How do you know if you have depression?

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A few prominent CFS clinicians have talked about imbalances of neurotransmitters that could benefit from antidepressants, even in the absence of clinical depression. In my case, my moods seem to change like the weather. I work (from home, pacing myself); I have goals; I have interests that I enjoy; and I am not thinking about suicide. On the other hand, I feel like $#!* every day - tired, in pain, brain fog, etc. (you know the score). However, in addition, I have days with really really low mood. I have not had a decent night's sleep since I came down with CFS after a virus in March. Could this be the effect of chronic sleep deprivation - utter exhaustion? Chronic pain? Is this depression? Would I benefit from an antidepressant?

(I'm actually laughing while I write this, because it seems so chaotic and confusing. My apologies: I don't mean to trivialize this.)

In any case, if this sounds familiar to any of you or you have already been down this path, I would love to hear your thoughts or advice about depression and the use of antidepressants.

As always, Thanks!
-Matt
 
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Have you thought about keeping a diary and seeing if there is a pattern. It could be useful to track to see if low mood is related to a worsening of symptoms and does it improve when symptoms get better? i.e. is low mood just another symptom of a crash and perrhaps have a metabolic cause?
 
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Mood fluctuations and much more powerful emotions than before are unfortunately part of the disease. I find that harder to deal with than some of the physical symptoms. On top of that, I have noticed that for me depression is part of a crash. This is over and above the "normal" mood fluctuations. When I am crashed I am depressed. I don't just mean I'm unhappy or berating myself for managing my energy badly and provoking a crash. I mean my emotions are utterly distorted and unhinged from reality. This goes away again when I get some energy back, but it's extremely painful in the meantime.

Depression is different from ordinary sadness. It's a feeling of intense hopelessness and despair. All the light goes out of the world, everything is meaningless, suicide suddenly feels logical in a world for empty of everything and without the possibility of change or growth. It's a layer of thick poison over your thoughts and I find it infinitely more painful than any of the physical pain associated with ME/CFS. I deal with it by knowing it is a consequence of a crash and will pass in a few days if I can wait it out.

If this sounds like what you are experiencing I would recommend getting some sort of outside help with it, whether that's medications or a support group or whatever. Particularly if yours does not go away after you have recovered from the crash. I think this depression is more than a reaction to having a dreadful disease. I think it's part of the "brain damage" the disease causes. Medscape had a blurb lately about depression being recognized as a core criteria of MS, and I'm starting to suspect it is the same for us.
 

Judee

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I do think sleep deprivation can have an effect like that.

If you suspect it could be originating with the sleep issues I would start with trying to fix those first. Also have your vitamin D levels checked. Mine were very low again and I am finding that a month on a high dose is helping with the pain/achiness all over feelings though not the brain fog. :(

I do also think having immune system reactions going on can cause depression. I always start to experience depression when I'm coming down with something. It's one of the first signals for me and I use it as a reminder to start with my immune supplements like Vitamin C and thymus glandular or garlic to head the sickness off.

These are just the things I have experienced. Keeping a diary (as others have said) could help you to learn your own situation and if there are triggers for what you're going through.
 

Tammy

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My CFS started with the EBV. I didn't have mood changes until after getting EBV. I think there is a link somehow between viral activity and mood/depression. I wasn't able to tolerate the anti-depressants although I didn't try all that were available. My mood has been better overall now that I have been on an anti-viral program.
 
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....Could this be the effect of chronic sleep deprivation - utter exhaustion? Chronic pain? Is this depression? Would I benefit from an antidepressant?
...
In my opinion this is the crux with this illness: it's like walking through fog with only a candle in your hand.
I've tried so many things and I can't tell you which I would wholeheartedly recommend :cautious:
Perhaps NAC and over-the-counter sleeping pills :)
That's what I would take to get some sleep.

Are you sure that you are pacing enough...especially on good days?
And I don't mean just physical stress.
My last holiday with my son was exhausting.
Even if I was mostly absent in the sleeping room.
 
