🧠 Overview — What is the Chronic–Systemic–Disease Type?
The Chronic–Systemic–Disease Type is a form of emotional disorder that develops and persists on the basis of chronic systemic disease, which directly affects both the body and the brain continuously over a long period of time, until the emotional system and life energy are gradually eroded bit by bit—often without the person realizing it.
In this group of patients, the feeling of being “tired–down–bored–drained” does not arise only from thoughts or life circumstances, but from chronic inflammation in the body that directly impacts the brain and neurotransmitters, disrupting the mood regulation circuit and the energy–motivation circuit in a continuous way.
Conditions in this category are usually diseases that affect multiple systems, such as:
Autoimmune diseases (SLE, Rheumatoid arthritis, Sjögren’s, IBD)
Endocrine and metabolic disorders (Diabetes, Hypo/Hyperthyroidism, Cushing, Addison, PCOS)
Neurological diseases (Multiple sclerosis, Parkinson’s disease, Neuropathy)
Cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and certain cancers
When the body has to fight these illnesses every single day, the immune system stays in a state of “constant alertness,” persistently releasing cytokines and stress hormones. These substances travel to the brain and disturb the balance of serotonin, dopamine, and norepinephrine—neurotransmitters that regulate mood, happiness, the desire to engage in activities, and motivation.
The result is that the brain and body enter a deeply ingrained chronic stress state—like an engine that is idling but never allowed to switch off. The accumulated exhaustion becomes a permanent background of life, so patients feel as if their “battery is always low,” no matter how much they rest or sleep, and they never truly feel refreshed.
Beyond the biological mechanisms, the psychological burden of living with a chronic illness is another major source of pressure. Patients must constantly attend medical appointments, take dozens of pills a day, and live with an unpredictable body—some days are good, some days deteriorate. They cannot reliably plan long-term life goals and often live in fear of becoming a burden to those around them.
Every time the disease flares, their mood drops immediately. They feel hopeless, become easily irritable, and automatically blame themselves—as if their body is “betraying them.” Some patients feel as though they are imprisoned in a body that no longer works the way it used to.
Therefore, the Chronic–Systemic–Disease Type is not just a superficial “emotional reaction to illness,” but rather a system-level dysfunction of the brain and body that are tightly interconnected—a chronically inflamed body changing the brain, and an exhausted brain further weakening the body.
The overall picture can be summarized as:
“The body is on a battlefield, the brain is in the smoke of inflammation,
and the mind is trapped in the shadow of chronic exhaustion—
not because the person is weak-willed, but because the entire system is fighting to survive every single second.”
This group of patients is often overlooked because most doctors focus more on test values and physical findings than on emotional states. Patients themselves may believe that “feeling depressed is just a side effect of the illness,” when in fact, in neurological terms, it is another comorbid disorder that arises alongside the physical disease, and if left unaddressed, can severely reduce their quality of life and capacity to engage with treatment.
In summary, the Chronic–Systemic–Disease Type is a state in which the body and brain enter a chronic exhaustion on two levels—the first level from chronic disease attacking the internal organs, and the second from the brain having to continuously cope with unrelenting stress and inflammation.
This is the picture of “one of the most complex forms of illness”, which can only truly be understood when we clearly see the interconnection between body–brain–emotion.
🔍 Core Symptoms — Core Features of the Chronic–Systemic–Disease Type
The core symptoms of the Chronic–Systemic–Disease Type arise from “chronically ill body + chronically inflamed brain + chronically fatigued mind” all stacked on top of each other, to the point that it is almost impossible to tell which came first. Therefore, what we see is not just classic depression alone, but a hybrid between depressive/anxiety symptoms and the manifestations of chronic systemic illness.
1) Chronic Fatigue
This is not just “a bit tired”—it feels like the battery is stuck at 10–20% all the time.
You wake up without feeling rested at all; even if you sleep the “right” number of hours, you still feel exhausted.
Everyday activities such as showering, getting dressed, or walking up a small flight of stairs feel like they require the same level of energy as running a marathon.
People around the patient often don’t understand and may think, “Why do you seem so lazy?” when in reality, the energy systems in the body and brain are leaking all the time.
The key point is that patients themselves are often confused and wonder:
“Am I tired because of the physical illness? Because of the medication? Or because I’m depressed?”
In reality, it is all of the above combined.
