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The Director Discusses: Co-occurrence as the Norm and Not the Exception

Photo: John F. Greden, M.D.The co-occurrence of depression and bipolar disorder with other medical and brain illnesses is increasingly being recognized and acknowledged.  Over recent months it has been widely publicized that military veterans especially are at high risk for experiencing some combination of depression, post-traumatic stress, anxiety, traumatic brain injury, and addiction.  More than 300,000 veterans from the Iraq and Afghanistan conflicts suffer from concurring disorders and are at growing risk for suicide.   What is less well publicized is that not only veterans suffer from such co-existing conditions.  In fact, co-occurrences of depression with other illnesses are actually the norm rather than the exception.

What are some of the most common co-occurring illnesses with depression and why do they occur together?
Depression has increasingly been linked to cardiovascular (heart) disorders, diabetes, cancers, emphysema, chronic pain conditions, addictions to alcohol, tobacco or other substances, anxiety, panic disorder, phobias, Attention Deficit and Hyperactivity (ADHD), and Post-Traumatic Stress Disorder (PTSD).  Some medical disorders contribute biologically to depression, but depression may also occur in response to stressful life events or the prognosis or pain that accompanies serious illness and related treatment.  It is also not surprising that depression can make those other illnesses worse, especially if the depression is undiagnosed.  While there are reasons that make co-occurring illnesses more likely, sometimes the disorders are unrelated and happen by chance. 

How do you treat depression with a co-occurring illness?
People diagnosed with both depression and another medical illness are often treated for both disorders at the same time.  In order to do this, integrated and collaborative care are needed so clinicians can help each other work effectively.  Research has shown that treating depression can also help improve the outcomes of the co-occurring illness.  While treatments may be different for each disorder, the best outcome occurs when they are cared for simultaneously.

What should I do?
The first steps are to be aware of the increased risk, and to talk opening with your medical professional if you have been diagnosed with a serious medical or psychiatric illness.  Educate yourself about all aspects of the illnesses.  Learning about the disorders can help you take an active role in the treatment process. 

Depressed patients are three times more likely than non-depressed patients to neglect to follow their doctor’s orders.  So, following “doctor’s orders” is a must.  You need to participate in your own recovery by adhering to your treatment plan. 

If you have been diagnosed with more than one disorder and have been prescribed several medications, it is important to keep track of what medications you use regularly as well as their effects.  Make sure to share a list of all of your medications with your treatment provider(s) so that possible medication interactions are not overlooked. 

There is hope!
Treating depression can significantly improve recovery from co-occurring medical illnesses.  Integrated treatment, in particular, is one of the most important factors in determining success.  The University of Michigan Depression Center has been a leader in creating collaborative care models that have been proven to be effective.  To learn more about the types of treatment options available to those suffering from depression and bipolar disorder and co-occurring conditions, visit www.depressiontoolkit.org.

Merci,

John F. Greden, M.D.


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