Being diagnosed with a chronic disease - whether it’s diabetes, high blood pressure, arthritiscancer, HIV/AIDS, chronic respiratory illnesses like chronic obstructive pulmonary diseaseheart disease or any other disease that requires lifelong management - can come as a shock.

The patient now has to restructure his or her entire life to manage the symptoms of the disease, because chronic diseases last a lifetime and can never be completely cured. You can have periods of remission, but to get there, you have to regulate your diet, lifestyle habits, sleep and exercise.

This change in the quality of their life can have a depressive effect on many patients. Increasingly, patients with a chronic disease are also showing symptoms of depression, because no matter what the disease is, it can take away any individual’s sense of independence and self-efficacy. According to the Cleveland Clinic, Ohio, US, one-third of people with a chronic illness also suffer from depression.

It can be very difficult to diagnose signs of depression in a person who is suffering from a chronic medical illness. Loved ones and the patients themselves might confuse symptoms of depression with the symptoms of the chronic disease because there are a number of overlaps between the two. Yet, early diagnosis of depression can help the patient cope with both the chronic disease and depression better and at the same time.

A positive mental outlook, though difficult to achieve when you have a chronic illness, can help you accept the changes you must make to battle the chronic disease and improve your overall quality of life too. This journey, however, should not and cannot be taken in isolation, so it’s very important for spouses or partners, family members, friends, and even older children to get involved in the process. Here’s everything you need to know about chronic disease and depression.

  1. Causes of depression in chronic disease patients
  2. Chronic diseases that can lead to depression
  3. Symptoms of depression in chronic disease
  4. Treatment of depression in chronic disease
  5. Tips to cope with depression in chronic disease

Depression is one of the most common complications of chronic diseases. According to a study published in The Western Journal of Medicine, the link between depression and chronic disease is established in three ways: 

  • Depression results from specific biological effects of a chronic disease: this is commonly seen in patients suffering from Parkinson’s disease, Alzheimer’s disease, cerebrovascular diseases, multiple sclerosis or endocrine (hormone-related) diseases like hypothyroidism, diabetes or polycystic ovary syndrome (PCOS).
  • Some medicines for chronic illnesses can also cause depression - it is a good idea to discuss your symptoms with your doctor to see if he or she can prescribe a different medication in this case.
  • Depression results from the behavioural or lifestyle changes brought about by the chronic disease: this occurs commonly in patients suffering from diabetes, heart diseases, epilepsy or autoimmune diseases like rheumatoid arthritis and lupus. The most common reasons for this are:
    • If the disease puts limitations on the patient's mobility.
    • If the disease puts dietary restrictions on patients, as in the case of irritable bowel syndrome.

It’s important to remember that suffering from any chronic illness is difficult and stressful. You must consult your doctor or seek the help of a mental health professional to figure out if your depressive thoughts are symptoms of depression or initial (and perhaps temporary) results of stress and the shock of being diagnosed with a chronic disease.

There are many types of chronic diseases, and suffering from any of them can put you at risk of depression. The rates of depression can be quite high for some types of chronic diseases. The diseases with the highest risk of depression as a comorbidity are:

Depression is a serious medical condition and has many symptoms, including physical ones. It’s easy to overlook these symptoms, especially if you have a chronic disease. This is because symptoms like fatigue, loss of appetite, lack of concentration, increased or decreased sleepiness, etc., occur in both depression and chronic diseases. These overlaps might make the diagnosis of depression in chronic disease more difficult, but you should be on the lookout for the following common symptoms of depression any way:

  • Feeling sad or anxious and irritability
  • Feeling empty, hopeless, guilty or worthless
  • Loss of pleasure in everyday activities, including those that previously gave your pleasure
  • Fatigue and decreased energy levels
  • Lack of concentration
  • Inability or trouble making decisions, even the simplest ones
  • Not being able to sleep or sleeping too much
  • Not being able to eat or eating too much, leading to unplanned weight loss or weight gain
  • Body pain, headaches, cramps or indigestion that do not ease with treatment
  • Thoughts of death, suicide and suicide attempts

Chronic diseases include all types of cancer, cardiovascular diseases, autoimmune diseases, endocrine disorders, etc. A number of these diseases can cause pain, disability, lifestyle limitations and social isolation, which can cause depression. Depression, in turn, can intensify pain, fatigue, self-doubt, loss of self-esteem and social isolation. This is a vicious circle, and once you are stuck in it, getting out requires proper intervention and support.

