Depression: Coping vs. Feeling

[eureka254]

I know that many in this community have struggled with their own depression, and would appreciate your thoughts and feedback.  A little background for those who may not know me, my husband has fought a long hard battle against hep c, cirrhosis, and HCC the last five years but is now End Stage and not eligible for transplant; he is trying some last-line chemo but things continue to decline. I've been coping the best I can, but with his prognosis, it's also natural for me to feel grief, sorrow, and naturally, that dreaded 'depression'.

Overall, at least in my mind, I'm coping fairly well... I'm functional, I'm managing to keep things afloat, and my husband is receiving excellent medical care.  I attend to my daily chores, I can be social, and civil, and even laugh at times, but of course there are days when I feel down.  I've lost some weight, and I'm not sleeping well (doesn't help that things are complicated by possible frozen shoulder), but I figure it sort of goes with the territory.  There are times when I just break down, but that's normal... right?

Recently when I met with my PCP, she encouraged me to consider ADs, and I have mixed feelings about it.  Of course I'm supposed to feel depressed somewhat, but does that mean I need medication to make me feel better?  No one around me seems to be telling me that I'm not coping well (the opposite in fact), so I'm inclined to brush off my doctor's quick offer to 'anti-depress' me.  Does depression always need chemical help? Isn't it okay that I feel depressed as long as I recognize it and am coping?

[jerialice]

Hi eureka- i am awaiting tx #3 and meanwhile having some anxiety attacks and sleep disruption. the docs  gave me lexapro, but i am loathe to take it. so i know how ya feel. i did take them during tx #2 cause i was having those major interferon issues. if you are having sleep probs maybe there is something else you can take that will not re-adjust your entire metabolism? i keep very low dose xanax in case my heart gets to racing too hard, but many days i take nothing, my preference.
thing is i am not sad or disfunctional, just panic and distracted, it's from all the stress.

so here's hugs and compassion for you; i had to watch my baby sister die for months and was with her at the end. very challenging. the "pre-grief" is almost worse......
many blessings and take strength from us.
jerialice

[milliehepc]

Hi Eureka:

Wish I had more words of wisdom for you as the ones expressed above.  Just wanted to send you as they say here - a cyber hug and my warmest and most heartfel good wishes.  

Millie

[flcyclist]

Eureka, since I've had no prior experience with AD's, I have little to add to the wonderfully insightful responses you've received from the caring members of  the forum.  This is such a great place to do a reality check to hear some feedback from their experiences.   As mentioned, take some well needed time for yourself to step away and recharge your batteries.  You're an incredibly strong and inciteful woman, and I have no doubt you'll do the right thing.  Those closest to you who see you routinely should help to keep a watchful eye on you and assist when needed if you do get to the point of needing some help.  

I wish you the very best as you go through this very difficult time.  My thoughts are with you and your husband and I think of you often.  Much love to you Eureka.

[can-do-man]

Yikes, texas toast........ Not sure i would be that lucky, were talking about a texas female that is treating and has a gun collection. I wonder if Mr bean sleeps with one eye open?

Well there goes my deductions hey Kat?

[Dee1956]

PM
Love you
Dee

[eureka254]

Thank you, everyone, for checking in and giving your thoughts, feelings, and personal experiences on this. My husband has been my best friend for most of my adult life, and sometimes it's hard not to question one's own singular perspective.  There's a lot of 'isolation' that goes along with him having been sick for so long, and as I spend less and less time with the outside world, it helps to have objective viewpoints.  

OH: I make a conscious effort to eat well and take care of myself, but the weight and sleep remain a bit elusive... at least I have the luxury of eating whatever my heart desires :).  Hospice care is available (and covered by my ins) when the need arises, but my husband is not quite ready for what he considers an 'intrusion'.  His nurse has encouraged him to consider it, as have I, but it does require his permission, which he is not quite ready to give as yet.

frijole: There are moments when my husband's HE is very similar to early onset Alzheimers... I had to some degree been prepared for the physical aspects, but not so well for the psychological aspects of esld. There are days when I struggle to take that first step out of bed, but that impetus hasn't failed me, yet anyway... here in New England, it's Dunkin' Donuts coffee that makes for that 15 minute getaway every morning. :) If the weight gets too crushing for me to get up and do that, I might then have to reconsider that I might need a little help... thanks for the virtual massage, though!  In my case, it's not the body but the mind that's scaly and crusty!
As far as can-do, space cowboy that he is, better a wise-cracker than a dumb-cracker :) ... levity is good for the soul... just don't give him the cold shoulder, you'll break his heart ;).

