After an injury or illness, depression or depressive thoughts are common side effects. Illnesses and Health issues are ranked number 2 for the most major cause in depression.

According to the DSM V, depression after an illness occurs in three forms.

First, depression after another medical condition can be “prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominate in the clinical picture.”

Second, “there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.”

Lastly, depression can be “the disturbance is not better explained by another medical disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).”

After facing an adversity, one can’t just assume they have a depressive disorder without a medical diagnosis.

First, the clinician has to diagnose the patient with a preexisting medical condition. Although depressive disorders due to another medical condition are most commonly associated with traumatic brain injuries, Huntington’s Disease, and Parkinson’s Disease, the list does not stop with these options.

After getting diagnosed with a medical condition, “the clinician must establish that the mood disturbance is etiologically related to the general medical condition through a physiological mechanism.”

In order to make the final judgment on whether or not the patient has a depressive disorder, the clinician must make careful decisions and assess the patient in multiple areas. Without cautiously examining the patient, a clear diagnosis on a depressive disorder due to another medical condition cannot be made.

Doctors typically tend to understand the patients feelings as well. Along with the prescription, doctors also recommend ways to fix patients’ mental health as well. Chronic issues that change people’s lifestyles completely are hard to manage, but doctors are willing to help their patients’ mental health change for the better.

One clear variable plays a key role in depressive disorders due to a preexisting medical condition: etiology, the origin or cause of a disease.

Mentally, physical and health-related illness tend to affect one’s thoughts. People can lose touch with reality and lose interest in the things they love.

“A couple times I skipped out on going to fun stuff like hanging out with my friends or going to football games because I was in pain or upset about my injury,” said senior Nina Rybansky.

During tough times, people want to find a way to get better. For Rybansky, she couldn’t cheer up enough to do her favorite activities.

John Murray is a clinical sports physician from Palm Beach, Florida. He focused his dissertation on how injuries truly affect one’s identity. He studied his athletes to see how they were affected by depression.

Murray’s patients range from juniors to professional athletes. Regardless of age, he determined that all of them experience depressive symptoms. Although anyone can be affected mentally, he discovered that patients’ success rate relates to their level of depression.

“In other words, an Olympian would be more affected psychologically by an injury than someone who plays pick-up basketball on Saturdays,” writes Murray.

Depression symptoms can also arise from a change in daily life. Going from training hours on end to sitting home affects people’s thinking. Eventually, they could even make injured athletes question their self worth. It is such an adjustment, and it really makes athletes miss their sports that much more.

Unfortunately, a team doesn’t just crumble when one player is sitting out. Teammates still have to play the game, celebrate their wins and ponder over the losses. Being injured, athletes have to sit back and just watch the team.

“At the moment my thoughts were pretty positive, but a lot of them turned negative too, mostly because I saw people celebrating on the field and I wish I was part of that again,” said Rybansky.

Olympic skier, Hannah Kearney, understands the impact of athletic injuries.

“Every single athlete has some sort of physical obstacle in their career, so it’s really just a part of their identity. In fact, it sort of solidifies it,” said Kearney.

Commonly linked to symptoms of depression, anxiety can also mentally affect someone after an injury.

According to the DSM V, there are three forms of anxiety after an illness.

First, anxiety after another medical condition can be described as “panic attacks or anxiety is predominant in the clinical picture.”

Second, “there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.”

Lastly, anxiety could be when “the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Similar to depression, one can’t automatically assume they have anxiety without a clear diagnosis from a doctor.

First, the clinician has to first prove that the patient has a previous medical condition. Anxiety symptoms are most common in endocrine disease, cardiovascular disorders, respiratory illnesses, metabolic disturbances, and neurological illness, among others.

After the diagnosis, “it must be established that anxiety symptoms can be etiologically related to the medical condition through a physiological mechanism before making a judgement.”

To find the best explanation for the symptoms in a specific person, the clinician has to make clear and careful decisions, along with assessing the patient in specific areas.

The DSM V clearly states “anxiety due to another medical condition is diagnosed when the medical condition is known to induce anxiety and when the medical condition preceded the onset of the anxiety.”

People start to worry about someone when they have anxiety along with a preexisting illness. Some disorders, like social anxiety, often link to illnesses like heart disease and gastrointestinal illnesses.

According to verywellmind.com, “those who suffer from both anxiety and physical illness have been shown to have a poorer quality of life, so it is important that you receive treatment to address both your anxiety and physical health concerns.”

Getting back into any routine could be challenging. Whether it’s starting up a diet or going back to school, injured athletes can find it extremely stressful going back to that routine.

While being injured, athletes find themselves sitting on the sidelines, watching their teammates condition and practice. When it’s finally time to return, the athletes have to break the cycle of not working out and start getting fit again. This can be hard on their mental health because their bodies won’t be as strong as they used to be.

