Depression and Other Medical Conditions

Depression and Cancer
Mood and anxiety problems are very much associated with cancer and its treatment. Directed by Michelle B. Riba, M.D., M.S., the PsychOncology Program, a joint endeavor between the University of Michigan Comprehensive Cancer Center and the Depression Center, provides an umbrella of services for patients and families who are being treated for cancer.

A multi-disciplinary Psychosocial Task Force, directed by Karen Hammelef, B.S.N. and Michelle B. Riba, M.D., M.S, has organized a host of programs for patients and families. Patients are first triaged for distress by their primary treatment team at the Cancer Center. If patients are moderately or highly distressed, patients may either be treated within the team structure; referred to a psychiatrist, social worker or psychologist; or evaluated for group therapy. Treatment may include individual or family therapy and modalities include psychopharmacology, psychotherapy, crises intervention, behavioral therapies, and others.

For those patients who have low distress or who seek additional care, the Cancer Center offers a Healing Arts Program; Art Therapy; and Support Groups.

We have several research projects underway in the area of evaluating distress in Melanoma and Bone Marrow Transplant Patients, directed by Peter Trask, Ph.D.

Finally, there are various education programs available to staff including our monthly Psycho-Oncology Patient Rounds; and training sessions through our Bereavement Program.

Depression and the Heart
Depression is a common risk factor for heart disease and can complicate recovery from a heart attack. Even minor depression is a significant risk for and appears to be related to future complications and even death. Depression is related to a number of heart related factors that can complicate and interfere with the patient's adaptation to and recovery heart disease of all kinds. One way that depression may very directly affect the heart is by actually altering how the heart and whole cardiovascular system works in ways that tax the heart and help to speed up the disease process. Depression is also related to lifestyles that contribute to heart disease such as poor diet, lack of exercise, excessive alcohol or other drug use, and social isolation. Finally, depression has also been found to make recovery and rehabilitation harder for patients.

Importantly, depression is often under-identified and therefore under-treated in patients with heart disease. A number of things contribute to this.

First, many of the symptoms of depression (such as low energy, sleep problems, irritability, etc.) can also be symptoms of heart disease. Second, some "down" feelings experienced by heart patients may be considered by the patient or their doctor to be a normal reaction to a potentially life threatening situation. Finally and perhaps most importantly, having a diagnosis of depression unfortunately continues to carry a stigma and it has been shown that many heart patients will refuse to admit they are depressed or may not even recognize depression in themselves.

Depression can be combated by a number of things that are also heart healthy.

Exercise can not only strengthen the heart and cardiovascular system but can also improve body image, self esteem, mood and quality of life.
Social support is ones connection to others. Increasing your relationship to others can not only improve your mood but now has a convencing impact on recovery and survivial from heart disease.
Substance abuse such as alcohol, recreational drugs and tobacco can alter mood and contribute to heart disease as well. Smoking is a significant contributor to diseases of the lungs but it also bad for the cardiovascular system (see also nicotine research lab). Alcohol and substance abuse can very directly contribute to depression and heart disease. Alcohol has also been shown to have some therapeutic effect. Patients often have questions about whether they should avoid alcohol or use it as a part of treatment. Several things should considered if one wishes to explore this option further.
1. One should never undertake the use of alcohol as part of a treatment program without the supervision of a physician.
2. Excessive alcohol use is always bad for you.
3. As a general rule there are other medications that can provide the same benefit with less problems than those posed by alcohol use.

How to take action
If you or a loved one is attempting to cope with depression (take our online screening test), heart disease or both, tell your doctor. Assessment of depression is relatively brief, painless and can be a self-educational experience even if it turns out you are not depressed. This website and your doctor can aid you in finding appropriate help.

The Depression Center maintains a strong clinical and research relationship with the Division of Cardiology and expertise for understanding how the two problems are related is also available to patients in either the Depression Center, the Cardiology Division or the University of Michigan Health Care System as a whole. Particular expertise for heart and mind is available through the Consultation and Liaison Program and Pediatric Consultation Program as active and integral parts of the Depression Center.

Useful Links:

Women's Health Program
Woman's Guide to Understanding Depression

Depression after Surgery
Depression and/or anxiety are often experienced after surgical procedures, at various times post operatively (immediately or months later). Intensity can range from mild dysphoria to major depressive symptoms. John Lauerman in the January 2000 issue of Harvard Magazine, addresses this topic in "An Understandable Complication...Coming to terms with postsurgical depression." The article talks about emotions before surgery as being expected and often handled quite well. Problems can also crop up in the recovery period which are not expected. After major surgery, according to the article, feelings of mortality, of loss, and of vulnerability can be profound." Shortly after surgery, depression can be attributed to pain, a problem with anesthesia, a sense of loss or another underlying cause. Post-operative depression, well after the crisis of surgery, can make it difficult for patients to cope with what they have endured. There might also be uncertainty about the future, or lack of understanding on the part of individuals close to them. This article points out the importance of communicating feelings of depression to medical professionals who may not be alert to symptoms, in order to have all possible causes of depression investigated.

In the April 15, 1997 issue of Annals of Internal Medicine, Herbert Waxman, M.D. relates his experience with depression following surgery. In "The Patient as Physician", he discusses his post surgery symptoms. Occuring several months after surgery, he experienced "dysphoria, sleep problems, joylessness and feelings of unworthiness." When he returned to work, he realized the importance of honest communication and sensitivity to patient concerns and believes the experience made him a much better physician.

The following references to other articles which may also be helpful. Although they are slanted towards specific surgical procedures, there is general information, including correlation of postsurgical depression and previous history of depression; social support; doctor-patient communication; surgical outcomes; trauma of surgery.

"Psychological Complications in 281 Plastic Surgery Practices" by Gregory Borah, et al. In Plastic & Reconstructive Surgery 104(5):1241-1246, October 1999.

"The Effect of General Anesthesia on Postoperative Depression", Scher C., Faw S, Anwar M. Abstract Presented at International Anesthesia Research Society, Anesthesia & Analgesia 88(2S) 27S. February 1999.

"Depression after Successful Treatment for Nonsmall Cell Lung Carcinoma", Uchitomi Y, Mikami I, Kugaya A, et al. Cancer 2000, Sep 1:89(5): 1172-9.

"QEEG and Neuropsychological Profiles of Patients After Undergoing Cardiopulmonary By Pass Surgical Procedures", Chabot R, Gugino L, Aglio L, et al. Clinical Electroencephalography April 1997 28(2):98-105.