A pulmonary hypertension (PH) diagnosis can drastically change a person’s life, as well as the lives of the people close to them, in a short amount of time. Since there is no cure, the goals of treating PH are alleviating the symptoms of the disease and prolonging patient survival. This includes both physical and mental complications of the disease. As with other chronic diseases, people living with PH may be at higher risk of developing depression. Screening for and treatment of any mental illness, including depression, is important for patients in order to receive the best possible care and have the greatest chance for survival and improved quality of life.
Depression is estimated to affect 5 to 6 percent of the general population. However, even the limited estimates available for PH patients show a much higher rate of depression than what we find in the general population. According to the REVEAL registry, 25 percent of patients with pulmonary arterial hypertension (PAH, WHO Group 1 PH) reported that they have a history of depression. Another study estimated that 26 percent of PAH patients have symptoms of depression. A survey by Lowe et al. found that as many as one-third of PH patients exhibited some form of mental illness — 15.9 percent of those patients had depression. Of those with mental illness, only 24.1 percent were receiving treatment for it. People diagnosed with PH undergo many life changes and stressful events that have been shown to be associated with depression, so it is not surprising that estimates for PH patients with depression are high. People with PH often experience limited mobility, which can lead to major lifestyle modifications and social isolation. In addition to changes and challenges to their daily lives, they also begin treatment for PH, which can place a significant financial burden on them and their families. The combined strain can lead patients to begin to experience symptoms of depression.
Effective treatment of PH involves treatment of all comorbidities, mental and physical, since each can have negative effects on the other. Some treatment recommendations for PH may also help to alleviate symptoms of mental illnesses as well — these include pulmonary rehabilitation, exercise and participation in support groups.
As with any physical disease, early detection and treatment of depression will yield the best results. Since depression cannot be diagnosed using a physical test, screening is key. Symptoms of depression include feeling depressed or irritable; decreased interest in most activities; significant weight loss or gain; changes in appetite; getting too little or too much sleep; moving slowly or feeling fidgety; loss of energy; feelings of worthlessness or guilt; inability to concentrate; or suicidal thoughts or actions.
The presence of five or more of these symptoms for a prolonged period of time, at least two weeks, indicates clinical depression. It is crucial for patients and their loved ones to discuss any of the symptoms of depression with their doctor to ensure that they receive the best, most comprehensive care to maintain the best possible quality of life. However, self-identifying with many of these symptoms can be difficult. Consider speaking with your PH specialist about whether you should get a depression screening by a mental health professional.
It is also important to note that it is quite common for people with progressive diseases, as well as the people that care for them, to experience some form of depression. There is nothing shameful or wrong with any person who experiences depression. The most important thing is to get help early on, so that it does not interfere with your PH care and treatments and your life.
Article by Zan Laughlin, Medical Communications Program Manager. This article first appeared in the Spring 2017 issue of Pathlight magazine. Become a member of PHA to receive this quarterly publication full of patient profiles, medical information and tips for living with pulmonary hypertension.