Depression and Other Medical Conditions

Depression and Cancer

Mood and anxiety problems are very much associated with cancer and its treatment. Directed by Rebecca Tamas, M.D., the PsychoOncology Program provides services for patients and families who are being treated at the Brown Cancer Center at the University of Louisville. Comprehensive evaluations are performed which lead to treatment plans including psychotherapy and pharmacotherapy.

Depression and the Heart

Depression is a common risk factor for heart disease and can complicate recovery from a heart attack. Even minor depression is a significant risk for and appears to be related to future complications and even death. Depression is related to a number of heart related factors that can complicate and interfere with the patient's adaptation to and recovery from heart disease of all kinds. One way that depression may directly affect the heart is by actually altering how the heart and the whole cardiovascular system works in ways that tax the heart and help to speed up the disease pro

cess. Depression is also related to lifestyles that contribute to heart disease such as poor diet, lack of exercise, excessive alcohol or other drug use, and social isolation. Finally, depression has also been found to make recovery and rehabilitation harder for patients.

Importantly, depression is often under-identified and therefore under-treated in patients with heart disease. A number of things contribute to this.

First, many of the symptoms of depression (such as low energy, sleep problems, irritability, etc.) can also be symptoms of heart disease. Second, some "down" feelings experienced by heart patients may be considered by the patient or their doctor to be a normal reaction to a potentially life threatening situation. Finally and perhaps most importantly, having a diagnosis of depression unfortunately continues to carry a stigma, and it has been shown that many heart patients will refuse to admit they are depressed or may not even recognize depression in themselves.

Depression can be combated by a number of things that are also heart healthy.

• Exercise can not only strengthen the heart and cardiovascular system but can also improve body image, self esteem, mood and quality of life.
• Increasing supportive relationships with others can not only improve your mood but can have a strong impact on recovery and survival from heart disease.
• Substance abuse such as alcohol, recreational drugs and tobacco can alter mood and contribute to heart disease as well. Smoking is a significant contributor to diseases of the lungs but it also bad for the cardiovascular system. Alcohol and substance abuse can very directly contribute to depression and heart disease. However, alcohol has also been shown to have some therapeutic effect. Patients often have questions about whether they should avoid alcohol or use it as a part of treatment. Several things should considered if one wishes to explore this option further.
• One should never undertake the use of alcohol as part of a treatment program without the supervision of a physician.
• Excessive alcohol use is always bad for you.
• As a general rule there are other medications that can provide the same benefit with less problems than those posed by alcohol use.

How to take action

If you or a loved one is attempting to cope with depression (take an online screening test), heart disease or both, tell your doctor. Assessment of depression is relatively brief, painless and can be a self-educational experience even if it turns out you are not depressed. This website and your doctor can aid you in finding appropriate help.

Depression after Surgery

Depression and/or anxiety are often experienced after surgical procedures, at various times post operatively (immediately or months later). Intensity can range from mild dysphoria to major depressive symptoms. John Lauerman in the January 2000 issue of Harvard Magazine, addresses this topic in "An Understandable Complication...Coming to terms with postsurgical depression." The article talks about emotions before surgery as being expected and often handled quite well. Problems can also crop up in the recovery period which are not expected. After major surgery, according to the article “feelings of mortality, of loss, and of vulnerability can be profound." Shortly after surgery, depression can be attributed to pain, a problem with anesthesia, a sense of loss, or another underlying cause. Post-operative depression, well after the crisis of surgery, can make it difficult for patients to cope with what they have endured. There might also be uncertainty about the future, or lack of understanding on the part of individuals close to them. This article points out the importance of communicating feelings of depression to medical professionals who may not be alert to symptoms, in order to have all possible causes of depression investigated.

In the April 15, 1997 issue of Annals of Internal Medicine, Herbert Waxman, M.D. relates his experience with depression following surgery. In "The Patient as Physician," he discusses his post surgery symptoms. Occuring several months after surgery, he experienced "dysphoria, sleep problems, joylessness and feelings of unworthiness." When he returned to work, he realized the importance of honest communication and sensitivity to patient concerns and believes the experience made him a much better physician.

Adapted with permission from the University of Michigan Depression Center Web site.