2) Low Mood & Anhedonia
It feels as if the “color tone” of life is being dimmed gradually. Things that used to feel “okay” or “good” now feel like “whatever.”
The joy from little things disappears—playing games, watching series, listening to music, meeting friends—these all become “draining, not engaging, and emotionally flat.”
They do not necessarily cry every day. Many patients present more with a vibe of “wilted–numb–neutral” rather than dramatic sadness.
They start to feel that life has only two modes: “going to the hospital” and “resting and recovering while waiting to go to the hospital again.”
The brain registers that:
“This world doesn’t reward me with anything anymore,”
and quietly shuts down the system responsible for wanting to do new things.
3) Irritability & Low Stress Tolerance
The baseline emotion of people in this group is not only sadness; there is a constant low-grade irritability simmering underneath.
Small things that others can tolerate—rescheduled appointments, traffic jams, heat, noise—become triggers that can cause an outburst.
When the disease flares (more pain, worse lab results, the need to increase medication), their emotions become noticeably unstable.
People around them are often puzzled:
“They used to be much calmer. Why do they snap so easily now?”
The reality is that their nervous system is being assaulted from all sides—by the physical illness, poor sleep, and continuously high stress hormones—with almost no chance to rest.
4) Illness-Related Anxiety
This group tends to have anxiety content tightly tied to the illness, such as:
Fear that the disease will progress to the point of disability / needing a wheelchair / being bedridden
Fear that their partner/family will not be able to handle the burden
Fear of losing their job, income, and career because of frequent absences
Some patients constantly monitor their lab results, scans, and bodily sensations.
They interpret almost every piece of information through Google.
Others don’t dare look at their test results at all for fear of discovering something they don’t want to know.
This anxiety occupies so much mental space that there is hardly any capacity left for other things such as relationships, work, or long-term goals.
5) Guilt & Self-Blame
“I’m a burden” is a sentence that repeatedly appears in the minds of people in this group.
They feel guilty for needing help, for taking sick leave often, and for forcing others to change plans because of their health.
Some blame themselves for becoming ill, for example:
“It’s because I didn’t take care of myself before.”
“If I hadn’t been that stressed, the disease wouldn’t have flared up.”
These thoughts are a double-edged sword:
On one side, they can motivate the person to try to take better care of themselves.
On the other, they destroy self-esteem and open the door to full-blown depression.
In more severe cases, guilt can flow into thoughts like:
“If I weren’t here, everyone else would be better off.”
This moves dangerously close to the zone of suicidal ideation.
6) Reduced Concentration / Brain Fog (Cognitive Fog)
Thinking becomes slower; information processing isn’t as sharp as it used to be.
They forget appointments, miss doses of medication, or forget sentences they just said moments ago.
Reading material doesn’t “go in”; it feels as if there’s a thin fog covering the brain all the time.
Patients often describe it as:
“It’s like my brain isn’t sharp anymore,” or
“It feels like I’m not fully awake all day.”
The problem is that both patients and some doctors tend to blame only the medication or the physical illness, when in fact neuroinflammation + depression/anxiety clearly play a role as well.
7) Sleep Disturbances
They have difficulty falling asleep, staying asleep, or wake frequently due to pain, shortness of breath, or ruminating about the illness.
Some patients are the opposite: they sleep a lot, as if they are trying to escape the world or their symptoms.
No matter how long they sleep, they never feel truly refreshed (non-restorative sleep).
The cycle becomes:
Physical illness → poor sleep → poor sleep increases brain inflammation/stress hormones → worse mood/more pain → even worse sleep → repeated loop.
8) Chronic Pain & Somatic Amplification
They experience chronic pain in joints, muscles, back, or head.
Some begin to develop pain patterns where no clear structural cause can be found, but which can be mapped along a “brain–emotion–stress” framework instead.
This leads to a pain–depression–inflammation loop:
Pain → stress/depression → increased inflammation → worse pain → endless rotation.
The brain learns that the body = a source of suffering, which leads to a sense of detachment from the body (“I don’t want to be in this body”) and withdrawal from various activities.
📋 Diagnostic Criteria — Conceptual Framework for Diagnosing the Chronic–Systemic–Disease Type
To emphasize again: this is not an official DSM/ICD diagnostic criterion, but a framework for thinking/communicating when writing articles or constructing a conceptual subtype so that readers can understand it more easily.
