Depression Due to Medical Disorders

Depression commonly co-occurs with other mental or physical illnesses, which can mask depressive symptoms or make them worse.

Up to 20 to 25 percent of people who have general medical conditions such as diabetes, cancer, myocardial infarction or other cardiac conditions, carcinomas and stroke will develop Major Depressive Disorder during the course of their general medical condition (DSM-IV-TR, 2000). And people with Major Depression have been found to have a high prevalence (65 – 71 percent) of the most common chronic medical conditions (NIMH, 1999).

Depression can also emerge in people who suffer serious physical injuries, particularly when the injuries result in chronic pain.

Depression intensifies pain and physical suffering, causing fatigue and an overall energy decrease that tends to worsen over time.

Managing a medical condition along with burdens of clinical depression can be overwhelming.

Managing a medical condition becomes more complicated if you’re clinically depressed, and the long-term health outlook tends to be less favorable. Having a serious medical condition adversely affects the depression prognosis, especially for those with Major Depressive Disorder. A person who’s juggling a serious medical condition is more likely to suffer longer depressive episodes, and not respond as well to treatment — particularly if the medical condition is chronic. People suffering from a chronic illness often have difficulty adjusting to the demands of managing the illness, while simultaneously focusing on treatment for depression.

Sometimes people with blame their symptoms of depression on their medical condition, meaning their clinical depression could go undiagnosed.

Chronic illness may also impact mobility and independence, which tends to affect self-identity and self-image — the way we view ourselves and relate to others. Some depressed people have a tendency to seek out a “less stigmatized” explanation for their condition, so they may undergo extensive procedures to diagnose and treat their physical symptoms; meanwhile, the depression goes undiagnosed and untreated.

While depression may not cause the medical condition, it will almost certainly make it worse, often making accurate diagnosis and treatment of physical illnesses more difficult.

Common complications include:

• Problems with serious illnesses; e.g., heart disease, diabetes and cancer
• Exacerbated hypertension and arthritis
• Migraine headaches
• Severe backaches, abdominal or other pains
• Sexual dysfunction
• Sleep disorders
• Severe fatigue and loss of energy

Depression Co-Occurring with Other Psychological Disorders

Depression may be caused by, or co-occur with (known as comorbidity) other psychological disorders, including:

• Bipolar Disorders (which, in addition to depression, includes manic, hypomanic or mixed episodes)
• Personality Disorders. Depressed mood is almost invariably an intrinsic element of Borderline Personality Disorder, and can accompany other personality disorders, such as Avoidant, Dependent, Histrionic Personality Disorders and sometimes Narcissistic Personality Disorder.
• Substance-Induced Mood Disorders. Around 30 percent of individuals with substance abuse problems also suffer from Major Depression. Alcohol or other substances can cause depressed mood, as well as the elevated mood associated with Manic Episodes. Substance abuse always worsens the mood disorder. Alcohol abuse or dependence literally doubles the risk of major depression in people of all ages. Some research suggests that alcohol may even trigger a genetic marker for depression.
• Schizoaffective Disorders. Symptoms of schizophrenia often coexist with Major Depressive or Manic Episodes.
• Cognitive Disorders. Dementia and Alzheimer’s Disease. Delirium often begins with depression or anxiety.
• Adjustment Disorders. Depression often accompanies difficulties with adjusting to change and adapting to stress. The person may be tearful, sad, feel hopeless.
• Other Disorders. Eating disorders, sexual and gender identity disorders, Panic Disorder, Obsessive-Compulsive Disorders, Phobic Disorder, Posttraumatic Stress Disorder and Somatization Disorder.

You can see why the causes of depression are not always immediately apparent and diagnosis can require careful evaluation by a trained mental health professional.