Beyond Depression: Co-Occurring Conditions
While depression can be hard to manage on its own, it’s even harder when you or a loved one are navigating additional health conditions. Many conditions may co-occur with depression. Co-occurring conditions are when a person lives with two or more diagnoses simultaneously*.
You may have heard people say, for example, that they experience both anxiety and depression. Conditions – like anxiety disorders, ADHD, heart disease, chronic pain, or diabetes – may affect or be affected by both the physical and emotional effects of depression. Awareness of the diverse ways that depression can exist with co-occurring conditions is important for supporting loved ones in this situation.
Co-Occurring Conditions
Anxiety Disorders
Anxiety disorders affect around 301 million people globally. There are shared genetic and environmental risk factors that can influence the development of depression and anxiety disorders. So it comes as no surprise these conditions can both affect individuals, often simultaneously. These overlapping factors may include a genetic predisposition for neuroticism (heightened negative emotions), similar rerouting of neural circuitry (how one’s brain is wired), and the impact of adverse life events.
Because they have overlapping symptoms, it can be difficult to identify both conditions in one person. However, this recognition is important because the effects of one may be synergistic with the other. Treatment approaches for anxiety and depression are often the same or similar. It can be challenging to separate out what is working for one but not the other. Caregivers can be especially helpful by supporting their loved ones to track positive and side effects, behaviors, and mood changes.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD, affecting approximately 3% to 5% of adults, can co-occur with depression. ADHD symptoms like impulsivity, difficulty paying attention, and hyperactivity can intensify feelings of frustration and emotional distress. The constant struggle with focus and self-control can lead to a heightened sense of failure, potentially exacerbating depressive symptoms. In addition, depression also often affects a person’s thinking, including their ability to reason, organize, analyze, pay attention, and remember. It’s essential to diagnose and treat both conditions concurrently to improve overall mental health and quality of life.
Heart Disease
Heart disease can often co-occur with depression but the details of this relationship are difficult to disentangle. Studies have shown both that there is a high prevalence of depression in people with heart disease, especially those who experienced a heart attack, and that people who live with depression have a higher likelihood of developing heart disease.
Heart disease is often associated with unhealthy lifestyle habits, which also become common in people living with depression. Not staying on treatment, including medication, can have negative impacts with both conditions. Medication can change a person’s hormonal balance, nervous system, or circulatory system, all of which can impact both health conditions. Because each person has a unique experience with their body’s reaction to medication, taking steps to get specialized care for both conditions is important. Even healthcare providers can have trouble identifying a treatment’s effect when heart disease and depression co-occur.
Chronic Pain
Those experiencing chronic pain often endure a diminished quality of life that can be marked by disrupted sleep, inability to work, or social withdrawal, which increases the risk for developing depression. Additionally, there is a higher incidence of pain symptoms in those with depression than in the general population.
There are similar biological mechanisms involved with both depression and pain. For instance, they can both lead to a reduction in grey matter volume in certain areas of the brain that are connected to emotion, the experience of pain, and memory. There can be a feedback loop between depression and pain, with one exacerbating the symptoms of another. Additionally, those with chronic pain self-report a lower efficacy with antidepressants than those without pain.
Diabetes
The growing prevalence of diabetes also means that there is an increase in those at risk for depression. People diagnosed with either type 1 or type 2 diabetes have to be attentive to their diet, medication, exercise, and blood sugar regulation. The stress of maintaining blood sugar levels can lead to depressive symptoms. Additionally, depression symptoms like low motivation, excessive sleep, and loss of appetite can make it more difficult to sustain the lifestyle habits that diabetes management requires. Depression and diabetes are usually chronic conditions and are best addressed through a holistic approach.
Addressing Co-Occurring Conditions with Your Loved One
Depression and co-occurring conditions can pose lifestyle, diagnosis, and treatment challenges. Shared symptoms can make identifying the separate conditions difficult, but effective treatment relies on proper diagnosis. Healthcare professionals aware of the interplay between depression and other conditions can often offer integrated or complementary treatments to address both conditions simultaneously.
It is essential that people living with mental health conditions disclose other diagnoses and concerns with their healthcare providers. You can support your loved one in seeking comprehensive care. For example, caregivers can help with maintaining records of diagnoses and treatments to ensure that providers have a full picture of a person’s whole health. With the help of caregivers who offer empathy and patience, families can navigate and manage coping with multiple conditions.
*Families for Depression Awareness uses the term “co-occurring” instead of “comorbid” because the meaning is more clear.
Joanna is currently working as a clinical research coordinator at the Cancer Outcomes Research and Education Program (CORE) after graduating from Boston College studying environmental science and global public health. Her experience working with a multidisciplinary group of clinician scientists on research studies with innovative supportive care interventions that improve the quality of life of patients with cancer and their loved ones sparked a profound interest in psychosocial health, prompting her to serve as a volunteer at Families for Depression Awareness. She is committed to understanding more about the intersection of physical and mental well-being when she matriculates into medical school this upcoming year at Rush Medical College.