MEDICAL ILLNESS AND MENTAL HEALTH

A strong relationship exists between medical (a woman's physical health) and mental health conditions. Medical illnesses and numerous medical conditions often contribute biologically to the development of a mental illness. Medically ill women can develop a mental illness as a psychological reaction to a prognosis, the pain being experienced and any incapacities caused by the illness or its treatment.

The risk of a mental illness, most specifically depression and anxiety, is often higher in women with serious medical illnesses, such as heart disease, stroke, cancer and diabetes. Warning signs are frequently discounted by women and their family members, who mistakenly assume feeling depressed is normal for women struggling with a serious health condition. The symptoms of depression are frequently masked by the medical illnesses, resulting in treatment that addresses the symptoms but not the underlying depression. It is often assumed feelings of depression is an expected emotional response to another illness; it is critically important to simultaneously treat both conditions.

Medical illnesses commonly associated with a woman's mental health are as follows, but not limited to:

Autoimmune disease
Cancer
Migraine headaches
Bone and joint disorders
Genetic disorders
Heart disease
Lung disease
Respiratory diseases
Chronic pain

Most women find it difficult to manage the painful emotions caused by the changes in their body and altered lifestyle. The lack of understanding of family and friends can cause intense feelings of stress and isolation.

Managing a chronic illness can be an isolating and often physically painful experience. Having to ask others for help, especially for some women, can be extremely stressful and overwhelming for those who are used to being independent and autonomous. Most women are caregivers to their families, extended members alike, so asking for help can be arduous and humbling.

ILLNESS AND MENTAL HEALTH

Medical illness can predispose women to mental illnesses in part because many physical conditions are associated with abnormal levels of hormones and neurotransmitters that influence a woman's mental health. Parkinson’s disease, for example, involves abnormalities in the dopamine system. Chronic pain is associated with imbalances of serotonin, dopamine, GABA and norepinephrine. Essentially, any medical condition that causes widespread inflammation may raise the risk of depression as depression has been associated with inflammation in the brain.

Chronic medical illness may also affect a woman's mental health through the mechanism of increased stress. There are many possible stressors and many common emotions associated with a physical disease. The initial diagnosis may bring shock, grief, overwhelming feelings of despair. Women often feel angry about the change of lifestyle and feel misunderstood by friends and family members who don’t have the same limitations. These feelings are normal and not in themselves evidence of mental illness, but the circumstances and associated emotions can add to the body’s level of psychological stress, which can be damaging when levels rise too high. Studies indicate that stress causes the body to generate fewer neurons than normal and more myelin-producing cells. This changes the ratio of gray matter to white matter in the brain. The hippocampus (the part of the brain that regulates emotions and is associated with emotional disorders), was also shown to be affected by this process. Researchers believe these neurochemical changes may explain why individuals under chronic stress are more likely to develop mood disorders, anxiety and other mental health conditions.

Women who are receiving medical treatments (ie, chemotherapy, dialysis, surgeries) who are depressed, experience high levels of distress, an increase in impaired functioning and less ability to follow medical recommendations, ultimately interfering with the management of the medical conditions. The diagnosis of depression is often overlooked in medical settings and goes untreated. Depression is sometimes mistaken as a side effect of chemotherapy or corticosteriods, both treatments for cancer. Depressive symptoms can be mistakenly attributed to the cancer itself, which can also cause appetite and weight loss, insomnia and loss of energy.

Medical conditions that occur in a more sudden onset, such as emergency surgeries, car accident injuries, physical body injuries, may cause women to develop post-traumatic stress disorder (PTSD). Research further indicates women who are cancer patients are five times more likely to be diagnoses with PTSD.

