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| Co-Occurrence Of
Depression With Medical, Psychiatric and
Substance Abuse Disorders
Depression is a common, serious and costly
illness that affects 1 in 10 adults in the U.S. each year, costs the
Nation between $30-$44 billion annually, and causes impairment, suffering
and disruption of personal, family, and work life. Though a majority of
depressed people can be effectively treated, two out of three of those
suffering from this illness do not seek or receive appropriate treatment. Of particular significance, depression
often co-occurs with medical, psychiatric, and substance
abuse disorders. When this happens, the presence of both illnesses is
frequently unrecognized and may lead to serious and unnecessary
consequences for patients and families. When depressive illness is a co-occurring
condition, it should be treated. With treatment, up to 80% of those with
depression can show improvement, usually in a matter of weeks. Common
interventions include a range of antidepressant medications, focused
short-term psychotherapy, or a combination of the two. The rate of major depression among those
with medical illnesses is significant. In primary care, estimates range
from 5 to 10 percent; among medical inpatients, the rate is 10 to 14
percent. Depressed feelings can be a common reaction to many medical illnesses. However, depression severe enough to receive a psychiatric diagnosis is not the expected reaction to medical illness. For those reasons, when present, specific treatment should be considered for clinical depression even in the presence of another disorder. Facts on Depression and Cancer: Each year, more than 1.3 million Americans are diagnosed with cancer. Receiving such a diagnosis is often traumatic, causing emotional upset, sadness, anxiety, poor concentration, and withdrawal. Often, this turmoil begins to abate within two weeks, with a return to usual functioning in about a month. When that doesn’t happen, the patient must be evaluated for clinical depression, which occurs in about 10% of the general population and in about 25% of persons with cancer. Early diagnosis and treatment are important because depression adds to a patient’s suffering and interferes with his or her motivation to engage in cancer treatment. Facts on Depression and Heart Disease: Depression affects nearly 10% of adults in
the U.S. each year. Studies show that depression strikes cardiac patients
at a significantly higher rate and often with devastating consequences. Among patients with coronary heart disease,
depression occurs in 18-20 percent of those who have not had a heart
attack (myocardial infarction) and in 40 and 65 percent of those with a
history of heart attack. Major depression appears to increase
disability in heart patients, perhaps because it can contribute to a
worsening of symptoms as well as to poor adherence to cardiac treatment
regiments. In addition, heart attack survivors with
major depression have a 3-4 times greater risk of dying within six months
than those who do not suffer from depression. The good news is that treating depression when it occurs in heart patients can minimize or avoid some of these serious health consequences. Facts on Depression After a Stroke: There are currently about 3,000,000 stroke
survivors in the U.S., and each year an additional 400,000-550,000 people
will suffer a stroke. Clinical depression occurs in 10-27 percent of
stroke survivors. The average duration of major depression in
stroke patients is just under a year. An additional 15 to 40 percent of
stroke survivors will have some of the symptoms of depression within two
months following the stroke. Early diagnosis and treatment of co-occurring depression are important because this second illness adds to a patient’s suffering, interferes with rehabilitation and family relationships, and reduces quality of life. Depression Co-occurs with Psychiatric Disorders: A higher than average co-occurrence of
depression with other psychiatric disorders, such as anxiety
and eating disorders has been
documented. Concurrent depression is present in 13
percent of patients with panic
disorder. In about 25 percent of these patients, the panic disorder
preceded the depressive disorder. Between 50 and 75 percent of eating disorder patients (anorexia nervosa and bulimia) have a lifetime history of major depressive disorder. In such cases, detection of depression can help clarify the initial diagnosis and may result in more effective treatment and better outcome for the patient.
Depression Co-occurs with Substance Abuse Disorders: Substance
abuse disorders (both alcohol and other substances) frequently
co-exist with depression. Substance abuse disorders are present in 32 percent of individuals with depressive disorders. They co-occur in 27 percent of those with major depression and 56 percent of those with bipolar disorder. Substance use must be discontinued in order to clarify the diagnoses and maximize the effectiveness of psychiatric interventions. Treatment for depression as a separate condition is necessary if the depression remains after the substance use problem is ended. Treatments Antidepressant
Medications: Several types of antidepressant medication are effective,
none of them are habit-forming. Most side effects can be eliminated or
minimized by adjustment in dosage or type of medication, so it is
important for patients to discuss all effects with the doctor. Because
responses differ, several trials of medicine may be needed before an
effective treatment is found. In severe depression, medication is usually
required and is often enhanced by psychotherapy. Psychotherapy: Interpersonal Therapy and
Cognitive Behavioral Therapy have also been shown to be effective in
treating depression. These short-term (10-20 weeks) treatments involve
talking with a therapist to recognize and change behaviors, thoughts, or
relationships that cause or maintain depression and to develop more
healthful and rewarding habits. Electroconvulsive Therapy: Electroconvulsive therapy (ECT) is a safe and often effective treatment for severe depression With permission from: National Mental Health Association |
