Aa
Question regarding depression and it's different etiologies
How does one, neuro or medical personnel, determine if depression in a MS patient is from the disease or from not adjusting to the new reality? I realize treatment is the same but what criteria would the neuro be looking at to determine this condition ?
Anyone?
Thanks,
Ren
Anyone?
Thanks,
Ren
No doctor can totally tease out what part of depression in a person with MS is primary to the disease, secondary to being ill and/or in pain or situational. We can make guesses, but that's all they are. It is treated the same, choosing an AD that fits with the particular problems the depression has caused in that particular person - vegetative signs, anxiety, pain, insomnia.
We know that MS messes with the gray matter and causes depression mostly from the fact that people with MS have a far higher incidence of depression than people with other chronic, disabling and painful diseases - like ALS or Lupus.
I would say in any one of us we could easily point to at least 3 separate triggers for depression.
Quix
We know that MS messes with the gray matter and causes depression mostly from the fact that people with MS have a far higher incidence of depression than people with other chronic, disabling and painful diseases - like ALS or Lupus.
I would say in any one of us we could easily point to at least 3 separate triggers for depression.
Quix
Hi!
Depression su*ks but its part of the disease. What you need to do is work through the guilt, just as I am doing, of how your disease has impacted others. Because of it I'm unemployed, my DH cannot retire as planned and my kids in college are feeling the monetary pinch.
The description that Alex provided that depression about inertia -lack of momentum to do something is depression. Her first post on this thread is good if you haven't read it yet.
Don't worry about putting things down wrong here because I'm just as guilty of poorly communicating some days and I think we are in good company in that respective.
Feel better,
Ren
If you don't feel like getting out, remember we're always here for support.
Depression su*ks but its part of the disease. What you need to do is work through the guilt, just as I am doing, of how your disease has impacted others. Because of it I'm unemployed, my DH cannot retire as planned and my kids in college are feeling the monetary pinch.
The description that Alex provided that depression about inertia -lack of momentum to do something is depression. Her first post on this thread is good if you haven't read it yet.
Don't worry about putting things down wrong here because I'm just as guilty of poorly communicating some days and I think we are in good company in that respective.
Feel better,
Ren
If you don't feel like getting out, remember we're always here for support.
Hi there... depression is horrible I find I get depressed quite often from this Dx..if it's not the pain, it's the reality that my/our lives have been changed so drasticly. I feel guilty alot of the time, that I'm not the same person my husband married and my family has been changed as well.
It affects alot more people then just us and that is what I'm having a difficult time with. I try to get out of it by putting on some music and it will pick up my spirits abit and singing along will help. But, that only helps when it's not that bad and I'm rested up etc.
right now, I'm having a hard time getting my point across correctly and feel like I might put things down wrong and maybe hurt someones feeling or others will not understand what I'm saying or typing here...so if I'm not making sense, please forgive me on this forum.
like everyone says... getting help and talking to support really helps.. I wish I could/would do that, but at times I just can't get myself up to talk or get out of the house. Not sure if it's depression or fatigue..??
take care everyone
wobbly
It affects alot more people then just us and that is what I'm having a difficult time with. I try to get out of it by putting on some music and it will pick up my spirits abit and singing along will help. But, that only helps when it's not that bad and I'm rested up etc.
right now, I'm having a hard time getting my point across correctly and feel like I might put things down wrong and maybe hurt someones feeling or others will not understand what I'm saying or typing here...so if I'm not making sense, please forgive me on this forum.
like everyone says... getting help and talking to support really helps.. I wish I could/would do that, but at times I just can't get myself up to talk or get out of the house. Not sure if it's depression or fatigue..??
take care everyone
wobbly
Thanks to all who responded. I appreciate the fact that you shared your personal experiences in this area which some do not like to acknowledge. This is why I love this forum! Always supportive and informative.
Pat and PD mentioned neuro-psych evaluations which I had done for LTD with my job. I had two done, each six months apart. Both of the reports stated that I had no signs of depression. A caveat to this the first testing was done during the time I was taking my son to Shriners. The doc said this must be bothering you and stressing you. I replied, no it wasn't because I have dealt with him being chronically ill for 16 years. This would provide us with the answers we've searched for years..I was excited.
He went on to tell me when his 5 yr old was ill it always put him in a state of stress so he couldn't imagine how I was dealing with the current situation. I think he reflected his own feelings into his recommendations for me. Which were to seek a therapist just share my new dx and the happenings of my son. He didn't say I had depression though. BTW, the referral was to the therapist who did the neuro-psych testing for him.
