The Unrecognized Problem of Depression in Sickle Cell Disease

We will frequently hear from patients that they are under a lot of stress and there is consistently anecdotes tossed around about patients reporting depressive symptoms. As is the case with most chronic disease populations, psychopathology in sickle cell disease is not uncommon; however, despite our acknowledgment of the issue, we continue to ignore those with sickle cell disease who are also suffering from a psychiatric condition. Patients with SCD are rarely referred for psychiatric assessments, and when they are referred, they are usually not receiving sufficient care. It may be that we believe taking care of the physical body will in essence, also take care of the mind. Yet, one could argue that the treatment paradigm works in the other direction.

Here is a case report from Leavell et al. 1983:

“Nine months after her initial evaluation, one of the women, age 37, was admitted after an overdose of flurazepam to our adult psychiatric inpatient unit. At the time of admission she complained of feeling depressed for the past year with recurrent hospitalizations and emergency-room treatment for sickle cell crises. She denied acute suicidal ideation, but indicated that there had been another “accidental overdose of pain medication” two to three years previously. She denied prior psychiatric treatment, but her hospital record indicated that she had been seen by the psychiatric service and diagnosed as “depressed.” She attributed her present depression to marital problems, to difficulty caring for two of her children who had SeD and required frequent hospitalization, and also to believing that she was going to die soon because she had been told that “people with sickle cell disease die before age 40.”

During hospitalization she responded to supportive psychotherapy, which allowed her to ventilate feelings about her marriage, her disease, and problems with her children. She agreed to continue outpatient psychotherapy, feeling that “It helped to have someone to talk to.” One day prior to discharge she had an acute sickle cell crisis. Her discharge diagnosis was dysthymic disorder with passive-aggressive personality traits.

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