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Managing Neuropathy, Anxiety, and Depression
By Cindy Tofthagen, PhD, ARNP

Editor’s note: This is the third in a series of articles aimed at helping you better understand the link between anxiety, depression, sleep disturbances, and neuropathy.

Depression 

Anxiety and depression—two unique conditions that often co-exist—are common responses to chronic illnesses such as neuropathy that deserve attention and need to be screened for and managed [1]. Left untreated, these conditions can slow the treatment of each other and worsen physical and psychological disability, thus increasing neuropathy’s burden and making its management even more of challenge.  Depression is described as prolonged sadness and loss of enjoyment in life. Anxiety is usually a result of fearfulness regarding possible future events and the uncertainty surrounding those events.

Neuropathy’s Link to Depression and Anxiety
People with neuropathy may experience anxiety, depression, or both at different times. Uncertainty regarding the underlying cause of neuropathy, loss of functional ability, pain, and concern about how the neuropathy will progress are all part of coping with neuropathy that can cause anxiety and/or depression.

Related Links:

What Do Depression, Anxiety, and Sleep
Disturbances Have To Do With Neuropathy?

Is Neuropathy Affecting Your Sleep?

Studies have shown that medical costs associated with caring for people with neuropathy, who concurrently have anxiety, depression, or both are higher than for those who do not have these associated conditions. You are also more likely to go to the emergency department or be hospitalized if you are anxious or depressed. [2] The more painful your neuropathy is, the more likely you are to experience anxiety and/or depression.  Neuropathic pain symptoms may seem worse during the night, causing you to lose sleep, and this can worsen both the anxiety and the depression as well as the symptoms of neuropathy [3].  Feeling that you have little control over your symptoms, not being able to participate in activities you normally enjoy, and changes in your social life may contribute to anxiety and depression [4].

The COPE Problem-Solving Approach
As with any chronic illness, it is important to learn how to take control of your symptoms. The acronym C. O. P. E.—representing strategies for taking back control and proactively managing your disease—stands for:

C-creativity
O-optimism
P-planning
E-expert information

The COPE problem-solving approach was developed to help patients with cancer and their caregivers manage symptoms at home, [5] but it can also be used to manage other chronic diseases such as neuropathy as well as its comorbidities.  I have shared this approach with the Tampa, Florida-based neuropathy support group I coordinate to help patients and their family members and friends; I also use it in my own life. You have probably used the COPE problem-solving approach in your own life without realizing it.

A Case History
Sue has neuropathy and after a series of evaluations and tests, her neurologist was unable to identify the underlying cause. Sue has been attending a local neuropathy support group for a few months; she met a woman at a recent meeting who just learned that she has a progressive and life-threatening illness. Sue starts to worry and become anxious that since she has many of the symptoms described by the woman she met, she too may have a similar illness.

Sue could use the COPE problem-solving approaches to manage her anxiety as follows:

Creativity: Sue could think back to the times in her life when she may have been anxious and recollect how she took back control of the situation and what she did to get through it. She could also try talking to others who have had anxiety for ideas about how they overcame their feelings.

Optimism: Thinking about things from a positive perspective has been shown to improve coping and reduce stress in people with chronic illnesses [6, 7]. Instead of dwelling on the possibility that Sue might have a life-threatening illness, Sue could use optimism to send herself positive messages. E.g., “Besides having neuropathy, there is no reason to think that I have a life-threatening illness;” or “I can cope with anything that comes my way;” or “I can do all things with the strength that God gives me, or that I have within myself.”

Planning: What plans could Sue make to help relieve her anxiety? Sue recognizes that her anxiety seems to increase when she is alone or when she is idle. She could plan to spend more time visiting with family and friends. She could also plan a new home decorating project so that when she has time alone, she can spend it thinking about her project instead of worrying and getting anxious. Additionally, Sue could  plan to consult with her neurologist again to ask him his opinion of the seriousness of her illness and any additional questions she might have.

Expert information: In addition to consulting with her neurologist, Sue could also plan to partner with a counselor or a psychologist for additional help with coping. Looking up information on methods to alleviate anxiety may also be helpful as long as they come from reliable sources.

Neuropathy affects your ability to live and work the way you once could. As such, treatment strategies should address all the areas of your life that are affected by neuropathy as well as the co-existing conditions such as anxiety, and depression. You will need a multidisciplinary approach to care and so partnering with the right team of health care providers is key. You will also find support from patient advocacy organizations such as The Neuropathy Association and from outreach to your peers via support groups.

References:
1. Jain, R., et al., Painful diabetic neuropathy is more than pain alone: examining the role of anxiety and depression as mediators and complicators. Current diabetes reports, 2011. 11(4): p. 275-84.
2. Boulanger, L., et al., A retrospective study on the impact of comorbid depression or anxiety on healthcare resource use and costs among diabetic neuropathy patients. BMC health services research, 2009. 9: p. 111.
3. Gore, M., et al., Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. Journal of pain and symptom management, 2005. 30(4): p. 374-85.
4. Vileikyte, L., et al., Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care, 2005. 28(10): p. 2378-83.
5. Bucher, J., P. Houts, and T. Ades, The Complete Guide to Family Caregiving2011, Atlanta: American Cancer Society.
6. Chesney, M.A., et al., Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention. Psychosom Med, 2003. 65(6): p. 1038-46.
7. Carver, C.S., M.F. Scheier, and S.C. Segerstrom, Optimism. Clinical psychology review, 2010. 30(7): p. 879-89.

Cindy Tofthagen

 Cindy Tofthagen, PhD, ARNP, AOCNP, is assistant professor at the University of South Florida in Tampa. Cindy received her Bachelor of Science in nursing degree from St. Petersburg College in St. Petersburg, FL and her Master of Science degree and her doctorate from the University of South Florida. She is a member of the Oncology Nursing Society, American Society of Clinical Oncology, Sigma Theta Tau, and Southern Nursing Research Society. Her research interests include symptom management, chemotherapy-induced neuropathy, psychological aspects of cancer, and survivorship issues. Cindy also leads a Neuropathy Association support group in Tampa, Florida, helping people with neuropathy and their family and friends better understand the disease and find support.

 

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