1) Presence of a Clear Chronic Systemic Disease
There must be a chronic illness that affects the whole system, not just an acute, short-lived issue.
Examples: SLE, RA, MS, DM, CKD, COPD, CHF, IBD, etc.
The disease should have been ongoing for at least several months to several years to confirm a chronic course.
Cases where someone has an acute illness (e.g., influenza) and feels temporarily down do not fall into this subtype.
The key point is that the disease must have a meaningful disease burden—not just mildly abnormal test values while the person can still live a normal life.
2) Clear Presence of Depressive / Anxiety / Emotional Dysregulation Symptoms
Symptoms should meet at least one major category:
Major Depressive Episode
Anxiety disorders (GAD, panic spectrum, etc.)
Or at least Adjustment disorder with depressed/anxious mood
Duration is at least 2 weeks or more (for MDE) or longer in chronic illness cases.
There must be observable functional impairment, such as:
Inability to work at full capacity
Withdrawal from social life
Lack of motivation to manage their illness (skipping appointments, not taking medication, etc.)
The difference from “just feeling a bit fed up with life” is that the symptoms occupy so much space that nearly every area of life is affected.
3) Evidence/Indications That Emotional Symptoms Are Directly Related to the Physical Disease
The defining point of this subtype is the temporal and severity link between the physical illness and the emotional state.
Common patterns include:
When the disease flares (higher inflammatory markers, increased pain, hospitalization) → mood drops significantly, irritability increases, and the person feels hopeless.
When the disease calms down, emotional symptoms improve partially, but never quite return to the baseline before the illness.
Or:
The person previously coped well with life.
Within 6–12 months after learning they have a chronic illness, clear depressive/anxiety symptoms emerge.
This connection differentiates it from depressive disorders that arise “in isolation” without a chronic physical illness as the central context.
4) Excluding Other Factors That Better Explain the Symptoms
Some medications can directly cause mood symptoms, such as:
Corticosteroids → can cause stress, irritability, insomnia, and in some cases, psychosis.
Interferon → is well-known for its “mood-lowering” effects.
Certain chemotherapeutic agents / some antiepileptics, etc.
Metabolic/hormonal conditions such as:
Thyroid dysfunction
Hypoglycemia/hyperglycemia
Deficiencies in certain vitamins, etc.
can also cause mood changes in their own right.
Substance use (alcohol, recreational drugs, misuse of painkillers, etc.) must also be considered.
The goal is not to “blame” a single factor, but to clarify:
What is the major driver?
What is a aggravating factor?
So that treatment can be tailored appropriately.
5) Functional Impairment on “Two Layers”
First layer: from the physical illness
Difficulty moving, body aches, shortness of breath, easy fatigue, needing frequent time off work
Inability to engage in activities they used to enjoy (sports, travel, intensive work, etc.)
Second layer: from mood/brain
No mental energy, not wanting to get out of bed
Poor concentration at work, difficulty handling paperwork/appointments
Withdrawal from friends/family because they feel “there’s nothing interesting to talk about except my illness”
These two stacked layers make life shrink very quickly if they are not recognized.
Clinically / in psychoeducation, this can be explained to patients as:
“Your body is losing energy to the illness, and your brain is losing energy to emotions and inflammation.
So when you feel like you can’t do anything, it’s not because you’re not trying—it’s because both systems are exhausted at the same time.”
6) Risk of Self-Harm / Suicidal Thoughts
Chronic illness + chronic pain = higher risk than the general population.
Common thought patterns include:
“I feel like I have no value left.”
“If things stay like this, there’s no point in going on.”
“I am too much of a burden on others.”
There does not need to be a specific plan for it to be considered risky.
Even a passive wish such as “If I slept and didn’t wake up, that would be nice” must be taken seriously.
Within this diagnostic framework for the subtype,
it is essential to assess this risk routinely, not only when the person is crying or explicitly stating it.
7) Summarizing the Pattern in a Clinical / Narrative Style
When using this framework in articles or case notes, it can be narrated like this:
“In a patient with 7-year chronic SLE, accompanied by chronic joint pain and fatigue,
there is persistent depressive symptomatology, anxiety about disease progression, and a continuous sense of being a burden on the family.
Emotional symptoms worsen clearly during disease flares and improve partially when disease activity decreases,
with functional impairment in both occupational performance and self-care.
The overall pattern is consistent with a ‘chronic–systemic–disease type mood disorder pattern.’”
