Depression, Anxiety, and Sickle Cell Disease

Symptoms of depression and anxiety are common in people with sickle cell disease (SCD). People with SCD may experience depression and anxiety because of physical symptoms like pain and fatigue. Other stressful aspects of living with the disease also play a role.

Depression is linked to worse health outcomes and increased use of healthcare resources. Preventing and treating depression are important to improve quality of life for people with SCD. This may be done with some combination of therapy, medications, and lifestyle changes.

What is depression?

Depression is a low or sad mood that lasts a long time and interferes with normal daily life. About 1 in 6 adults experience depression at some point in their lives. Some people have recurring periods of depression, while others always show symptoms.^1,2

Some symptoms of depression are:^1,3

• Feeling sad often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable, easily frustrated, or restless
• Having trouble sleeping or feeling tired after sleeping well
• Eating more or less than usual or having no appetite
• Having aches and pains that do not improve with treatment
• Having trouble concentrating
• Feeling guilty, worthless, or helpless
• Thinking about suicide or self-harm

Some of these symptoms may be caused by other complications of SCD. If you think you are depressed, talk to your doctor or a mental health professional about treatment.

What is anxiety?

Anxiety is often connected to depression. People who have anxiety have intense feelings of fear, worry, or nervousness. These feelings can interfere with normal activities and last a long time. Symptoms of anxiety include:^1,3

• Excessive worry about everyday matters such as health, money, family, and friends
• Restlessness
• Trouble sleeping or feeling tired
• Irritability
• Sweating and trembling

Why does sickle cell disease cause depression and anxiety?

About 1 in 3 people with SCD experience depression. In many cases, it goes undiagnosed and untreated. This is because many of the symptoms of depression and anxiety are also symptoms of other complications of SCD.⁴

Pain, fatigue, and sleep disturbance are major causes of depression in people with SCD. Sickled red blood cells can block blood flow to any part of the body. This leads to low oxygen levels and intense acute pain. Acute pain crises often lead to problems sleeping at night and fatigue during the day.⁵

People with SCD are more likely to have depression even after accounting for physical symptoms. This means that other aspects of the disease affect self-esteem and self-confidence. For example, the healthcare system can be stressful for many people with SCD because of cost, poor interactions with doctors, and disruptions to daily life. In addition, people with SCD are more likely to experience depression if they:⁶

• Have a lower family income
• Have less than high school education
• Are female
• Have had multiple blood transfusions
• Have lower social support
• Use hydroxyurea

How does mental health affect individuals' outcomes?

People with SCD who have depression use healthcare resources more often than people with SCD who do not have depression. Depression increases the frequency of hospital visits for acute sickle cell pain, ER visits, and chronic blood transfusions. People with depression pay twice as much in healthcare bills.^4,7,8

Depression also leads to worse medical outcomes of SCD. The symptoms of depression make it more difficult to manage pain. People with depression also have more difficulty sleeping and more severe acute pain crises.^4,5,7

What are treatment options?

Depression and anxiety lead to lower quality of life for people with SCD. Preventing and treating depression and anxiety can help people with SCD manage their healthcare. For example, people can become more able to stick to treatment schedules, get exercise, socialize, and eat healthier.⁷

Therapy or counseling is a common way to prevent and treat depression and anxiety. Therapy can help you find ways to cope with situations in your life and prepare for future challenges. You can learn skills in therapy to:¹

• Get healthier
• Overcome fears and insecurities
• Cope with stress
• Understand why something bothers you and how to deal with it
• Identify things that worsen your symptoms of depression
• Improve relationships with friends and family

Many people also benefit from prescription medications called antidepressants. Talk to your doctor about whether these are right for you. Other lifestyle changes or self-care methods may improve symptoms, such as:⁹

• Eating healthy
• Exercising
• Spending time on hobbies
• Yoga and meditation
• Mindfulness practices like journaling and deep breathing