Depression increases risk of chronic diseases, study reveals

Middle-aged adults with a history of depression have more chronic diseases, according to a study from the University of Edinburgh in Scotland, published in the journal Plos One . The research evaluated the association between depression and so-called multicomorbidities, that is, the coexistence of two or more diseases.

It is known that depression affects several systems, and the authors sought to quantify its relationship with the presence or development of 69 health problems, such as cardiovascular and pulmonary diseases, diabetes, arthritis, among others.

To do this, they evaluated data from more than 172,000 participants from the British Biobank, a large health database, followed for an average of seven years. Around 18% had been diagnosed with depression when the research began.

At the outset, those diagnosed with depression had an average of three chronic diseases, compared with two for the other participants. At the end of the follow-up, those with depression had a twice as high risk of having other diseases. The result remained the same even after adjusting for other risk factors, such as a sedentary lifestyle or smoking.

“The study highlights the bidirectional issue between depression and clinical conditions: we know that these patients have a greater risk of developing chronic diseases throughout their lives and that chronically ill patients have a greater risk of developing depression throughout their lives,” analyzes psychiatrist Gabriel Garcia Okuda, from Hospital Israelita Albert Einstein.

One of the reasons behind this association is the impact of depression on health care. “It is very difficult for a depressed patient to take good care of clinical comorbidities, such as high blood pressure, dyslipidemia or diabetes,” says Okuda.

These individuals also have more difficulty in maintaining treatments, from seeking initial care to continuing. “They may not take their medication, or they may take it for a while and then stop, which can worsen their overall clinical condition,” says the specialist.

Furthermore, the symptoms of the disease itself — sadness, lack of willpower or energy, changes in appetite and sleep, for example — have a direct impact on health. “Sleep plays an important role in regulating the hypothalamic-pituitary-adrenal axis, which can alter the cycle of cortisol, the stress hormone. When you don’t sleep well, you tend to have high cortisol levels, which can increase the risk of obesity, heart disease, among others.”

Changes in appetite can lead to malnutrition or, on the contrary, to a worsening of the quality of food, leading to weight gain. This in turn can lead to an increase in blood pressure, worsening of diabetes and cholesterol levels.

“These are frequent situations that depression can cause, generating a cascade effect, with worsening of the clinical aspect. This worsening makes it even more difficult to improve mood symptoms,” explains the psychiatrist. In addition, these people are more likely to use substances such as alcohol, tobacco and others.

Therefore, the study emphasizes the need for more active screening of these cases, which may end up evolving into more serious conditions. It is worth remembering that treatment is based on a three-pronged approach that includes psychiatric monitoring and medication, when necessary, psychotherapy and lifestyle measures, including care with the quality of sleep, diet, stress control and physical activity.

Hence the need for integrated and collaborative treatment between doctors and other professionals. “Educating patients is also important, as they sometimes think that taking medication is enough, remembering this bidirectional effect between depression and other illnesses and the importance of treating the physical, emotional and mental aspects to improve the condition.”

Source: Einstein Agency

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