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Is it a mystery worth solving?

One of the many, many difficult aspects of depression is the fact that it’s not an illness with a definite cure.

Rather, it’s an illness that must be managed constantly, one that can come roaring back without warning, just when you least expect it. And when it does come roaring back, it’s hard not to ask “WHY???”

For about the last week, my husband’s depression was with us in full force. He was unable to think coherently. Unable to answer questions. Literally moaning whenever he had to complete any simple task. Sleeping much more than usual. For someone who generally operates in depression-recovery mode, it was a huge change.

I spent a lot of time over the last week asking myself that big “WHY???” Trying to come up with some explanation in my own mind for what had triggered this particular episode. Gently discussing with him whether he ought to go see our GP, as it’s been quite a while since he’s had a routine checkup. (His answer, with a moan: “That would mean making an appointment.” Clearly not a task he was able to even contemplate).

And, all the time, going as easy on him as possible. Asking little, even to the point of deliberately not even engaging him in conversation – because every exchange seemed to create unbearable stress.

Then, today, suddenly a switch was flipped. When I got home from work around noon, he was digging into our tax paperwork so he could start the process of filing. He spoke normally, even showed concern for me when I declared I felt like I was coming down with something. Later in the afternoon he spent a couple of hours on vehicle maintenance, unprompted by any requests. He was, apparently, back to his usual self.

So I started asking that “WHY???” again. And I couldn’t help but piece together a trigger that I’m not sure makes sense, but that I’m pretty sure I’m seeing. His depressive episode clearly began when our son come home for spring break, and concluded the day he left. Thinking it over a little more, I recalled that the same had happened over winter break, as well.

I can imagine a theory or two as to why this might be. But I ask myself a new question – Is it even worth it? Would knowing make any difference? I could discuss it with him, but might that make him feel even worse?

I’m still not sure what the right answer is. But one thing I do know is that I’m storing that little piece of information in my memory bank. Because in a couple of months our son will be home for the summer, and if there’s anything I can do to keep  us from having three full months of depression ruling our household, I’ll do it.

And in the meantime I’ll be thinking hard about whether the answer to “WHY???” is important or not.

-Amy

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You Gotta Have Heart…..and Mind Too!

cardiac-156059_150Many of us are schooled in the risk factors of heart disease.

We know that smoking, inactivity, being overweight, and high blood pressure all contribute to cardiac disease.  Depression, however, is not usually listed as one of the risk factors of heart disease although it has been on the list of risk factors for over a decade, but few doctors take that into account when dealing with their patients.

“Depression is a risk factor that needs to be taken as seriously as any other – it’s up there with smoking,” says Professor Gavin Lambert, National Health and Medical Research Fellow at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia.  “Not only is it a risk factor for developing heart disease, but it may also exacerbate existing heart disease. If you already have heart disease and go on to develop depression you’re four times more likely to die within six months.”

We talk about depression as being a mental illness and often neglect to realize that it is a physical illness as well.  Depression can cause damage to the heart by increasing the production of stress hormones.  Too much of this hormone can damage blood vessels over time.  It can constrict the blood vessels, making them narrower than they should be, can raise blood pressure and increase plaque build up as well as increase inflammation which can in turn cause clots to form.  This doesn’t even mention the effects that naturally flow from depression – low moods that can lead to or increased smoking or to drinking too much or to eating poorly or to forgetting exercise or medication.

We know that often people who suffer serious illness like cancer or a heart attack are prone to experience depression but we seldom consider that depression can arrive because of such illness.  “It’s possible that there’s also a physiological affect on the brain – your brain needs oxygen and nutrients like any other part of the body so if circulation is affected by disease it could have an impact on the brain,” Lambert says. “There’s also a strong link between inflammation and heart disease and inflammation and depression. It could be that inflammatory chemicals that contribute to heart disease could also cause changes in the brain, but we don’t know.”

Today people having suffered a heart attack are seen by physiotherapists and nutritionists but they are not usually seen by a psychologist or a social worker who would deal with the mental health of the patient.  Perhaps we need to see that physical and mental issues cannot be isolated and that we have to treat the whole person, not segments of them.  Just raising the awareness of the possibility of depression as a factor in heart disease is a beginning.  Sadly it is a factor in far too many physical diseases.

