For the Medical Community

• The Impact of Physical Health on Mental Health
• Medical Illnesses & Medications with Mental Effects
• Post Illness Mental Health Challenges

Acute and chronic illnesses, including comorbidity, can present themselves as depression. Left untreated, these conditions can lead to hopelessness and noncompliance with medical directives.

We present the information below in the hope that coordinated care and treatment will lead to better health outcomes.

We thank former Samaritan volunteer and Brown University graduate Ganaelle Joseph-Senatus, MD, Resident Physician in Psychiatry at Massachusetts General Hospital and McLean Hospital and Clinical Fellow, Harvard Medical School for compiling this list. Additional acknowledgments: Janice M. Kizirian, MD and Richard L. Wagner, MD.

Other Related Links

Trauma: Normal Reactions to Tragic Events

Stanford University SCOPE/Blog Take Depression Seriously “What is Is”

Stanford University SCOPE/Blog Take Depression Seriously “Anxiety, addiction and chronic illness”

Untreated sleep apnea: fatigue, headache, depression

Temporal lobe seizures: anxiety

Sensory impairment: hearing and sight add to isolation and depression

Poor dental hygiene: depression, isolation, poor nutrition.

COVID Depression and Anxiety

IMPACT OF PHYSICAL HEALTH ON MENTAL HEALTH

When diagnosed with a physical illness or a medical condition, it is common to experience a range of emotions. The lifestyle changes required to take care of our body can lead to an increased risk of developing mental health problems and/or the worsening of current mental health concerns. Some of the common emotions are feelings of being alone and isolated, loneliness, stress, pressure to return to a previous health status, sadness, anxiety about the future, guilt, and many more. These emotions are normal and everyone reacts differently. Therefore working to improve physical health can also have positive impacts on mental health and wellbeing.

Being alone and isolated

• An illness, a broken bone, a pandemic, and many other events can be barriers to keeping up with desired activities and previously established routines. Being bedridden, homebound, or hospitalized limits the number of people that we are able to interact with. This can be extended to working from home, attending school virtually, missing work or school days, and having limited access to spiritual/faith-based gatherings. Both introverts and extroverts can feel alone and isolated with extended periods of time without contact with others.

Loneliness    

• Loneliness is the absence of connection, not company. People can feel lonely when alone or in a room full of friends. Because physical sickness or limitation can prevent us from fully engaging in activities, it can also impact how connected we feel to the people present in our everyday lives. Therefore it is possible to feel lonely even though we have a stable group of friends, a partner or spouse, a group of coworkers and colleagues, or other communities. 

Stress

• It is a state of emotional or mental tension caused by adverse or demanding circumstances. No two people have the same lived experience. One person having a major medical procedure or a minor illness may not have any impact on them, while the same situation turns the life of another person completely upside down. Physical illness often leads to financial stress on top of the pressure of recovering or rehabilitating oneself.

Guilt  

• Becoming physically sick can lead to feeling that one has committed an offense. This can be against oneself or toward others. Often the first thing that comes to mind is, “If only I had taken better care of myself earlier” and other similar lines. Another feeling is often about not being able to deliver on projects or keep promises made previously. All these repeated thoughts of self-deprecation that can lead to low self-esteem and low mood. 

Depression and Anxiety    

• Decreased physical activity by choice or by force, due to being house-bound or hospital-bound, can impact mood and overall mental health. Just as a runner’s high is associated with euphoria and positive mood, inactivity is associated with the negative moods. Lack of physical movement can become routine and make it harder to get back on track to being active, the longer one is inactive. Because physical and mental health are related, low activity can increase the risk of episodes of depression and/or anxiety, especially in people with a previous history of these conditions. 
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 The Centers for Disease Control and Prevention (CDC) has many publications acknowledging the link between physical health and mental health and has been promoting physical activity as one of my tools to prevent mental illness (1, 2, 3). Therefore it is important not to dismiss the effects of physical health when managing mental health.

MEDICAL ILLNESSES & MEDICATIONS WITH MENTAL EFFECTS

Many physical illnesses can present with psychological symptoms. Therefore it is always recommended to check in with a doctor regularly and to discuss any and all symptoms, no matter how minute you believe the symptoms are. A primary care doctor can assess a person's physical and mental health by looking for underlying physical problems that can contribute to mental health concerns, such as side effects of medications, untreated medical conditions, unknown environmental exposures, presence of recreational drugs, and much more (1). Below are a few conditions and medications that cause a change in mood and behavior:

• Anemia - a deficiency of blood cell function presenting with tiredness and chronic fatigue often associated with poor nutrition, blood loss, or chronic inflammatory disorders.
• Dementia - a progressive and chronic disorder of the brain presenting with impaired memory, personality, and/or reasoning. Examples are Alzheimer’s disease, Parkinson’s disease, frontotemporal dementia, and many more.
• Hormone Imbalances - a state of having too much or too little hormones in the bloodstream. This can happen in both men and women, regardless of menstruation or pregnancy.
• Hyperthyroidism - a state of overproduction of thyroid hormones that can cause unintentional weight loss, rapid heart beat, anxiety, irritability, insomnia, and much more.
• Hypothyroidism - a state of underproduction of thyroid hormones that can cause unintentional weight gain, depression, constipation, fatigue, lethargy, and much more
• Pheochromocytoma - a benign tumor in your adrenal glands that secretes epinephrine, with symptoms similar to panic attacks with sweating, chest pain, 
• Premenstrual Syndrome - a group of recurrent symptoms that occur in women around the time of menstruation. Symptoms can include mood swings, food cravings, fatigue, irritability, depression, and much more.

