The Physical-Mental Health Link

Depression can cause and worsen physical illnesses

September 28, 2011 / Author:  / Reviewed by: Joseph V. Madia, MD

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Most of us have experienced some episode of depression in our lives, whether it was a temporary, situational episode or more chronic, ongoing depressive episodes. Depression is common but serious; it can interfere with daily life and cause pain for both its victims and those around them.

Other psychological disorders are commonly associated with depression, such as anxiety, social phobia, obsessive-compulsive disorder and post-traumatic stress disorder. Alcohol and other substance abuse tend to be higher among people who are depressed, all of which greatly affect overall health.

But depression isn't only a mental health concern; it's also linked to many prevalent physical diseases. According to the National Institute of Mental Health, depressive symptoms are significantly related to cardiovascular disease, osteoporosis, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease.

People who have depression along with another medical illness tend to have more severe symptoms of both depression and the medical illness. It's also harder for them to adapt to their medical condition, and their medical costs are higher than for patients with the same disease, without depression.

Depression and Pain

Depressive disorders are also closely related to the pain we experience, and according to Daniel K. Hall-Flavin, MD, each can cause the other. "Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain," Hall-Flavin says.

Depression can cause otherwise unexplained physical symptoms such as headaches, back pain, stress and sleeping problems—and these problems are often the first symptom of depression.

Dr. Hall-Flavin explains that pain and depression share chemical messengers in the brain, and so co-treatment for both issues can be most effective. He recommends:

  • Antidepressant medications, which can relieve both pain and depression since they utilize the same chemical messengers.
  • Counseling or psychotherapy
  • Stress reduction techniques such as exercise, meditation and journaling.

Depression and Cancer

This idea of journaling as a way to deal with depression, particularly when combined with health issues, is one that has been medically proven. Perhaps not surprisingly, depression is also hugely associated with cancer. Scientists have found that depression affects a cancer patient's likelihood of survival; a University of British Columbia study found death rates of up to 39 percent higher in cancer patients diagnosed with depression.

For men with testicular cancer, keeping a daily journal with a positive slant eased the men's psychological trauma and aided both their recovery and quality of life. Researchers at Baylor University divided 48 men with testicular cancer into three groups and gave them all a journaling assignment. One group was to write positively about their cancer experience, a second group was to write negatively, and the third group was instructed to write neutrally about unrelated topics.

The men who kept a positive journal reported improvements in their mental health; the other two groups did not. "We think writing about the experience could add to the therapy and can help with recovery and quality-of-life issues after treatment, as the men try to get on with their lives," said Dr. Mark T. Morman, graduate program director at Baylor.

Breast cancer patients also show higher signs of depression, which may not only impact their recovery, but possibly even prevent them from undergoing preventative health screenings. Particularly among Latina breast cancer survivors, depression is a barrier that thwarts a person's follow-through on recommendations for cancer screenings.

The Cancer Therapy and Research Center at The University of Texas Health Science Center found that among 117 Latina breast cancer survivors, of the one-third also diagnosed with depression 60 percent had not been screened for colorectal and ovarian cancers as their doctors had recommended.

“Depression can make people more inattentive to potential risks to their health and more likely to ignore recommendations to reduce their risk,” Amelie G. Ramirez reported at the Fourth AACR Conference on The Science of Cancer Health Disparities in September 2011.

Case-Managed Care Improves Outcomes

For people suffering both depression and a physical illness, the way care is delivered may mean significant differences in improvement. When patients have a care manager who not only coordinates medical care, but also educates the patient and provides motivational support, recovery seems stronger and faster.

An NIMH study showed that, for patients with diabetes or heart disease coupled with depression, receiving such case-managed care not only improved their depressive symptoms but resulted in physical improvements as well. Blood glucose levels, blood pressure and bad cholesterol levels were all improved.

The study was done among 214 patients of primary care clinics in Washington; half were seen only by a primary care physician, while the other received TEAMcare in which a nurse care manager coordinated with medical professionals. Such an approach seems to improve physical and mental results for patients, and they practice better self-care as well. 

Reviewed by: 
Review Date: 
September 27, 2011
Last Updated:
July 11, 2013