-Bernadette

 

Depression and Faith: Wailing, gnashing of teeth, and renting of garments

There’s been a fair amount of that kind of “biblical” activity in this household in the last few days. Wailing, gnashing of teeth, and renting of garments, I mean. Metaphorically, mostly.

Strong faith can be a real lifeline when depression hangs around. Strong faith can also be pretty darned elusive, when depression keeps hanging on, and hanging on, and hanging on.

My husband’s depression started in earnest about 20 years ago. First there were years of the darkest depths of despair. Then some improvement. Then lots of ups and downs, keeping me guessing and on edge at all times. Then several years of a good place of recovery. Then a few years of a downward slide ending in the pits. Most recently, we’ve experienced the most complete recovery in our 20-year journey. Enormous relief and great joy, but the scars are still there…wondering how long it will last.

Circumstances have not been in our favor. An injury put his recovery – and, quite honestly, my faith – to the test recently. For eight weeks he was unable to participate in the new career that brought about such improvement. The cosmic unfairness of it all made me rail against God. I know God can handle my anger. I’ve lived with my faith long enough not to worry about that. But when that enforced eight weeks off led to the all-too-familiar and all-too-ugly depression symptoms, one of the things that upset me the most was my lack of tolerance for them. Apparently I’ve pretty much reached the saturation point. My stores of patience, support, and kindness are scraping the bottom of the barrel.

And then good news came along, and he was back to work. Joy! Relief! Then another unfortunate turn of events, and it’s off again for a time. Hence the wailing, gnashing of teeth, and renting of garments. My main thought just now is “What the #^#$*@#! is God thinking?!?”

What I think I believe most of the time is that the whole “when bad things happen to good people” thing is absolutely a mystery but that God is right there beside us, crying along with us in those terrible times. Isn’t that lovely? Well, it’s all out the window just now. I’m just mad.

My husband has worked his butt off to recover and build a new life. The crap we’re dealing with is just plain wrong.

I’ve been strong and loving and supportive until I resemble a wrung-out sponge. Nothing left.

I’m thankful that when I put all this to my husband, his first concern was for my state rather than his own. That is a glimmer of sunshine. It means that, at last for now, the depression is at bay and he’s able to see beyond himself. Most certainly his resilience has improved.

But still, depression sucks. And just now, I’m blaming God.

And I guess I’m writing this to let other caregivers know that they’re not alone. It’s pretty normal for faith to take a beating when your life has taken a beating. My point, I suppose, is don’t despair when you get to that place. Because deep down I know – and God knows I know – that there is peace and comfort waiting for us when we’re able to see it.

-Amy

Depression: Always lurking around the corner.

I know a lot about the illness of depression. I’ve lived with it in my household for 23 years, I’ve experienced it myself in the form of post-concussion depression and SAD, and I’ve done plenty of research.

And yet, I continue to be blindsided by its painful effects.

My dear friend is in the thick of it with her husband, in a terribly frustrating and long-term bout of the illness. It hurts me to know what she’s dealing with.

My own SAD is in a low point right now, as we’re trapped indoors for weeks at a time and as situations beyond my control get me down.

My husband’s recent amazing depression recovery is at risk. Forced inactivity for six weeks of recovery after a broken rib, compounded by uncertainty about the future of his new career due to that injury has produced anxiety and his most commonly-used depression defense – sleeping at every opportunity.

I know the right things to do: keep up consistently with medications, use the light therapy box daily, exercise, keep as busy as possible, talk about it and reach out for support. But even when we think we’re doing the right things to combat it, depression is always hanging around in the shadows, waiting to jump out at us.

I could really use a huge dose of warm weather, sunshine, and good news about now.

Overheard

Late last week I was at a large performance event with a family who I know has struggled long-term with the father’s depression. I knew, behind the scenes, that they’re under constant stress from every direction due to this illness. The importance of the event only served to bring that stress to a head.

Neither of the two parents handle stress well in the best of times, but what I observed spoke to me of a relationship at the breaking point. Hurtful tone of voice. Sarcastic, irritable comments. Confusion and miscommunication.