Boobert & gene53:  Appreciate your kind words and opinions and prayers.

workingdog:  Yes... I still continue to walk 3-4 miles a day minimum...

pooh55811:  It helps to get confirmation (or negation) of one's thoughts, and thank you for framing things in such clear detail.  Using quality of life as a barometer is more and more difficult these days, but I don't believe my depression is out of proportion to the circumstances... I'm inclined to agree with you, at least for me, that my PCP is offering up meds too soon.  

aj7538:  Yes, always good to keep the risk/benefit equation in mind, ty.

Willy50:  I was originally born in the tropics, but having been a New Englander for many years has taught me a lot about bearing up through the 'seasons'... I'm certainly no stranger to brutal winters :).  Thank you for the links and overviews... I think for the moment I am still digesting the process okay...keeping in mind that I might consider alternatives if I feel like I'm getting swallowed... thank you.

Hector: I often times feel like we're different sides of the same coin... or maybe more appropriately (hopefully) the same side of two different coins? :)  I definitely feel a wide array of emotions... all those ups and downs you mention... as I'm sure you do to a much more magnified effect... but as yet I don't feel alien to myself... a little numb sometimes, but I'm still me, just sadder more often, I suppose.  This disease and the caregiving can be all-consuming sometimes, but I do feel the depression isn't for the moment... you gave me much food for thought, though... many thanks.

can-do-man:  It was strange having a doc offer up ADs like you offer up candy :).  Be wary there can-man, you thought the cold shoulder was chilling? Isn't midland where they can make any man Texas toast?

screaming48:  Your dad sounds a lot like my husband... he's a fighter and it's a battle every day for him, but it's not in his nature to give up :).  My son struggled over the years with his father's diagnosis, and has benefitted from Lexapro but I've not felt the need for that myself as yet... I think in some ways my PCP was at a loss as to what else to do to try to get me some sleep and needed body weight.  My husband is still somewhat ambulatory, so he's held off on having Hospice, but at least I do know I have one of the best (Connecticut Hospice) in the country when the need arises.

Diane1186:  Thank you for the encouragement and hugs back.

beeblessed: It would not even have occurred to me had my doctor not suggested it... we seem to be driven by the same faith in the powers above :).  Counseling is certainly an option, but that also requires a time commitment on my part that I don't necessarily have... thank God for this forum and folks like you who offer up encouragement... much appreciate it.

Anne1717:  I've seen that ADs have helped many, and part of my worry is that I don't want to NOT feel... my (somewhat estranged) family has always taken the view that ADs are 'shameful', but I have managed to get over that view myself, though I remain hesitant as to whether or not they would help me in my present circumstances... hugs to you too.

You folks are better than any medicine my doc could have prescribed for me...

[JasmineT]

Hi eureka, there is nothing I can add to the caring helpful thoughts above.  But wanted to send you some hugs and support.

[Anne1717]

I am so sorry for your feelings and  as everyone  has said, it's natural and I would be worried about you if you didn't feel.  You and your husband have taken quite a beating.  My feeling about AD's - I have never taken them although I have been painfully sad in the past.  As a society I think we always think we nee to feel good and go to any lengths to make sure we or our loved ones feel no pain - physical or emotional.  Having said that, no one can or should tell you what you should do and if you feel AD's would get you over a hump, then there is no shame or harm in trying them.  I do have friends who used them temporarily through rough patches and found them helpful.  

My best to you and a big cyber hug.

[frijole]

There is lots of wisdom on this forum, and of course, one wise cracker - always one in every bunch of bananas - right can-do?  Come on down to Midland and I will give you a frozen shoulder!

[beeblessed]

Eureka ~ Sending you.....shoulders to lean on; hugs to console you; prayers to lift you; ears to listen; exhales.....

