What Is the Connection Between Chronic Illness and Depression?

Many people with chronic illness will experience depression. In fact, depression is one of the most common complications reported by people with chronic illnesses. According to the Cleveland Clinic, up to one-third of people living with a serious chronic disease will experience symptoms of depression.

It’s not difficult to see how the stresses of a chronic disease can trigger feelings of despair and sadness. Serious illnesses have significant effects on a person’s life and can limit a person’s mobility and independence. Additionally, the physical effects of chronic illness and the side effects of medications to treat the condition may also lead to depression.

Chronic Illness Defined

Chronic illnesses—also called chronic diseases— are conditions that last a year or more, require ongoing medical care, and limit a person’s activities of daily living. According to the Centers for Disease Control and Prevention (CDC), 6 in 10 American adults have a chronic disease, and 4 in 10 adults have two or more chronic conditions. Additionally, chronic conditions, such as heart disease, diabetes, cancer, and autoimmune diseases, are leading causes of death and disability in the United States.

Most chronic illnesses have the following characteristics:

• Originating from complex and, sometimes, unknown causes, such as is the case with autoimmune diseases
• Risk factors that increase a person’s chances of developing a condition, such as family history, poor diet, lack of activity, and cigarette smoking
• A latency period—the time that passes between the onset of an illness and feeling its true effects
• A long illness—by definition, a chronic disease is persistent, lasts for a long time, and/or is constantly recurring
• Functional impairment or disability

Most chronic illnesses are not curable, but they are treatable. Some, such as heart disease, can be life-threatening. Others, such as autoimmune arthritis conditions (lupus, rheumatoid arthritis, psoriatic disease, etc.) can linger and require thorough management.

Symptoms of Depression

Depression is a leading cause of disability and a fourth leading contributor to a global disease burden. According to the World Health Organization (WHO), 4.4% of the World’s population is living with depression. Additionally, the National Institute of Mental Health reports that depression is a common and serious disorder affecting how you feel, think, and handle daily activities, such as working, sleeping, and handling self-care. For a healthcare provider to make a diagnosis of depression, a person experiencing depression must have had symptoms for at least two weeks.

The symptoms of depression vary from person to person, but there are common symptoms associated with the condition.

Common symptoms of depression include:

• Depressed mood and/or loss of interest or pleasure in daily activities
• Weight gain or weight loss
• Sleeping too much or not being able to sleep
• Concentration troubles, including trouble with focus, making decisions and remembering things
• Lack of feelings or emotions
• Anger and/or irritability
• Feelings of worthlessness, hopelessness, or helplessness
• Extreme fatigue or lack of energy and motivation
• Unexplained aches and pains
• Thoughts of death or suicide

Diagnosing Chronic Illness-Related Depression

People with chronic illness and their family members often overlook depression symptoms, either assuming that feeling this way is typical for someone living with a chronic illness or that depressive symptoms are disease-related. Symptoms, such as fatigue, poor appetite, sleep issues, and concentration troubles are characteristics of both depression and many chronic diseases. This can make it harder to recognize and diagnose depression.

Your healthcare provider can make a diagnosis of depression by asking you specific questions about symptoms of depression you are experiencing and how long you have had them. They may also order lab work to rule out our conditions that may cause depressive symptoms, including anemia or vitamin deficiencies.

Chronic Illness-Depression Connection

The risk for depression in people with chronic illness increases based on the severity of the chronic illness and on the amount of disruption it brings to a person’s life. People with chronic illness have a two- to threefold risk for depression in comparison to others of the same age and gender without chronic conditions.

Research shows comorbid depression (depression existing with another chronic condition) is associated with additional disease symptoms of the chronic condition, functional impairments, high medical cost, lack of adherence to treatment, and increased risk for other conditions and mortality (shortened lifespan).

One study published in 2016 in the journal Quality of Life Research finds depression, stress, and other mental health conditions may negatively affect a person’s disease management more than the disease itself. The study’s researchers looked at quality of life and psychological health to determine how chronic illness impacted the overall wellbeing of over a million participants, broken down into 5 age groups over a six-and-a-half-year period. The study included people with no history of chronic disease and people living with a variety of health conditions, including chronic pain.

The results of the study suggest depression was associated with both a lower quality of life and a lower health-related quality of life. The researchers suggest psychological stress—a common complication of chronic disease—impacts a person’s life quality as much as, or potentially more than having a chronic illness.

Chronic Illnesses Leading to Depression

Depression has a complicated relationship with a variety of chronic medical conditions, including heart disease, inflammatory arthritis, diabetes, fibromyalgia, cancer, and more.