I wonder if I would have picked up on the undercurrents of pain and distress had I not known their circumstances, and if I hadn’t been through the same myself. Husband only barely functioning, and taking his depression out on the wife. Wife exhausted with over-functioning and caregiver burnout. Daughter snapped at for no reason, trying to take it in stride because it happens so often.

It’s a story that replays itself in many, many families in which depression has taken hold. And, of course, it can just as easily be the other way around – depressed wife, caregiver husband at wits’ end.

I don’t have an answer. Bern and I have written two books on the topic of dealing with a family member’s depression, yet I have no answers. I have empathy. I try to reach out to the caregiver with support and concern. But bottom line, all I can do is watch and recognize the pain.

I really hate depression.

-Amy

Depression and the extended family – part one

Recently a “Depression’s Collateral Damage” reader requested that we address the topic of talking to extended family about a spouse’s depression. It’s a topic Bern and I have addressed in our books but not, so far, on the blog. Thank you to Jennifer for the suggestion. It’s a big topic and I hate to write a post so long that it seems intimidating, so I’m going to give spread this one out over two or three days…

Every family in which depression plays a role has its own story about how the experience played out. Each family is different. Rarely are two cases of depression the same. Consequently, though there are likely to be some similar themes, every depression story is unique.

In my husband’s case, there were warning signs for a long time that something serious was going on. For a number of reasons, I didn’t pick up on those signs. I passed all the red flags off in my own mind, and in my conversation with extended family members, with excuses and extenuating circumstances.

Until, one day, I couldn’t.

He finally hit the point of what was once termed a “nervous breakdown.” I won’t describe what that looked like, but believe me – it was frightening. Having a two-year-old who I felt needed to retain as much normalcy as possible made it impossible to handle on my own. I had no choice but to reach out for help from both our parents.

I was met with some interesting reactions. Support, caring, tangible assistance certainly – especially in the initial “shock phase.” But then there were subsequent reactions that left me reeling at the time and still make me scratch my head today. Jumping to bizarre conclusions about causes of the breakdown. An (absolutely untrue and uninformed) assertion that “He always was selfish. He just has to pull himself together and think of others.” An ostensibly supportive piece of advice to remember that I could always just walk away from him and get a divorce. (I will stress here that I make absolutely no judgment against anyone who makes the decision to do just that. As I said before, every case is unique and I fully support anyone who feels that’s the best option. In my particular case, I did not feel walking away was an option.)

That was all at the beginning of our journey. But then severe depression dragged on and on. Literally for years. More than a decade. And that extended period required an entirely different kind of framework for conversation with our extended family.

More on this subject to come soon…

-Amy

Putting recovery to the test

Lately I’ve been writing about how amazing it is to watch and enjoy my husband’s current triumph over depression and anxiety. As Bern and I have both said before in this space, recovery can be an up and down thing, hard to trust.

Most recently my husband has had a major physical setback (a fall that caused a broken rib) that forced him to postpone his new career until he heals. Knowing that his joy about that new career that was largely responsible for his depression recovery, my first thought was whether he’d have a significant setback emotionally.

Initial readings looked good. When he phoned from 8 hours away to tell me the bad news, I was surprised by how positive he sounded. So positive it was a little frightening, actually…he was trying so hard to reassure me that I was afraid he was just acting.

When he got home and had to spend days zoned out on pain killers and muscle relaxers (NOT a great thing for someone with brain illness, in my experience), my concern grew. He was irritable, illogical. He provoked arguments and assumed ill intent from everyone at every turn. All typical of his worst depression behaviors.

Thankfully, when he was able to ease up on the meds, his former healthy (well, healthy emotionally…the rib is still not in great shape) self returned. He’s thinking clearly, making preliminary plans to return to work, dealing with the regular ups and downs of life in a productive way.

But the point of Depression’s Collateral Damage isn’t the depressed person him/herself – it’s the loved ones who have to struggle through the illness right alongside the depressed person. Notice how I wrote that even though my husband sounded positive initially, I immediately worried that he was just covering? And how, rather than shrugging his rotten moods off as the effects of strong pain meds, I quickly jumped to imagining them as depression symptoms?

It’s a constant trap we caregivers have to watch out for. I’ve been burned so many times it’s hard to trust the recovery when it’s put to the test. So I write to remind myself. And to remind others out there who are supporting a depressed family member. Hang in there, everyone.

-Amy