At any rate if my MS neuro thinks its necessary I will go, if nothing else than to take the issue off the plate. Then perhaps the fatigue can be treated which is all I was seeking.
Again,many thanks,
Ren
Pat and PD mentioned neuro-psych evaluations which I had done for LTD with my job. I had two done, each six months apart. Both of the reports stated that I had no signs of depression. A caveat to this the first testing was done during the time I was taking my son to Shriners. The doc said this must be bothering you and stressing you. I replied, no it wasn't because I have dealt with him being chronically ill for 16 years. This would provide us with the answers we've searched for years..I was excited.
He went on to tell me when his 5 yr old was ill it always put him in a state of stress so he couldn't imagine how I was dealing with the current situation. I think he reflected his own feelings into his recommendations for me. Which were to seek a therapist just share my new dx and the happenings of my son. He didn't say I had depression though. BTW, the referral was to the therapist who did the neuro-psych testing for him.
At any rate if my MS neuro thinks its necessary I will go, if nothing else than to take the issue off the plate. Then perhaps the fatigue can be treated which is all I was seeking.
Again,many thanks,
Ren
Pat
You hit the nail on the head. I could not figure out why I am feeling depressed this week. I had a shot in my shoulder and for a few days after it hurts until my neck, shoulder and collar bone pop back into place from the lessening of inflammation.
I love this Forum.
Ren thanks for bringing this up Brilliant!
You hit the nail on the head. I could not figure out why I am feeling depressed this week. I had a shot in my shoulder and for a few days after it hurts until my neck, shoulder and collar bone pop back into place from the lessening of inflammation.
I love this Forum.
Ren thanks for bringing this up Brilliant!
Fascinating thread, with lots of insight all around. Thank you all for sharing your experiences and feelings.
The neuro-psych eval I went through said I showed no signs of depression. That struck me as odd, since my PCPs have been treating me for depression for ten years or more. However, he explained that I showed no signs of it because the drugs we're using to combat it seem to be working. That whole thing seems to be stable, which also strikes me as odd, since so much else connected with my brain has been changing over the past 18 months.
What the neuro-psych guy did identify was some specific shortcomings in the ties between visual and motor functions, if I recall correctly. I am theorizing that, despite a "clean" cerebellum, brainstem, pons, and visual cortex, there is something wrong in the deep white (or grey, who knows?) matter that is interfering with the coordination of signals between some of these centers. Just a theory.
The neuro-psych eval I went through said I showed no signs of depression. That struck me as odd, since my PCPs have been treating me for depression for ten years or more. However, he explained that I showed no signs of it because the drugs we're using to combat it seem to be working. That whole thing seems to be stable, which also strikes me as odd, since so much else connected with my brain has been changing over the past 18 months.
What the neuro-psych guy did identify was some specific shortcomings in the ties between visual and motor functions, if I recall correctly. I am theorizing that, despite a "clean" cerebellum, brainstem, pons, and visual cortex, there is something wrong in the deep white (or grey, who knows?) matter that is interfering with the coordination of signals between some of these centers. Just a theory.
Brilliant question, I am seeing a neuro-psychologist as you know at the moment. She was asked to see me about cognitive issues but she decided that my sadness / depression was a more important issue to deal with first as that can make teh cognitive issues worse.
Her answer is that depression is a biological response and needs treating as such and MS can cause chemical changes in the brain. However, it does not matter what causes the depression (they have no real answer) it needs treating as it is a serious condition.
Stress / sadness on the other hand is a way of thinking and the treatment there is often cognitive therapy.
In my case she decided that my pain was causing my state of mind as it was a constant sx that makes you feel very, very sad. I kept a thought diary for her for a short time and when I analysed it I thought I looked a very sad old lady (lol) and depressed but her analysis was that she saw someone in a lot of pain both physically and mentally. Treat the physically pain and tackle the mental torture and hey presto - well no it's not that easy I am still working on it.
The thought diary I was required to complete every couple of days, pick a time when I felt really sad, depressed, stressed and write down - time, date, where I am, who else is there, what I was doing and what I was feeling as a precentage - so 100% sad, 90% tearful, 60% angry, etc.
This is a very useful exercise as it allows you to objectively look at what is causing the feelings. If it is true depression it should be obvious.
I hope this helps Ren
It's not a nice way to feel - I know it well.
Sending (((hugs)))
Pat
Her answer is that depression is a biological response and needs treating as such and MS can cause chemical changes in the brain. However, it does not matter what causes the depression (they have no real answer) it needs treating as it is a serious condition.
