posts links to specialists and patient-friendly guidelines to follow.
“Patients often don’t want to talk about this with their doctor, but it is a very important part of care,” Riba says. “Many patients tell me the emotional aspects of cancer are the hardest to deal with. We want to help people through this journey.”
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Coping With Depression When You’re Terminally Ill or Have a Serious Disease originally appeared on usnews.com