Medical Problems and Mood
Medical Problems and Mood
Certain medical problems are linked to lasting, significant mood disturbances – either the sadness or loss of pleasure typical of depression or the elation or hyperirritability seen in mania. In fact, medical illnesses or medications may be at the root of up to 10% – 15% of all depressions.
Among the best-known culprits are two thyroid hormone imbalances. An excess of thyroid hormone (hyperthyroidism) can trigger manic symptoms. Hyperthyroidism occurs in about two and a half million Americans. Hypothyroidism, a condition in which your body produces too little thyroid hormone, often leads to exhaustion and depression. This imbalance affects more than nine million Americans.
Heart disease has also been linked to depression, with up to half of heart attack survivors reporting feeling blue and many having significant depression. Depression can spell trouble for heart patients: It's been linked with slower recovery, future cardiovascular trouble, and a higher risk of dying within about six months. Although doctors have hesitated to give heart patients older depression medications called tricyclic antidepressants (TCAs) because of their impact on heart rhythms, newer drugs such as selective serotonin reuptake inhibitors (SSRIs) seem safe for people with heart conditions.
The following medical conditions have also been associated with mood disorders:
- degenerative neurological conditions, such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, and Huntington's disease
- stroke
- some nutritional deficiencies, such as a lack of vitamin B12
- other endocrine disorders, such as problems with the parathyroid or adrenal glands that cause them to produce too little or too much of particular hormones
- certain immune system diseases, such as lupus
- some viruses and other infections, such as mononucleosis, hepatitis, and HIV
- cancer
- erectile dysfunction in men.
When considering the connection between health problems and depression, an important question to address is which came first, the medical condition or the mood changes. There is no doubt that the stress of having certain illnesses can trigger depression. In other cases, depression precedes the medical illness and may even contribute to it. To find out whether the mood changes occurred on their own or as a result of the medical illness, a doctor carefully considers a person's medical history and the results of a physical exam.
If depression or mania springs from an underlying medical problem, the mood changes should disappear after the medical condition is treated. If you have hypothyroidism, for example, lethargy and depression often lift once treatment regulates the level of thyroid hormone in your blood. In many cases, however, the depression is an independent problem, which means that in order to be successful, treatment must address depression directly.
Clinical depression commonly accompanies general medical illnesses, although it is often undetected and untreated. In fact, while the rate of major depression among persons in the community is estimated to be between two to four percent, among primary care patients it is between five and ten percent, and among medical inpatients it is between ten and fourteen percent. An additional two to three times as many persons in these groups experience depressive symptoms.
Some studies have suggested that nearly 65% of all visits to primary care physicians involve emotional symptoms associated with psychological problems, with depression being the most common problem. Yet, very few primary care patients are referred for psychological treatment. For this reason, you should consult a psychologist when you have signs of depression, even after you consult your family physician. Research suggests that recognition and treatment of co-occurring depression may improve the outcome of medical conditions, enhance your quality of life, and reduce the degree of pain and disability experienced by the medical patient.
Recently, there has been research suggesting a better recovery rate from many serious illnesses, when psychological treatment is offered as well as medical treatment. This makes a lot of sense, since a serious medical condition can easily result in a reactive depression. There has also been some research that suggests that psychological distress can reduce the effectiveness of your natural immune system, making it more difficult for your body to fight disease. While conclusive evidence of all of these factors is not yet available, there is enough evidence to suggest that psychological treatment may be a benefit to your health, in addition to any medical treatment.