I have had people in my life die unexpectedly, suddenly, and a few -- slowly, painfully.  Never occurred to me to take ADs (until this tx), as I am a big believer in -- God gave us emotions for a reason, so no one is expected to be happy all the time.  I agree with Pooh, in that it is good you are able to continue getting out of bed each day.  Instead of ADs that may mask your feelings, do nothing at all, have adverse affects, or may actually help...... how about talking to a therapist?  I think, as much as you can find comfort from the words in this forum, seeing a therapist face to face will give you opportunity to break down and share your weight of emotions, so you can feel lighter, even if it's temporary.  It helps even in the gray-est (sp?) of cloudy days, to catch a glimpse of sunlight before the next storm passes through.

Based on what this online support group has given me during tx...an in person support group with people facing what you are facing....would give you even more and help you to not feel alone in this.  
Blessings, Bee

[Diane1186]

You are doing what needs to get done.  Don't forget your needs as well.  I am not going to repeat all the great suggest others made.  Just remember to love yourself, take time for yourself, and ask for help.    Hugs, Diane

[screaming48]

Eureka, sometimes people need a little help, especially if you are the main caregiver. My family went through that with my dad. None of us were on ad's. We coped with watching him accept that he would not reach 63 we spent our last Christmas with him and knew it was the last. He was 6ft1 and 200lbs before the cancer and tough as nails, retired military.

We managed it but two years later my mother started having anxiety and panic attacks, her Dr told her it was more than likely due to pushing everthing aside and not thinking about it. He put her on lexapro, she has done well with it and has faced the pain of loosing her husband of 41 years. Yes you are strong and people can tell you that, but how do you feel inside is what matters. I don't like ad's myself but sometimes people need a little help.

I was the one in the family who gave my dad his last dose of morphine, so he could go out peacefully. That was the hardest thing I have ever done in my life.

If you need some help Eureka that is up to you, ad's do have their uses at times. I will continue to keep you in my prayers, I think of you often.
I would suggest getting some help like hospice, my mother didnt and she about collapsed, they are there to help you out and give you a little time to yourself if only for 15 minutes, and don't feel guilty about not being with him 24 -7 because it will not do you any good and will just make you sick.
Anne

[can-do-man]

I really feel for you with what your going thru and tend to agree with the posters about not taking AD's.... But only you know how much you can handle. Wishing you the very best.

frijole says.... I wish I could give you the massage coupon I just got for Christmas for your "frozen" shoulder.

Hmmm, what if its not your shoulder that is "frozen"? You know i was just thinking that, oh never mind midland is to far away...:)

[HectorSF]

Hi Eureka,

This is my personal opinion about clinical depression and the use of antidepressant based on my own personal experience and what I know about your circumstances. I don't think there is one answer for everyone so I am only speaking from my own personal life experience which includes ESLD and liver cancer and death. I hope you find something here that is at least as food for thought. ;-)
P.S. (My HE is acting up today so forgive my "flow" of thoughts but I did want to add my 2 ¢ worth.)

* "Of course I'm supposed to feel depressed somewhat, but does that mean I need medication to make me feel better?"  
Of course you feel sad, hurt, angry and a million other things that you are grappling with which is 100% appropriate in your situation. If you weren't, then I would be worried.
This is very different then what happens to someone who becomes clinically depressed. They lose the capacity to fell anything. Good or bad. They become numb. That is why medical depression is called an "affective disorder". A disorder of feeling. It is the inability to process emotions normally. They lose interest in the things that use to interest/excite them. They lose the ability to cope with day to day life. Depending on the degree of depression they may even lose the ability to even take care of themselves. They may want to sleep all the time or awake early in the morning and not be about to sleep properly.
Feeling sad is not what is meant by depression when a doctor is using the term depression. Is is a misnomer that the general public doesn't understand.
So what is "depression" to the general public is an entirely different animal then clinical major depression.

