Depression: It Doesn’t Need to Derail Disease Management

Steve has always been a reliable and excellent floor supervisor for over a decade. Everyone on the floor respects him and his shift always goes without incident. This however is about to change.

Over the past several weeks something does not seem right. He appears off his game, arrives slightly late, works more sluggish, and makes some small, all be it manageable, clerical errors.  As the overnight floor manager, he has always kept things running smooth, though you begin to worry that something catastrophic may go wrong.  You decide to check in with him and he says everything is okay and a few more days pass without incident.

It is late on a Friday night and you receive the call you have dreaded.  Steve has collapsed at work during his shift and has been rushed to the hospital.

Steve is a severe diabetic with high blood pressure, though he has managed his conditions successfully for years, he recently experienced the loss of his dog, Charlie, and has been feeling worthless since his loss.  He has been depressed for weeks and stopped managing his health condition as vigilantly as he was in the past, ultimately leading to his collapse and emergency medical event.

1 in 5 will experience major depression in their lifetime

This story is not out of the realm of possibility.  One in five individuals will experience a bout of major depression in their lifetime [1]. However, when they experience this episode of depression it does not have to derail the success they have had managing their chronic health condition(s) to date.

Depression:

Depression is a common medical illness that impacts how someone feels, the way they think, and the way they act.  It is not always perpetual sadness; depression can cause loss of interest in activities that were once enjoyable.  Depression is not a all-or-none condition, and can vary in severity and symptoms from person to person.  Further, it is important to note, depression is not always externally visible. Someone you know and talk with every day may be struggling and you would never know.

Situational depression can generate the same feelings of major depressive disorder.  It usually coincides with an event that brings on sadness, loss of self-worth, loss of interest, and changes in daily routines.  Situational depression is when someone has feelings of depression when having difficulties managing a stressful event in life such as a loss of job or loved one, or diagnosis of a chronic disease.

While depression does impact each individual differently, depression can affect other chronic health conditions as well.  Changes in sleep, diet, exercise, diminished pleasure, weight loss, reduced concentration, and feelings of self-loathing or hatred, can impact the way we manage our chronic health conditions.

Chronic Diseases and Depression

Having a chronic health condition drastically impacts the prevalence of depression.  One in three individuals with a chronic health condition also have symptoms of depression [2]. This ultimately leads to a vicious cycle.

Diabetes: For an individual with diabetes, depression can have a drastic impact on their health.  Ultimately, the presence of depression can worsen the prognosis of diabetes and increase non-compliance to the patient’s plan of care. 

Depression and stress alone impact blood glucose levels.  However, if the individual stops with their treatment, decides to not watch what they are eating, or decides to stop exercising they could see a spike in hyperglycemia (high blood sugar).  Cardiovascular disease, nerve damage, kidney damage, and various skin conditions are common complications of untreated diabetes.  This could lead to a medical crisis including the one Steve faced on the factory floor.

Heart Disease: Not only does being diagnosed with heart disease increase the chance of a bout of depression, depression may also have a drastic impact on the heart health of the individual.  It is well accepted that lifestyle habits brought upon depression are also risk factors for heart disease including sedentary lifestyle, smoking, poor diet, overeating, excessive alcohol consumption, and lack of medication adherence.

Individuals with chronic health conditions who also get treatment for co-existing depression often are better at self-management and have an improved quality of life.

How can I get ahead of this potential crisis?

For myself?

  • Seek Help. If you are worried you or a loved one may be suffering from depression, please schedule an appointment with a healthcare professional.
  • Eat Healthier Foods.  Foods that are nutrient dense will help improve heart health, diabetes management, and assist in improving mood.
  • Exercise Regularly. The American College of Sports Medicine recommends 150 minutes of moderate intensity exercise each week.  Regular exercise improves heart health, blood glucose regulation, and is a great way to assist in managing depressive moods.
  • Drink Less Alcohol.  Alcohol is a depressant; therefore, excessive alcohol intake can exacerbate depressive symptoms.  Further, excessive alcohol consumption can negatively impact both heart health and glucose regulation.
  • Quit Smoking.  Smoking is a risk factor and catalyst for heart disease and diabetes.  While smoking may provide a sense of relaxation during bouts of depression, it is having a greater negative impact on your health.
  • Practice Good Sleep Hygiene.  Develop strong sleeping habits, this can assist with feelings of fatigue and restlessness.

For my employees?

  • End The Stigma.  An employee should never feel embarrassed or concerned about how their employer will respond to a mental health concern.  
  • Provide Resources.  Treat mental health with the same urgency as work place safety and other health concerns your company has.
  • Open Your Door. You do not need to be someone’s therapist, but they should feel safe letting you know of something they are struggling with that may impact their quality of work.
  • Provide Regular Training.  Train the management team in workplace mental health wellness, as well as keeping them up-to-date on resources they can provide the employees.
  • Regular Communication And Education.  Educate the company on mental health, help end the stigma they may have about their own mental health.  Communicate resources available and provide support when necessary.
  • Never Judge. You do not know the employee’s full story, never judge them when something has them feeling down. Your support and encouragement to seek help could help change their life.

End the Stigma. Provide Resources. Open Your Door. Provide Regular Training, Communication, and Education. Never Judge.

Helplines

If you or someone you know is struggling with depression, please do not hesitate to reach out to the follow resources.

  • National Alliance on Mental Illness: 1-800-950-NAMI (6264)
  • National Suicide Prevention Lifeline: 800-273-TALK (8255)

Steve has always been a reliable and excellent floor supervisor for over a decade. Everyone on the floor respects him and his shift always goes without incident.  

Several weeks ago, you noticed that Steve was not his usual self. He had been more sluggish, arriving to work slightly late, and making some small but manageable errors.  You remember a recent lunch-and-learn where you learned about ways to better support the employees and their health. You decide to ask Steve if he is okay. He tells you about his dog, Charlie, and how it has really been bothering him.  You actively listen and offer your support. 

The next day you call Steve into your office and offer him information about the Employee Assistance Program the company has and some of the benefits they have in grief support available.

A couple weeks after that conversation, Steve seems to be doing much better, he appears back to his old self and things go on without incident.  To prevent a crisis sometimes it is just about asking if someone is okay and providing the proper support when you can.

To prevent a crisis sometimes it is just about asking if someone is okay and providing the proper support when you can.

Cited:

  1. Badescu, S., Tatura, C., Kobylinska, L., Georgescu, E. L., Zahiu, D. M., Zagrean, A. M., & Zagrean, L. (2016). The association between Diabetes mellitus and Depression. Journal of Medicine and Life, 9(2), 120–125.
  2. Chronic Illness and Depression. (2017, January 17). Retrieved from https://my.clevelandclinic.org/health/articles/9288-chronic-illness-and-depression.
  3. Ryu, E., Chamberlain, A. M., Pendegraft, R. S., Petterson, T. M., Bobo, W. V., & Pathak, J. (2016). Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records. BMC Psychiatry, 16(1). doi: 10.1186/s12888-016-0821-x