Newswise — In her 1984 boot camp graduation photo, Adrienne Fitts is smiling. Her hair is neatly groomed, her Navy cap and dress whites are spotless and she is regulation fit and trim.
Flash forward to 2001. Fitts, now a retired Gulf War veteran, struggles with a mental illness called schizoaffective disorder. She is 90 pounds heavier and has developed type 2 diabetes. She is certain her regimen of antipsychotic drugs ("there are so many" ) caused the diabetes as well as high blood pressure.
In April 2006, Adrienne Fitts suffers a stroke. And there's Gloria, a 56-year-old legislative advocacy worker, who also deals with both a major mental and medical condition. Gloria,has long-term clinical depression, neurological problems and on top of that, partial kidney failure.
"Multiple conditions are not rare and they become even more common as people get older," says Dennis Freeman, Ph.D., the CEO of Cherokee Health Systems in Tennessee.
"Twenty-five percent of people in a primary care practice have a psychiatric illness," says Wayne Katon, M.D., vice chair of the department of psychiatry and behavioral science at the University of Washington School of Medicine.
Children are vulnerable, too. "Kids with asthma are more likely to have every kind of anxiety and depressive disorder," Katon says. "This makes more of an impact on school performance and the ability to make and keep friends. Parents and schools have to be especially watchful for the additive effects of having two conditions."
For many people, physical conditions can contribute to problems with their mental health—problems that are often ignored and untreated. But your emotional health and physical health affect each other. Here's what you should know.
The stakes are high.
When recovering from a heart attack, it's natural to be focused on your physical recovery rather than your state of mind, but the two are intertwined, says Eric Goplerud, Ph.D.
"A heart attack produces large amounts of cortisol that precipitates depression," explains Goplerud, the director of the Center for Integrated Behavioral Health Policy at George Washington University Medical Center.
"At least twenty percent with heart attacks have severe depression—and these people are three times more likely to die if the depression is not dealt with promptly," he says.
"People who have mental problems often have other health problems and they come together in legion," Goplerud says.
Drugs that help your mind can harm your body.
In a health care Catch-22, the same drugs that help people manage bipolar disorder, schizophrenia and depression can have serious physical side effects.
As part of her treatment, Fitts has received some heavy-duty drugs, including olanzapine.
"Clozapine and olanzapine are the two antipsychotic drugs that the American Diabetes Association found the highest risk of causing weight gain and poor lipid control." Goplerud says. As for drugs to combat depression, "some SSRIs are associated with weight gain and may contribute to diabetes. So you may be developing life-threatening illnesses from appropriate treatment of your mental illness."
The dilemma works both ways, Goplerud adds: "Sometimes treatment we prescribe for in medical care end up causing mental health problems." For instance, "People who have been legitimately prescribed powerful pain meds can become addicted."
If you are ever prescribed antidepressants, or given medication to help you sleep, doses often need to be fine-tuned and you might need to try several drugs before to find one that works for you. Although primary care practitioners or clinic doctors can prescribe these drugs, follow-up can fall through the cracks. Let someone know if your treatment isn't helping.
Patients have options, Goplerud says. "Talk to your physician about other medicines that might be used."
Speaking up is vital to your mental health.
Fear of the stigma of mental illness can keep patients from speaking up, says Chris Koyanagi, policy director of the Bazelon Center for Mental Health Law. Some "are reluctant to tell primary care doctors about their psychiatric medicines: 'I just don't want my regular doctor to know.'"
Recalls Gloria: "As a teenager I had aches and pains and my parents took me to the Mayo clinic. They wanted me to see a psychiatrist. My father said fine, as long as they could come with me. The psychiatrist asked, 'Are you depressed?' Dad answered, 'No, she's not.'"
Meanwhile, physical conditions arose that could not be brushed aside. It was only years later, when she had an emotional collapse on the job that Gloria began treatment for depression.
Your health care is usually scattered across different settings.
"Health systems are fragmented, people are integrated," says Dennis Freeman, Ph.D., the CEO of Cherokee Health Systems in Tennessee.
People are often are forced to work with an array of health care providers. "It's daunting to go to three different clinics; it's hard for anyone," Katon says. "Fragmentation is even worse for people with mental health issues."
Dangerous drug interactions are possible when no single health professional has a handle on all the medications you take: you could receive heart pills from one doctor and an antidepressant from another doctor without either being aware of what the other prescribes.
"At the least, one single person or entity needs to know all the medications you take and all the diagnoses you have," Koyanagi says. "This can be your primary care physician, your mental health practitioner, your pharmacist."
Some mental health care is "nested" with medical care.
Katon, who brings his psychiatric expertise to a medical practice one day a week, says, "It's ideal if psychiatric care can be merged into medical care,"
"We found that mental health care programs with primary care onsite—sometimes provided by a nurse practitioner or physician assistant—who can do regular and effective screens, can link people to community services [work best]," Koyanagi agrees.
Federally qualified health centers, like Freeman's Cherokee Health System in Tennessee, provide a full range of services from professionals who communicate daily with one another and have access to a single, unified medical record for each patient.
Unfortunately, it can be hard to find mental health care at all, much less integrated medical-mental care. "Half of counties in the United States don't have mental health providers," Freeman says.
In those areas, "You probably go to a primary care physician. They will do the very best they can. They're not psychotherapists or behaviorists, but psychiatrists are in short supply every place, even among insured," he says. "So you go to see your primary care physician, talk to your minister, if you're in school it may be your teacher and guidance counselor."
We're all vulnerable at various times in our lives.
Just as we have ups and downs of physical health, everyone also deals with challenges that affect our moods and stability. It helps to know your baseline: What's your usual mental state? How do you know when things are out of control?
"We all have times we're not as resilient and not managing as well," Freeman says. "That's when the team needs to support you, help you through the rough times."
You might need additional support, not only from mental health professionals but also the people in your life. Sharing confidences and concerns with trusted friends and family or joining a support group can help restore your mental balance.
Fitts has found—and given—support through the Depression and Bipolar Support Alliance, a peer group for people with mood disorders. Earlier, when she developed substance abuse issues " which often go along with mental illness and can complicate medical treatment —she looked outside herself for help. "I just made some decisions. It's a process. I use a 12-step approach. I have a group in my church. It's helped me to get my thoughts together."
If you've been diagnosed with a medical illness and you don't feel right emotionally: "Talk to your physician, tell your nurse." Goplerud says. "Misery is not necessary. You don't have to live with feeling physically miserable or mentally miserable."
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