Dealing with Depression

AskNurseLindaAskNurseLinda Posts: 55Moderator, Information Specialist Information Specialist
10 Comments 5 Awesomes Reeve Staff 5 Likes
edited February 11 in Mental Health

Dealing with depression can be a challenging situation. It can even be hard for some people to realize they might be facing it. Everyone deals with the challenges of life in different ways. The same situation can lead to depression in some people and not in others. Even discussing depression can be difficult because how people think about it is unique to each person.

There are many avenues to discuss mental health with professionals. Talking with your healthcare provider is a great start. There are even options online for information gathering. A good source is the Christopher & Dana Reeve Foundation including Dr. Dan who provides insights that are extremely helpful. The most important lesson is that everyone has a unique way of dealing with paralysis and depression.

First and foremost, depression should be acknowledged as a condition just like an infection, a broken bone or paralysis. Through the years, when mental healthcare was not well understood, depression was not well diagnosed or treated. Advancements in mental health issues has demonstrated that depression is a condition that has certain characteristics and can be treated.

The American Psychiatric Association lists the following symptoms of depression:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

To be considered depression, any or a combination of the above symptoms are typically present for two weeks or longer. Depression can affect loss of interest in activities that were once enjoyed, affect work, or home life.

Depression is different from being sad. Sadness is a temporary condition of feeling loss, or grief. Depression lasts longer. Sadness can evolve into depression. You might need the skills of an expert to help you distinguish between sadness, grief of a loss of function or depression. The symptoms for each condition are close to the same. You could be experiencing a prolonged phase of grief or sadness or depression can set in earlier than the two-week diagnostic parameter.

There are risk factors for depression. The makeup of a person’s brain or the consistency and way the chemicals in the brain function, can make some people more vulnerable to depression. This is not a failure or problem with anyone’s way of thinking. It is just the natural differences in individuals. Just as you have a unique facial structure or hair color, everyone’s brain works just very slightly different from others. This subtle difference can make the risk of depression higher or less for you.

Genetics is another risk factor. Depression tends to be more pronounced in some families. This might be due to those subtle differences in brain chemistry or perhaps in the ways you have learned to deal with situations or a combination of both. We inherit the physical and emotional attributes of our families.

Along with genetics, personality affects risk of depression. People who have low self-esteem or pessimists tend to have a higher risk of depression. If you always see the negative, you are more apt to have depression. Changing your way of viewing the world does not mean you will be able to reduce your risk. It can help, but a true change does not come easily.

Environmental factors also affect your risk of depression. Being in situations without the ability to escape will shape your mental ability. For example, if you are in a cycle of poverty that you cannot escape because you did not receive a solid education or have the money for proper nutrition, you might not be able to see positive outcomes for yourself or your family.

Any kind of paralysis, from disease, stroke or trauma, is a life altering event. Mortality is questioned. Changes in physical abilities occur. Loss can be displayed as grief. These are just a few of the consequences of such a huge change in your life. Work might be altered. Family life and dynamics can change. This is a combination of events that can lead to extreme emotional upheaval. Recovery from paralysis can take a long time. Combine these factors and you can see that depression is not unusual.

You may not recognize depression in yourself. Personally, I have had life situations where my own healthcare professional has said, you certainly have enough reasons and situations in your life to be depressed. Indeed, life’s situations can add up. This is called situational depression. Remove the person from the situation and the depression resolves. Unfortunately, some situations cannot be removed.

The good news is that depression is a treatable condition. The first step is to talk with your healthcare provider. Ask for a screening. Be as honest as possible. Your thoughts and feelings are exactly that-YOURS. It does not matter what others think or say. You know what is in your heart and mind. Report as accurately as possible what you are feeling. This is not the time to be ‘strong’ for someone else or the time to repeat how someone else thinks you should be feeling. This is the time to let your true self come through. That is the best way to receive the treatment that is right for you.

It can be hard to acknowledge your thoughts and feelings. Thinking about a situation in your life is a positive step. Really take time to think about the issue and the outcomes that go with it. You can even pick a specific time to do this. Some people might tell you not to think about the thing that is bothering you the most, as if not thinking about it will make it go away. It doesn’t. Allow time to think, to cry, to grieve. You might want to do this in private or with someone. But put a stop time about the thinking as well. This does not mean the issue will not be with you or that it will magically disappear. Just don’t let the issue consume your whole life.

Remember, too, that those around you might be depressed about your situation or the new life challenges they now face. Paralysis affects you but also those who love you. Family members, children, friends can be responding to you through their depression. Recognizing how the depression of others affects you is important to your well being.

There are many medications that can help with depression. Some people resist taking medication for depression but remember, depression is an alteration in your brain chemistry. Adjusting that chemistry can help reduce the alteration. The medication will not change your personality or dull your thinking. You will still be you, my friend. There can be side effects such as drowsiness, but side effects resolve or can be corrected with a dosage adjustment or even a different medication. It does take time for the medication to become effective. You might not notice a change for several weeks.

