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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Coping with physical illness

 

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 describes:
 
  • the emotional effects of having a serious physical illness Physical Illness and Mental Health
  • 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 depressed?
  • 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 life:
  • relationships
  • work
  • spiritual beliefs
  • how we socialise with other people.
A serious illness can make us feel sad, frightened, worried or angry.
 
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 do.
  • 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 depressed?

Anxiety and depression affect both our mind and body. Often the two happen at the same time.

Anxiety feels like:
  • constant worrying thoughts, often about the illness and its treatment
  • 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
  • sweating
  • breathing too fast (hyperventilating)
  • feeling dizzy
  • feeling faint
  • indigestion and diarrhoea.
Depression feels like:
  • 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 hopeless
  • 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 directly.
  • 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 depressed?

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 your illness
  • you are female (women report more anxiety and depression than men)
  • 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 loved one
  • 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 attack
  • 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 before
  • 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, if:
  • you think all your symptoms are due to the physical illness
  • 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 you.
 

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 physical care;
  • 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 depression;
  • 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 situation
  • making sure you know enough about your illness and its treatment
  • 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.
 
  • Talking treatments
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, but all have the following ingredients:
  • a trusting relationship between the patient and the professional
  • an opportunity to talk freely and openly about your thoughts, feelings and problems
  • help coping with worrying thoughts, bad feelings and practical problems.
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 weeks.
 

Antidepressant drugs

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 side-effects?
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.
 

How can 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 routine.
  • 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 lifts.
  • 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 doctor.
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.
 

References

  • 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 Psychiatrists.
 

Further help

Helpline: 0808 800 4050; email: info@arthritis.org.uk
Provides information and support for patients with arthritis and their families and carers.
 
Helpline: 0808 800 5050; email: helpline@epilepsy.org.uk
Provides information for people with epilepsy, including information on epilepsy and depression, and a telephone and email helpline.
 
Heart helpline: 0300 330 331; email: heartmatter@bhf.org.uk
Supports research into and provides information on heart disease, including depresison and the heart.
 
Helpline: 03000 030 555; email: helpline@blf.org.uk
Information, support and understanding for people affected by lung disease, including the Breathe Easy support network.
 
Depression Alliance
Tel: 0845 123 23 20; email: information@depressionalliance.org
Information, support and understanding for people who suffer with depression, and for relatives who want to help. Self-help groups, information, and raising awareness for depression.
 
Helpline: 0808 800 8000, tel: 020 8438 0700.
Provides information on multiple sclerosis (MS), including MS and depression.
 
Helpline: 0845 601 02 09; email: helpline@kidney.org.uk
Provides support services for patients with kidney disease.
 
Helpline: 08457 90 90 90, (Ireland): 1850 60 90 90; email: jo@samaritans.org
National organisation offering support to those in distress who feel suicidal or despairing and need someone to talk to. The telephone number of your local branch can be found in the telephone directory.
 
Saneline
Helpline: 0845 767 8000 (1pm - 11pm). National telephone helpline offering practical information and emotional support to anyone affected by mental health issues.

 

Further reading

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
 
Illustration: Lo Cole: www.locole.co.uk
 
This leaflet reflects the best available evidence available at the time of writing.

© May 2014. Due for review: May 2016. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

 
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Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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