Chronic disease can lead to depression in some patients
Dr. Eve Glazier and Dr. Elizabeth Ko
Tuesday, November 7, 2017
Dear Doctor: My husband, who is 79, was diagnosed with Grover's disease. I don't know if that's the cause of his depression, but now he just sits in his recliner all day. He's also moody, confrontational and seems to have given up on life. Is there really no hope for us?
Dear Reader: We're very sorry to hear about the struggle you and your husband are now going through. Disease is often more than merely physical, and the distress it causes a patient can have a profound effect on the entire family.
Grover's disease, which is also known as transient acantholytic dermatosis, is a rare skin condition. It is characterized by itchy red bumps, most commonly on the patient's chest or back. Because a feature of the disease is the gradual loss of the "glue" that holds our skin cells together, watery blisters can form. Grover's disease is mostly seen in men over the ages of 40 or 50, though some women have been affected. The cause is not known, and, at this time, there is no cure.
The skin eruptions, which are often unbearably itchy, can last for weeks or months. In some cases, the disease spontaneously resolves within a year. For some individuals, however, it persists indefinitely. Treatment consists of managing the patient's discomfort. Topical high-potency steroids and antihistamines can offer short-term relief. In some cases, light therapy has been found to be helpful.
While depression is not among the symptoms of Grover's disease, it can certainly be a side effect. In fact, depression is among the most common complications of all chronic disease. It's estimated that one-third of patients diagnosed with a chronic illness or a serious medical condition will experience symptoms of depression.
In your husband's case, he is dealing with a disease that's mysterious, incurable and profoundly uncomfortable. It comes at a stage of life when, with a career behind them, children grown and gone, and friends and siblings beginning to pass away, many elderly people become prone to depression. It's not at all surprising that his response has been to withdraw. But depression brings its own set of health challenges. People who are chronically depressed have higher rates of heart disease and stroke. A new study has linked it to dementia.
Your first challenge is to persuade your husband that he can benefit from medical help. Unlike Grover's disease, depression can be successfully treated with medication, if he's open to it, and talk therapy. Since he has become moody and confrontational, it's a good idea to consider who is the best person to broach the idea with him. If you're comfortable having the discussion, we urge you to do so. Perhaps a trusted friend or a family member can lend a hand. Early diagnosis and treatment can reduce distress and head off complications.
Even with treatment, it can take weeks and even months for depression to loosen its grip. If your family can be supportive and understanding, it will be a big help. And as your husband is working his way back, be sure to take care of yourself. Stay engaged with the world, spend time with friends and family, and perhaps consider joining a support group.
Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.