BERKELEY, CA (UroToday.com) - The association between depression and lower urinary tract symptoms (LUTS) is complex. The social anxiety and embarrassment of LUTS may lead patients to feel isolated and clinically depressed.[1, 2] Depression evokes poor health habits such as alcohol use and decreased physical activity, both of which are risk factors for developing LUTS.[3] Further research is required to help determine common pathophysiological pathways between LUTS and depression, in particular, the role that LUTS may have on suicidal ideation.
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| Figure 1. Model of the association between depression and LUTS. Sequela of LUTS synergistically affects the stress-induced HPA axis causing inflammation and, along with genetic factors, may lead to depression. Depression is a mediator between LUTS and suicide. |
Figure 1 shows a possible diagram of the relationship between LUTS and depression/suicide. LUTS potentiates the HPA axis, leading to worsening depression, which can then progress to suicidal ideation and possible suicide. In this model, depression mediates the connection between LUTS and suicidal ideation, and thus is required for the pathogenesis of suicide. Special attention may be required in patients with relapsing or undiagnosed depression presenting, with LUTS, to the urologist.
Like others, we propose screening for depression in patients with severe LUTS, especially those presenting with nocturia, as these symptoms have the potential to worsen depression, and thus increase risk for suicidal ideation. Screening for depression is only as useful as our ability to do something about it.[4] As the connection between LUTS and depression is further uncovered, more training and collaboration between urologists, psychiatrists, and primary care physicians will be needed.
References:
- Trueman P, Hoo SC, Nayak US et al. Prevalence of lower urinary tract symptoms and self-reported diagnosed ‘benign prostatic hyperplasia’, and their effect on quality of life in a community-based survey of men in the UK. British Journal of Urology. 1999; 83: 410.
- Huang CY, Chiu KM, Chung SD et al. Increased risk of depressive disorder following the diagnosis of benign prostatic enlargement: one-year follow-up study. J Affect Disord 2011; 135: 395.
- Parsons, JK. Benign Prostate Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Current Bladder Dysfunct Rep. 2010; 5: 212-218.
- Screening for depression in adults: U.S. Preventative Services Task Force recommendation statement. Ann Intern Med. 2009; 151:784.
Written by:
Thomas W. Gaither, BS; Sarah D. Blaschko, MD; and Benjamin N. Breyer, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, University of California-San Francisco, San Francisco, California USA
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