Stress / sadness on the other hand is a way of thinking and the treatment there is often cognitive therapy.
In my case she decided that my pain was causing my state of mind as it was a constant sx that makes you feel very, very sad. I kept a thought diary for her for a short time and when I analysed it I thought I looked a very sad old lady (lol) and depressed but her analysis was that she saw someone in a lot of pain both physically and mentally. Treat the physically pain and tackle the mental torture and hey presto - well no it's not that easy I am still working on it.
The thought diary I was required to complete every couple of days, pick a time when I felt really sad, depressed, stressed and write down - time, date, where I am, who else is there, what I was doing and what I was feeling as a precentage - so 100% sad, 90% tearful, 60% angry, etc.
This is a very useful exercise as it allows you to objectively look at what is causing the feelings. If it is true depression it should be obvious.
I hope this helps Ren
It's not a nice way to feel - I know it well.
Sending (((hugs)))
Pat
My Neurologists have all been double board certified in Neurology and Psychiatry. Depression is like pain something they can't really see, measure or fix easily. The one who blew me off personally gave a talk to the MS Society explaining pain and depression are very real. They are probably related to gray matter damage something Neurologists are just looking at in MS. My take is on one level they all depression know is caused by MS and on another level they can't see it it or fix it so they don't address it.
You are smart to get a Psychiatrist who deals with chronic illness. This stuff is complicated. Heck the meds could be making you sleep that much. I had to find a balance of meds so I was not a zhombie.
Hang in there,
Alex
You are smart to get a Psychiatrist who deals with chronic illness. This stuff is complicated. Heck the meds could be making you sleep that much. I had to find a balance of meds so I was not a zhombie.
Hang in there,
Alex
Thank you I appreciate the input!
Alex, first I'm sorry you've had to deal with so much. It puts my problems in a proper perspective. I can certainly relate to many things you wrote about.
Ess, your statement "It might be that every neuro draws his own conclusions, maybe without adequate training. Neurology and psychiatry are similar, but far from the same." is what prompted the question among other things. The neuro is basing my 10-12 hours of sleep to depression, but with the array of drugs to combat symptoms it;s a wonder I can stand upright! What about the the 9 month flare he said I was in?
I've got 75% of the situational depression under control with the help of a great therapist but now I am supposed to see a psychiatrist to go on yet another drug in my list of drugs in my poly-pharmacy per my MS neuro. The guy he recommended deals with poly-pharmacy and chronic illness so he's an excellent choice but he is out of network. DH and I discussed it and I think I am going to use him.
Thanks ladies for your valuable input!~
Warmly,
Ren
Alex, first I'm sorry you've had to deal with so much. It puts my problems in a proper perspective. I can certainly relate to many things you wrote about.
Ess, your statement "It might be that every neuro draws his own conclusions, maybe without adequate training. Neurology and psychiatry are similar, but far from the same." is what prompted the question among other things. The neuro is basing my 10-12 hours of sleep to depression, but with the array of drugs to combat symptoms it;s a wonder I can stand upright! What about the the 9 month flare he said I was in?
I've got 75% of the situational depression under control with the help of a great therapist but now I am supposed to see a psychiatrist to go on yet another drug in my list of drugs in my poly-pharmacy per my MS neuro. The guy he recommended deals with poly-pharmacy and chronic illness so he's an excellent choice but he is out of network. DH and I discussed it and I think I am going to use him.
Thanks ladies for your valuable input!~
Warmly,
Ren
Hi, Ren. I hope others will be able to address this issue, but I'm guessing that there is no real answer.
It might be that every neuro draws his own conclusions, maybe without adequate training. Neurology and psychiatry are similar, but far from the same. Depression can be primary, situational, or totally coincidental. If a patient has had depression for years before MS diagnosis, I really doubt that anyone can establish cause and effect.
However, like you, I'd like to know more about this.
ess
It might be that every neuro draws his own conclusions, maybe without adequate training. Neurology and psychiatry are similar, but far from the same. Depression can be primary, situational, or totally coincidental. If a patient has had depression for years before MS diagnosis, I really doubt that anyone can establish cause and effect.
However, like you, I'd like to know more about this.
ess
From my own experience I think this would be difficult to access. Depression is real and complicated. It is easier even for professionals to see in hind sight. I think it is probably more helpful to try to stop the depression. The same things work for both kinds of depression. Usually we have a mixture of brain chemistry and situational depression.