* Does depression always need chemical help?
No it doesn't. First I think it is important to clarify which is medical depression vs the public's idea about what depression is.
What depression is not"
It is not feeling sad or disappointed when things don't go the way we want is life. Feeling sad or disappointed is an appropriate emotional response to life.
What medical major depression is.
"Clinical depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Individuals with clinical depression are unable to function as they used to. Often they have lost interest in activities that were once enjoyable to them, and feel sad and hopeless for extended periods of time. Clinical depression is not the same as feeling sad or depressed for a few days and then feeling better. It can affect your body, mood, thoughts, and behavior. It can change your eating habits, how you feel and think, your ability to work and study, and how you interact with people. People who suffer from clinical depression often report that they "don't feel like themselves anymore."

* "Isn't it okay that I feel depressed as long as I recognize it and am coping?"
I thing what you mean is it okay to morn and feel sad as long as you still are able to live and take care of other parts of your life.
When a person has clinical depression they are no longer able to cope with their life. The depression because all consuming. Spreading to every area of their lives. They are no longer able to cope. This is what can lead to suicidal thoughts and unfortunately attempts and sometimes self inflected death.

My experience with clinical depression:
I had suffered with major depression over many decades of my life stating in the early 1970s and first starting antidepressants in 1980. Even though I am not depressed any longer I take an antidepressant to prevent going into a major depressive episode. I recently started taking an antidepressant again in 2008 when I treated for my hepatitis C. After that I you know I have been diagnosed with End-Stage Liver Disease and now of course liver cancer and am dealing with the possibility of dying in the very near future if my cancer should go beyond the Milan Criteria as has happened to your husband.

Obviously we all suffer at different times of our lives but true clinic depression is very different then when we are not clinical depressed. Now when we are emotionally healthy we can feel sad, hurt, loving, happy, irritated, hopeful, frightened, anxious, passionate, angry, surprised, discouraged, enthusiastic etc. etc.

What antidepressants can do for many people is prevent them from going into a tail spin down into clinical depression. They can prevent a depressive episode or at least moderate its affect. This is why antidepressant are often prescribed to individual with a history of depression before starting hep C treatment with interferon because it is known that one side effect of interferon use can be depression. Treatment can be difficult enough without having depression on top of everything else that treatment can burden a patient with.
"Life-threatening or fatal neuropsychiatric reactions may manifest in all patients receiving therapy with PEGASYS and include suicide, suicidal ideation, homicidal ideation, depression, relapse of drug addiction, and drug overdose."

I think it is up to each individual to decide for themselves what drugs, medical procedures, etc. I person chooses to do. I also know that there are many people who don't want to take a drug if they don't really need it. I understand this as I myself feel the same even though I take my antidepressant as a preventative measure "just in case". In my opinion for me to take a drug that I have no side effects from, to prevent a depressive episode is a "no brainer". The only thing worse than the depression I have experience is my current challenge of dealing every day with my possible death. I look at the risk vs benefit. We are all different. So I would say only you can tell what is right for you.

I hope I shed some light on your concerns. If you have further question just ask.

Peace
Hector

[willbb]

PM

[Willy50]

Grieving is a natural process.  There are "seasons" in our lives and we have to accept, and even to some extent.....embrace  that there will be periods of depression along with periods of joy.

In that it is a process...... I would think that anything which sufficiently blunts or stalls the process could simply forestall getting through it.  For me...... I would think that being present throughout the process is part of the process.  No one wants or expects a cheerful always up mother, wife or friend.  I understand that you may feel bad to be withdrawn or down at times, but this same thing can accompany being over medicated.  To that end..... some people also have troubles leaving the AD's when one figures it is time.

No one can answer for you.  I would encourage you to read up on Kubler -Ross and the steps of grieving

http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model

Use of AD's and such in the USA;
http://www.aljazeera.com/indepth/opinion/2011/07/20117313948379987.html

Questions about their effectiveness;
http://www.thedailybeast.com/newsweek/2010/01/28/the-depressing-news-about-antidepressants.html

Try not to let it swallow you.  Give yourself both time to smile and time to grieve.  