Psychotherapy, especially Cognitive Behavioral Therapy, is a good treatment along with medication. This therapy can assist with learning new coping behaviors that will assist you with dealing with challenges now and in the future. Sometimes electroconvulsive therapy or magnetic therapy can help adjust the brain chemicals as well.

There are activities that will help you daily with depression. These include movement of your body. Providing movement, even passive movement, improves symptoms of depression. Your body craves movement so find a way to engage all of your body through moving it. Your body also needs nourishment. Eating a healthy diet will provide the energy it needs. Keeping hydrated will assist with internal body function and internal movement. Researchers are discovering more of the benefits of sleep every day. It can be difficult to get a solid night’s sleep when you have turning and catheterizing to do. Plan your schedule to include a period of sleep in the middle of the night.

Reduce caffeine, a stimulant, so you can sleep better. Stop the use of nicotine which deprives your body of needed oxygen for function. Avoid alcohol and other depressant drugs, which counteracts your hard work to reduce your depression.

Treating depression is just as important as treating a urinary tract infection or monitoring for pressure injury. It is critical to your health and progress. Be sure to ask for a depression screening at your annual physical to start early treatment if needed.

I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

Leave a comment any time below. Let's get the discussion going!

Nurse Linda

Register for my next webchat! Sign up here!

Comments

  • CruckerCrucker Posts: 38Moderator Moderator
    25 Likes 10 Comments Name Dropper 5 Awesomes
    I've been paralyzed for twenty-two years. The day I was first moved from the ICU to a regular hospital bed, my neurologist prescribed Zoloft. I am still taking it to this day, along with Wellbutrin, another well-known anti-depressant that effects other neurotransmitters. They don't completely eliminate occasional bouts of depression but they mitigate its occurrence and severity. The condition I have, called transverse myelitis, is known to trigger organic depression, ie, a physiologic change in brain chemistry. I think the drugs are handling that well. Much more important in my life is psychological depression, which I find can be regulated without drugs or therapy. The Finnish have a concept called "sisu." It means, very broadly, a spirit of tenacity and resilience and the willful pursuit of those things. In this approach, depression is best defeated by what they call "movement as medicine." Real, sustained physical exertion changes your body chemistry, including brain chemistry, and builds confidence, disciple, and a sense of self-control. The Finns do extreme sports like "winter swimming," jumping into a frozen lake for 30 seconds, then sitting in a hot sauna. You can choose your own activity, as long as it's strenuous and continuous. It's not a pill. It's a way of life. AR
  • iamdadmaniamdadman Posts: 95Moderator Moderator
    25 Likes 10 Comments Name Dropper 5 Awesomes
    I had been diagnosed with depression prior to my injury.  It was treated with antidepressants and I was able to function only having to deal with periods of occasional depression.  
    When I became injured, I became severely, clinically depressed.  I didn't want to live and felt as if my life was over.  I saw a rehab psychologist and right after my injury and continued seeing one as an outpatient until my insurance decided it was not medically necessary and stopped paying.  I was okay with just my meds for a long time and then I had a bad experience with my doctor and my depression came back like gangbusters.  I was on Medicare and a supplemental insurance and got approved for seeing a rehab psychologist.  My rehab psychologist was great and referred me to a psychiatrist for an evaluation of my meds.  I had been on Welbutrin XL 300 mg. and Zoloft 100 mg.  The psychiatrist changed me from Zoloft to Cymbalta  and what an incredible difference.  I know that the therapy with the rehab psychologist really helped as well but the change in medication was quickly noticeable.  I too work out twice a week with a personal trainer, have a stander in my home as well as a mat table for stretching.  I also do a lot of advocacy work all of which make a difference.  At first I didn't want to admit or accept my depression thinking if I ignored it, it would go away but it didn't.  Now I know, just as Nurse Linda said, depression is like any other illness and can be treated.  I am so glad I took the necessary steps to get the help I needed. 
  • lauragracebecklauragracebeck Posts: 11Moderator Moderator
    10 Comments 5 Awesomes 5 Likes Name Dropper
    i also struggled with depression before my injury. after the injury they put me on 10 mg of citalopram. my counselor at shepherd center suggested we try to come off of it 4 months after my accident. i dropped HARD the week after stopping. she quickly got me back on it and recommended we just don’t try to fix something that’s not broken as it is.
    i still get depressive spouts, but i believe most important is really letting yourself have those depressive times. this injury is not easy and stuffing down the grief will only come back up stronger. i’m a big believer in allowing negative emotions do their work and giving grief and sadness the time it needs. how would you know what good days were without the bad ones? and to be dead real, sometimes my bad days i wonder questions like “why didn’t the wreck just kill me?” “what’s the point in being here?” but i do a lot of internal work when those questions pop in my head. my husband and friends let me explore those tough thoughts out loud, and i think that makes a lot of difference.
    lauragracebeck
  • Dan_GottliebDan_Gottlieb Posts: 13Moderator Moderator
    10 Comments 5 Awesomes 5 Likes Photogenic
    Please be aware that there is a huge difference between feeling depressed or blue and having a clinical depression. A depressed mood is fairly common. It happens after a loss or a disappointment and it typically does not last very long.