Recently I knew I was in big trouble and needed to get help from many sources. My Neurologist blew me off. Thank God my Psychiatrist stuck to me like glue trying different things. We had to try different combinations of drugs for about two years to get the right fit. He believes mine is Neurological and brain chemistry, hormones, and some times situational. He is a brilliant Psychiatrist and I went through many duds before finding him. We talk about seeing 5 or more Neurologist. Try 50 Psychiatrists.
My PCP has also been a big part of my team and even my gynecologist since with women hormones play a big part in our moods.
I also use a support group and friends.
Finally when I found myself still helplessly sliding to the abyss I had to find a good counselor.
With everyone's help I still kept falling. Finally it was decided ECT, shock treatments were the only option. I did not want to do them but agreed in the end.
Then things changed. I think the Copaxone kicked in. I think it was an MS attack. I saw how out of whack my thinking really was. Thank God I dodged ECT.
The other thing no one addresses is the guilt we carry for having MS. The cost to our families financially, physically, and emotionally. The guilt if we were bread winners not being able to contribute. Guilt we can not physically do what we used to for our families.
I found this guilt was hurting my marriage. Not only was it hard for my husband to deal with our new circumstances but by beating myself up I was making our relationship worse. You have to let go of the guilt and work through things together.
We have to allow our family members have their feelings about this disease. It is not personal if they think this disease stinks. Sometimes they are going to get mad at us. Life goes on.
Bottom line do what ever it takes to deal with the depression. For me that is going to a Counselor once a week, calling my Psychiatrist once a week to say how I am doing, taking medication for my mood, eating well, doing as much exercise as possible, talking to my husband, reaching out to others.
Today I woke up depressed as anything, which is unusual the last few weeks. I got up. Ate something healthy, went to another kinda support group, went grocery shopping, treated myself to a coffee milk shake, and got on the forum. I feel better.
Momentum versus inertia (depression). Bottom line I have to move forward. I recall a time when I was in a State Mental Hospital and all I was allowed to do was sit in a chair in the hall day in and day out. I learned then either I had to take control of my life or other people would have control. I choose to have control and I like the responsibility.
Take Care,
Alex
P.S. I watch Polly. She lives in the moment and is the happiest creature I know.
Recently I knew I was in big trouble and needed to get help from many sources. My Neurologist blew me off. Thank God my Psychiatrist stuck to me like glue trying different things. We had to try different combinations of drugs for about two years to get the right fit. He believes mine is Neurological and brain chemistry, hormones, and some times situational. He is a brilliant Psychiatrist and I went through many duds before finding him. We talk about seeing 5 or more Neurologist. Try 50 Psychiatrists.
My PCP has also been a big part of my team and even my gynecologist since with women hormones play a big part in our moods.
I also use a support group and friends.
Finally when I found myself still helplessly sliding to the abyss I had to find a good counselor.
With everyone's help I still kept falling. Finally it was decided ECT, shock treatments were the only option. I did not want to do them but agreed in the end.
Then things changed. I think the Copaxone kicked in. I think it was an MS attack. I saw how out of whack my thinking really was. Thank God I dodged ECT.
The other thing no one addresses is the guilt we carry for having MS. The cost to our families financially, physically, and emotionally. The guilt if we were bread winners not being able to contribute. Guilt we can not physically do what we used to for our families.
I found this guilt was hurting my marriage. Not only was it hard for my husband to deal with our new circumstances but by beating myself up I was making our relationship worse. You have to let go of the guilt and work through things together.
We have to allow our family members have their feelings about this disease. It is not personal if they think this disease stinks. Sometimes they are going to get mad at us. Life goes on.
Bottom line do what ever it takes to deal with the depression. For me that is going to a Counselor once a week, calling my Psychiatrist once a week to say how I am doing, taking medication for my mood, eating well, doing as much exercise as possible, talking to my husband, reaching out to others.
Today I woke up depressed as anything, which is unusual the last few weeks. I got up. Ate something healthy, went to another kinda support group, went grocery shopping, treated myself to a coffee milk shake, and got on the forum. I feel better.
Momentum versus inertia (depression). Bottom line I have to move forward. I recall a time when I was in a State Mental Hospital and all I was allowed to do was sit in a chair in the hall day in and day out. I learned then either I had to take control of my life or other people would have control. I choose to have control and I like the responsibility.
Take Care,
Alex
P.S. I watch Polly. She lives in the moment and is the happiest creature I know.
This is a great question - one that I have wondered about myself. I wonder if seeing a neuro-psychologist is part of the process? Maybe even the neuro-psyche evaluation?
Will be interesting to hear what others think.
Hugs,
Chrisy
Will be interesting to hear what others think.
Hugs,
Chrisy
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