Depression Poll

[MeSci]

Kati said: ↑
Shave your head and tell people you have cancer. You'll receive homemade meals, offers to cut the grass, clean your house and much more.

I'm anxious with anticipation.

I think many people may find this very distasteful. I certainly do.

 

[Mij]

Just out of interest. Distress vs Depression in diabetes.

http://www.diabetes.org/newsroom/press-releases/2014/diabetes-distress-vs-depression.html


Diabetes distress (DD) refers to the often hidden emotional burdens, stresses, and worries that are part of managing a demanding, progressive, chronic disease like diabetes (1). The point prevalence of moderate and high DD is as high as 45.4% of type 2 diabetic (T2DM) adults in community settings (2), and DD has displayed significant linkages with poor glycemic control, self-management, and self-efficacy, independent of clinical depression (3–6). Approximately 70% of high-DD type 2 patients do not reach criteria for clinical depression (4).

 

[Valentijn]

I've seen studies citing this too. This one, astonishingly by 2 notorious psychs, talks about (mis)diagnosis of psychiatric illness in people with CFS. (Which of course is nothing to do with them...)

It looks like they come out with an overall depression rate of 33.8%, in a group of Oxford patients. They describe the SADS and DSM as the gold-standard, then recommend using HADS instead

The DSM at least has the problem that physical symptoms can be used to indicate psychiatric disorder, but using an Oxford cohort with few physical symptoms would largely avoid that problem. I can't find much data on SADS - looks like it's pretty old and not popular.

HADS of course comes with a lot of issues when used inappropriately. It's designed for use in a hospital setting, where most patients are being medically treated, physically cared for, experiencing acute (not chronic) problems, and experiencing relatively simple (not complex) problems. So overall, it's quite inappropriate for neglected outpatients with chronic and complex illnesses.

But yes, it is a low rate for a BPS study. However the principle author is Deale, not Wessely, and she seems less inclined to bury or fudge unimpressive results. Though she does unwaveringly interpret everything in a fanatical BPS light. For example, the conclusion is that only trained CFS psychiatrists should diagnose CFS or psychiatric disorders

Overall, Oxford makes the study useless from the start. Some of the other aspects aren't bad, but others are problematic, which makes it impossible to get even an approximate depression prevelance rate out of it which might apply to ME/CFS patients. Hence my interest in having our own little simplified and informal poll

 

[Bananas]

People suffering from clinical depression get very angry when people who get down about life say they are 'depressed' and that there is no semantic differentiation between their condition and the state of being 'fed up'. Which is why I am always careful to make the distinction - out of respect for people who have clinical depression, whose pain I cannot fully understand.

I agree with the person who said that depression is a spectrum or a sliding scale which ranges from feeling fed up with something, to someone taking their own life. But I am pretty sure that on that scale there is a dividing line where life circumstances, like not being able to fulfil your potential, go out, support yourself financially, accidents, traumas, relationship problems, etc. end, and physiological factors such as chemical imbalances, genetic predispositions, mental health conditions etc. take over. Let's call them the environmental and internal causes.

So someone like say Stephen Fry, who has bi-polar can tell you that there are times when his 'black dog' has made him suicidal, and yet he has a happy life, supportive family, good relationship, rewarding career, financial stability, etc. On the other hand, someone can go to the far extreme of the 'environmental' causes - ie. living alone, struggling financially, no real friends, chronic loneliness, etc. but never have clinical depression, and if all the causes of their sadness in life were reversed, they would be content again.

The grey area comes where the environmental causes may trigger the internal factors, or vice versa, and create a downward spiral, and the essential question is whether sufficient environmental causes could tip someone into having internal causes - could poverty and loneliness and continued ill-health give someone clinical depression? bi-polar? marginal personality disorder? or any of the other conditions of which depression is a feature? Or are there some people who could never get these because of their physiological and genetic make-up? Personally, I tend to believe the latter. My husband and I have had some really, really bad times and pressures, but he has never once shown signs of clinical depression, even when it has seemed like the world was falling apart. And although he gets very, very miserable at times about his ill-health, I would not feel comfortable describing his anguish as 'depression' in front of someone who has been diagnosed with clinical depression.

