About this leaflet
Many of us will, at some time, have a serious physical
illness. Both the illness, and the treatment for it, can affect the
way we think and feel. This leaflet is for anyone who has a serious
physical illness and for their friends or relatives. It
- the emotional effects of having a serious physical illness
- what does it feel like to be anxious or depressed?
- why are depression and anxiety more likely to happen if we have
a physical illness?
- what might make you more likely to become anxious or
- when should you seek help?
- how can depression and anxiety be helped?
- how can you help yourself?
- how can family and friends help?
- some places to get information and support.
The emotional effects of having a serious physical illness
A serious physical illness can affect every area of your
- spiritual beliefs
- how we socialise with other people.
A serious illness can make us feel sad, frightened, worried or
It may be because:
- We feel out of control of your body and our situation
generally. We may feel that there is nothing that we can
- We feel lonely and isolated from family and friends.
Sometimes it can be difficult to talk about the illness with those
close to you. We don't want to worry or upset them.
For some of us, the emotional impact of a serious physical
illness can be overwhelming. Cancer or heart disease, for example,
can make us very anxious and depressed. It can stop us from doing
the things we need to do in our daily lives.
What does it feel like to be anxious or
Anxiety and depression affect both our mind and body.
Often the two happen at the same time.
- constant worrying thoughts, often about the illness and its
- fearing the worst, for example, that our illness will get worse
or that we might die
- being very aware of our heart beating (palpitations)
- tension and pains in our muscles
- being unable to relax
- breathing too fast (hyperventilating)
- feeling dizzy
- feeling faint
- indigestion and diarrhoea.
- feelings of unhappiness that don't go away, and are there
nearly all the time
- losing interest in life
- being unable to enjoy anything
- finding it hard to make even simple decisions
- feeling utterly tired
- feeling restless and agitated
- losing appetite and weight (some people find they do the
reverse and put on weight)
- difficulty in sleeping and waking up earlier than usual
- losing interest in sex
- losing self-confidence and feeling useless, inadequate and
- avoiding other people
- feeling irritable
- feeling hopeless about ourselves, our situation and the world
generally - we may feel as if we are never going to get
better, or that we are worthless
- thinking of suicide - this is common in depression. It is much
better to talk about it than to try to hide it.
Some of these symptoms, such as feeling tired, poor sleep and
loss of appetite, may be similar to those caused by the physical
illness or its treatment. If you talk through how you are feeling
with a doctor or nurse, they can help to sort out whether it is
your physical illness or depression that is responsible.
Why are depression and anxiety more likely to happen if you
have a serious physical illness?
- People become depressed and anxious when they are stressed for
any reason. Being ill and having treatment are stressful. This is
probably the most common reason.
- Some drug treatments, such as steroids, affect the way the
brain works and so cause anxiety and depression directly.
- Some physical illnesses, such as an under-active thyroid,
affect the way the brain works. They cause anxiety and depression
- Anxiety and depression are common. You may just happen by
chance to become anxious or depressed at the same time as you
become physically ill.
What might make you more likely to become anxious or
You are more likely to experience severe anxiety and
depression when you are physically ill if:
- you have been anxious or depressed before
- you do not have any family or friends you can talk to about
- you are female (women report more anxiety and depression than
- you have other problems or stresses going on in your life at
the same time, for example, redundancy, a divorce or the death of a
- you are in a lot of pain
- you illness is life-threatening
- your illness stops you from looking after yourself.
The times when we are most likely to become anxious
and depressed are:
- when you are first told about your illness
- after having major surgery or if there are unpleasant
side-effects to your treatment
- if the illness comes back, after you seemed to be feeling
better, for example, a recurrence of cancer or a second heart
- if your illness stops responding to treatment.
When should you seek help?
If your feelings of
anxiety and depression:
- are worse than the fears, worries and sadness that you have had
- don't seem to be getting any better with time
- begin to affect your feelings towards family and friends, your
work and your interests
- if you feel that life is not worth living, or that other people
would be better off without you.
You may not realise you are depressed,
- you think all your symptoms are due to the physical
- you blame yourself for being lazy or feeble.
Other people may have to reassure you about this. They may
need to remind you that seeking help is not a sign of weakness.
Some of us try to cope with our feelings of anxiety and depression
by keeping busy. This works for some people, but can also make us
even more stressed and exhausted. Sometimes anxiety and depression
may not show themselves as feelings of unhappiness and fear, but
may produce bodily pain, headaches, or sleeplessness.
It may be enough to talk things over with a relative or
friend who may be able to help you through this difficult
time. But, if this doesn't seem to help, it is probably a good idea
to talk to one of the doctors and nurses who are looking after
Is feeling like this a good
enough reason to ask for help?
It can be difficult asking for help with anxiety and
depression when we are physically ill because:
- you may feel your distress is understandable and therefore
there is nothing that can be done about it;
- you don't want to appear ungrateful, or as if you are
complaining to the doctors and nurses who are providing your
- you don't want to interfere with the treatment of your physical
illness, by admitting that you are having difficulty coping;
- you may feel that the doctors and nurses are too busy looking
after your physical illness to be interested in your anxiety and
- you feel the doctors and nurses are more interested in your
physical problems than your emotional ones.
Just because we can understand why someone with a serious
physical illness becomes anxious and depressed, this does not mean
that we should ignore the problem. Doctors and nurses are
concerned about all aspects of your health, including any
depression or anxiety that you are feeling. They can help by
- knowing about your worries and concerns about your
- making sure you know enough about your illness and its
- helping you to talk about your feelings
- deciding if you need treatment for anxiety or depression.
How can depression and anxiety be helped?
