Depression and Illness - ispog.org · illness, but has beneficial effects on quality of life: –...
Transcript of Depression and Illness - ispog.org · illness, but has beneficial effects on quality of life: –...
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Depression and Illness
Jonathan Schaffir, MDDept. Of Obstetrics and GynecologyOhio State University, Columbus, Ohio
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Objectives
• Appreciate how depression and illness may interact
• Discuss how treatment of illness may impact mood, and vice versa
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Depression
Illness
Depression and illness are highly interactive:They have separate but additive effects to adversely impact well-being
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Depression is more common in women with chronic medical illness
• Overall, depression affects 25‐33% of people with a chronic illness– Heart attack: 40‐65%– Parkinson’s disease: 40%– Multiple sclerosis: 40%– Cancer: 25%– Diabetes: 25%
Risk may be higher in those with a previous history of depression
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Why does illness lead to depression?
• Creates stress• Interferes with daily activities:
– Impairs independence– Limits mobility– Interferes with social interaction
• Affects self‐image/ self‐confidence• May cause despair/ lack of hope
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Chronic illness may involve pain
• Pain is a separate but related factor leading to depression
• 30‐54% of patients with chronic pain experience depression
• Those whose pain limits mobility and independence are most likely to be depressed
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Symptoms of illness can overlap those of depression
• Fatigue• Sleep changes• Appetite changes• Loss of energy
These factors may impact the assessment and diagnosis of the underlying disease
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Depression can affect the course of illness
• Depression increases the risk of various disorders:– Heart disease– Stroke– Irritable bowel syndrome– Parkinson’s disease– Dementia
Could be associated with less attention to healthy behaviors or compliance with healthcare
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How can depression influence the course of illness?
• Associated with decrease in certain markers of immune function
• Leads to delay in seeking medical care• In setting of pain, may involve suppression of neurotransmitters (5‐HT and NE) that also modulate sensation of pain
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What does this have to do with obstetrics & gynecology?
• Women suffer from depression at twice the rate of men
• Depression may impact the course of:– Gynecologic cancers– Infertility treatments– Chronic pelvic pain– Fetal development and neonatal behavior
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Treating illness
• May improve psychological well being:– Reduce pain– Improve outlook/ hope– Improve function and social interaction– Reinforces healthy behaviors
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Treating depression
• Does not necessarily directly affect course of illness, but has beneficial effects on quality of life:– Decreased perceived disability and fatigue– Improves social and emotional functioning– Relieves psychological suffering
• In chronic pain patients, antidepressant treatment may reduce intensity and severity of pain
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Conclusions
• Be sure to ask patients about their psychological well‐being as part of any medical assessment
• Include management of depression symptoms in the treatment of medical disease
• Appreciate that mental health is an important measure of quality of life as your patient deals with medical illness
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References
Goldberg D. The detection and treatment of depression in the physically ill. World Psychiatry 2010; 9: 16‐20.Meana M. The meeting of pain and depression: comorbidity in women. Canadian Journal of Psychiatry1998; 43: 893‐99.Musselman DL, Nemeroff CB. Depression really does hurt your heart: stress, depression, and cardiovascular disease. Progress in Brain Research 2000; 122: 43‐59.