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Hi @Matthew_2 . I think this is a fascinating area of exploration and I am so glad you brought it up. It is pretty familiar to many of us that our moods go low when we are feeling sick, lacking vitality and agency and then--the kicker--when we are dismissed by those we go to for help. I think you are doing pretty well in this latter department? Though no one to really help yet....

Anyway--I think this makes good sense. When we are as limited as we are as well as mostly invisible--why would we not feel sad? That strikes me as healthy, actually.

I have been contemplating the relationships of body-mind. It is pretty well established now (though it was considered heretically un-scientific a few decades back) that the mind can affect the body. The edge lies in the consideration of how the body affects the mind or mood. More studies are demonstrating a connection between gut function and depression so it makes sense to question the origins of mood.

Yesterday I had cervical traction as part of assessing for CCI. For an hour after the short session of traction, I felt a very rare sense of well-being. Just: it is all ok and everything is right in the world, even those things I know are not. I simply felt good. I had some physical improvements as well, but what stood out was this honey-like sense of pleasure at being in a body, my body. About an hour later, things went south and my legs stopped working well, I started having all sorts of dysautonomia symptoms and ultimately a crash.

It was short-lived and this morning I feel ok (relatively speaking) physically, but I am noticing severe anxiety. It is exactly the opposite of that well-being I experienced after the traction. I have a sense of impending doom and no matter how I work with it--emotionally and energetically--it hangs on. I am not at all mentally anxious--it is my body--my belly is cold and tight and my shoulders are tight and hunched and I feel a strong urge to curl up in a ball under the covers.

So...is this mechanical? Is this the result of the movement of my brainstem and spinal nerves? I am quite confident that an anti-anxiety med wouldn't help me with this, but I don't know if anti-depressants would help you. To me, you sound really good in light of what you are having to contend with. You describe a lot of interest in life especially given that you do not sleep. That alone can be devastating. And losing as much as you have lost in the last few months would make any psychologically healthy person prone to grieving.

I wish good luck in sorting it through.
 

Judee

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@Matthew_2, I also wondered if you felt the low moods more in the first half of your day. I think you mentioned a while back that evenings are better for you...a symptom that seems to run common for most of us PwME/CFS (people with ME/CFS).

I think I am much more vulnerable to negative thinking/more discouraged in the morning and daytime and then I start to feel more positive and optimistic at night.
 
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@Matthew_2 I’ve suffered from depression (major, recurrent) almost all my life, and have been on various antidepressants for more than 30 years. Many things affect it, including poor sleep, but it’s more complex than just feeling down. Many symptoms overlap with those of ME/CFS, for example depression can make you feel very tired, and insomnia is common, as circadian rhythms get disrupted. I’ve been sick for a little over a year with CFS, and have noticed that my depression has steadily worsened. I think it’s partly simply because of the frustration of there being no cure, and great confusion among doctors as to what to recommend. There are things I want to do but can’t. With depression alone, there’s nothing I want to do, no one I want to see, nowhere I want to go, etc. This is different—I DO want to do things, see people etc. but can’t expend that much energy. So that makes me blue. I’m trying to make a distinction between depression that’s a medical condition, and the kind of blues anyone would get from being chronically ill, but there’s no clear line. Antidepressants can be a big relief. I’d definitely mention this to your doctor.
 
