April 3, 2023 / Vanessa C. Prokuski-Lund, MD
What is Depression? Depression is a mental health condition defined as a period of at least two weeks when a person experiences a very low mood or loss of interest in daily activities combined with symptoms like problems with sleep, eating, energy, concentration, or self-worth. Depression is a common mental health condition in the United States, with 8.4% of adults experiencing a major depressive episode each year. Genetic, biological, environmental, and psychological factors may all play a role in depression. Depression can occur along with other serious medical illnesses. These illnesses are often worse when depression is present, and research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses. This is no different when it comes to orthopedic problems including hand and arm-related issues. There are many studies which suggest that depression makes a patient’s experience of his or her hand issues worse. How can depression impact hand and arm issues? Studies have shown that 1 in 8 patients who see a hand surgeon have symptoms of depression. This means that many patients can have hand issues and depression at the same time. Psychological distress including symptoms of depression can worsen a patient’s experience of pain and worsen function of the hand and arm. Ample research demonstrates that the same hand symptoms occurring in patients without depression may be experienced as more painful and debilitating in patients with depression. Even after treatment of hand and arm issues, the outcomes for patients with depression tend to be worse than outcomes for patients without depression, whether patients are treated with or without surgery. However it is important to remember that patients with depression can still have good improvement in their hand and arm issues after treatment, even if the improvement is not as significant as it may have been if the patient did not have depression. Sometimes treatment of chronic hand and arm problems can help lessen the severity of depression. For example, some patients with carpal tunnel syndrome (compression of a nerve at the wrist that can cause hand numbness and sometimes pain) can have improvement of both the carpal tunnel symptoms and improvement in the depression symptoms after treatment of the carpal tunnel syndrome. This may be because issues like carpal tunnel syndrome can interrupt sleep, and problems with sleep can also worsen symptoms of depression. However, it is not always the case that correcting a hand issue can help improve depression. Depression tends to impact how much hand issues bother patients more than those same hand issues impact symptoms of depression. Patients with greater symptoms of depression tend to make more visits to hand and arm doctors than patients without depression for the same issues. This means that depressed patients may have a higher time and cost burden of seeking hand care compared to patients without depression. Can hand and arm problems cause depression? Sometimes mood disorders like depression can be partially caused by serious hand or arm injuries, especially if a patient has to adjust to a new disability, chronic pain, or posttraumatic stress disorder (PTSD) from a traumatic event. However, it is less likely for a hand injury to cause depression than for depression to cause a more painful and limiting experience for a patient after an injury. After a hand injury, patients with depression are much more likely to suffer PTSD than patients without depression who experience a hand injury. Depression and PTSD after a hand injury often worsen a patient’s general health status. How can depression be treated? Depression is treatable. Early recognition and treatment can improve long-term outcomes for people with depression. There is evidence that lifestyle changes including exercise, diet changes, improving sleep, social interaction, and reducing the use of alcohol, nicotine, and recreational drugs may improve depression. Other forms of treatment include medications, psychotherapy, or both. If these treatments do not help, there are certain brain stimulation therapies which may be an option for some patients. While hand surgeons are experts in helping hand and arm symptoms, they are not specialists in treating mood disorders like depression. For this reason, people who think they may have depression should speak to their primary care provider about treatment options and may be referred to a psychiatrist - a doctor who specializes in mental health. Improving depression may help improve many aspects of a person’s life, including hand and arm symptoms. If you are thinking of hurting yourself or concerned that a loved one may hurt themselves, call or text 988 to be connected to the Suicide and Crisis Lifeline. References: Crijns, Tom J., et al. "The association between symptoms of depression and office visits in patients with nontraumatic upper-extremity illness." The Journal of Hand Surgery 45.2 (2020): 159-e1. Datema, Mirjam, et al. "Outcome of carpal tunnel release and the relation with depression." The Journal of Hand Surgery 43.1 (2018): 16-23. Ip, Agnes Ka-Yan, et al. "Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial." Plos one 16.10 (2021): e0258059. London, Daniel, et al. "The Impact of Depression and Pain Catastrophization on Patient-Rated Outcomes Before and After Treatment for Atraumatic Hand Conditions: Level 1 Evidence." Journal of Hand Surgery 38.10 (2013): e48-e49. Oflazoglu, Kamilcan, et al. "Prevalence of and factors associated with major depression in patients with upper extremity conditions." The Journal of Hand Surgery 41.2 (2016): 263-269. Sarris, Jerome, et al. "Lifestyle medicine for depression." BMC psychiatry 14.1 (2014): 1-13. U.S. Department of Health and Human Services. (2022, January). Major depression. National Institute of Mental Health. Retrieved February 17, 2023, from https://www.nimh.nih.gov/health/statistics/major-depression Vanessa Prokuski-Lund is a hand and orthopedic surgeon in Massachusetts. She is an Associate Professor of Orthopaedic Surgery at the Warren Alpert School of Medicine at Brown University.
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