Depression

Lesson 7: Depression and Other Illnesses

Depression is a partner in crime with heart disease, diabetes, substance abuse, and numerous other ills. This lesson explores those connections and advises what you can do to avoid double jeopardy.

Introduction, Heart Disease, Diabetes, Cancer, Stroke

Two of the most common misconceptions about depression is that it is all in the mind, and is nothing more than a low mood or a bad case of the blues. One may as well declare an El Nino or La Nina a mild warm front. Depression amounts to a full-scale attack on everything that holds body and mind in place, leaving in its wake a trail of wreckage and destruction that points to nothing less than a biological hurricane raging through every process we associate with human activity:

Circadian rhythms are thrown out of whack, along with psychomotor function, appetite, and cognition. Bodily functions are disrupted, resulting in fatigue, poor sleep, lack of concentration, and loss of motivation, and more. Scientists are now beginning to uncover the links between depression and heart disease, depression and diabetes, depression and cancer, and depression and stroke - amongst others - and what they are finding suggests a cruel illness going to work in a variety of insidious ways, all with the power to kill:

Heart Disease

According to a Montreal Heart Institute study, depressed patients with heart attacks are four times more likely to die within six months as their non-depressed counterparts. A Washington University study found that depressed people with newly-diagnosed heart disease are twice as likely to have a heart attack or require bypass surgery. A recent Johns Hopkins study concluded that those who are depressed are four times more likely to have a heart attack within fourteen years.

Eighteen percent of heart patients are depressed at any given time compared to low single figures for the general population. Unbelievably, the possibility of depression is rarely addressed by the physicians who treat heart disease. In one study, almost none of the patients were accurately diagnosed or treated with antidepressants over a seven-month period - this despite the fact that heart patients respond well to SSRIs and are safe for them to take.

Some scientists theorize heart disease is the result of bad lifestyle choices a depressed person makes. Others think it's a result of stress, which we will discuss later. The likely answer is a combination of the two.

Diabetes

Diabetes findings are equally as depressing: A Kaiser Permanente study discovered that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84 percent of diabetics also reported a higher rate of earlier depressive episodes. While depression affects maybe three or five percent of the population at any given time, the rate is between 15 and twenty percent in patients with diabetes, according to the American Diabetic Association.

Whether a cause or an effect, the combination of diabetes and depression can be deadly. "One plus one equals much more than two when you add diabetes and depression," says Patrick Lustman, PhD, professor of medical psychology in the department of psychiatry at Washington University School of Medicine in St Louis. "Because of physiologic and behavioral interactions between diabetes and depression, each becomes more difficult to control, increasing the risks of cardiovascular disease, diabetic retinopathy causing blindness, neuropathy and other complications."

Lustman also mentions obesity as a risk factor for macrovascular disease. Unfortunately, depressed people tend to eat more and exercise less, which results in weight gain and sabotages efforts at controlling blood sugar levels. One study found that depressed adults with diabetes had significantly higher body mass indexes than nondepressed adults with diabetes.

A recent study found Prozac not only lifted depression in depressed diabetics, but also demonstrated a significantly greater improvement in blood sugar levels.

Cancer

A National Institute of Aging study found that chronically depressed people were 88 percent more likely to develop cancer. Scientists are a long way from figuring out how a chemical storm in the brain may result in a tumor elsewhere in the body. It could be that genes and environment are the actual causes, with depression acting as the trigger, or it may be that a low mood of long duration suppresses the body's immune system, allowing cancer cells to flourish. But unless future research starts turning in consistent results, we cannot say for sure if depression is a cause or trigger of cancer.

We do know this for a fact, however: About 25 percent of cancer patients will experience major depression over the course of their illness. People with cancer are three times more likely than the general population to develop depression, and twice as likely as other hospitalized patients. The greater the pain, the more likely the depression.

Ironically, owing to the intensely horrific nature of cancer, not to mention its treatment, it is not uncommon to dismiss a patient's depression or suicidal ideation as normal. "I'll throw myself out the window if I have to go for chemo one more time," sounds perfectly appropriate coming from a person who has been through far too much, already. As a result, many physicians do not look for depression, or assume that because depression is a normal reaction to cancer, it does not merit treatment.

This is sort of like assuming that because bleeding is the result of being stabbed, the wound does not have to be stanched.

Stroke

Those who experience major depression increase their risk of stroke by 73 percent, according to a two-decade study by the Centers for Disease Control.

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