Someone previously said the dividing line was whether the depressed ill person could tell you what they would do on regaining their health. Maybe another dividing line would be if you took away all the environmental causes, of which having M.E/CFS would be one, whether the person would be instantly restored to a feeling of at the very least, contentedness once more. And another would presumably be the effects of antidepressants designed to neutralise negative brain chemistry (rather than add chemicals which gave an artificial 'high'), because if you were depressed about relationship problems, loneliness, financial strains, illness, bereavement, none of those things would go away on taking pills, because your problems weren't caused by negative brain chemistry in the first place. Maybe the difference is the length of the mood - we talk about a 'bad day' here - it rarely lasts longer than that. It never includes staying in bed and not communicating, or not eating. And perhaps the word 'hope' is a useful dividing line, because we are always hopeful, always planning for the future. Depression is characterised by hopelessness.

So my belief is that there are two types of people in the world - those who could get clinical depression, and those who could not. And of those who could get it, there are people with a low threshold, for whom an attack could mean a suicidal low at a time when there has been no apparent environmental trigger (everything is going well), and those with a high threshold, who could conceivably go through life without ever experiencing depression because the environment never challenges them so badly that they are kicked into a state of depression, or maybe they have their first attack in their fifties - and of course everything in between. It is possible you could go from one type to another for physiological reasons, such as hormone changes connected with hypothyroidism and the peri-menopause (which is how come I think I could say I have had a 'glimpse' into depression), but you are fundamentally one way or the other.

I would totally disagree with people with M.E. not wanting the 'label' or 'stigma' of depression. The main stigma of depression is in the workplace because a colleague goes off sick for long periods, and others have to cover for them, and employers will avoid people with that diagnosis because they need workers to have good attendance. M.E. often means that people cannot work a conventional job anyway, so I am not sure what they would have to lose. The other stigma would maybe be with friends not knowing how to talk to someone with depression, but your friendships are what they are, and your friends will know you have M.E. and the condition has never interfered with my husband's relationships with his friends, beyond him not being able to meet up with them for physical reasons - so again, nothing more to lose really. I would agree with people who say that conflating a physiological condition like M.E. with a psychiatric illness like depression is an opportunity for lazy or badly funded medical edifaces to blame the patient and dish out cheap antidepressants instead of doing the proper research.

 

[luludji]

Welcome to the forums @luludji, I 'liked' your post because I agreed with you. i am sorry about your circumstances and wish the very best for you. You are in good company here.

Hello Kati, I am sorry, I missed your post before.
Thank you for your welcome and kind words.

As you can tell English is not my native language, so I am a regular reader on PR, but not an active writer....
I think I should have said that I am vulnurable to depression, not sensitive...

Well, anyway, I think PR is a great medium for information & support. So thanks for responding!

 

[luludji]

Back on topic, when I have a PENE I can be really very very depressed, almost suïcidal and desperate.

It is for me directly linked with the neuro-immune exhaustion. And it can improve relatively quickly with rest, that is, it takes some days, but mostly not weeks or months like other forms of depression.

I wonder if more people experience this relatively short, but very bad moods?
And indeed, I am surprised that only say 25 percent of us suffer depressions, because it thought it to be one of the symptoms of ME. But maybe we all expereince it differently.

 

[Hip]

I also asked that people vote based on which response is most accurate, most of the time. If someone is a bit upset from time to time, but generally not depressed, then they don't have depression and the answer would be "no".

Fair enough.

I can't speak for everyone of course, but I find the stigma accusations to be quite bizarre.

The stigma issue with mental health is a very real one, that affects lots of people, even though it shouldn't be this way. See this survey, for example: BBC News - Survey reveals prevalence of mental health stigma, which found that 47% of people would not want anyone to know if they were suffering from a mental health problem.

Having been hit myself by multiple nasty mental heath problems, both before and after coming down with ME/CFS, I am very much aware of this mental health stigma. I was in both self-denial about these mental heath conditions I had, as well as denying them to others who suggested that I might be having some trouble. When you were once a mentally healthy and competent person, you don't want to admit to yourself, or to anyone else, that this is no longer the case. Your whole ego and self-image are at stake. If you are fortunate enough to have never been in this situation, it may be hard to understand why there is this stigma to admitting and talking about your mental health conditions.

