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Depression May be Underdiagnosed in People with Autoimmune Diseases
Dealing with a chronic disease can be emotionally draining, but when does the normal stress of being ill become clinical depression?
While the exact number of people with chronic conditions who suffer from clinical depression is hard to estimate, doctors agree that people with chronic conditions should be screened more aggressively for psychological disorders.
Autoimmune diseases, such as rheumatoid arthritis, scleroderma and lupus, may put people at an increased risk for depression.
A French study, presented recently at the annual convention of the American College of Rheumatology, found that although depression is a common disorder among people with scleroderma, it remains largely unrecognized and untreated.
"Depression is under-diagnosed in the general population, so I wouldn't be surprised if it is under-diagnosed in the rheumatology clinic," says Celso Velazquez, M.D., assistant professor of rheumatology at the University of Missouri-Columbia School of Medicine.
The link between chronic disease and depression is not causal. Depression occurs in physically healthy people, as well as in people with chronic conditions, and is not always related to the severity of the disease. On the other hand, many people with chronic illness manage just fine.
Steroids, used in conditions such as lupus, can cause depression, and doctors should carefully monitor patients who take steroids and adjust the dosage if necessary.
In fact, many of the symptoms associated with autoimmune conditions are also signs of depression, including lack of energy, fatigue, anxiety, lethargy, sleep disturbances, mood swings, changes in appetite and others.
Fibromyalgia is another disorder where depression screening is crucial since some of the symptoms of fibromyalgia can mimic symptoms of depression and vice versa, Velazquez says.
However, what differentiates true depression from transient blues is the persistence of symptoms--usually six weeks or more. In addition, true depression impedes a person's ability to perform normal daily activities.
"I would say we, as doctors, need to be more aware of it, and we should find ways to screen for it more often," Velazquez says.
Routine screening using a standard questionnaire is relatively cheap and easy to do, but it could put an extra load on doctors' already-cramped schedules.
Symptoms of depression include:
-- Sadness throughout the day
-- Feelings of emptiness or hopelessness
-- Loss of interest in previously enjoyed activities
-- Feeling stressed and overwhelmed
-- Trouble concentrating
-- Feelings of worthlessness or self-hatred
-- Irritability or restlessness
-- Thoughts of death or suicide
-- Fatigue or lack of energy
-- Sleeping too much or too little
-- Change in appetite or weight
-- Vague aches and pains
-- Headache
-- Back pain
-- Digestive problems or change in bowel movements
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