It is an unfortunate double jeopardy—being sick can make you depressed...and being depressed can make you sick. New research shows that many chronic illnesses, including heart disease, diabetes and osteoporosis, have this two-way connection to depression.

Consequences can be grave. In a recent study, heart attack patients who were depressed had a two-to fourfold increased risk of dying within five years, compared with heart attack patients who were not depressed. In a global study from the World Health Organization involving 245,000 people, those with a chronic illness fared far worse if they also were depressed.

One in eight women experiences depression at some point, compared with only one in 16 men—a gender discrepancy due primarily to hormonal differences. That means it is especially important for women who are depressed to get regular checkups to screen for chronic illness... and for women who have a chronic disease to be alert for signs of depression. Self-help strategies and/or professional care can protect both your mental and physical well-being.

Explaining The Connection

Scientists are trying to learn more about how disease and depression interact. What the evidence suggests...

  • How disease can lead to depression. Common sense tells us that a woman with a chronic illness might feel sad—but physiologically speaking, the explanation may involve an overactive immune system.

Theory: Inflammation is part of the body's normal healing process...but if the immune system fails to turn off the inflammatory mechanism at the appropriate time, inflammation becomes long-lasting and widespread. This can alter metabolism and damage blood vessels, bones and other body tissues, bringing on a variety of chronic illnesses and disrupting the balance of neurotransmitters (brain chemicals) that affect mood, triggering depression.

Recent studies show that the following conditions may be linked to depression--cancer... heart disease...diabetes...fibromyalgia a syndrome of widespread pain)...psoriasis (patches of scaly, red skin)...rheumatoid arthritis (an autoimmune disease) and stroke.

  • How depression can lead to disease. It is logical that a depressed woman may not take care of herself well enough to guard against illness, but this is only a partial explanation. Physiologically, depression is linked to high levels of stress hormones-which in turn may raise blood pressure and cholesterol levels...promote accumulation of harmful abdominal fat...impair digestion...and hamper immune function. Along with depression comes increased production of proteins called cytokines, which cause widespread inflammation. This can trigger changes in the brain that reduce its resistance to dementia.

Recent studies suggest that people who suffer from depression may be at increased risk for Alzheimer's disease...asthma...breast cancer... cardiovascular disease...diabetes...gastric ulcer... high blood pressure...osteoarthritis...osteoporosis...and thyroid disease.

Defense Against Depression

Getting relief from depression can help prevent chronic illness or make an existing illness easier to deal with. Yet even though up to 90% of depressed people can be treated effectively, only one in three seeks treatment. To overcome depression…

  • Develop realistic expectations. You may pessimistically assume that your physical prognosis is worse than it really is...or you may be overly optimistic, then feel crushed if your progress is slow. Either attitude can negatively affect your motivation to participate actively in your own physical recovery,

What helps: Be proactive. Write down all of your questions about your condition, treatment and prognosis, and review them with your doctor. Use the Internet to find a national association that addresses your illness, or ask your doctor if he/she knows of one. Be sure to take medication as prescribed, and keep all of your doctor appointments.

  • Eat foods rich in omega-3 fatty acids. Omega-3s reduce inflammation and aid neurotransmitter function. Research suggests that omega-3s may be better absorbed from food than from supplements.

What helps: Have at least four servings weekly of omega-3-rich foods.

Good choices: Two tablespoons of ground flaxseeds or flaxseed cup of walnuts.. three ounces of herring, salmon or cup of navy beans, cabbage, cauliflower, squash or leafy green vegetables.

  • Stay active. Exercise releases endorphins, brain chemicals that lift mood and block pain.

What helps: Don't tell yourself, I feel too lousy to work out. Ask your doctor or physical therapist to recommend exercises that you can do-such as water aerobics, which is easy on joints and bones...or slow stationary cycling, which won't overtax the heart.

  • Strengthen social ties. You may hesitate to tell loved ones how down your illness makes you feel for fear of burdening them—yet emotional support is vital to healing.

What helps: Remember that your illness affects your family and friends, too. Everyone will feel better if emotions and concerns are discussed honestly.

  • Know when to get professional help. Many people incorrectly assume that depression is an unavoidable part of physical illness, so they don't seek treatment.

What helps: Learn the symptoms of depression -sleeping too much or too little, unintended weight gain or loss, low energy, persistent sadness, frequent crying, irritability, feelings of hopelessness, poor concentration, low libido or lack of interest in daily activities. If you have any thoughts of suicide or if you experience two or more of the symptoms above for more than two weeks, tell your doctor.

  • Consider psychotherapy. A form called cognitive behavioral therapy helps depressed patients replace negative beliefs and behaviors with positive ones.

What helps: Talk to a therapist experienced in treating depression linked to chronic illness. Ask your primary care physician to refer you to a suitable mental health professional.

  • Try natural non-prescription supplements. Sold at health food stores, these may relieve mild-to-moderate depression. If you use pharmaceutical medications, get your doctor's approval before taking natural supplements to avoid possible adverse interactions.

What helps: Ask your doctor about appropriate dosages and usage guidelines for the following...

  • 5-adenosylmethionine (SAM)
  • 5-hydroxytryptophan (5-HTP)
  • St. John's wort
  • Vitamin D
  • Consider pharmaceutical antidepressants. These medications work by slowing the removal of neurotransmitters from the brain.

What helps: Antidepressants often are very effective, though it may take trial-and-error to find one that works for you and does not cause side effects (such as nausea, weight gain, drowsiness and low libido).

Useful: Ask your doctor about the new cytochrome P450 blood test, which helps identify genetic factors that influence your response to certain antidepressants.

Obesity Is Depressing!

In middle age, obese women are twice as I likely to be depressed as non-obese women -and depressed women are twice as likely to be obese as nondepressed women.

Possible reason: The stigma of obesity damages self-esteem...which contributes to feelings of hopelessness and depression...which can make it harder to lose weight.

To break the cycle: Seek help from a mental health professional.

Phone Therapy Can Be Effective

Researchers recently analyzed 12 studies on psychotherapy for adults that was conducted by telephone and involved at least four sessions (typically 45 to 50 minutes each).

Result: About 8% of patients discontinued treatment soon after its start compared with an average dropout rate of nearly 47% for those receiving traditional face-to-face psychotherapy. Telephone therapy also appeared to be as effective at treating depression as office visits.

Theory: Telephone psychotherapy transcends barriers to office sessions, such as transportation problems or juggling appointments with work and family obligations. Anyone who is considering discontinuing psychotherapy treatments because of time constraints or transportation problems should ask his/her therapist if phone therapy is an option.

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