In my extensive research, interviewing, and writing both of my
healthcare-related books, as well as in my own experience, I have
found that one of the most difficult things for patients with chronic
illness to recognize, accept and cope with is depression. Although
there are more treatments for it than ever before, and more literature
and other information available to patients and their loved ones
regarding depression, this one area of health and well-being can
be utterly frustrating, confounding, even debilitating. Misconceptions
about depression persist (I’ve heard everything from, “Depression
is something weak people fall into,” to “I can’t
be depressed - I don’t have time.”) Media reports
about medications and side effects can be confusing. Medical professionals
might be too pressed for time to probe into their patients’
psychological health and possible symptoms of depression.
The lupus patient is not immune from depression. Whether mild
or severe, it can affect how we cope with our disease and life in
general. Depression can cast a faint shadow over our everyday activities,
or it might even prevent us from participating in them. As people
living with chronic illness, sometimes is can be difficult to recognize
when we are suffering from depression because pain, fatigue, and
other physical symptoms can be overwhelming. In fact, it is just
that added burden of living with on-going illness that can weigh
us down to the point that we feel we might never feel “up”
or “happy” again.
Just as it is important to be able to recognize physical symptoms
when they occur, it is important to be aware of what depression
is and to know what resources are available to us to help us cope
better. In this article, I hope to give some basic information about
depression and some guidance about how to approach getting help
for it. Above all, I write this with one overriding premise: There
is no stigma to being depressed, and a lupus patient should never
feel like he or she has failed in some way if he or she suffers
from depression.
Depression - An Overview
On its website, the Mayo Clinic lists two “hallmarks”
of depression: Loss of interest in normal daily activities, and
a depressed mood (sadness, helplessness, hopelessness, crying spells.)
Depression can sometimes be manifested physically, too, and some
of these indications can mimic lupus symptoms (for example, loss
of appetite, pain, and “brain fog.”) For this reason,
it is very important to consult with your doctor to determine if
you might be suffering from depression, if your lupus or other physical
condition might be causing your symptoms, or if your particular
situation is a combination of these two possibilities. If you are
not comfortable speaking with your primary physician, ask for a
referral to a healthcare professional with whom you can discuss
your feelings and concerns (I’ll speak more about the role
of the healthcare professional a bit later).
How depression is treated depends in great part on the cause for
it. In my upcoming book, “The First Year™- Hypothyroidism,”
I interviewed Lisa Waldman, a licensed clinical social worker and
patient educator who works with lupus patients and others who are
chronically ill. She says, “Depression needs to be addressed
inside and outside the patient. That is, if the depression is biologically
based - brought on by a chemical or hormonal imbalance related
to an illness or medication - it should be treated medically,
just like any other symptom. This type of depression can be effectively
treated with medication.
“If life’s stressors or a patient’s own attitudes
and behaviors are causing depression, then other methods of coping
should be undertaken and psychological counseling may be considered.
Quite often, both biological and personal factors play a role in
depression. In this case, medication along with counseling will
be helpful. Unfortunately, some people still feel a stigma about
taking antidepressant medication or getting other psychological
help. But it is really important to seek these options.”
Getting Over the Stigma
The history of identifying, treating and perceiving mental health
is littered with misconceptions, prejudice, and sometimes horrible
results. Despite the excellent treatments available today, and the
expertise of those in the medical community, some people still harbor
misgivings about seeking help for their “blues,” even
if they become quite debilitated because of them. Societal pressure
to maintain a “positive attitude” can contribute to
this, as well, causing some people to feel guilty if they are depressed,
or even feel as though they’ve failed in some sort of human
test.
Again, I go back to my overriding premise for this article: There
is no stigma to being depressed, and a lupus patient should never
feel like he or she has failed in some way if he or she suffers
from depression. In fact, if you acknowledge how you feel and take
positive, appropriate steps to do something about helping yourself,
you are making great strides toward establishing a better quality
of life for yourself. Getting your depression under control can
open up a new world of possibilities in the plans you can make,
the things you can accomplish, and the degree to which you feel
comfortable, even happy, with your life with lupus.
Who Cares?
There are many people today who work with patients to deal with
their depression in varying degrees. These include physicians, psychiatrists
(physicians who specialize in mental health and can prescribe medication),
licensed clinical social workers, counselors, clergypeople, and
psychiatrists. Others concerned with patient wellbeing, and who
might be able to give some relief in conjunction with a patient’s
medical treatment, include massage therapists, art and music therapists,
exercise specialists, and yoga and tai chi instructors.
On the research front, scientists are constantly developing new
medications and protocols to treat those suffering from depression
and who can benefit from taking drugs for it. Many community service
and other non-profit organizations have telephone help lines, shelters,
and other programs designed to address sometimes critical personal
situations. These groups are often involved in public awareness
campaigns, too, and provide information about depression and other
mental health issues through websites, advertisements, and forums
for patients and health professionals.