The first step you need to take, according to the National Institutes of Mental Health, US, is to never dismiss depression as a normal part of having a chronic disease. Effective treatment for depression is available and it works whether you have a chronic disease or not. If you, or a loved one, are showing signs of suffering from depression, tell your primary healthcare provider and explore the treatment options.

It’s important to involve your primary healthcare provider who is treating the chronic disease because this doctor is prescribing a treatment course to manage your chronic illness, and would know what sort of treatment option for depression would help you the most without medications or therapies for both diseases interfering with each other. This doctor will also be able to deduce if any medications prescribed to treat your chronic illness are causing symptoms of depression to manifest, and prescribe alternative medications to relieve the depression.

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While a doctor or mental health professional will be able to treat you for depression while you are also coping with a chronic disease, a large part of the healing process will depend on the primary care you can get by yourself or from your family and friends. You can use the following tips to cope with depression in chronic disease.

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Accept what you cannot change

Living with a chronic disease can be difficult at times, but the best course of action is to follow the proper treatment course which includes medicines, diet, exercise, rest and sleep. This will help to manage the symptoms well enough to go into a prolonged remission stage. Accept this, and understand that while you cannot turn the clock back, you can make your future more enjoyable despite having a chronic disease.

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Change what you can

Depending on the chronic disease you have, you might have to make many changes in your life. Think of these as positive changes that will improve your overall quality of life. These changes can be exercising more, eliminating unhealthy foods from your diet and adding healthy ones instead, tracking your blood sugar or any other bodily changes, or even visiting your doctor more often than you did before. These changes are in your hand, and while you may not have total control over your chronic disease and how it progresses, you do have control over everything else to do with it.

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Build a social support circle

Isolation can make both depression and the chronic disease you’re suffering from much worse. It might be difficult, but asking your spouse, older children, family members, friends, colleagues and loved ones for help is important. Build a circle of people you can depend on physically (to perform chores like getting groceries or helping you move) and emotionally (talking through your feelings before a diagnostic test or treatment procedure). It’s also important to engage with people who are in the same boat as you, so find support groups for your chronic disease, whether it’s cancer, diabetes or multiple sclerosis. Hearing stories of how others are facing the same predicament as you, and how they coped with similar changes will help you feel less lonely and also encourage you.

If you can't find a support group for your chronic ailment in India or in your neighbourhood, see if you can start one - take help from with resident welfare association or Facebook to invite members for your group.

Trust your doctors

Yes, it can be difficult to find the perfect doctor, but once you have found a specialist who has experience in treating your chronic disease, try to build a relationship based on trust with them. Your disease might last a lifetime, and so should your doctor’s support.

Trust the doctor’s advice and try not to second-guess it or underplay it.

Be utterly honest with your doctor, even about the things you might be ashamed of (say, you indulged in your favourite junk food one too many times in the last week or smoked a pack of cigarettes when your doctor expressly told you to quit smoking).

Your doctor and loved ones enforce these lifestyle changes because they have a stake in your well-being. It’s no good hiding anything from your physicians.

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Put your health first

Being diagnosed with a chronic disease is a life-changing experience. Clearly, you can't go on living the way you were before being diagnosed because the primary focus should be your own health and happiness now.

If a high-stress job or friends who encourage your reckless side are not what you can accommodate in your life any more, remove them from your circle of influence.

Your priority should be your health now, and you need to learn how to say no to protect it - protecting your health like you would protect a child is what needs to be done here.

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Create new life goals

A chronic disease can be life-altering, but as long as you learn how to manage the symptoms and how to cope with the effects of the disease, your life will go on (happily, too, at that). Of course, you might not be able to follow-through with your previous life goals, but that does not mean that you cannot dream anew. Set new life goals for yourself - ones that accommodate the effects of and limitations set by the chronic disease - and strive to achieve them.

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  1. Cleveland Clinic. [Internet]. Cleveland. Ohio; Chronic Illness and Depression
  2. Voinov, Boris. et al. Depression and Chronic Diseases: It Is Time for a Synergistic Mental Health and Primary Care Approach. Prim Care Companion CNS Disord. 2013; 15(2): PCC.12r01468. PMID: 23930236
  3. National Institute of Mental Health [Internet]. National Institutes of Health; Bethesda, Maryland, United States; Chronic Illness & Mental Health
  4. Anxiety and Depression Association of America [Internet]. Silverspring, Maryland, United States; Living with Chronic Illness
  5. Simon, Gregory E. Treating depression in patients with chronic disease. West J Med. 2001 Nov; 175(5): 292–293. PMID: 11694462
  6. Katon, Wayne J. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci. 2011 Mar; 13(1): 7–23. PMID: 21485743
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