This helps readers on the website see that
it is not just “ordinary depression,” but a mood pattern embedded within the context of a chronic systemic illness.
🧬 Subtypes or Specifiers — Subtypes of the Chronic–Systemic–Disease Type
These subtypes can be created for explanatory/organizational purposes in NNS, for example:
1) Autoimmune–Inflammatory Load Type
Underlying diseases: SLE, RA, IBD, psoriasis arthritis, MS, etc.
Key features:
Overactive immune system → high cytokines → neuroinflammation
Fatigue + brain fog + anhedonia are especially prominent.
Mood rises and falls clearly in line with disease activity—for example, a flare leads to an immediate crash in mood.
2) Metabolic–Endocrine Dysregulation Type
Underlying diseases: Diabetes, hyper/hypothyroidism, Cushing, PCOS, metabolic syndrome, etc.
Key features:
Fluctuating blood sugar/hormone levels → mood swings, irritability, frequent hunger, easy fatigue.
Changes in weight/body shape → damaged self-image and self-esteem.
3) Neurodegenerative–Linked Type
Underlying diseases: Parkinson’s, MS, early dementia, etc.
Key features:
Dopamine/serotonin circuitry is disrupted → prominent depression + apathy.
There is a gradual loss of abilities over time → existential grief, anticipatory loss.
4) Cardio–Pulmonary Burden Type
Underlying diseases: CHF (chronic heart failure), COPD, pulmonary fibrosis, etc.
Key features:
Shortness of breath, easily fatigued even with minimal exertion → feeling that the “body has betrayed” them, and a sense of being trapped inside their own body.
Often has panic-like symptoms when breathing becomes difficult → overlaps with anxiety / panic spectrum.
5) Treatment–Burden & Steroid–Related Type
Underlying: patients who need long-term steroids, chemotherapy, biologics, dialysis, etc.
Key features:
Steroids themselves cause mood swings, irritability, insomnia.
A dense treatment schedule → life becomes that of a “full-time patient,” leading to a loss of a sense of normal life.
🧠 Brain & Neurobiology — Brain and Biology of the Chronic–Systemic–Disease Type
The Chronic–Systemic–Disease Type reflects a direct connection between a “chronically inflamed body” and a “chronically exhausted brain” at the neurobiological level. The brain and immune system are not separate; they constantly communicate through the neuroimmune axis. When this becomes a state of chronic low-grade inflammation, the system becomes distorted and begins to generate emotional symptoms directly.
Over time, the brain is not merely “responding to physical illness,” but gradually restructures its architecture and functioning, creating a pattern of “inflammatory depression” commonly seen in patients with chronic illnesses worldwide.
1) Cytokine–Brain Axis — When Inflammatory Signals Penetrate the Brain
A body in a chronic disease state persistently releases cytokines such as IL-1β, IL-6, TNF-α, and IFN-γ into the bloodstream.
These molecules can send signals through neuro–immune pathways to the brain, for example:
Through circumventricular organs (which lack a full blood–brain barrier)
Or via the vagus nerve, which connects internal organs to central brain structures
When the brain detects these signals, it activates microglia (immune cells in the brain), prompting them to release cytokines within the brain itself → resulting in neuroinflammation.
An inflamed brain produces symptoms similar to when we have a fever: fatigue, loss of appetite, social withdrawal—this is known as “sickness behavior.”
This is the fundamental model of depression arising from chronic medical illness.
When inflammation persists for months to years, the brain can no longer “reset” itself, and mood abnormalities become a chronic state.
2) HPA Axis Dysregulation — A Stress System Beyond Its Limits
The HPA axis (hypothalamus–pituitary–adrenal axis) is the core system controlling stress hormones.
In chronic illness, this system is repeatedly activated by both pain and worry → the body secretes cortisol at elevated levels for extended periods.
When cortisol remains high for too long, the brain tries to shut down the signal, but the net result is disrupted balance—a dysregulated cortisol rhythm.
Some individuals end up with consistently low cortisol → chronic fatigue and cognitive slowing.
Others have high cortisol at night → insomnia and heightened anxiety.
This disturbed cortisol pattern impairs neurogenesis in the hippocampus and reduces connectivity in the prefrontal cortex → leading to poorer memory and decision-making.
