Depression, Cancer and Chronic Illness: How do they relate?

The symptoms involved with a variety of chronic conditions–rheumatoid arthritis, cardiovascular disease, diabetes, or cancer, –may require some serious lifestyle changes. And one of those symptoms may be depression. In fact a recent study presented at the European Psychiatric Association Congress 2024 concludes that both depression and anxiety can negatively impact survival rates and reduce the quality of life for breast cancer patients. Breast cancer is the most common cancer among women and a leading cause of death globally.

Depression is also a common symptom of chronic disease. In fact, people with a chronic illness are at a much higher risk for clinical depression: approximately 25-33 percent of those who have been diagnosed with chronic disease will admit to having depressed feelings. That percentage may even be higher in individuals who have a history of depression.

But this coupling, or co-morbidity, of disease presents a big chicken-and-egg problem: Do people simply have low energy and sadness due to the lifestyle changes linked to managing their illness? Or are those feelings of depression a separate condition that require more medical assistance?

Michael Groat, Chief Clinical Officer at Lindner Center of HOPE in Mason, Ohio, says it can often be difficult to tease apart—especially because sometimes the treatments used to fight chronic illnesses can have depression-like side effects.

“There are a large range of chronic issues that you can see that may co-occur with a psychiatric illness like depression. It’s very common,” he says. “So if you are having symptoms of depression, it’s very important to talk about those feelings with your physician. Because some of those symptoms might be explained by a certain condition, or some by the treatments or medications your doctors are administrating. Patients need to talk to their doctors, so they can do a thorough evaluation to see what might be behind those feelings.”

Groat says that the combination of collaborative care and diagnosis, with a few simple lab tests, can often pinpoint whether depressed feelings may just be a byproduct of one disease or something that may warrant separate psychiatric care. And he stresses that it is important for that analysis to happen, especially since many individuals with chronic conditions are dealing with polypharmacy, or taking multiple drugs simultaneously, to manage their symptoms.

“Today, we can do pharmacogenomic testing so we can better understand how a patient’s body may process medications,” he says. “We’ve learned that some people are very rapid metabolizers of particular kinds of medications. Others are very slow to metabolize medications. That matters because it affects dosage, as well as how medicines might interact and work together. It can help us do a thorough medication review to see what kind of side effects or interaction effects might be going on.”

But none of that can occur until you speak to your physician about how you are feeling. Groat says there’s no need to try to appear strong or to downplay those symptoms if you have them. “This is important clinical information and can help your doctor get you the right treatment,” he says. “So it’s smart to speak up and talk about it.”

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