Now after many years, I am reconciled with the fact that I have these various mental health conditions, so I am not too concerned with the stigma. But that may be to do with the fact that at one stage, for a few years, these mental health issues became so severe (not to mention indescribably hellish), that it was impossible to deny them to myself, or to others. Just getting through each new day of mental torture was my only concern. Thankfully those really hellish years appear to be over.

In the UK some years ago, there was a phase were famous people with mental health disorders were encouraged to talk about their mental health issues on TV, in an attempt to de-stigmatize mental health, and bring the issues out in the open.

Getting celebrities to do this works well, I think, because the general public often look up to celebrities as people who are perfect and/or successful individuals, so when these people intimately expose their mental issues, their skeletons in the closet, it helps greatly to de-stimgatise mental health. I remember one TV program in which Stephen Fry talked very frankly, eloquently and openly about his bipolar disorder, and how badly this affected his life. For me that program had a powerful influence. Such things help defuse the stigma of mental health problems.

I'd counter that depression is not a particularly widespread problem for ME/CFS patients, especially when compared to other chronic multi-system illness.

I agree, I would expect that only a minority of ME/CFS patients will have depression.

Though I would expect the majority of ME/CFS patients to have at least one comorbid mental health condition.

Some studies have shown that, across the entire board of mental health conditions, around two-thirds of ME/CFS patients have some kind of mental health condition, whether it is major depression, dysthymia, dysphoria, bipolar, seasonal affective disorder, generalized anxiety disorder, panic disorder, OCD, social anxiety, psychosis, anhedonia, depersonalization, derealization, etc.

There are two dangers to accepting their assertion of near-universal depression in ME. The first has been mentioned by others: ME patients end up being treated for depression while having their biological symptoms ignored. The second risk is that ME patients with depression will ignore it, or have it ignored by doctors, as "just another ME symptom", instead of getting the help necessary for coping with such a serious problem.

I am certainly not sugggesting that there is near-universal depression in ME/CFS. I would expect only a smallish fraction of ME/CFS patients to have comorbid depression. Though I would expect around the two-thirds mark to have at least one mental health condition of some sort.

Emotional sadness and depressed mood from life circumstances is not the same as the bad chemical trip an imbalance in the body can cause. English does not differentiate between the two. I do not believe "depression is depression" regardless of the cause. My experience with it was vastly different depending on circumstances.

As @Bananas points out in the post quoted below, life circumstances (environmental causes) may compound biochemical dysfunctions, which then together trigger depression.

I experienced this myself once, decades ago, when a very bad set of life circumstances hit me precisely during the one month in winter in which my regular seasonal affective disorder (SAD) depression is always at its worst. This combination of bad life circumstances + the SAD biochemical dysfunction then triggered full clinical depression, which took me about 2 years to recover from.

The grey area comes where the environmental causes may trigger the internal factors, or vice versa, and create a downward spiral, and the essential question is whether sufficient environmental causes could tip someone into having internal causes - could poverty and loneliness and continued ill-health give someone clinical depression? bi-polar? marginal personality disorder? or any of the other conditions of which depression is a feature?

Absolutely.

 

[MeSci]

Back on topic, when I have a PENE I can be really very very depressed, almost suïcidal and desperate.

It is for me directly linked with the neuro-immune exhaustion. And it can improve relatively quickly with rest, that is, it takes some days, but mostly not weeks or months like other forms of depression.

I wonder if more people experience this relatively short, but very bad moods?
And indeed, I am surprised that only say 25 percent of us suffer depressions, because it thought it to be one of the symptoms of ME. But maybe we all expereince it differently.

I have moderately low mood at times, often linked with lack of sleep or PEM/PENE. I do find that when I have PEM it is hard to imagine feeling happy and relatively well again, but having been ill for so long and knowing the pattern, I don't get so bothered about that as I know rationally - if not emotionally - that I will feel better again.

The word 'hopelessness' struck a chord in @Bananas's message. I have been trying to remember how I actually felt when I was clinically depressed, and hopelessness was definitely part of it. It's sometimes called 'learned helplessness' and can be due to having tried for a prolonged period and with great effort to improve one's situation but found that it is beyond one's control. Then the evolutionarily-logical thing is to rest - to stop trying - at least for a while. But it is perceived as a very low feeling - depression. Other animals get it too - think of a caged wild animal, at first pacing obsessively, then hunching up in a corner.

