AAAAI - Patients & Consumers Center: Allergy & Asthma Advocate: Winter 2003

Asthma and depression
by Stuart Tousman, BS, MS, PhD, Associate Professor of Psychology, Rockford College

While the winter blues hit many of us each year as temperatures plunge and sunlight wanes, this time of year can be even harder for people with chronic disease.

Depression is the most commonly diagnosed mental disorder, prevalent among both men (12.7%) and women (21.3%). For people living with diseases that can lessen their quality of life like asthma, depression can be common. Sometimes asthma, especially untreated or improperly managed asthma, can prevent patients from doing all the things they want to do physically, resulting in isolation or frustration.

People with asthma report depression at a rate of 20% to 50%, with higher numbers frequently occurring among inner city residents, including children. Missing school days, not being able to play with other children, waking up in the middle of the night with an asthma attack and going to the emergency room can lead to feelings of helplessness in children with asthma.

Research has indicated that people with asthma may have a poor self esteem. This condition can cause them to blame themselves for asthma attacks and never attempt to get better. This type of "learned helplessness" can negatively affect self-efficacy, problem-solving skills, family interactions and lead to depression.

Research has also indicated that people with asthma who are depressed may not follow their asthma management plan, and that they may have difficulty adjusting their behaviors overall. Thus, one can get into a cycle whereby asthma symptoms lead to feelings of helplessness and depression, which then lead to poor self management of asthma, resulting in worsening of asthma symptoms.

Changing behavior
Medications are available to help treat depression, allowing patients to feel more energized, confident and in control. Although medication can help to effectively treat depression, research has shown that a treatment regimen should also focus on behavior.

Depression research has clearly indicated that medication, when combined with cognitive-behavioral therapy (talk therapy), leads to the most effective outcomes. Much of the cognitive-behavioral therapy is focused on changing a person’s thought process and behavior. Frequently, a person with depression is given a prescription and then required to attend a support group for several weeks. In the support group, patients can share their experience with depression with others and learn skills (relaxation, self-affirmation, assertiveness), which can improve their outcomes.

People with asthma report depression
But the "blues" is not depression. Major Depressive Disorder is diagnosed when five or more of the following symptoms have been present during a two-week period:

Depressed mood
Diminished interest in activities
Significant weight loss or weight gain
Sleep disturbances
Coordination difficulties
Fatigue
Feelings of worthlessness
Diminished ability to think or concentrate
Recurrent thoughts of death

Effective asthma management programs also address behavior, which can help improve your physical and psychological well-being. Asthma management programs that include social support and effective teaching and learning can make a huge difference. Asthma is highly controllable if medications are taken and lifestyle modifications are made to effectively manage the condition. People with well-controlled asthma can lead normal lives, participating in activities of their choice, with minimal, if any, restrictions because of their asthma.

Communication is key
Patients with asthma who have experienced feelings of depression need to share this with their asthma specialist. Be sure to establish an ongoing, trusting relationship with your physician so you feel comfortable discussing personal health issues such as depression.

Once your physician knows that your asthma has been preventing you from enjoying your life to the fullest, he or she can help you to take steps to better manage the condition with a management plan and/or possibly prescribe medication to treat your depression.

An open and honest relationship with your allergist/immunologist can help you to improve your overall quality of life and reduce any physical or emotional challenges that asthma has created for you.

For more information on effectively controlling your asthma or for an allergist/immunologist in your area, visit the AAAAI Web site, www.aaaai.org.