But despite the fact that depression and anxiety often accompany otolaryngologic disorders, few otolaryngologists regularly assess their patients for mental health problems or include mental health interventions in treatment plans. “Right now, the standard of care is ‘Do nothing,’” said Luke Buchmann, MD, assistant professor of otolaryngology-head and neck surgery at the University of Utah in Salt Lake City.
Explore This IssueApril 2014
Ignoring mental health issues puts both patients and physicians at a disadvantage; appropriate treatment of mental health concerns may improve patient health and quality of life. “The whole key is to heal the patient, not necessarily cure the disease,” Dr. Lydiatt said. “Curing the disease may well heal them, but it’s also possible to be cured but not healed or healed and not cured. The key is trying to understand what a particular patient needs to be healed.”
The Link Between Mental Health and Otolaryngology
Depression and anxiety can be caused or exacerbated by an otolaryngologic condition or treatment modality. And depression and anxiety can play a role in the development—or worsening—of an otolaryngologic condition.
According to The National Institute of Mental Health (NIMH), nearly one in five U.S. adults has experienced an anxiety disorder within the last 12 months. Nearly 7% of U.S. adults have experienced a depressive disorder in the last 12 months. Only about half of all people with depression or anxiety are receiving treatment and, in many cases, treatment is sub-par. (According to NIMH, only about 20% of people with depression are receiving minimally adequate treatment.)
In other words, many otolaryngology patients have concurrent—and possibly untreated—mental health issues. Patients with a personal or family history of anxiety or depression are more likely to experience clinically significant anxiety or depression, especially during periods of stress, such as when dealing with an otolaryngologic disorder.
There is a growing body of evidence that suggests a physiological link between some otolaryngologic conditions and depression. “Evidence is accumulating to illuminate the possibility that the dysfunctional central behaviors that patients with chronic sinus disease complain of, including sleep loss, fatigue, and depression, may be due to the underlying mechanism of the disease itself,” Dr. Alt said, “such that depression and sleep loss may be related to the underlying inflammatory component of the disease. We’re finding that the same immune mediators and cytokines that are found locally during inflammation are also found in the brain and are known to alter behavior.” These inflammatory mediators, also called cytokines, Dr. Alt said, may trigger changes in the brain that cause depression, anxiety, and sleep and cognition problems. The fact that cytokines act in the brain to induce physiological adaptations may begin to help explain the pathophysiology of chronic sinus disease and how to treat the pathologies it is commonly associated with, including depression, fatigue, impaired cognition, and memory and sleep disturbance.