Another group of people that is important to anyone coping with
depression is the personal support group. Comprised of family and
friends who know and care about us, this close and vital group is
important to each of us and shouldn’t be ignored or taken
for granted. Throughout my walk with lupus, I’ve learned many
things, not the least of which is that a strong support system,
where you have and can be a true friend, is integral to maintaining
peace of mind, heart, and health - especially in the face
of depression.
Given all the resources available to us to identify and treat
depression, how do we know which ones to use? The answer lies in
a carefully thought-out plan of action and an honest assessment
of your own individual lupus and life picture.
Steps You Can Take
Here are some ideas to help you address and cope with your depression.
It is by no means a complete list, but I hope it will help:
• Talk with Your Doctor. An assessment of your emotional
and psychological well-being should be a part of your overall health
check-ups. You should feel free to speak with your doctor if you
don’t think you are coping well, or if you suspect you might
be depressed. If you don’t feel comfortable speaking with
your doctor, ask for a referral to someone who might be better suited
to help you in this area. You might not need to give up your current
doctor, but you will feel better in the long run if you can work
with someone who is equipped to address depression or other personal
issues.
• Keep an Honest Health Journal. In your lupus/health journal,
you should record symptoms, medications and side effects, and anything
else that relates to your life with the disease - including
how you feel emotionally, psychologically and spiritually. It might
take some practice to articulate these areas in writing, and it
might be difficult to face your feelings on the printed page. But
you will benefit from being able to look over the passage of time
and identify areas that need to be improved upon and also how far
you’ve come.
• Educate Yourself. By keeping close to a lupus support
group, organizations such as Lupus Foundation Illinois, and finding
out as much as you can about your health, you will be able to be
more proactive when you run into symptoms or problems. This goes
for depression, too; the better informed you are about it, the more
quickly and effectively you will be able to work with your medical
team to treat it through the means that are right for you.
• Be Selective in Communicating What You’re Going
Through. I think it’s a lupus patient’s rite of passage
to have at least one person (non-lupie) tell us: “But you
can’t be sick! You look so good!” Sometimes, we can
laugh off this comment, but sometimes we find it really bothers
us or makes us angry. So, we need to be a bit selective in what
and how we communicate our health issues, including depression,
to others who aren’t in our medical circle. Some people will
understand completely (keep in mind that close support group). Others
won’t have a clue what we’re talking about. Choose your
audience carefully, and rely on the support of loved ones when the
going gets rough.
• Give Yourself Time. We might live in an instant society,
but often there’s no speeding up the process of working through
depression. Coping with a chronic illness adds layers to our lives,
and sometimes we have to give ourselves a lot of time to make sense
of it all and/or to let medication work appropriately. When you
begin treatment for depression, ask your doctor or other medical
health professional what might be a realistic time frame for seeing
results. Take this into account when you are going “down the
path” of treatment, but also be aware that it might take longer
than initially thought. That’s okay. The important thing is
that you’re taking steps to manage your mental health. You’re
headed in the right direction!
• Be Good to Yourself. Sometimes, we try to force our way
through our pain, illness, or other ailment. We lose sight of the
importance of being good to ourselves. In fact, taking care of ourselves
is vital to our wellbeing. Find healthful ways to pamper yourself.
They needn’t be expensive or elaborate, just nurturing. Learn
to laugh - a lot. Enjoy the world around you. And be good
to others, too.
Some Final Thoughts
As lupies, I think we are in a unique position to get to know
ourselves and others more deeply and more completely than many other
people do. We have to pay close attention to our physical, emotional,
spiritual and psychological health, and we often have to rely on
others to help us through the flares, crises, and fears of being
lupus patients. Although some people might say an illness like lupus
makes one weak, I think it makes us incredibly strong and resilient.
We can face depression, just as we face other symptoms and manifestations
of our disease. And we can be the better for it - and show
others just what we lupies are capable of!
Maureen Pratt
Maureen Pratt is co-author, with David Hallegua, M.D., of Taking
Charge of Lupus: How to Manage the Disease and Make the Most of
Your Life (New American Library). She is also the author of the
upcoming book, The First Year™- Hypothyroidism: An Essential
Guide for the Newly Diagnosed (Marlowe & Company, February 2003).
Ms. Pratt is a founding Executive Board member of Lupus LA, an Ambassador
for the Arthritis Foundation, Southern California Chapter, and a
trained facilitator of lupus support groups in Southern California.
She is also the author of the novella, “Dear Love,”
in Tyndale House Publishers’ Letters of the Heart Anthology.
In April, she will be touring Illinois as part of an awareness and
fundraising campaign hosted by Lupus Foundation Illinois. Ms. Pratt
welcomes comments and suggestions and may be reached through her
website: www.maureenpratt.com
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