“I was incredibly nervous [to return], because I was almost completely unable to kick with my left foot,” said Adam Harvey, a senior on the boys soccer team.

Coming back from adversity is a challenge on the body since it hasn’t been pushed that hard in a while. Without being completely ready to return, this leaves athletes to not play at their best.

Along with being anxious to play again, athletes often find themselves anxious waiting on results from doctors. From CT scans to X-rays, waiting for the gut-wrenching news can be a nail-biter.

“I was really anxious while waiting to get my X-ray results back and to find out how long my recovery would take,” said Harvey.

Jitender Sareen and her colleagues from the University of Manitoba did a study on how anxiety disorders relate to physical conditions.

Out of the 4,181 adults who were part of the German Health Survey, 429 had an anxiety disorder within the past month. In addition, 2,610 had a physical condition within the past month.

The survey questioned whether or not the patient has any physical illnesses through a questionnaire. It consisted of 44 specific questions, including blood pressure measurements and urine samples.

A psychologist interviewed the patients and used the DSM IV to detect disorders.

Finally, a quality of life survey was used to ask questions such as the participants’ general health and physical functions.

If you find yourself nervous to play again, just make sure to be confident and know that you can do it.

“Stress is an ignorant state. It believes that everything is an emergency. Nothing is that important,” said Natalie Goldberg.

Opioids and other prescription drugs are commonly used by athletes to help ease the pain during their recovery process.

Unfortunately, oxycontin and opioids do such a great job that these athletes can become addicted to the drugs.

Some drugs that are prescribed to student athletes include codeine, methadone, morphine, oxycodone, hydrocodone, fentanyl, hydrocodone/acetaminophen, hydromorphone, meperidine, oxycodone/acetaminophen, oxycodone/naloxone and more.

According to the Substance Abuse and Mental Health Services Administration, “over 22% of people who end up abusing prescription painkillers got them from a doctor. That’s in addition to the more than 50% of people whose prescription drug misuse started because they got it from friends or family members for free. That adds up to well over 72% of prescription drug abusers whose prescription drug abuse started because they got pills from someone they trusted.”

There are many reasons why athletes might misuse drugs. Drugs such as steroids enhance athletes’ performance value. If they are out with an injury, athletes may feel that they need all the help they can get to stay on top.

Drugs can also help ease the side affects of mental health disorders; rather than getting help from doctors, many athletes who are struggling will fall back on drugs and other addictive substances like alcohol to help manage the pain of a mental health disorder.

It is very common for people with illnesses and injuries to become addicted to drugs, which is a sign of comorbidity.

Comorbidity is the presence of more than one disease or medical condition, and it happens to around half of those diagnosed with a preexisting medical condition.

“It can be common for people who are struggling with an undiagnosed mental health issue to begin using drugs/alcohol to self-medicate. In regards to injury, I think this can often lead to opioid addiction, specifically,” said Ms. Heather Eckhardt, Delaware Valley’s Student Assistance counselor.

Around 94% of the time, opioid users discover heroin as a cheaper alternative to pain killers. Heroin is an opioid drug that is made from morphine and is commonly seen as a white powder, brown powder or a black sticky substance (also known as black tar heroin).

According to drugabuse.org, “Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.”

Heroin costs around $5-$20 for a small, single use bag. Once people aren’t able to afford the prescribed drugs, they fall back on heroin.

“It is often easier and cheaper to then start using heroin to avoid the withdrawal symptoms they may experience when they are no longer able to get their pain meds,” said Eckhardt.

Often times people believe that drug abuses do this to themselves. People believe it’s a personal choice, and that it is all their fault.

“They lose so much: family, friends/loved ones, jobs, freedom, and ultimately for many…their life.  I do not believe anyone would choose to live their life this way,” said Eckhardt.

Athletes don’t choose to get hurt. Once they’re hurt, they trust medical centers and pharmacies to prescribe them with a useful drug that can help them recover. By relying on these pharmacists, they take these drugs that can leave them wanting more.

“I believe addiction is an illness, like heart disease, diabetes and cancer are illnesses. Addiction is not about weakness.  Addiction can happen to anyone at any age and is much more likely to happen if someone starts to use/drink at a young age,” said Eckhardt.

If you are a student and notice yourself struggling with substance abuse, depression or anxiety, there is help out there. You can reach out to Ms. Eckhardt, any of the school’s counselors or a trusted adult.

The Substance Abuse and Mental Health Service Administration hotline is 1-800-662-4357.

“No matter the motivation, external or internal, I am willing to help someone through the process with the hope that after time, the external motivation turns to internal motivation because in my experience as a drug and alcohol counselor and SAC, that is really the only way for someone to maintain their recovery, because they want it for themselves and not for anyone else,” said Eckhardt.