There are several different types of professional who may be
able to help you. These include your GP, trained counsellors,
psychotherapists, clinical psychologists and psychiatrists. Any
treatment suggested will depend on your symptoms, the severity of
your anxiety and depression, and your circumstances. It may involve
talking, antidepressant tablets or both.
It can be hard to express real feelings, even to close
friends. It may be easier to do this with an interested
professional. He or she can help you to get things in perspective
and to find ways of sorting out your problems. Talking therapies
are usually brief, involving up to 8 sessions. You might see
somebody on your own or as part of a group. If you have a partner
or carer, it could be helpful to involve them. There are many
types of talking treatments,
have the following ingredients:
- a trusting relationship between the patient and the
- an opportunity to talk freely and openly about your thoughts,
feelings and problems
- help coping with worrying thoughts, bad feelings and practical
Will it help?
The thought of seeing someone just to talk may seem
frightening or pointless, or both. However, once started, most
people with a serious physical illness find it very helpful.
How does it work?
Talking treatments work by helping you to be clearer about what is
happening to you emotionally. They help you to find ways of
coping better with feelings, thoughts and practical problems. It's
also helpful to be able to talk freely with someone you trust and
who doesn't pass judgement on you.
How quickly does it work?
Some people feel better straight away, simply from being able
to talk about their worries. For others, it may take a few
If your anxiety and depression is particularly bad, or goes on
for a long time, a course of antidepressants
may be helpful. They help
people with anxiety and depression to feel better, so that they can
start to enjoy life and deal with their problems effectively again.
They are not
tranquillisers, although they may
help you feel less anxious and agitated. They can also help pain
and disturbed sleep.
Will you feel
better straight away?
Probably not. Unlike many medicines, you won't feel the effect of
antidepressants straight away. People often don't notice any
improvement in their mood for two or three weeks, although some of
the other problems may improve more quickly. For instance, people
often notice after a few days that they are sleeping better and
feeling less anxious.
What about the
Like all medicines, antidepressants do have some side-effects,
although these are usually mild and tend to wear off as the
treatment goes on. Different antidepressants have different
effects. Your doctor can advise you about what to expect. If
necessary, you can also take antidepressants with painkillers,
antibiotics and the contraceptive pill. However, you should avoid
too much alcohol - alcohol can make you very sleepy if you drink it
while taking antidepressant tablets. Your doctor will advise you
whether they will interfere with any treatments that you are taking
for your physical illness.
you help yourself?
As well as seeking professional help, there are a number of
things you can do to help yourself.
- Share your fears and concerns with people close to you. You may
be surprised - rather than finding this a burden, you may also be
relieved to talk about these things.
- Ask your doctor questions about the illness. If there are
aspects of the illness or its treatment that you are uncertain
about - ask. If you know about your illness, you are likely to cope
better with it.
- Try to eat a balanced diet. If you have lost your appetite
because of worry or depression, you may lose weight. This can make
your physical health worse.
- Balance the demands of your illness and the demands of your
life. You will need to try and find the balance between 'giving
into the illness' and 'pressing on regardless'.
- Look after yourself. Make sure that you build relaxation,
pleasurable activities and, if possible, physical exercise in your daily
- Try not to drink too much alcohol to make yourself feel better.
It can actually make anxiety and depression worse and it may
interfere with your tablets.
- Try not to worry about not sleeping properly. This happens in
anxiety and depression and usually gets better when your mood
- Don't change the number of tablets you are on, or stop taking
them, or try other remedies, without discussing this with your
doctor. If the tablets have unpleasant side-effects, tell your
doctor or nurse. Don't suffer in silence.
How can family and friends help?
It is often a relative or friend who first notices anxiety and
depression coming on in someone with a physical illness. If you
have noticed someone close to you becoming depressed, gently
encourage them to seek help. Explain that anxiety and depression
are quite common and that, with help, they get better in the great
majority of cases. To see a professional, such as a psychiatrist or
a psychologist, is not a slur on the patient or their family, or a
sign of weakness.
- It is helpful to spend time with someone who is anxious and
depressed. They don't need to be nagged, but they do need to be
encouraged - perhaps to talk, but also to keep going with some of
the things they normally do.
- Reassure the person who is anxious and depressed that they will
get better - they may find it hard to believe that they can.
- Try to make sure they are eating a well balanced diet and help
them to avoid drinking too much alcohol.
- If the anxious and depressed person is getting worse and has
started to talk of not wanting to live, or has hinted at harming
themselves, take these statements seriously and make sure that
their doctor knows about this.
- Try to help the person to accept the treatment prescribed. If
you have doubts about the treatment, discuss them with the
Caring for someone who is both physically ill and troubled
with anxiety and depression can be exhausting. If you are getting
worn out, do ask for help.
- Antidepressants for depression in physically ill people (2010)
Rayner L, Price A, Evans A, Valsraj K, Higginson IJ and Hotopf M.
Cochrane Database of Systematic Reviews.
- Depression in adults with a chronic physical illness, treatment
and management (2009) National Institute for Health and Clinical
Excellence (NICE).Managing depression in physical illness (2002)
MacHale, S. Advances in Psychiatric Treatment 8: 297-304.
- Mood disorders in the general hospital setting (2009) Cleare
JC, Psychiatry 8: 67-70.
- Psychological reaction to physical illness (2012). Guthrie E
& Nayak A in Seminars in Liaison Psychiatry. Eds
Guthrie E, Rao S and Temple M. Royal College of
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Series Editor: Dr Philip Timms, Chair, Royal College of
Psychiatrists' Public Education Editorial Board
Expert Review: Dr Jim Bolton
With contributions from the Liaison Psychiatry Faculty of the
Royal College of Psychiatrists
This leaflet reflects the best available evidence available at
the time of writing.
© May 2014. Due for review: May 2016. Royal College of
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