    A clinical depression is when you feel your brain has a big cloud over it, when you look to the future and see nothing but negative, when you don't feel like socializing and when things that brought you happiness no longer bring you happiness.

    So let's start with feeling depressed. Many of us feel depressed after a loss like we and our loved ones have endured. We may be confused or exhausted. We may be fully energized and filled with adrenaline and cortisol. But like I said, this usually doesn't last more than several months tops.

    I've had clinical depression myself. I had an episode in college was never diagnosed. And then a couple of years after my accident I slipped into a deep depression. I was not even in a depressed mood (that I was aware of), but I did fear that my thoughts were of no value, so I did not speak up in meetings for fear of saying something stupid. It was so very hard for me to get up and face the day every day and all I wanted to do was stay in bed and hide from the world.

    Fortunately, I got treatment with medication and psychotherapy.

    Speaking of psychotherapy, nurse Linda was correct when she talked about Cognitive Behavioral Therapy as the gold standard. But if you are looking for a therapist, look for one who is good one you can relate to. Look for one you think would want to understand you and help you feel safe in the office. If you have that, there are many many types of therapies that will help. But the most important thing is the relationship. It's always about the relationship.

    Dan

    Daniel Gottlieb PhD
    WWW.DrDanGottlieb.com
  • raysellersraysellers Posts: 7Member
    Name Dropper 5 Likes First Answer First Comment
    Depression it’s real I feel in to a deep depression post injury  for almost 2 Years. Crazy right but true  to be honest I didn’t want to live I found my self wishing I would have just died. Again crazy right lol my turning point was when I started to link with others  battling from spinal cord injuries and getting involved in activities that I would be capable of doing. That really helped me  mentally and physically to be honest.  It helped me keep busy and keeping busy is what really helps me because I don’t have time to think about what I can’t do because I’m to busy doing what I can do. A fellow quad told me to get out of the bed  even when I don’t feel like it so that’s what I do every day and that plays a big part in battling depression daily so that would be my advice to all get up and get out even  when you don’t feel like it.
  • arethamorcearethamorce Posts: 4Member
    First Comment
    Hi guys, do you know that both depression and anxiety disorder have been linked to sleep disruption. CBD oil can alleviate symptoms of these disorders because it activates serotonin receptors in the brain; the release of serotonin has soothing, anti-anxiety effects that can help people sleep. They said that medical cannabis is very effective when it comes to insomnia, migraine, anxiety and depression. At first, I was doubtful so I started doing my own research and read articles about marijuana. I found out that each marijuana strain has different uses for different diseases. Like this strain https://blimburnseeds.com/cannabis/original/medical-cbd This one is very effective when it comes to stress and mild anxiety. Let me hear your two cents with this.thanks
  • arethamorcearethamorce Posts: 4Member
    First Comment
    Hi guys, do you know that both depression and anxiety disorder have been linked to sleep disruption. CBD oil can alleviate symptoms of these disorders because it activates serotonin receptors in the brain; the release of serotonin has soothing, anti-anxiety effects that can help people sleep. They said that medical cannabis is very effective when it comes to insomnia, migraine, anxiety and depression. At first, I was doubtful so I started doing my own research and read articles about marijuana. I found out that each marijuana strain has different uses for different diseases. Like this strain https://blimburnseeds.com/cannabis/original/medical-cbd This one is very effective when it comes to stress and mild anxiety. Let me hear your two cents with this.thanks
  • Mnichols23Mnichols23 Posts: 29Moderator Moderator
    10 Comments First Answer Name Dropper 5 Likes
    Hey everyone! Initially after my injury I was doing well! Not many depressing thoughts. Now 5 years after my injury I’ve become depressed. I have difficulty socializing with people I don’t know. I prefer to be alone. I feel as if I put on a mask often to hide my emotions. I do go to a therapist to work on things though
  • AskNurseLindaAskNurseLinda Posts: 55Moderator, Information Specialist Information Specialist
    10 Comments 5 Awesomes Reeve Staff 5 Likes
    Hi, Mnichols23, you know you are among the many. Some people don't 'hit the wall' until they have been injured awhile. I typically see about 2 years in. Keep up with therapy as you are doing. I think personal interactions are very helpful. You are already engaged there as a moderator. You are successful at five years so your experience is valuable to those who are struggling in early years. Thank you for your support. Nurse Linda

    I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

    Leave a comment any time below. Let's get the discussion going!

    Nurse Linda

    Register for my next webchat! Sign up here!

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