"A time for every purpose under heaven".

willy

[aj7538]

I come from a family of drs, and was always told that less is more. Ads r not for everyone and r prescribed too freely. You r doing a remarkable job ofcoping, and what u r feeling is normal. Any time u take any meds, u take the chance of possible consequences. U need a shoulder to lean on and some help, but I think u r fine. Sending prayers and hugs to u

[aj7538]

I come from a family of drs, and was always told that less is more. Ads r not for everyone and r prescribed too freely. You r doing a remarkable job ofcoping, and what u r feeling is normal. Any time u take any meds, u take the chance of possible consequences. U need a shoulder to lean on and some help, but I think u r fine. Sending prayers and hugs to u

[pooh55811]

"Overall, at least in my mind, I'm coping fairly well... I'm functional, I'm managing to keep things afloat, and my husband is receiving excellent medical care.  I attend to my daily chores, I can be social, and civil, and even laugh at times, but of course there are days when I feel down.  I've lost some weight, and I'm not sleeping well ... but I figure it sort of goes with the territory.  There are times when I just break down ..."

I think you may have the answer in your own post. I do not mean the answer to feeling down, but the answer about ADs.

Usually people in a clinical depression (versus those who are feeling down due to circumstances or things that are adversely affecting their lives) actually do not function very well, often cease to maintain even daily activities or grroming, and are not coping well at all. Often people who are clinically depressed either do not sleep much or they sleep way too much and have difficulty getting out of bed. They may either eat too much or not eat much at all. There is no motivation and it is difficult to get anything done or to think straight. Clinically depressed people often find no joy in life. Many think about how much better it would be to just not be alive. Some contemplate suicide.

Of course, there are all ranges of depression, but clinical depression (major depression) does have some significant differences from feeling a little or moderately depressed or down due to circumstances in ones life.

Not knowing exactly how you feel or how severe the depression is, I cannot offer advice, per se. In the end, deciding what to do is your decision but from your description, your feeling down and your depression is probably normal for all you have been going through. You may not need ADs. I think the main thing is to be able to recognize if you do become deeply depressed in a way that impacts your life, your ability to function normally, and your quality of life greatly. Be alert for any danger signals of worsening depression. If your depressions deepens, then you may need ADs.

In the meantime, for right now, support groups may help and/or grief counseling may help. At some point seeking the help of a psychiatrist may be helpful. Personally, I think many PCPs start people on ADs too often and/or too soon. (They are not experts.)

I am truly sorry you are going through all of this. You have a lot to cope with. I wish you the very best.

[working dog]

this is sad...your doing a great job...and you've been able to help so many here...exercise is really important...cardio workout ...good luck with everything.....billy

[gene53]

Eureka,  Like the others have said your feelings are natural. I personally don't like the ad's but this is something you need to decide if it is right for you.
All I can say is you are doing and have been doing the very best anyone could in you and your husbands predicament.
Hospice should be able to offer you some kind of help in this situation.

Just want you to know you are in my prayers!

Cyber Hugs to you!
Gene

[Boobert]

Eureka what your feeling is what you should be feeling. I can't even imagine what your going through. I agree with the others about taking ADs it sounds like your going through normal feelings of sadness. I do think your husband has been blessed to have you as a wife and without ever meeting you if I could give you a miracle I would. Stay strong.

Bob

[frijole]

OH - we are similar minded   Yes, eureka needs a little break.  I can see that too.  Both of you take good care of yourselves
bean

[frijole]

eureka, my heart goes out to you.  I have never taken ADs either and would be reluctant to do it.  I think you are going through the greiving process.  I would equate it with what I went through when my dad had Alzheimers.  The grieving for the man I knew took place for 3 years.  The death was anti-climatic as we had all grieved for so long.  I know you  are keeping face and doing your daily tasks but this has to be more difficult than anything you have ever gone through before.

I think I feel a lot like you.  I don't want ADs to take away what is real.  I guess it would be another story if it got so bad I could not get out of bed, but I don't think I will ever get there.  So no, in my opinion, you do not need meds to boost you.  Your experience is real and so are you.

I feel very close to you right now.  I am not a hugger but wish I was there to give you one -- or take you to Starbucks for a good cup of coffee.  I wish I could give you the massage coupon I just got for Christmas for your "frozen" shoulder. (I am hesitiant to get a massage on treatment as crusty and scaley and bruised as my poor body is right now).

Hospice has grief counselling for lots of things -- not just death.  There is a children's hospice here called Rays of Hope that sees children through death and even divorce of a parent.  Perhaps there is something like that in your town.

bean