Back in the day, the words of a popular song went something like, “life is just a bowl of cherries.”
I don’t know whose life the songwriter was describing. Those words sure don’t describe my life, and I suspect they don’t describe yours either. Life has lots of high points, even days when life does feel like a bowl of cherries. But there are other days, when life is pretty hard, and the challenges overwhelming.
When one down day seems to follow another, when you just aren’t feeling a whole lot of enthusiasm for life… well, that can be a sign of depression.
Depression and Chronic Conditions Can go Hand in Hand
Now, let’s talk about the connection between chronic conditions and depression. Recent research has shown that there is a clear connection between chronic conditions and depression symptoms. Depression can result from the limitations that chronic conditions can impose on your life, the daily responsibilities of managing your condition, as well as stress that arises along the way.
When untreated, depression can actually cause the symptoms of conditions like diabetes and heart disease to progress more rapidly, resulting in a poorer prognosis. People who are experiencing depression don’t always feel like taking the best care of themselves, and this can affect self-care and compliance.
So why aren’t physicians always identifying and treating depression? There are a few reasons. For one, their patients don’t always tell them about depression symptoms. Patients may feel like it’s “normal” to feel down, given the challenges they are facing. And for better or worse, physicians may make the same assumption about their patients. Also, the symptoms of depression and chronic conditions, like lack of appetite and fatigue, can overlap, so that doctors may assume the depression symptoms are the result of the chronic condition and not depression.
Here’s something else to consider: Patients with chronic conditions may also go through times of “distress” when their symptoms and/or their self-care regimen feel especially challenging. Distress, which can lead to feelings of frustration and sadness, is temporary, and may gradually subside when the patient gets some emotional support. Depression on the other hand, just kind of hangs around.
So if patients and their doctors aren’t talking about emotions on a regular basis, it’s easy to see why there may be assumptions on both sides and, as a result, symptoms of depression may be overlooked.
I am not trying to paint a bleak picture here. Instead, I want to inform you and encourage you to keep an eye out for depression in yourself and in others. The good news about depression for people living with chronic conditions is that when depression is treated, not only is quality of life improved, but treatment can also have a positive impact on disease progression.
But to experience that good news, it’s really important to take the first step. If you suspect you could be experiencing depression, here are some ideas to consider:
Be aware of the symptoms. The symptoms of depression are too numerous to list here, but some of the key symptoms include lack of energy, lack of interest in activities you normally enjoy, difficulty concentrating, changes in eating or sleeping patterns, feeling sad, feeling hopeless, low self-esteem, and other symptoms. As I mentioned previously, depression symptoms don’t go away on their own. If you are experiencing one or more of these symptoms daily, for a couple of weeks or more, then you may be experiencing depression.
Make a list and bring it to your doctor. You might want to consider keeping a journal of what’s going on with you emotionally. Any symptoms you are experiencing, what kinds of thoughts you are having, along with how often you feel or think this way. Make an appointment with your doctor and go through your list with him/her. Ask your doctor if he/she is comfortable talking about depression and if they can recommend treatment. And if not, ask for a referral to where you can get help. (Some internists would prefer to refer patients to a psychiatrist or other mental health professional.)
Also consider reaching out to a mental health professional. You may want to make your own connection with a therapist or a counselor. Ask a friend for a recommendation, check out your local community mental health resources, or get a list of mental health professionals through the website of your insurance company.
Most important, get support. Don’t go through this alone. Talk to a supportive friend or family member. Or with a member of the clergy. Gather people around you who can listen without judging you or trying to tell you what to do.
If you have a friend or family member who you are concerned about, here are some ideas:
Express concern. Find a time when the two of you can talk alone. Let them know that you are concerned about them and want to offer your help.
Be specific. Make sure the person you are concerned about is aware of what is causing your concern. Tell them what you have observed, any depression symptoms you have noticed, as well as any changes you have seen over time that seem out of the ordinary. You might want to recommend a website, such as mayoclinic.com, that offers information on depression.
Offer to support them in any way you can. This might include being willing to lend a listening ear. Or to help them find resources for help with depression. Or even to accompany them to a doctor’s appointment or to a session with a mental health professional.
Don’t push it. Be careful about being perceived as “diagnosing” the person you are trying to help. You can express the concern that the symptoms you have observed could be related to depression but be careful about being perceived as having diagnosed them yourself. That can result in defensiveness. And if the other person doesn’t want to have this discussion, then respect their wishes, though you may want to say that you are there for them if they want to talk further.
When the going gets tough… Depression is treatable. If you think you may be depressed, reach out for help. If you think someone you care about may be depressed, offer to help them find help. We’re all in this together.