Sunday, June 11, 2006

GRIEF VERSUS DEPRESSION IN MS...How Do We Know The Difference?

(DISCLAIMER:  Occasionally I write articles in advance for "Cheese" and post them later...this would be one of those times because I am in steroid craze right now and a bit cognitively impaired!)

     I suppose it’s about time I take on a topic I might know a little something about.  After all, I’ve worked in the mental health field for the past 20 years.  But the longer I’ve worked in this area, attended workshops, dealt directly with clients, and kept an eye on my OWN mental health, the LESS I seem to really know!  The practice of psychiatry is no more an exact science than any other form of medicine…it’s all about “guess work” and speculation.  It is a system of diagnoses based on the old, “If it looks like a duck, walks like a duck, and quacks like a duck, it probably IS a duck”.  Let me tell you now…a lot of eagles and swans are misdiagnosed in the mental health field!

     I often hear from and read blogs about folks dealing with their MS and the overwhelming feelings that surface when Multiple Sclerosis rears its ugly head.  I hear people talk about feeling sad, angry, blue, overwhelmed, scared, embarrassed, ashamed, and depressed.  I hear the word “depressed” a lot and not just from MSers.  The word “depression” has been used synonymously with any feeling of emotional discomfort we don’t like in our society.  But true depression and its clinical syndrome are not so easily explained away.

     The diagnosis of MS bringswith it a myriad of unpleasant feelings and losses.  Loss of physical function, loss of employment, loss of mobility, loss of self-concept, and many more losses…these losses can be perceived as catastrophic.  They are heart-felt and tangible realities resulting in changes we did not want or perceive.  There can also be a profound loss of sense of security with MS as fear of the unknown forces us to plan for futures without any type of set map or guidelines. 

     It is not only normal, but also essential to a healthy psyche to grieve these losses as they occur.  Grief is NORMAL.  Grief is the process of the mind and soul rebalancing itself to changes.  Without the grief process, we would become lost in our existential darkness.  Some might even refer to the grief process as the “Dark Night Of The Soul”…that sense of profound absence of light and hope and connection to ourselves and our higher being.  Grief is when we begin to question life and its meaning and the meaning of MS in OUR lives.  Grief is not clinical depression, although depression is presumed to be a steppingstone in the grief process according to Dr. Elizabeth Kubler-Ross, a renowned writer and researcher in death and dying.

     Grief in itself is not a condition requiring treatment because it IS normal.  The grief process is best experienced via a supportive and nurturing environment.  The grief process will require space and time to exam uncomfortable feelings and there is no set time limit on how long one should experience grief.  Your past baggage, coping mechanisms, and personal insights will determine how long you will grieve and how often your grief will surface.  And feel free to smack the person who tells you, “Get over it”.  They are obviously insightless morons who are afraid of uncomfortable emotions and quite possibly their own shadows!

     There is a period one eventually reaches in the grief process called “acceptance”.  Acceptance doesn’t imply you have to love your MS or hug it like a long lost friend…instead, you become “tolerant” of it, you “deal” with it, you strategize and take control of what you can and you go on with your life as it is now…knowing the next lovely change MS brings will most likely also surprise you with yet another grief process to work through.

     Depression in MS is a much more difficult beast to tame and it IS common in MSers.  Literature suggests clinical depression occurs more frequently in MS because of progressing disability, the nature of the disease destroying insulating myelin surrounding nerves that transmit signals effecting mood, lesions in the frontal lobe directly connected to emotions and cognition, and side effects from Interferons and other drugs.  Researches simply don’t know why clinical depression is so common in Multiple Sclerosis because some people who are profoundly disabled are not and do not become clinically depressed.

      Often times, the very symptoms of MS can also be interpreted as symptoms of depression.  Take for instance chronic fatigue, listlessness, difficulty concentrating, decreased sex drive, insomnia or hypersomnia, uncontrolled crying or affect dysregulation, or unexplained aches and pains…these are ALL possible symptoms of MS AND clinical depression!

     So how do we know when we are grieving, experiencing physical symptoms of MS, or in a full-blown clinical depression?  Here are a couple of tips:


1.      Grief and sadness lift a little when something pleasant happens.  Clinical depression does not.

2.      MS symptoms, which mimic clinical depression, worsen in relapse, and then some or all remit with remission.  Clinical depression does not.

3.      Grief and MS symptoms do not generally present without some sense of impending resolution or “acceptance”.  Clinical depression feels hopeless.

4.      Grief is generally time-limited and will resolve on its own with support.  Clinical depression can last weeks and months and is generally unremitting without intervention.

5.      Constant thoughts of death or suicide or planning suicide attempts are not symptoms of grief.  And just for the record, one study has shown MSers are at a risk of suicide 7.5% more than the general population.


     I tend to be a big believer in the resilience of the human spirit, physically, spiritually, and mentally.  We are hot wired to survive and to adapt to change.  But in Multiple Sclerosis, those “hot wires” can reach a melting point physically and interrupt that adaptive survival process.

     If you have MS and you are experiencing grief, do whatever is necessary to move into the process so you can eventually emerge on the other side.  And if you are clinically depressed, seek help.  It’s not a character flaw or a sign of weakness.  Reach out to what is available to you until you have exhausted your options. 

     I trust you will know what is right for you...



sonyasuzanne said...

I have to thank you for sharing this information.  I'm definately in the grieving process, and didn't know quite what to do about it.  I wonder at times 'how long will this last?'  I guess it will last as long as I ignore it and not take action to face it and deal.

I'm finally at that point, at least I hope I am.  And I'm learning it's a process that is hard, will take some time, but will be worth it in the long run.  =o)

LauraX said...

Thank you so much....My friend Judy (peace be with you) passed this on to me. Every time I tell my neuro about my unrelenting fatigue or lessening function she brings up the "D" word. I have been clinically depressed in my younger years multiple times...I KNOW what that feels like. That is NOT what is happening now. I do feel some sadness, anger, disappointment that I'm not feeling better on the medication I'm on the way her "other patients" are (which she tells me all the though this should make me feel better or buck up and get with the program). I am feeling a bit anxious and frightened because she told me yesterday that I have JCV and we need to reassess staying on Tysabri (I've now had 14 doses), which limits the few treatment options available even more. But that was I can see that I was getting caught up in the story of "what if, what if what if" and this morning, after meditating I am feeling more peaceful about "what is" (still fatigued, and still having difficulty walking, and certainly annoyed at my doctor, but sending her lovingkindness to ease that up) but I am not in the acute panic phase I felt last evening after talking with her. I think I am perfectly normal and she is fixated on presuming that ALL of her patients are living with underlying depression...I disagree. I have told her this before...and every time we come to a cross road like this (the last time it turned out that Gabapentin had become toxic to me and was what was making walking a part of my past and all kinds of other weird phenomena...that she was quite sure was depression until other practitioners observed me and they did a round table discussion on me)...I started buying into her theory briefly yesterday. But NOT today. I have freakin' MS and every body is different their is no miracle cure or fix that works for everyone...AND we will figure out the next "move"...AND I'll adjust...I always do.

So again, thank you...I feel reassured by my own assessment of what is going on in my heart as totally normal...and ready to call my other neuro in Boston and find out if perhaps she sees an alternate reality from my "can't fix it you must be depressed" local neuro. Good thing I have a team of people looking out for me!!!

Have a wonderful day...the clouds are just starting to pink up with the sun:)