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Hey, Everyone! Thanks for your responses and insights! I do keep meticulous daily records to try to identify patterns in my mood, pain, energy, etc. I am in the process of trying to find combinations of medicines that will solve the sleep issue. However, in addition to that problem, I also have really low B12, D3, and magnesium (which, as you know, is the usual for CFS). In addition, my testosterone levels, which have always been on the very high side have plummeted recently and are now abnormally low; and I recently got confirmation that my thyroid levels are too low, as well. So, the low mood could be caused by any combination of these. However, I do wonder if, in addition, there is a level of depression or even neurotransmitter deficiency (even in the absence of clinical depression) that would benefit from an antidepressant. I know when I tried an extremely low dose of Klonopin (which can tend to be a downer) to help with my sleep, even though it did nothing to improve my sleep, it did help a lot with my mood the next day, which got me wondering about the possible effect of treatment that explicitly targeted that low mood. In any case, one of the first things I did when I first got sick with CFS was to establish a relationship with a therapist. Given the health traumas that I and my family have experienced in the past several years, I knew I was going to need all the help I could get. So, I think with family, friends, a helpful doctor, a therapist, and the good people of this forum, I have enough support in place to make some progress on this. :)
 

Mary

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@Matthew_2 - well, I would try addressing your low B12, D3 and magnesium first before trying any prescription anti-depressants. Many of us with ME/CFS (including me) can't tolerate those drugs. They're not for everyone and can have very serious side effects. If after you address your low B12, D3 and magnesium, you still have trouble with your mood, you might try 5-htp - it helps the brain produce serotonin without the side effects of the prescription ADs.

But I'm guessing you know that low D3 and low B12 are well-known causes of depression, so I don't think you should try anything until you get those sorted out.

Klonopin is a benzodiazepine - benzos are very addictive so I'd stay from them.
 
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Thanks for the advice, Mary! And, yes, benzos have some great qualities and some very bad ones, too, like addiction, tolerance, and withdrawal. At this point, I am trying several different medications to test their effects on my body and sleep. I still have not settled on a regimen that works yet.
 
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I know this is a bit of an old thread, but I just came across something interesting on youtube about The Emotional Side of Diabetes.

It's a very interesting person who talks about how emotionally hard it is to manage a chronic illness. I know all of us aren't diabetic, but the diabetes people sound like they are trying to get a handle on this and maybe it would be helpful for us. At the end, the speaker talks about diabetes distress vs. major depressive disorder. High blood sugars cause lethargy, eating too much or too little, and troubles sleeping. But these are also symptoms for depression. So it's important to differentiate high sugar problems from real depression. Also, having chronic illness is a real bummer. It's important to differentiate that from depression. It's not a pathological state to realize you have something serious and scary, as the speaker said.

We all know this, of course. But I was just really impressed that the diabetes community has recognized "diabetes distress" is different from depression (and exactly what parts of the biology of their disease create it) and they're working on treating it different from depression. (Not that you can't have real depression and diabetes at the same time of course.) It would be really wonderful if we could work on a recognition of ME/CFS distress different from depression, which parts of our biology cause that, and how to treat it differently from depression.
 
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It would be really wonderful if we could work on a recognition of ME/CFS distress different from depression, which parts of our biology cause that, and how to treat it differently from depression.
My understanding is our fatigue, the Post Exertional Malaise- is very different from the reaction a depressed person would have after getting a little exercise or going outside...for instance. That is described in quite a few MECFS research papers.

On days when we feel extra horrible, that is depressing, simply- comes with the territory. It would be great if we could receive viable treatment to feel better, and then we'd be less depressed-feeling.
 

wigglethemouse

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In addition, my testosterone levels, which have always been on the very high side have plummeted recently and are now abnormally low; and I recently got confirmation that my thyroid levels are too low, as well.
You probably want to see an Endocrinologist if you haven't already done so, to rule out other causes for hormone changes which can cause testosterone to drop - for example a pituitary adenoma.
 

CFS_for_19_years

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FWIW I always feel better (not depressed) when I'm not hypothyroid. Your primary GP can get you started on thyroid replacement. You may not need an antidepressant if your hypothyroidism is adequately treated. I don't have the energy to look for references right now, but even if you were to start taking an antidepressant, thyroid hormones would make the antidepressant work better.

I'm not familiar with how testosterone levels would affect anyone, but again, maybe your GP or even an endocrinologist could help.