Depression is common with illness

On Call

September 24, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

Four months ago my wife had a heart attack followed by coronary bypass surgery. She recovered well from the heart attack, the bypass operation was a success, the cardiologist placed no restrictions on her and she has had no further chest pain. Yet, she feels tired and listless, appears sad and discouraged, has trouble sleeping and lacks the energy to return to her former activities. Do you have any suggestions?

From your description it sounds like your wife is suffering from a significant episode of depression (often referred to as clinical or major depression). Depression is common in people who have a serious medical disorder.

Studies have shown that some form of depression occurs in 40 percent to 65 percent of patients who have a heart attack. About half of these individuals have a major depressive episode.

The rate of depression is also high after bypass surgery. Patients depressed after a heart attack experience a decline in their quality of life, greater social problems and more disabling symptoms; and they are slower to return to work. Depressed individuals are also less likely to comply with medications and recommended lifestyle changes. Perhaps as a result, heart attacks and deaths from coronary heart disease (CHD) are significantly higher in depressed patients with CHD, whether or not they have had a heart attack, than in those who are not depressed.

Between 10 percent and 27 percent of stroke victims have a major depression lasting a little less than a year on average. In a subgroup of stroke patients the depression is directly related to damage to a specific area of the brain.

About 20 percent of patients with cancer have a major depression. The likelihood of depression in cancer patients is greater in those with social isolation, a problem with alcohol or drug abuse or a history of a prior mood disorder. Depression may be a side effect of certain drugs used to treat cancer.

Although the majority of people with diabetes do not develop hTC depression, the problem is nonetheless three times more common in them than in the general population. Depression in diabetes is associated with poor blood sugar control, probably due to poor adherence to treatment.

Reactions such as shock, denial, sadness, anxiety and inability to concentrate are normal following a diagnosis of cancer, for example, but this pattern usually abates after several weeks. All too often family, friends and even doctors assume that continued symptoms of depression are the naturalconsequence of a serious illness.

As a result, the depression is seldom diagnosed or treated in such patients even though it interferes with their ability to enjoy life and may worsen their medical condition and even shorten their lives. Moreover, treatment of major depression, which is successful in about 80 percent of patients, may improve both their quality of life and their medical problems.

The persistent manifestations of depression in your wife indicate that she should seek treatment for depression.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 9/24/96

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