@Hip mentioned anhedonia. That was another key feature of my depression, and made me realise how bad I was. I could walk out in a beautiful village (albeit one I was having to leave) on a beautiful day, with the birds singing, flowers everywhere, and feel - nothing at all. I could look at my beloved cats, and again feel almost nothing. The only feelings I had were hopelessness, pain, fear, despair, etc. It's hard remembering it, and brings tears to my eyes.

I would bl**dy well know if I had that again!

 

[Mij]

Though I would expect the majority of ME/CFS patients to have at least one comorbid mental health condition.

I think this would apply to the general population.

 

[Valentijn]

And indeed, I am surprised that only say 25 percent of us suffer depressions, because it thought it to be one of the symptoms of ME. But maybe we all expereince it differently.

It's not a required or optional part of any of the ME/CFS criteria, nor listed as a symptom, and I think all except Oxford generally exclude or clearly differentiate patients with clinical depression versus ME.

Of course, patients can have both, but in that case they should still fulfill the ME/CFS criteria even with depression successfully treated. Oxford, on the other hand, explicitly embraces several mood disorders.

So while ME/CFS and depression may have a few overlapping symptoms, they also have symptoms which clearly distinguish them from each other. The confusion only arises because psychobabblers like to start their research papers by describing depression as a common symptom of ME/CFS - even though it clearly is not. But if they repeat it often enough, some people will believe it anyhow.

Personally I have only felt properly depressed and suicidal once, and it lasted for about a day. A psychologist told me that doctors could not help me, and that if I did not choose to stop being ill then my life would never improve. Fortunately the physiotherapist who I saw immediately after that appointment was much more supportive, as was my fiance who was also at the appointment. The depression turned into anger, and then into plotting some passive-aggressive revenge ... but that's another story

 

[MeSci]

I absolutely agree with @Hip that there still exists a stigma about mental health issues.

However, I haven't been afraid to tell doctors about mental health problems, e.g. the anxiety that I now know could have been fixed through diet (and now has), and the depression when I have had it. It had been impossible to hide the latter from doctors as I have ended up sobbing uncontrollably in the doctor's surgery/office. I was probably naive to be so open with doctors, not knowing that it would lead them to ascribe future, physical illness to mental problems.

I've also been open with friends and family, but sometimes been given the brush-off because people don't want to talk/hear about it.

But I don't know why people wouldn't be honest in a poll where no one can see who is voting or how. We may not even know most of the people who are voting.

 

[ukxmrv]

Unless we ever get an actual test for depression or anxiety we will never know who actually suffers from what and who is "just" upset, harassed by benefit claims, worried about their future, lonely, pressured by their family and all the normal things people feel when they lose their jobs, family and health.

I remember as a young Uni student being taught that there was a reactive depression in response to events and a depression that descended on people with no obvious reason. This idea seems to have died and I wonder if there would be any benefit bringing it back.

In my local support groups I am seeing people having their unhappiness medicalised and diagnosed with depression. Some of them are taking AD's because it helps numb that unhappiness. They think it is better than feeling that fullness of their emotions which never resolve. They are under such stress in their lives and fighting for medical help and benefits keeps making them more unhappy. The mental pain for them never goes away so they take the drugs to help dull this.

I don't suffer from depression so I may be wrong about all of this.

 

[Hip]

I have been trying to remember how I actually felt when I was clinically depressed, and hopelessness was definitely part of it. It's sometimes called 'learned helplessness' and can be due to having tried for a prolonged period and with great effort to improve one's situation but found that it is beyond one's control.

Another major feature of depression is loss of self esteem. You view yourself as very lowly. You have no good feeling about yourself, and this compounds the feeling of hopelessness, making you feel hopeless about both your circumstances and your abilities to deal with them.

@Hip mentioned anhedonia. That was another key feature of my depression, and made me realise how bad I was. I could walk out in a beautiful village (albeit one I was having to leave) on a beautiful day, with the birds singing, flowers everywhere, and feel - nothing at all. I could look at my beloved cats, and again feel almost nothing.

Yep, that's anhedonia, and it's an unimaginably awful condition when it gets bad, even though by its description you would not think it would be much of a problem.

With anhedonia, nothing in life seems to have any meaning or value anymore, as you feel nothing. Anhedonia may or may not be present in depression, but if it is, then I understand it can greatly increase the desire for suicide. When my anhedonia was very severe, even though much of the time I did not have any other symptoms of depression, just anhedonia, I constantly had the desire not to be alive anymore.

