Nearly 6.7 percent of Americans are diagnosed with major depressive disorder. It’s a serious mental illness that interferes with daily activities and can significantly reduce quality of life.
Patients with heart disease and other chronic conditions such as diabetes are at very high risk for developing depression. According to some studies, up to 30 percent of patients with a serious medical condition demonstrate symptoms of depression.
Depression in patients with a chronic disease is associated with higher healthcare costs and increased use of medical services.
Data from numerous trials on congestive heart failure (CHF) patients has shown that depression leads to increased hospital admissions and worse outcomes. With CHF, patients’ heart muscle is weakened, resulting in the accumulation of fluid in the abdomen, lower extremities and lungs (also called edema).
Ultimately, CHF results in shortness of breath and other serious cardiovascular symptoms.
Depression is highly prevalent in patients with CHF, affecting 20 to 40 percent. Depression can result in loss of motivation, loss of interest in everyday activities, lower quality of life, loss of confidence, and sleep disturbances.
The most effective way to manage CHF requires strict patient engagement and meticulous involvement in daily care. But when patients are depressed, their level of participation in daily disease management suffers; lack of energy and loss of interest significantly hampers their ability to remain complaint with medications.
Moreover, depressed patients are much less likely to report changes in symptoms to their family or healthcare providers. When patients with CHF ignore their symptoms, they can become seriously ill and require hospitalization.
Such admissions for CHF exacerbations can sometimes be avoided by early intervention at home
A study presented at the European Society of Cardiology Congress in Spain, has linked depression with a fivefold increase in all-cause mortality.
In the study, researchers used surveys and questionnaires to assess depression in more than 150 patients hospitalized with CHF. They found that those who were not depressed were 80 percent less likely to die.
This study should serve as a call to action to anyone who has cardiovascular disease, along with their families and their healthcare providers.
As patients and families, we must be aware of the signs and symptoms of depression. We must reach out to those who are at risk and help them get appropriate therapy — either pharmacological or counseling — BEFORE depression becomes severe.
Unfortunately, symptoms of depression are often overlooked by both patients and families because symptoms of chronic illness (such as CHF) and depression frequently overlap.
In addition, symptoms of depression include can be indistinct, such as fatigue, insomnia, loss of appetite, and feelings of hopelessness. Physicians and other healthcare providers must be more attentive to at-risk patients who are fighting a chronic disease, and intervene early.
Recognizing and treating depression may be the difference in a patient’s outcome — particularly those with chronic heart disease.
While the latest study focuses on patients with congestive heart failure, it can be applied to all patients with heart disease. If we can affect patients with depression, we can impact their outcomes.
But, ultimately, much of the burden for preventing depression falls on the patient.
Keys to Preventing Depression
It is important for patients to keep in mind these ways to avoid depression:
• Do not isolate yourself. Reach out to friends and family. If you don’t have a support group, take steps to build one.
• Inform yourself about your condition. The more you know about your disease, the more empowered you will be.
• Surround yourself with healthcare professionals that you trust and that you have confidence in.
• If you feel depressed, get help from a professional. Do NOT wait.
• If you feel as though your medications are bringing you down, contact your doctor immediately.
Posts by Kevin R. Campbell, M.D.
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