Important
new research has shown that if depression exists alongside other
illnesses, these diseases and their recovery are much more severe
and difficult. In such illnesses as diabetes, chronic pain problems,
substance abuse, arthritis, hypertension and heart disease,
effective identification and treatment of depression may bring
marked benefit in the form of medical improvement, enhanced quality
of life, reduction in the degree of disability and improvement in
treatment compliance.
Health
care money spent for depression in the United States, plus the cost
of lost work, is enormous. Most studies have shown that effective
intervention for depression, when it exists with substance abuse or
medical problems, lowers health care costs.
Depression
can clearly predate a medical or addiction problem, or it may be a
reactive response to the illness or to the stress of it. It can also
relate to the physiology of the illness or its treatment. In
neurological conditions such as Parkinson's disease, multiple
sclerosis, Alzheimer's disease and strokes, the lifetime prevalence
of depression is 30 to 60 percent, compared to 16 to 17 percent in
the general population.
In
diabetes, the lifetime prevalence of depression is double to triple
that of the general population. It can cause increased insulin
requirement and increase the risk of diabetic complications. People
with coronary artery disease and depression are estimated to have a
40 percent higher risk of having a cardiac event. Depression
increases the risk of death from heart attack fivefold and is a
significant predictor of disability one month after a heart attack
or one year after coronary bypass surgery. Estimates of depression
and cocaine dependence range from 33 to 53 percent. Estimates of
depression in alcoholics seeking treatment range from 15 to 67
percent. Those who are dependent on opiates have rates of depression
estimated as high as 75 percent.
Early
diagnosis and treatment of depression is critical in preventing and
alleviating sickness, suffering and possible death. Some studies
suggest that in primary care settings, 30 to 50 percent of depressed
patients go unrecognized and only about 20 percent of those
recognized receive adequate treatment. Health care providers,
friends, family and employers all need to make a greater effort.
Community education about key signs of depression is important.
Symptoms
include loss of interest or pleasure in doing things; often feeling
down, hopeless or sad; trouble sleeping or sleeping too much;
feeling tired or having little energy; poor appetite or overeating;
frequently feeling bad about yourself; trouble concentrating;
slowing down of speech or movements, or being fidgety or restless
more than usual; thoughts of dying or of hurting yourself;
difficulty functioning at home, work or getting along with people.
An
integrative approach to treatment gives the best chances for
improvement or recovery. Identification and treatment of
contributing factors can be as important as taking an antidepressant
medication or other remedies. Specialized testing may uncover
hormone deficiencies such as hypothyroidism; deficiencies in B12,
folic acid, minerals, amino acids or essential fatty acids; toxic
metals such as mercury; environmental illness such as allergies to
mold; food sensitivities to wheat or diary; or any of the medical or
addiction problems listed above.
People
with depression, beyond simply taking an antidepressant pill or a
natural remedy, can benefit greatly from social support,
psychotherapy and other complementary approaches. Seek out help from
appropriate health professionals, especially integrative health-care
practitioners, and learn as much as possible about depression by
seeking information, attending educational programs and reading.
Ronald
R. Parks, M.D. practices integrative medicine and psychiatry in
Asheville. Shan Parks assists at Dr. Parks' Integrative Medicine and
Psychiatry office and with this website.
Call 828-225-1812 for information and directions.