This state also destabilizes immune function, making it either over- or under-responsive, which worsens the physical illness further—a vicious cycle of “illness triggers stress – stress exacerbates illness.”
3) Monoamine Neurotransmitter Shift — When Neurotransmitters Change Mode
Chronic inflammation increases activity of the enzyme indoleamine-2,3-dioxygenase (IDO), which diverts tryptophan (the precursor of serotonin) into the kynurenine pathway.
As a result, serotonin decreases, while kynurenine is converted into quinolinic acid, which is a glutamate agonist → making the brain more excitable yet more easily fatigued.
The dopamine system, responsible for motivation and reward, is also suppressed, leading to:
A state of “wanting to just lie there and do nothing” (anhedonia).
Meanwhile, the norepinephrine system, which controls alertness and attention, becomes imbalanced → contributing to irritability, easy anxiety, and brain fog.
Overall, the brain loses balance across three key neurotransmitters (serotonin, dopamine, norepinephrine) simultaneously, which is why the picture is not just sadness, but exhaustion, fatigue, and loss of drive at the cellular level.
4) Brain Regions Impacted — Brain Areas Under Direct Attack
Anterior Cingulate Cortex (ACC)
A key hub for processing pain and emotion. When pain is prolonged, the ACC becomes overactive, causing the brain to interpret many stimuli in a negative way.
Insula
A central hub for processing “internal bodily signals” such as heartbeat, breathing, and pain. With neuroinflammation, the insula becomes hypersensitive, so the person feels bodily discomfort even without clear external triggers.
Prefrontal Cortex (PFC)
Responsible for emotional regulation and logical thinking. When it is constantly suppressed by cortisol and cytokines, its capacity to “brake” emotional reactions declines → resulting in irritability and poor self-control.
Hippocampus
Responsible for memory and learning, and extremely sensitive to stress hormones. Prolonged high cortisol causes it to atrophy → leading to long-term memory problems and cognitive decline.
Amygdala
The emotional center for fear and anger, which becomes overactive in chronic stress → patients react excessively to perceived threats or feel easily suspicious and on edge.
5) Pain–Emotion Circuit — Pain and Emotion in a Single Loop
The brain’s pain matrix (ACC, insula, thalamus, somatosensory cortex) is directly wired to the limbic system, which governs emotion.
When there is chronic pain, the brain “learns” that the body = a source of suffering → generating learned helplessness and chronic hopelessness.
The more the brain interprets pain in an emotional context, the more intense the subjective experience of pain becomes.
This is not imagined; it reflects structural changes in neural circuits that can be observed via fMRI.
This explains why treating chronic pain must include psychological/emotional care as well—because these two systems share the same “wiring.”
6) Neuroplasticity & Oxidative Stress — An Inflamed Brain Cannot Heal Well
Long-term inflammation increases oxidative stress and reduces secretion of BDNF (Brain-Derived Neurotrophic Factor).
Low BDNF makes it difficult for the brain to recover from stress, resulting in disrupted neuroplasticity.
Patients feel that their thoughts keep looping back to the same patterns, and their mood cannot recover even when circumstances improve.
This is the core of chronicity in the Chronic–Systemic–Disease Type—
the brain is not just sad; it has “lost its ability to reset itself.”
🧩 Causes & Risk Factors — Systemic Risk Factors and Mechanisms
The Chronic–Systemic–Disease Type does not arise from a single factor, but from the accumulation of biological + psychological + social + medical system influences over many years, until the brain enters a maladaptive state of adjustment (maladaptive neuroplasticity).
1) Biological Factors
Having a chronic, multisystem illness such as autoimmune, metabolic, endocrine, or neurodegenerative disease.
Persistently elevated inflammatory markers (CRP, ESR, IL-6, TNF-α) → indicate that the immune system is in a constant state of activation.
Hormonal abnormalities such as thyroid disease, diabetes, and cortisol dysregulation → lead to unstable mood circuits.
Sleep disrupted by the illness (shortness of breath, pain, nocturia) prevents the brain from entering deep sleep → the HPA axis cannot recover.
Certain genetic factors (e.g., polymorphisms in the serotonin transporter gene) make individuals more sensitive to the emotional effects of cytokines than the general population.
Chronic nutritional deficiencies (e.g., vitamin D, B12, folate, omega-3) impair neurotransmitter synthesis and brain recovery.
2) Psychological Factors
A personality style that is perfectionistic / highly responsible.