• Delirium - an abrupt change in the brain that can cause fluctuation in level of awareness, inattention, confusion, hallucinations, memory and emotional disruption. A person experiencing delirium may be unable to recall their name, their location, and the current date and year. There are multiple causes such as sleep deprivation, intoxication, dementia, awaking after surgery, infections (ex. UTIs), and much more.
  
  
• Post-Concussion Syndrome - a group of symptoms occurring after injury or trauma to the head, that can last weeks to months. It can cause mental changes such as fogginess, fatigue, emotional sensitivity, hyper-reactivity, poor concentration, and mood change.
  
  
• Heart Arrhythmia - irregularity in heart rate that can be chronic or a single occurrence. This can be associated with sudden sweating, a sense of impending doom, palpitations, difficulty breathing, and much more.
  
  
• Chronic pain - the experience of having undertreated physical pain for months to years is associated with increased risk of mental illness. People suffering from chronic pain often anticipate painful stimuli before they happen, putting them in a constant state of hyper-alertness and anxiety.

• Immune encephalitis - a syndrome of brain inflammation thought to be caused by antibodies that attack neuronal cells in different regions of the brain. This can cause memory and cognitive deficits, abnormal movements, and other symptoms similar to psychiatric disorders such as depression, anxiety, psychosis, and more. 
  
  
• Migraines - a type of headache lasting several hours, associated with other symptoms such as sensitivity to light or noise, nausea or vomiting, aura (a phenomenon of such as a symptom or a feeling that happens before or during the headache episode), irritability, mood change. They usually start mild and worsen to the point of being debilitation. Some migraine episodes may have alarming symptoms such as confusion, weakness, or even be associated with an increased risk of suicidality, all of which should prompt seeking medical attention.
  
  
• Corticosteroids - a drug class used to treat autoimmune disorders, allergic reactions, eczema, asthma, COPD, rheumatoid arthritis, gout, and much more. Possible side effects are weight gain, emotional lability, depression/anxiety, and change in hair growth pattern. These steroids are not the same that people may take to build muscles. Some drugs that fall into this class are: prednisone, prednisolone, dexamethasone, hydrocortisone, and triamcinolone.
  
  
• Beta blockers - a drug class used to treat abnormal heart beats, chest pain, high blood pressure, glaucoma, migraines, tremors, and much more. Possible side effects are fatigue, depression, sleep disturbance, dizziness, ejaculatory dysfunction, and disorientation. Some drugs that fall into this class are: atenolol, carvedilol, esmolol, labetalol, metoprolol, and propranolol.
  
  
• Antimalarial drugs - multiple drugs in combination are often used to treat or prevent malaria. Possible side effects are headache, sleepiness, vivid dreams, anxiety and confusion, insomnia, and loss of appetite. Common drugs to treat malaria are: chloroquine, mefloquine, primaquine, and sulfadoxine-pyrimethamine.
  
  
• Dopamine agonists - a drug class used to treat movement related and hormone related disorders such as Parkinson’s Disease, restless leg syndrome, pituitary dysfunction. Possible side effects are cause sleep attacks, compulsive behaviors (such as uncontrolled shopping, gambling, eating, and sexual urges), confusion, paranoia, or agitation. Some drugs that fall into this class are: bromocriptine, cabergoline, and ropinirole.

IMPACT OF PHYSICAL HEALTH ON MENTAL HEALTH: References

1.    https://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm

2.    https://www.cdc.gov/workplacehealthpromotion/tools-resources/pdfs/issue-brief-no-2-mental-health-and-chronic-disease.pdf

3.    https://www.cdc.gov/heartdisease/mentalhealth.htm

POST ILLNESS MENTAL HEALTH CHALLENGES (1, 2, 3)

Many people identify illnesses as traumatic, emotional, and even stressful events. This can come from directly experiencing a disease and recovering from it. This can come from being a family member, friend, and/or caregiver and witnessing someone else experiencing a disease. Even repeated exposures of the news of an illness can cause stress. For example, about 50% of COVID-19 survivors struggle with depression after recovering (3). Depression is common after illness or serious medical treatment. Anxiety is also common. It can be generalized to every aspect of a person’s life or limited in the form of illness anxiety disorder (the medical terminology for people known as hypochondriacs). 

 At times, the stressor experienced does not reach the level of a formal diagnosis of depression or anxiety, but is still bothersome. This called adjustment disorder and is defined in the psychiatric diagnostic manual as (4):

• Having emotional or behavioral symptoms within three months of a specific stressor 
• Experiencing more stress than would normally be expected in response to a stressful life event and/or having stress that causes significant problems in personal relationships, at work or at school
• Symptoms are not the result of another mental health disorder or part of normal grieving.
  
  

Grief is often exclusively linked to the deep sorrow experienced after the passing of a loved one, when a person is in mourning. A more holistic definition of grief is a response to loss. Grief can be tied to loss of physical or intellectual capacity, loss of the ability to work or participate in certain functions, loss of routine, loss of a home environment when placed in a care facility, loss of the ability to care for oneself independently, and much more. A few scenarios in which depression, anxiety, adjustment disorder, or grief can occur include after a stroke, an intensive care unit (ICU) stay, childbirth, or upon waking from a procedure requiring anesthesia.

 Post-viral fatigue is also a real phenomenon, separate from regular tiredness (4). It is a feeling of exhaustion that can last weeks to months after recovering for an illness caused by a virus, such as the flu. Because a person feels physically down, it can be mistaken for lack of motivation or sign of depression. Therefore, it is always ideal to speak to a doctor about symptoms in context to allow for accurate diagnosis and an honest discussion about effective treatment options. 

POST ILLNESS MENTAL HEALTH CHALLENGES - References

1.    https://www.psychiatrictimes.com/view/post-covid-stress-disorder-emerging-consequence-global-pandemic

2.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507979/