Treating the Head with the Heart

by Simon J. Evans, PhD

Treating the Head with the HeartIt is common for people suffering from chronic illnesses like diabetes or heart disease to also battle depression at the same time. However, mental health care is often delivered by a different doctor, if at all, and is not well coordinated with care for their chronic illness.

People will often go to the doctor to get help with ‘physical’ problems without really considering getting help from their primary doctor for emotional issues as well. Many times people will simply try to deal with the emotional stress of chronic illness on their own, or maybe even seek counseling without including their primary physician in the loop.

A couple of recent studies asked whether treating depression or emotional stress at the same time with chronic illness was better than ‘usual care’ for heart disease or diabetes alone. In other words, does helping people emotionally help them better manage their chronic physical illness.

In the first study, researchers in Washington State, found that patients who received coordinated care for both mental and physical ailments through their primary doctor improved more than those who received usual care, on all fronts. After 6 and 12 months of treatment, patients who received coordinated care had better relief of depression symptoms, better blood sugar control (for diabetics), lower cholesterol and lower blood pressure. Also, in this study, patients who received coordinated care rated their own satisfaction with their care much higher than those in the usual care group – they were happier with the system.

In the second study, researchers in Sweden wanted to see if patients with heart disease would have fewer recurring cardiovascular problems if they participated in talk therapy in addition to their regular care, regardless of whether they had depression or not. They found that patients who participated in the talk therapy sessions had fewer cardiovascular problems, including heart attacks, than those who only received regular care.

Both of these studies support a growing movement in medicine to treat patients as a whole person, focusing on the head and the heart, rather than just treating specific symptoms. Old school medicine viewed chronic illness of the body as completely separate from mental health issues like depression. But we are realizing that they are often related, sometimes even stemming from the same cause, and it is beneficial to treat them in one big package.

This approach has several advantages for the patient and the medical system. First, as these studies show, working with your primary doctor to help you coordinate different medical care to treat both mental and physical illnesses will help you improve on all fronts better than dealing with each issue separately. Second, you will likely be more satisfied as a patient if you seek this type of care and your doctor will be better able to make sure the approaches work well together. Third, this approach is usually less expensive for you and the medical care system.

If you suffer from any type of chronic illness, like heart disease, diabetes, arthritis or whatever, consider talking to your doctor about getting help with the emotional stress and potential depression that often co-occur with these and don’t just try to ‘tough it out’. You will probably be glad you did.

Archives of Internal Medicine (2011), 171(2):134-140
New England Journal of Medicine (2010), 363(27):2611-2620



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