Heart Disease

Up to 20% of people with heart disease may experience depression. And according to the American Heart Association, up to 33% of people who have had a heart attack will become depressed. Additionally, the risk for heart disease is greater for people with depression and having depression can interfere with heart attack recovery.

Inflammatory Arthritis

People with inflammatory arthritis conditions, such as rheumatoid arthritis (RA), have a much higher risk for depression than others in the general problem. RA is also an autoimmune disease where the body’s malfunctioning immune causes inflammation that attacks the joints. The prevalence of depression in people with RA is around 19%, according to a 2019 report in Lancet Psychiatry. While the relationship between RA and depression is complex, the report’s authors speculate pain and fatigue are to blame for causing and exacerbating depression, and affecting quality of life, similarly to the way in which RA does.

Diabetes

The rate of depression in people with diabetes is around 25%. The combination of the two conditions presents a major challenge for managing and treating both conditions because each is worsened by the presence of the other. This means quality of life is worsened, diabetes self-management is impaired, and the potential for complications and reduced life expectancy is higher than it would be for someone who has diabetes alone.

Fibromyalgia

Fibromyalgia is a disordered characterized by widespread muscle pain, fatigue, sleep, and mood problems. Researchers estimate up to 40% of people living with fibromyalgia also have depression. It is believed the effects of pain and fatigue lead to depression in people living with this condition. A second theory is that depression is a symptom of fibromyalgia just as pain is. Regardless, having both conditions can interfere with the way a person manages activities at home and at work, and also has a negative effect on a person’s quality of life.

Cancer

Depression can affect up to 25% of people living with cancer. Researchers aren’t sure why a quarter of people with cancer get depressed, but they think this is related to immune system changes, genetics, or specific cancer types. Additionally, cancer treatments can lead to sleep problems, fatigue, and other side effects that can cause people with cancer to become depressed.

Treatment

Depression is one of the most treatable mental disorders, and up to 90% of people with depression respond well to treatment. Depression is treated mainly with psychotherapy, medicine, or a combination of both. Depression related to chronic disease or the side effects of medication used to treat the underlying chronic illness can be managed by adjusting disease treatments.

Psychotherapy

Psychotherapy, or “talk therapy," is used for treating mild depression and for moderate to severe depression, along with anti-depressant medications. It involves talking a psychiatrist, psychologist, or another mental health provider to learn about taking control of your life and responding to the challenges imposed by chronic illness through healthy coping. Depending on the severity of your depression, talk therapy sessions can take a few weeks or longer.

Medications

Brain chemistry can contribute to depression. It can also be a factor in treatment. Several different medications are thought to change the levels of certain brain chemicals. In fact, antidepressants can improve depressive symptoms within the first week or two of treatment. But full benefits many are not seen for several months. Your healthcare provider may adjust medication doses or offer a different treatment if you are not seeing improvement after a few weeks.

Preventing Depression

Depression and chronic illness create a vicious cycle because they feed off each other. Fortunately, there are things you can do to prevent depression and manage the challenges and stresses associated with chronic illness.

Focus on the positive: The more hopeful you are the more resilient can you be. Try to be optimistic about your treatment plan and try to keep your life as normal as possible. It also helps to be grateful for the people and things in your life that make you happy.

Learn from your experience: Pay attention to how disease treatments may affect you. Are they helping or are they causing unpleasant side effects? If they are not helping, causing ongoing side effects, or affecting your emotional health, talk to your healthcare provider before things get worse.

Expand Your knowledge: Learn everything you can about your specific chronic condition, including how to manage it and when to be concerned.

Participate in your life: Make sure you are finding time to do the things you enjoy doing. Spend time with friends and family and avoid self-isolating.

Stay active: Movement not only keeps you active, but it helps to improve your mood and reducing risk for depression.

Get support: Your friends and family can be a great source of comfort when you are struggling with your emotions towards chronic illness. And for the times when you cannot reach out to loved ones, support groups—either online or in-person—can be a great place to share your feelings and challenges, or simply allow you to be around others who understand your struggles.

Change what you can: There are things related to your illness you simply cannot change, but there are things you can. Depending on your condition, this may include things like regular exercise, eating healthy, regularly visiting your healthcare provider, following your practitioner's treatment advice, and avoiding unhealthy habits, such as smoking.

A Word From Verywell

Chronic illness-related depression is often overlooked. But this doesn’t have to be the case. If you or someone you love is living with chronic illness and experiences depressive symptoms, it is important to get help.

Depression isn’t an inevitable consequence of chronic illness or something you have to live with. Speak up, ask for help, and work with your healthcare provider to find the best ways to practice self-care, treat symptoms of your chronic illness, and reduce the risk for depression. Remember that even when it feels like your chronic illness is winning, you are still in control and very capable of managing your disease and living your fullest life.