Coping with physical illness

• relationships
• work
• spiritual beliefs
• how we socialise with other people.

• 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.

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.

• 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.

• 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 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.

• 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.

• 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 think all your symptoms are due to the physical illness
• you blame yourself for being lazy or feeble.

Is feeling like this a good enough reason to ask for help?

• 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.

• 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.

Talking treatments

• 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?

How does it work?

How quickly does it work?

Antidepressant drugs

Will you feel better straight away?

What about the side-effects?

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.

• 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.

Organisations that can help

Further reading

• Coping with anxiety and depression: (Overcoming Common Problems) Shirley Trickett.
• Manage your mind: the mental fitness guide: Gillian Butler and Tony Hope.

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.

Credits

This page reflects the best available evidence available at the time of writing.

• Series Editor:  Dr Philip Timms, Chair, Royal College of Psychiatrists' Public Education Editorial Board
• Expert Review:  Dr Jim Bolton