Cancer, cardiac disease, diabetes, chronic pain, post-surgical recovery. Depression and anxiety are common in serious illness, frequently go unmentioned, and are treatable — with attention to how the medicines interact.
When someone is being treated for a serious physical illness, the mental side is usually last on a long list — if it appears at all. People assume low mood is simply what is expected, their physician is focused on the disease, and nobody asks the question.
Depression in serious illness is not an understandable reaction to be endured. It worsens pain, reduces the chances of sticking with treatment, and is independently associated with poorer outcomes. Treating it is part of treating the illness.
Usually prefaced with an apology for taking up the time.
The cancer is in remission. Everyone is relieved. I cannot explain why I feel worse now than during treatment.
Patient, 52My sugar has not been controlled for two years. I know what to do. I just cannot make myself do it.
Patient, 58Since the bypass I am waiting for it to happen again. I have not gone back to work.
Patient, 61Serious illness affects mood through more than one route, and some of them are purely physical.
Steroids, interferon, some cardiac and Parkinson's medicines, thyroid disturbance and low sodium all cause mood symptoms directly. The first job is working out how much of this is pharmacological rather than psychological.
Work stops, independence narrows, the body changes and the future becomes uncertain. These are real losses and they accumulate quietly, often becoming heaviest after the acute treatment has ended and everyone else has moved on.
This is not an optional extra on top of the real treatment. It affects how the real treatment goes.
Bring everything, including what a different specialist started. A meaningful proportion of mood symptoms in medically unwell people are caused or worsened by something already prescribed.
Fatigue, poor appetite and disturbed sleep belong to both. The assessment leans on the parts that do not overlap — loss of interest, hopelessness, guilt and how the person sees the future.
Interactions with blood thinners, cardiac medication, tamoxifen and chemotherapy agents are checked before anything is prescribed, and your treating physician is written to where it matters.
Medication chosen for safety with your existing treatment first and effectiveness second — because the most effective antidepressant is of no use if it interferes with your cardiac drugs. Doses usually start lower and move more slowly than in physically well patients.
Where helpful, a letter to your oncologist, cardiologist or physician so that everyone is working from the same plan. Fragmented care is the usual problem in people with several conditions, and it is avoidable.
For this consultation in particular, the existing medicine list and recent blood work change what can safely be prescribed. Photographs of the prescriptions are fine — upload them at booking or show them during the call.
Includes the written plan and, where useful, a letter to your treating physician. Reviews are ₹800.
That is checked before anything is prescribed. Some antidepressants genuinely do interact — with tamoxifen and with certain cardiac drugs in particular — which is why the medicine list is gone through properly rather than glanced at.
Sadness is. Persistent depression is common in serious illness but not an inevitable part of it, and it responds to treatment. Being understandable and being treatable are not alternatives.
Yes, and it is often useful. They frequently see changes the patient has stopped noticing, and in long illness they are usually carrying a good deal themselves.
Online consultation works well here. The written plan and, where useful, a letter to your treating team mean the care stays joined up regardless of where the physical treatment is happening.
Illness and age together
Health anxiety and scan dread
Review of current medication
Call Tele-MANAS 14416 — free, 24 hours. If someone is in immediate danger, call 112.