Mental health & chronic diseases (31.01.2018)
Today’s a special day in Canada, a day that has been dedicated to raising awareness of (and money for) mental health. It started as something of an experiment by one of our largest telecommunications companies, Bell Canada, in 2011 and has grown to a national event.
For every tweet/retweet using the #BellLetsTalk hashtag today, or view of a FaceBook video, etc., Bell Canada will donate 5¢ to mental health initiatives. I know, it doesn’t seem like much. But last year they raised over $6.5 million, in just one day!
To find out how to participate – to reduce stigma and to raise both awareness and money – visit: https://letstalk.bell.ca/en/bell-lets-talk-day
So I thought this would be a good day to write about mental health and chronic diseases. We focus so much on the disease itself that its mental health impact is often forgotten. By patients, as well as by our physicians and other healthcare team members.
This really struck me when I went to my (new) patient evaluation day at a multidisciplinary pain management unit (PMU), based at a large university-hospital centre. This was back in 2016, about 6 months after my rare disease diagnosis (which took 3 months from disease onset, but that’s another story!).
At the time, I thought it was odd that one of the first assessments I had that day – as a new patient at this PMU – was a mental health assessment. Since then, in my reading/research into rare diseases and chronic pain diseases, I’ve realized that “The complex interrelationship between depressive disorders and chronic disease has important implications for both chronic disease management and the treatment of depression.”(1)
Why, or how, could a chronic disease lead to depression? An interesting medical journal article in 2011 said that: “biological changes and complications associated with chronic medical disorders may precipitate depressive episodes”(2). That the changes to a person’s body (including the brain) caused by a chronic disease could cause bouts of depression.
This is important for the treatment plans of people with chronic diseases, because depression “can worsen their associated health outcomes”(3). I’ll use Chronic Regional Pain Syndrome (CRPS, also called RSD or Reflex Sympathetic Dystrophy) as an example. It’s a rare & chronic disease of multiple symptoms and extreme pain.
A medical journal article last year, on CRPS, said that: “Chronic pain affects the health-related quality of life and places a huge emotional and psychological burden on patients. Thus, it is essential for newly diagnosed patients with CRPS to have a discussion with a psychological care provider regarding their condition and its progression as well as the need for active self-management and participation in a care plan.”(4)
And this is true for many other chronic diseases that cause high-level and long-term pain. Over 25 years ago it was “widely recognized that an appreciable proportion of chronic pain patients have depressive disorders.”(5) That statement is from an article in a medical journal, the Clinical Journal of Pain.
I’ve been lucky, and have been spared the mental health issues that so often accompany chronic diseases. I don’t know why, but I’m volunteering in a research project with some physicians who’re trying to find out; in the hopes that someday the results of the research will be able to help other people.
In the meantime, if you have a chronic disease and are dealing with mental health issues, what can you do? This is where I’m going to say that I’m not a doctor, and this isn’t medical advice! These are just my suggestions…
If you’re in crisis, call a mental health hotline or ask family member or trusted friend for help – get help now!
First off, talk to your physician: “Depressive disorders and their concomitants are an integral part of the experience of chronic pain and are important in developing an optimal treatment plan. For these reasons, they should be carefully evaluated in all patients with chronic pain.”(5)
In many cases your doctor will be able to refer you to a healthcare professional who can help. Some of the possible therapies for depression (using CRPS as an example again) are: “cognitive behavioural therapy, learning relaxation skills and biofeedback to facilitate rehabilitation, reduce pain intensity and provide patients with more control”(4) and medications for the depression itself.
And as counter-intuitive as it may seem, exercise can help. “Individuals with chronic pain conditions may exhibit systemic inflammation as a result of their condition or due to comorbid diseases. Physical activity is known to mitigate cellular inflammation.”(6) So exercise can help to deal with chronic pain, which might be one of the causes of depression.
For depression alone: “The mechanisms underlying the antidepressant effects of exercise remain in debate; however, the efficacy of exercise in decreasing symptoms of depression has been well established.”(7) Again, talk to your doctor before you start any exercise program, especially if you haven’t been exercising regularly for a while and have a medical condition!
Good luck, and remember; you’re not alone.
(1) Chapman, Daniel P, Geraldine S Perry, and Tara W Strine. “The Vital Link Between Chronic Disease and Depressive Disorders.” Preventing Chronic Disease 2.1 (2005): A14. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1323317/
(2) Katon, Wayne. “Epidemiology and Treatment of Depression in Patients with Chronic Medical Illness.” Dialogues in Clinical Neuroscience 13.1 (2011): 7–23. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181964/
(3) Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. “Depression, chronic diseases, and decrements in health: Results from the World Health Surveys”. Lancet. 2007 Sep 8;370(9590):851-8. Web: https://www.ncbi.nlm.nih.gov/pubmed/17826170
(4) Goh, En Lin, Swathikan Chidambaram, and Daqing Ma. “Complex Regional Pain Syndrome: A Recent Update.” Burns & Trauma 5 (2017): 2. PMC. Web. 31 Jan. 2018. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244710/
(5) Dworkin RH, Gitlin MJ. “Clinical aspects of depression in chronic pain patients”. The Clinical Journal of Pain [01 Jun 1991, 7(2):79-94]. Web: http://europepmc.org/abstract/med/1809423
(6) Ambrose, Kirsten R., and Yvonne M. Golightly. “Physical Exercise as Non-Pharmacological Treatment of Chronic Pain: Why and When.” Best practice & research. Clinical rheumatology 29.1 (2015): 120–130. PMC. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534717/
(7) Craft, Lynette L., and Frank M. Perna. “The Benefits of Exercise for the Clinically Depressed.” Primary Care Companion to The Journal of Clinical Psychiatry 6.3 (2004): 104–111. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/