Worse, undiagnosed depression can make it even harder to take medication, eat properly, and keep clinic appointments - making one sicker and perhaps even more depressed.

In fact, depression is one of the most common complications of many chronic diseases, which also include rheumatoid arthritis and related disorders, emphysema, many kinds of cancer, and HIV, according to Katharine E. Stewart, Ph.D., M.P.H., a psychologist and new associate dean of the College of Public Health at the University of Arkansas for Medical Sciences (UAMS).

UAMS established the new College of Public Health thanks in part to funding from the state's share of the nationwide tobacco settlement.

"The nasty trick of depression is if you're depressed, it's often very hard to acknowledge it. It may feel more like guilt or shame," Dr. Stewart says. "Physicians can get frustrated with patients who don't follow their doctors' orders. We want to help physicians and other health care professionals with ways to support patients with chronic illnesses so they feel good enough to stay on track."

Dr. Stewart came to UAMS in January. She will serve as associate professor of health behavior and health education and associate dean for student and academic affairs in the UAMS College of Public Health.

Dr. Stewart has studied the issue of medication adherence, or whether patients with chronic illnesses take their medicines as prescribed, with colleagues around the nation. In various studies, the researchers have interviewed patients, counted the remaining pills in medicine containers when they keep clinic appointments, and even used electronic monitoring devices to record the dates and times when patients open pill bottles.

"We know that, overall, about 60 percent of people adhere, meaning they take 80 percent or more of their medications as prescribed. Different demographic groups may miss medications for different reasons," she says.

Dr. Stewart offers the following advice to people with chronic diseases:

*Use the buddy system. Ask a family member or close friend to remind you to take your medicine each day. The people who care about you will admire you more for taking a positive action to take care of your own health.

*If side effects are bothering you, don't keep it a secret! Talk to your pharmacist, physician, nurse, or a friend who can speak up for you. For example, some drugs, including some for depression and hypertension, can cause problems with sexual interest or performance, but there may be solutions. Your pharmacist and physician may be able to suggest a different medication. Some drugs for HIV cause nausea and diarrhea, but other medications for those side effects, or small amounts of food with simple carbohydrates, such as crackers, can help.

*Find a support group of people with the same medical condition. "Talking to somebody else who has walked in your path can be a powerful source of inspiration," she says. "You probably have something to teach others about how to manage, too."

*Know the signs of depression and ask for help if you need it. The signs are a major change in appetite or sleep - either eating or sleeping more or less than usual; a lack of interest in things that you previously enjoyed; feeling helpless or hopeless; and thoughts of harming yourself or committing suicide. If you have any of these symptoms daily for two weeks, call your doctor for an emergency appointment.

Links on This Page

Collegeof Public Health: http://www.uams.edu/coph/
UAMS Creates: http://www.uams.edu/today/2003/011603/DepressionCheck.htm
Public Health Experts: http://www.uams.edu/today/2003/010103/PHexperts.htm
A Great Day: http://www.uams.edu/today/2002/070202/cphtopping.htm

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