Our health is something we take for granted – until it lets us down. And when we are faced with a chronic long-term illness like cancer, diabetes, arthritis or multiple sclerosis, to name a few, our mental health takes a knock too. Long-term illness, mounting medical bills and, in many cases impaired mobility, become a bitter pill to swallow.
It is estimated that up to one-third of people with a serious medical condition experience symptoms of depression – and depression can aggravate the diagnosed condition. Long-term patients are also at risk of anxiety disorders, panic attacks and mood disorders.
Cilla Webster, 62, of Scottburgh in KwaZulu-Natal is a case in point. Stricken with polio at the age of three, she has had a life of disability that has worsened to the point where she is virtually bed-ridden. As a toddler, polio caused her to spend 18 months in hospital on an iron lung at an age where she needed her parents. As a disabled child she had to board at the Open Air School for the physically disabled and saw her parents only a few times a year.
“I hardly saw my mother for eight years,” she says.
Physically, she recovered well, but the mental scars were deep.
“I was able to work as a secretary, but one day while coming home from work, I was in a train accident and, after that, I developed panic attacks. I became nervous of travelling on the train alone. This was followed in the next few years by asthma and epilepsy attacks. While I appeared to be coping, inside I was a wreck.”
She married, had a daughter, divorced and married again. At 35, her legs collapsed. By 36, she was in a wheelchair. She had developed post-polio syndrome, a condition that affects some polio victims later in life and is characterised by weakness, pain and fatigue. Her panic attacks intensified and she became terrified of being alone. Depression intensified and she attempted suicide.
It was a turning point and she started seeing a psychiatrist. Therapy and medication helped and she started walking with crutches, but as she aged, her mobility decreased.
Today she is virtually bed-ridden but that does not stop her from being a prolific letter writer to the local press about current affairs. She types CVs to earn money and is supported by an understanding husband, Len.
Polio and post-polio syndrome has however snatched away her chance of a normal life.
“I can’t breathe properly, live on a BiPAP machine and I am immobile. I have to rely on others, their moods and their itineraries in order to get around. If I type too many CVs, my arms ache. Every morning I swallow 26 tablets.”
It’s a tough ask for anyone and Cilla says she would not cope if she were not on anti-depressant medication.
“People with a mental illness deserve as much support as those with a physical illness. I am a Christian and I draw strength from my faith, medication and support from Sadag (the South African Depression and Anxiety Group).”
Like Cilla, there are many people for whom chronic illness, depression and anxiety disorders are part of life.
“Chronic illness means getting sick and being told it is not going to go away,” says Johannesburg-based psychologist Dr Colinda Linde. “We lose control of the thing we thought we could rely on and that is really scary.”
“Serious illnesses cause immense changes in lifestyle and limit a person’s mobility and independence making it impossible to do the things they want, or used, to do. This can undermine self-confidence and hope. It’s not surprising that people who have been diagnosed with a chronic illness often experience despair, sadness and anger.”
The risk of depression increases with the severity of the illness and the level of disruption it causes to the patient. While 10- to 25 percent of women and five- to 12 percent of men are generally at risk of depression, those with chronic illnesses face a much higher risk – between 25 and 33 percent. Research shows that 40-65 percent of heart attack patients; 40 percent of Parkinson’s patients; 25 percent of cancer patients; and 30-54 percent of chronic pain syndrome patients develop depression.
Very often patients and their loved ones overlook the symptoms of depression.
These are often masked by other medical problems which are symptomatically treated but the underlying depression is not.
Depression can also aggravate the chronic condition. It can intensify pain, and fatigue and can cause people to isolate themselves even further. When a person has both a chronic illness and depression, it is very important to treat conditions simultaneously.
“Side effects of medication can sometimes cause depressive symptoms, in which case they may need to be adjusted or changed,” says Linde.
“Early diagnosis and treatment is important to reduce the distress people feel, and to help them adjust to their diagnosis,” says Cassey Chambers of Sadag. “Treatment of depression can also help improve the person’s overall health and make it more likely that they comply with their treatment.”
Depression, disability, and chronic illness form a vicious cycle: chronic conditions may bring on bouts of depression, which, in turn interfere with successful treatment of the chronic illness. But more than 80 percent of people with depression are treated successfully with medicine, psychotherapy, or a combination of both.
* l For info on workshops or mental health issues, contact Sadag at 0800 21 22 23 between 8am and 8pm seven days a week. Or see www.sadag.org
Symptoms of depression
* Loss of interest or pleasure in hobbies and activities that were once enjoyed
* Feelings of hopelessness and pessimism
* Feelings of guilt, worthlessness, helplessness and self-reproach
* Insomnia or hypersomnia, early morning awakening or oversleeping
* Appetite and/or weight loss or overeating and weight gain
* Decreased energy, fatigue and feeling run down
* Thoughts of death or suicide; suicide attempts
* Restlessness, irritability, hostility
* Difficulty concentrating, remembering and making decisions
Tips to help you cope
The SA Depression and Anxiety Group (Sadag) has four tips for coping with a chronic illness and depression.
* Be sure you have the right doctor. Your relationship with your doctor is second only to your family. Be honest and trust your doctor to hear you. If you don’t have that kind of relationship, get a second opinion.
* Get a circle of support. Isolation leads to depression. It’s easy to isolate yourself when you feel sick, sore and negative. People may surprise you – acquaintances may be good support while those you thought you could count on, disappear. If someone inside the circle asks, “How are you?” tell them the truth. When someone outside the circle asks, lie, say, “I’m fine” and change the subject. If someone asks if they can help – accept.
* Protect your health as you would a small child. You are more than your illness. Look after the basics – sleep, exercise and diet. Learn how to identify when you’re wearing your health thin. Signals like lowered ability to concentrate, neck and shoulder tension, irritability, no sense of humour, exhaustion are warning lights and need to be listened to. Stop, assess and make changes. Ignoring those signals can cause relapse. Set limits and say No!
* Create a new measuring stick. To thrive with a chronic illness, throw out your old habits and rethink your standards. If you define yourself by your 50-hour work week, not being able to keep up with those demands can make you miserable. Is doing everything yourself reasonable or is it more reasonable to delegate? Address old pressures and imagine ways of doing things differently. - Daily News