I think this would apply to the general population.

I managed to find this article from the WHO which quoted a figure of 27% of the adult population experiencing at least one mental health disorder over the course of one year.

However, I haven't been afraid to tell doctors about mental health problems, e.g. the anxiety that I now know could have been fixed through diet (and now has), and the depression when I have had it. It had been impossible to hide the latter from doctors as I have ended up sobbing uncontrollably in the doctor's surgery/office. I was probably naive to be so open with doctors, not knowing that it would lead them to ascribe future, physical illness to mental problems.

I've also been open with friends and family, but sometimes been given the brush-off because people don't want to talk/hear about it.

I have found that the average GP, like your average person, can feel quite uncomfortable about any talk of personal mental health issues. They seem to find this sort of talk awkward, and quickly want to leave the subject behind. Whereas when you speak to anyone with interests in psychology (or spirituality), they are generally excellent and empathetic listeners, who don't seem to be afraid of your issues, but rather the reverse, are genuinely interested in hearing them.

GPs I find have no problem when you want to talk about even the most embarrassing physical ailments, like a rash on your rectum that you need pull your pants down to show your doctor; but when it comes to mental conditions, this often seems like something they would rather not have to deal with.

Knowing this, I now tend not to mention mental symptoms to my GP. If I thought I wanted medical help for these symptoms, I would just ask my GP for a referral to a psychiatrist.

But I don't know why people wouldn't be honest in a poll where no one can see who is voting or how. We may not even know most of the people who are voting.

I think this is because people may often deny mental health issues even to themselves, and this is understandable, as accepting that you do have a mental health condition can be detrimental to your self-image and self-esteem.

What I found greatly eases the negative effects on self-image of admitting a mental condition to yourself is the understanding that many mental health conditions are likely caused by some physical dysfunction in the brain, such as a viral infection giving rise to brain inflammation, which then induces mental symptoms.

When you view mental health conditions in this way — as being a physical dysfunction in your body — it does not seem to create such negative effects on your self-image and ego. It allows you to separate the "you" from the mental condition you have. You are still you, and the mental condition is just a physical dysfunction in the body that you have, which if fixed would make your mental symptoms disappear.

 

[MeSci]

Another major feature of depression is loss of self esteem. You view yourself as very lowly.

I don't think this is always the case. I don't think I felt unworthy - more that I was undervalued by others.

With anhedonia, nothing in life seems to have any meaning or value anymore, as you feel nothing. Anhedonia may or may not be present in depression, but if it is, then I understand it can greatly increase the desire for suicide. When my anhedonia was very severe, even though much of the time I did not have any other symptoms of depression, just anhedonia, I constantly had the desire not to be alive anymore.

I think that the day I described was the day I attempted suicide, and that I had gone out to post my suicide letter to my friend so that she would take care of my cats. It's painful to recall.

I have found that the average GP, like your average person, can feel quite uncomfortable about any talk of personal mental health issues. They seem to find this sort of talk awkward, and quickly want to leave the subject behind.

One walked out of the room, leaving me sobbing alone. I waited for him to come back, but he didn't. I was left to try to compose myself and walk out past the other patients, with no help at all. It was appalling.

 

[Mij]

When I first became ill and mentioned applying for disability to my GP, she said "I don't know anything about disability", and walked out the room. I looked out the door and asked the nurse where she went and was told she was done.
I was left there crying too. Unbelievable. I guess they don't want to get involved with conditions they don't understand or time involved.

 

[Bananas]

Personally I have only felt properly depressed and suicidal once, and it lasted for about a day.

I am not sure that feeling suicidal is always a symptom of clinical depression. To commit suicide might feel like a logical conclusion in the face of overwhelming environmental pressures. So for instance a terminal patient, or Captain Oates, or a man who faces bankruptcy but whose family would get an insurance payout after his death - all these people might make the decision that it would best if they 'weren't there'. Or a person might think about life without a loved one, who has died or deserted them, and decide that there will be no joy in a future without them. The only time I ever felt suicidal was when I was giving birth and it was all going wrong and I wanted to end the pain. The only thing that stopped me was a tiny scrap of hope that I would be saved and the pain would not go on for ever.

