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Depression with Other Illnesses
Depression often co-occurs with medical, psychiatric,and substance abuse disorders,
though it is frequently unrecognized and untreated. This can lead
to unnecessary suffering since depression is usually treat able,
even when it co-occurs with other disorders.
Individuals or family members with concerns about the co-occurence of depression
with another illness should discuss these issues with the physician.
Depression also frequently co-occurs with a variety of other physical illnesses,
including heart disease, stroke, cancer, and diabetes, and also can increase
the risk for subsequent physical illness, disability, and premature death. Depression
in the context of physical illness, however, is often unrecognized and untreated.
Furthermore, depression can impair the ability to seek and stay on treatment
for other medical illnesses. Research suggests that early diagnosis and treatment
of depression in patients with other physical illnesses may help improve overall
The results of a recent study provide the strongest evidence to date that depression
increases the risk of having a future heart attack. Analysis of data from survey
revealed that individuals with a history of major depression were more than
four times as likely to suffer a heart attack over a 12-13 year follow-up period,
compared to people without such a history. Even people with a history of two
or more weeks of mild depression were more than twice as likely to have a heart
attack, compared to those who had had no such episodes. Although associations
were found between certain psychotropic medications and heart attack risk, the
researchers determined that the associations were simply a reflection of the
primary relationship between depression and heart trouble. The question of whether
treatment for depression reduces the excess risk of heart attack in depressed
patients must be addressed with further research.
Stress and Depression
Psychosocial and environmental stressors are known risk factors for depression.
Research has shown that stress in the form of loss, especially death of close
family members or friends, can trigger depression in vulnerable individuals.
Genetics research indicates that environmental stressors interact with depression
vulnerability genes to increase the risk of developing depressive illness. Stressful
life events may contribute to recurrent episodes of depression in some individuals,
while in others depression recurrences may develop without identifiable triggers.
Research also indicates that stressors in the form of social isolation or early-life
deprivation may lead to permanent changes in brain function that increase susceptibility
to depressive symptoms.
The hormonal system that regulates the body's response to stress is overactive
in many patients with depression, and researchers are investigating whether
this phenomenon contributes to the development of the illness.
The brain region responsible for managing hormone release from glands throughout
the body, increases production of a substance called corticotropin releasing
factor (CRF) when a threat to physical or psychological well-being is detected.
Elevated levels and effects of CRF lead to increased hormone secretion by the
pituitary and adrenal glands which prepares the body for defensive action. The
body's responses include reduced appetite, decreased sex drive, and heightened
alertness. Research suggests that persistent overactivation of this hormonal
system may lay the groundwork for depression. The elevated CRF levels detectable
in depressed patients are reduced by treatment with antidepressant drugs or
ECT, and this reduction corresponds to improvement in depressive symptoms.
Scientists are investigating how and whether the hormonal research findings
fit together with the discoveries from genetics research and monoamine studies.
Co-occurrence of Depression and Anxiety Disorders
Research has revealed that depression often co-exists with anxiety disorders
(panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder,
social phobia, or generalized anxiety disorder). In such cases, it is important
that depression and each co-occurring illness be diagnosed and treated.
Several studies have shown an increased risk of suicide attempts in people
with co-occurring depression and panic disorder, the anxiety disorder characterized
by unexpected and repeated episodes of intense fear and physical symptoms, including
chest pain, dizziness, and shortness of breath.
Rates of depression are especially high in people with post-traumatic stress
disorder (PTSD),a debilitating condition that can occur after exposure to a
terrifying event or ordeal in which grave physical harm occurred or was threatened.
In one study, more than 40 percent of patients with PTSD had depression when
evaluated both at one month and four months following the traumatic event.
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