MEDICATIONS AFFECT MENTAL HEALTH

Often not just a medical illness or chronic medical condition increases the risk of developing a mental illness, but the medications used to treat it. A surprising number of medications are known to contribute to a the development of mental illness, including the following:

Beta-blockers – People suffering from high blood pressure, angina, migraines, tremors, irregular heartbeat and some types of glaucoma may be prescribed these medications. Many drugs that have names ending in “-olol” are beta-blockers, including metoprolol, propranolol and atenolol.
Statins – Statins are generally prescribed to lower cholesterol. The drugs may contribute to depression because cholesterol in the brain helps release neurotransmitters.
Interferon – This medication may be prescribed to treat hepatitis or certain cancers, like melanoma.
Opioids – Opioid pain relievers like morphine, oxycodone and hydrocodone may initially cause euphoria, but can contribute to depression over time due to their effects on dopamine and GABA.
Anticonvulsants – Drugs in this class, including Neurontin, Lyrica and Lamitical, are used to treat seizures, fibromyalgia, neuropathy and a wide variety of other health conditions.
Corticosteroids – These drugs, which include cortisone and prednisone, are anti-inflammatory and used to treat conditions such as lupus, gout and rheumatoid arthritis. They may cause depression by their effect on serotonin levels.
Stimulants – Stimulant drugs like Ritalin may be prescribed to treat attention deficit hyperactivity disorder (ADHD), fatigue and daytime sleepiness. They alter dopamine levels, which may contribute to depression.

Anxiety is also a possible side effect of many medications, especially for women. Some drugs, such as steroids, stimulants and blood pressure medications, may cause anxiety in addition to, or instead of, depression. Other drugs that may cause or contribute to anxiety include asthma and thyroid medications. Low blood sugar can contribute to both depression and anxiety, so when diabetic medication lowers glucose levels beyond the desired range, mental health symptoms can result.

MENTAL ILLNESS AND MEDICAL ILLNESS

Research further indicates, depression and anxiety conditions increase a woman's chance of developing heart disease and even heart failure. The more severe the symptoms are, the greater the risk. Depressed women typically have less healthy lifestyles as they tend to be overweight, less active, smoke and misuse alcohol. All these factors lead to poor cardiac health.

States of depression and anxiety trigger a greater amount of stress hormones to be released through out the body. During periods of stress a women can feel their pulse going up and rate of breathing to speed up, which is the result of hormones being released. Those stress hormones also induce inflammation and plaque buildup in arteries, which contributes and accelerates heart diseases. Further considerations indicate depressed women and those with anxiety find it more difficult to follow advice about how to take medications, follow health care recommendations, and present with willingness to improve their lifestyle.

PREVALENCES

HEART DISEASE AND DEPRESSION - Depression occurs in 40 to 65 percent of patients who have experienced a heart attack. After a heart attack, patients with clinical depression have a three to four times greater chance of death within the next six months.

STROKE AND DEPRESSION - Depression occurs in 10 to 27 percent of stroke survivors and usually lasts about one year. An additional 15-40 percent of stroke survivors experience some symptoms of depression within two months after the stroke.

CANCER AND DEPRESSION - One in four people with cancer also suffer from clinical depression.

DIABETES AND DEPRESSION - People with adult onset diabetes have a 25 percent chance of having depression. Depression also affects as many as 70 percent of patients with diabetic complications.

EATING DISORDERS AND DEPRESSION - Research shows a strong relationship between depression and eating disorders (anorexia and bulimia nervosa) in women.

ALCOHOL/DRUGS AND DEPRESSION - Research shows that one in three depressed people also suffer from some form of substance abuse or dependence.

References

http://www.nimh.nih.gov/depression/co_occur/heart.htm

http://www.nimh.nih.gov/depression/co_occur/stroke.htm

http://www.nimh.nih.gov/depression/co_occur/cancer.htm

http://www.nimh.nih.gov/depression/co_occur/co_oc.htm

University of California, Berkeley News, February 11, 2014.

IMPORTANCE OF TREATMENT

Women who receive effective treatment for co-occurring depression and/or anxiety often experience an improvement in their overall medical condition and have better compliance towards their medical illness treatment regimens. Ultimately these women experience greater outcomes for their overall health. More than 80 percent of women with depression and and/or anxiety can be treated successfully with medication, psychotherapy or a combination of both.