I think when a person with clinical depression commits suicide it is to get out of the equivalent mental pain, but there is no hope in the equation. I don't think there is any 'logic' in the decision. It is an irresistible impulse to escape pain made in a kind of void, like say if you could switch off your nervous system and cut your finger with a knife. Which is why in these cases there is often no suicide note, because there is no reasoning. I don't know how to explain what I mean very well...

 

[Aurator]

Some studies have shown that, across the entire board of mental health conditions, around two-thirds of ME/CFS patients have some kind of mental health condition, whether it is major depression, dysthymia, dysphoria, bipolar, seasonal affective disorder, generalized anxiety disorder, panic disorder, OCD, social anxiety, psychosis, anhedonia, depersonalization, derealization, etc.

Given the number of vaguely defined, subjective and rather too conveniently diagnosable conditions included in that list, not to mention your use of "etc" at the end, I'd say the figure of two-thirds of ME/CFS patients being affected by one or other of these conditions probably puts them at below average susceptibility compared to the population as a whole.

In its race for respectability and the influence it thinks it deserves, Psychiatry has come up with labels for almost every quirk of personality and every kind of apparent non-conformity to arbitrary norms. But such labelling can be uniquely damaging to ME/CFS patients on the receiving end of it, as well as detrimental to progress in finally understanding the disease. Even those ME/CFS patients with serious mental health co-morbidities that call for appropriate psychiatric care stand to lose much from the continued prevalence of the idea that ME/CFS is or may be a psychatric disorder. As long as that lie has life in it, our hope of a cure is jeopardised.

 

[Antares in NYC]

@Antares in NYC
This thread is about whether ME/CFS patients have depression as a commodity or not.

If you were once misdiagnosed by the medical profession, that is unfortunate (although not uncommon), but is not the subject matter here. And if like many ME/CFS patients you have been told "it's all in you head", well that is certainly very annoying and insulting, but again, it's not really the subject of this thread.

The questionnaire in this thread is very simple: it just asks are you depressed? If you are, for whatever reason, you should really answer "yes". If ME/CFS patients are experiencing depression, but answer "no" to this questionnaire because they blame their depression on the tribulations of having ME/CFS, well that is wrong, and will skew the poll results.

If you have depression, whatever you blame it on, it's still depression.

Apologies for my somewhat "snappish" reply last night, Hip. Nothing personal. It's just that for many of us the issue of depression is quite sensitive. As in my case, we have been told for years our ailments were "all in our heads". Not sure it's the fear of the "mental health stigma", but more to do with the way we have been told countless times that our illness "wasn't real", and we were just depressed, if not outright lazy. It can elicit an instant reaction from many ME/CFS patients, specially after the UK psych lobby successfully hijacked the syndrome for decades, building pseudo-academic constructs to tell the world "it's all in our heads".

Like others have posted here, I don't think being sad or beaten down by life is the same as clinical depression. The serotonin chemical imbalance at the core of depression does not need a reason or motive to manifest. On the other hand, I think it is perfectly human and normal to be upset, sad, beaten down or even bitter after years of suffering a chronic illness and experiencing the awful consequences of such condition in all aspects of your life. I don't equate sadness with depression; many people do, but for me they mean different things.

I think that this poll, to get around these concerns, should expand the questions a little. This issue may require more than a "yes/no" answer. I think it would make sense to expand the questions to ask if the patient experienced depression before CFS, or only after CFS. Also if the use of antidepressants helped at all. It may add a few layers of grey instead of a black and white "yes/no" answer.

 

[Tired of being sick]

Many studies show high rates of depression in CFS patients, but usually use inappropriate questionnaires which take physical and cognitive symptoms as an indication of depression. Hence actual rates are difficult to even guess at.

Our cognitive symptoms come from lack of oxygen/blood-flow to the brain due to dysautonomia.
which then creates disorders such as ADHD/Anxiety/Major depression.......

 

[Tired of being sick]

The fact is,we are ALL depressed whether we want to admit it or not.

But our depression can only be managed by addressing the mother-ship of symptoms as the
underlying cause which is CFS/ME.
So the more we face and fight CFS/ME the less depressed we will be..
But the depression will always be there waiting for us to slack off so it can attack us
full throttle..
So
As long as we are ACTIVELY FIGHTING CFS/ME,this depression will be in check.....