People who used to be “high-achievers / highly responsible” experience intense psychological pain when their bodies become limited, leading to a sense of identity loss.
The belief that “I must fight and never be weak” prevents them from accepting help and leads them to suppress emotions until they burn out.
Feelings of guilt and self-blame for becoming ill.
Fear of depending on others or losing physical independence → high anxiety.
Traumatic experiences from treatment (e.g., painful procedures, failed therapies) → create learned fear of hospitals/doctors.
Inability to plan for the future → chronic uncertainty, which is potent fuel for brain-level stress.
3) Social & Environmental Factors
Lack of supportive networks, such as family members who do not understand, or friends drifting away because the patient frequently declines social activities.
Financial difficulties due to medical costs and lost work → creating feelings of worthlessness and burden.
Misunderstanding in the workplace—for example, invisible illnesses being dismissed as “laziness / faking sickness.”
Living in an environment filled with pollutants and toxins (PM2.5, heavy metals, pesticides) which increase inflammation in the body.
Inadequate health welfare/safety nets, forcing patients to struggle alone against bureaucratic systems or insurance companies, increasing stress and loneliness.
4) Medical Systemic Factors
Healthcare systems that prioritize lab numbers over wellbeing → emotional issues go undetected.
Short consultation times that do not allow room to discuss feelings → patients learn to “smile and say I’m fine.”
Use of certain physical treatments (like corticosteroids, interferon, chemotherapy) that can trigger mood swings without parallel psychological monitoring.
Some physicians avoid referring to psychiatry for fear that patients will interpret it as “I’m being seen as crazy” → leading to underdiagnosed and untreated depression.
Lack of multidisciplinary teams that integrate psychiatrists, psychologists, and medical specialists.
Some patients fear the side effects of antidepressants because they believe “once you start, you’ll be addicted” → they refuse treatment from the outset.
5) Cross-Factor Interactions
All these factors do not exist in isolation; they reinforce each other in a cycle:
Physical illness → leads to chronic fatigue → mood declines
Depressed mood → reduces adherence to medical care → illness worsens
Illness worsens → requires higher steroid doses → mood deteriorates further → repeated cycle
When this system completes the loop, the brain learns permanently that:
“Life = surviving exhaustion,”
which marks the beginning of chronic depressive adaptation.
Breaking out of this cycle requires an integrated biopsychosocial treatment approach—treating all systems together, not just one component.
6) Overall Summary of Risk Factors
The Chronic–Systemic–Disease Type does not arise because the patient “isn’t strong enough.”
It arises because the body, brain, mind, and social environment all enter a chronic state at the same time.
Recovery, therefore, is not about “fixing a single disease,” but about rebuilding a new system in which body–brain–mind
can once again function together in harmony.
🏥 Treatment & Management — Approaches to Managing the Chronic–Systemic–Disease Type
Key concept = “integrated care” → treating physical illness + mental illness together.
1) Stabilizing the Physical Illness as Much as Possible
Control disease activity effectively to reduce flares and inflammation.
Adjust or change medications if they have a strong impact on mood (e.g., high–dose steroids).
Emphasize communication between “physical medicine doctors–psychiatrists–nurses–physiotherapists” so that they function as a single team.
2) Psychiatric / Psychological Treatment
Medication (pharmacotherapy)
Use antidepressants / anxiolytics that are safe for the specific physical condition.
Be cautious about drug interactions with primary medications (e.g., warfarin, immunosuppressants).
In inflammatory diseases, some studies suggest that SSRIs / SNRIs may help reduce certain inflammatory markers as well.
Psychotherapy
CBT for chronic illness: focuses on managing thoughts like “I’m worthless / I have no future” + pain coping.
ACT (Acceptance and Commitment Therapy): helps patients learn to live with the illness while still living in accordance with their values.
Supportive therapy / psychoeducation: explains that feeling tired–down–bored does not mean being weak, but is part of the illness + brain changes.
3) Rehabilitation & Lifestyle
Pacing & energy management
Plan energy usage throughout the day so it is not all burned at once leading to a crash.
Appropriate exercise for the illness
Low–impact activities such as light walking, swimming, stretching, yoga/taichi.
Done to adjust brain–hormone systems, not solely for “looking fit.”
Sleep hygiene
Keep a consistent sleep schedule; reduce caffeine/screens before bed.
