Depression and Anxiety with Physical Illness

Depression and anxiety can occur with various physical illnesses, including endocrine issues, cancer, AIDS, and heart attack.  Both the mind and the body need to be treated.  If you need emotional help, please call a health psychologist.

Depressed? Anxious? It Could Be An Early Symptom Of These Illnesses
By Jennifer Gerson Uffalussy | Yahoo Health – Tue, 17 Feb, 2015

When it comes to your health, mind over matter may not be so much of a thing as mind and then matter.

In the January 2015 edition of Psychotherapy and Psychsomatics, a group of Italian researchers explored whether depression, anxiety, and other psychiatric mood disorders might be early symptoms of medical disorders, as opposed to being “just” psychological symptoms.

Their research showed that depression in particular can be a strong indicator of other forms of illness, finding it “to be the most common affective prodrome [early symptom] of medical disorders and was consistently reported in Cushing’s syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson’s disease, and AIDS.”

But here’s the irony: Many physicians are quick to dismiss symptoms like anxiety and depression, referring patients exhibiting signs of mood disorders to psychotherapists and psychiatrists for treatment instead of recognizing mood disorders as potential indicators of more serious physical conditions.

“Unfortunately, the view that mental symptoms and physical symptoms represent different domains — Cartesian dualism— is a relic that survives, defying both science and common sense.  Many physicians choose to ignore cognitive and affective symptoms, in part because their pursuit often requires additional time (which they don’t have) and because of the mistaken belief that behavior is something other than a product of brain activity,” David Rubinow, MD, chair of the department of psychiatry and a professor of medicine at the University of North Carolina at Chapel Hill School of Medicine, tells Yahoo Health.

The main information-processing systems of the body — the endocrine, central nervous, and immune systems — share are in constant communication to inform the body about the internal and external environments. So a disturbance in one system often manifests itself in disturbances in one of the other systems.  “As such, the appearance of CNS [central nervous system] symptoms as a manifestation of somatic illness is both old news and, again, a matter of common sense,” explains Rubinow. “We don’t understand why the symptoms appear in some individuals and not others, but that variability is part and parcel of medical illness.”

It’s crucial to remember that our minds and bodies are intimately connected. “We think of the brain as the organ that does our thinking, but the purpose of the brain is to control the body,” Arthur B. Markman, PhD, a psychologist at the University of Texas, tells Yahoo Health. “So, physical problems can influence mental states and mental problems can lead to bodily problems.”

When you are sick, your body is trying to fight off a disease. That takes energy, and one natural response to that is to be tired. In addition, illness creates an undesirable state, which can engage the motivational system to enter an “avoidance mode,” which can lead to anxiety. “Because we are often unaware of the sources of our motivations, we may attribute that anxiety to something in the environment rather than something internal,” says Markman.

Writing in Psychotherapy and Psychosomatics, the Italian research team noted that “The DSM-5 [the most current version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association] provides examples of medical conditions that may be associated with mood and anxiety disturbances but not a list of medical disorders characterized by affective prodromes. Further, it does not list irritability as a disturbance that may be due to a physical condition, despite its common presence in medical settings,” adding that many individuals who present with symptoms of depression cannot get a depression diagnosis by DSM standards; many of these individuals may, then, be showing symptoms of a greater underlying medical illness that is causing their depression.

That is, it’s not “all in your head.”

Furthermore, they concluded that “affective symptoms due to a medical illness tend not to fully respond to antidepressant drugs, even when properly administered, but rather to the proper treatment of the underlying medical disorder. Indeed, many patients dismissed as suffering from a mood or anxiety disorder, with an adequate follow-up, may later present with a medical illness responsible at least in part for it.”

If you have depression or anxiety, should you be worried about a serious illness like cancer? Probably not,  if your mood disorder is a long-term, diagnosed condition and your treatment is working. But, if your psychiatric treatments are not working, or, if you’re newly experiencing these conditions, tell your physician.

Says Rohan Ramakrishna, MD, a neurosurgeon specializing in the treatment of brain tumors and other central nervous system tumor at Weill Cornell Medical Center in New York, “In my experience, psychiatric prodromes preceding cancer diagnoses are relatively rare. It is usually and understandably the case that psychiatric illnesses like depression follow cancer diagnoses as people grapple with their cancer, its treatment and the uncertainty regarding their eventual outcome.”

Ramakrishna notes that while he has seen cases in which psychiatric prodomes preceded diagnosis of a brain tumor, “this is pretty infrequent. The psychiatric burden of disease from a public health perspective is much greater than the public health burden of tumors. In other words, very few patients with a psychiatric illness will have a brain tumor or other systemic cancer.”

Markman reinforces this idea, observing, “At any given moment, roughly 10 percent of the adult population is dealing with anxiety and depression. The incidence of these other diseases is much lower. So, most cases of anxiety and depression have other causes.”

He does suggest, though, that patients undergoing psychological or psychiatric treatment also receive regular physicals as part of their treatment plan to potentially catch any other medical issues that may underlie their mental symptoms.

Or as Ramakrishna puts it, “Studies like these need to be interpreted in the larger context of a patient’s totality of symptoms. Only then will the clinician consistently arrive at the right diagnosis.”