Depression As A Byproduct Of Brain Disease

Managing a brain disease can be challenging enough on its own, however, it’s relatively common for those with neurological disease to also suffer from other illnesses such as depression or anxiety.  Depression, in particular, is a highly prevalent occurrence in those with a chronic illness.

Depression is a mood disorder characterized by a persistent low mood in which the sufferer has feelings of sadness and/or low self-worth. One in five people in the United States will experience depression at some point in their life, and while periods of sadness are common in most people, suffering from major depression can be severe enough to hinder daily function and threaten relationships, employment, financial stability, etc.

The prospect of depression or anxiety alongside a brain disease may sound daunting, but it is a reality for many.

A Few Statistics

“Improved mental health is extremely important to all, with research showing that taken together, mood, depression, and anxiety have the greatest impact on health status, even more than motor impairments commonly associated with the disease.”

The Parkinson’s Foundation Parkinson’s Outcomes Project

Experts have learned the following about the relationship with some prevalent brain diseases and depression/anxiety:

• Up to 40 percent of people with Alzheimer’s disease suffer from significant depression
• At least 50 percent of those diagnosed with Parkinson’s Disease (PD) will experience some form of depression during their illness, and up to 40 percent will experience an anxiety disorder
• Almost a third of those who have had a stroke develop depression
• Mortality rates are 10 times higher in people who experience depression after a stroke
• Research suggests many people with Parkinson’s Disease experience depression or anxiety two to five years before the diagnosis of Parkinson’s Disease – this means that depression is not simply a psychological reaction to the illness, but a part of the underlying disease process

Why Brain Diseases & Depression?

Watch the video below in which Neurologist, Irene Richard, discusses symptoms of and new treatments for depression in patients with Parkinson’s Disease.

Research has shown that depression and anxiety as a result of a brain disease could be due to a variety of factors, one of which is the chemical change happening in the brain. Specifically, in the case of Parkinson’s, depression is part of the disease itself, as Parkinson’s disease causes changes in areas of the brain that produce dopamine, norepinephrine, and serotonin — chemicals that are involved in regulating mood, energy, motivation, appetite, and sleep.

In addition to the chemical changes in the brain, other psychological, biological and environmental factor factors that may cause depression or anxiety include:

• Psychological factors such as negative thoughts after receiving a diagnosis, the idea of living with a chronic illness, helplessness or severe stress
• A more restricted lifestyle as a result of social isolation or lack of support
• Major life changes such as retirement or a loss of independence due to symptoms from a brain disease
• Biological factors including a history of mental health issues
• Side effects from medication taken for the brain disease

A Snapshot of the Relationship Between Brain Diseases & Depression/Anxiety

Stroke

Post-stroke depression is the most frequent psychiatric complication of stroke, however, it is common for doctors to overlook cases of post-stroke depression.  Stroke sufferers either hide the symptoms or may not be aware of them.

According to Healthline, “Depression can affect a person’s quality of life. It can also make it more difficult to recover from a stroke. Depression can also increase the risk of cardiovascular disease, which in turn increases the risk of experiencing another stroke.”

Parkinson’s Disease

Experts have found that mood, depression, and anxiety have the greatest impact on health status, even more than the motor impairments commonly associated with PD. Depression can intensify both the motor and cognitive symptoms of the diseases and researchers have found that people with PD who experience depression begin PD medications for motor symptoms earlier.

Depression in PD, like that post-stroke, can often be overlooked and undertreated, as some of the symptoms, such as sleep problems and lack of energy, may overlap. Many PD sufferers express less emotion due to the effect known as facial masking, which makes a person unable to express emotion through facial expressions.

Epilepsy

Adults with active epilepsy were three times more likely to report depression and other mood disorders in the prior year as adults without epilepsy, which suggests that some of the brain areas responsible for certain types of seizures also affect mood and can lead to depression.

Researchers have found that a strong relationship exists between the severity of epilepsy and depression – the more severe epilepsy, the more severe the depression.

Alzheimer’s

Depression presents itself differently with each brain disorder, but because this disorder is so prevalent with Alzheimer’s, The National Institute of Mental Health created a formal set of guidelines for diagnosing depression in Alzheimer’s patients.

Although the criteria are similar to the standard another testing for depression, this reduces the emphasis on verbal expression and includes irritability and social isolation.

Warning Signs & How to Help

Unfortunately, there is no single test or questionnaire to detect depression, but knowing what to look out for may help. Diagnosis requires a thorough evaluation by a qualified medical professional, such as psychiatrists, psychologists, psychiatric nurses, social workers, or mental health counselor,  who has expertise in mental health.

To be diagnosed with depression, a person must experience one or more of the following symptoms over a period of two or more weeks: 

• Persistent sadness
• Disinterest in activities that one used to enjoy
• A change in appetite or weight
• Oversleeping or difficulty sleeping
• Physical slowing or agitation
• Fatigue or energy loss
• Feelings of worthlessness or inappropriate guilt
• Difficulty concentrating
• Recurrent thoughts of death or suicide.
• Social isolation or withdrawal
• Irritability
• Fatigue or loss of energy
• Crying
• Decreased attention to hygiene, medical and health needs
• Loss of motivation

Treatment for Depression & Anxiety

Fortunately, depression is very treatable, even in serious cases. Just as the symptoms and causes of depression can differ from person to person, so too can suitable treatment approaches.

“By being vigilant for depression in patients with PD, informed about how the condition can mask itself, and committed to developing individualized treatment plans, health care professionals can significantly improve the lives of those affected by the disease, while we continue seeking a cure,” says James Beck, Ph.D.

A few treatment options for depression include:

• Medication:  Although antidepressants are often effective in reducing symptoms, they should seldom be used alone. In most cases, the best approach is a combination of antidepressant medication and other methods
• Psychotherapy:  Broad term used to refer to the many varieties of counseling or talk therapy available today. This is an important treatment option for people with depression and is often used in combination with medication
• Cognitive-behavioral therapy (CBT): Helps people change negative thinking patterns and behaviors to reduce symptoms of depression or anxiety. Learning these skills helps people cope better and think positively for the long term
• Exercise:  walking, yoga, gardening or any movement that is of interest can help to ease symptoms of depression
• Social support or support groups:  Support groups can be very helpful in managing the emotional toll a chronic illness along with depression and anxiety can take
• Other complementary therapies for depression:  Light therapy, relaxation techniques, massage therapy, acupuncture, aromatherapy, meditation, and music therapy

The video from an episode of 60 Minutes shows an alternative method of treatment for people with an illness and depression utilizing high dose psilocybin administered in a highly controlled environment:

60 Minutes