Evaluate for sleep apnea or nighttime breathing problems in cardiac/pulmonary diseases.
4) Social & Existential Support
Patient groups (support groups)—online/offline.
People with similar illnesses often understand the depth of exhaustion and fear better than the general population.
Conversations about life, meaning, death, and the future in a straightforward, non sugar–coated way.
Helping patients find “small spaces” where they still feel a sense of self—such as writing, drawing, online projects, etc.—instead of being nothing but “a patient” all the time.
📝 Notes — Common Misunderstandings
“Feeling down–tired–bored” does not mean the person is weak-willed.
It is the brain’s response to chronic inflammation and stress.
Never separate “physical illness” and “mental illness” as if they are unrelated.
In this group, they are one interconnected system in constant dialogue.
Asking about mood should be part of routine assessment in chronic illness,
not something done only “if they complain a lot, then refer to psychiatry.”
Many patients do not dare to say they feel like dying or that they are hopeless,
because they fear the doctor will think they are “being dramatic” → the clinician must be the one to proactively create space for such discussions.
Treatment goals = quality of life, not just lab numbers.
If the labs look good but the patient spends all day staring at the ceiling, that is not an acceptable outcome.
Narrative matters.
Helping patients “rewrite their life story” from “I am a sick person” to
“I am a person who has this illness in my life, but it is not the whole of who I am”
has real impact on the brain, behavior, and long-term treatment outcomes.
📚 Reference — Key Academic and Theoretical Sources
Note: “Chronic–Systemic–Disease Type” is a conceptual subtype used to link chronic physical illness with emotional and brain changes. It is not an official diagnostic term in DSM-5-TR or ICD-11, but is derived from evidence on the “Neuroinflammation & Depression Pathway.”
🔹 Major diagnostic manuals
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Revision; DSM-5-TR). Washington, DC: APA.
→ Sections: Depressive Disorder Due to Another Medical Condition and Somatic Symptom and Related Disorders
World Health Organization. (2021). ICD-11: International Classification of Diseases. Geneva: WHO.
→ Section: Mood disorders due to known physiological condition
🔹 Key research and review articles on the neuroinflammation–depression link
Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. Nature Reviews Neuroscience, 9(1), 46–56.
Miller, A. H., & Raison, C. L. (2016). The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nature Reviews Immunology, 16(1), 22–34.
Capuron, L., & Miller, A. H. (2011). Immune system to brain signaling: neuropsychopharmacological implications. Pharmacology & Therapeutics, 130(2), 226–238.
Felger, J. C., & Treadway, M. T. (2017). Inflammation effects on motivation and motor activity: role of dopamine. Neuropsychopharmacology, 42(1), 216–241.
Haroon, E., Raison, C. L., & Miller, A. H. (2012). Psychoneuroimmunology meets neuropsychopharmacology: translational implications of the impact of inflammation on behavior. Neuropsychopharmacology, 37(1), 137–162.
🔹 Clinical articles and guidelines on chronic illness with comorbid mood symptoms
Katon, W. J. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23.
Matcham, F., Rayner, L., Steer, S., & Hotopf, M. (2013). The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology, 52(12), 2136–2148.
Gold, S. M., & Irwin, M. R. (2019). Depression and immunity: inflammation and depressive symptoms in multiple sclerosis and other chronic inflammatory diseases. Brain, Behavior, and Immunity, 79, 1–8.
Whooley, M. A., & Wong, J. M. (2013). Depression and cardiovascular disorders. Annual Review of Clinical Psychology, 9, 327–354.
Valkanova, V., Ebmeier, K. P., & Allan, C. L. (2013). CRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. Journal of Affective Disorders, 150(3), 736–744.
🔹 Additional theory on brain and recovery
Sapolsky, R. M. (2004). Why Zebras Don’t Get Ulcers. New York: Holt Paperbacks.
Maes, M. (2011). The cytokine hypothesis of depression: inflammation, oxidative & nitrosative stress and neuroprogression. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 35(3), 702–721.
Drevets, W. C., Price, J. L., & Furey, M. L. (2008). Brain structural and functional abnormalities in mood disorders: implications for neurocircuitry models of depression. Brain Structure and Function, 213(1–2), 93–118.
🔹 General sources
Harvard Health Publishing. (2023). The link between inflammation and depression.
Johns Hopkins Medicine. (2022). Chronic Illness and Depression: Understanding the Connection.
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