Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness

CFS_for_19_years

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Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness
Andrew R Devendorf
Stephanie L McManimen
and Leonard A Jason

Full text: http://sci-hub.tw/10.1177/1359105318785450

Abstract
Chronic illness is a risk factor for suicide but is often explained with depression. Research has shown an increased suicide rate in patients with myalgic encephalomyelitis and chronic fatigue syndrome, but specific risk factors have been unexplored. We qualitatively analyzed responses from 29 patients who endorsed suicidal ideation but did not meet depression criteria. Two themes were developed: (1) feeling trapped and (2) loss of self, loss of others, stigma and conflict. Myalgic encephalomyelitis and chronic fatigue syndrome caused patients severe disability, restructured their lives, and inflicted serious pain. Participants emphasized that they were not depressed, but felt trapped by the lack of treatments available.
 
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Spot on.

It is so incredibly important to get the correct message out there that CFS ≠ depression and should not be approached or treated as such. The Journal of Health Psychology that the text is pubished in has a good impact factor (a measure of a periodical's academic gravitas) and it's the lead article, too! Well done, Devendorf, McManimen and Jason!
 
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ChrisD

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When I first came down with ME, I was still able to make small, struggled journeys out to the local shop in the middle of winter - I was very depressed and I would find myself stalling around the zebra crossing with the thought ''Would it be so bad if a car hit me? would it be easier than dealing with this?''. I talked about this with my psychotherapist but unfortunately as per usual they focused on this as the cause of my illness, either way it was good to deal with those worrying thoughts, but unfortunately this added to my doctors understanding of ME as somatised depression.
 
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When I first came down with ME, I was still able to make small, struggled journeys out to the local shop in the middle of winter - I was very depressed and I would find myself stalling around the zebra crossing with the thought ''Would it be so bad if a car hit me? would it be easier than dealing with this?''. I talked about this with my psychotherapist but unfortunately as per usual they focused on this as the cause of my illness, either way it was good to deal with those worrying thoughts, but unfortunately this added to my doctors understanding of ME as somatised depression.
I think the more I talk to Drs about my illness, the more I have to prove ME exists. Im better off with my mouth shut. How rediculous is that
 

Wonkmonk

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I think one of the worst things is that the disease isn't recognized and even from very well-meaning and supportive people, there is always the implicit suspicion that it may not be real after all or it might in fact be a psychological problem and not a "real" illness.

I think if the cause were found, if there would be a proper diagnosis based on accepted hard criteria (e.g. blood tests), if people could somehow prove that they are really sick, things would get a lot better.

First of all, all the legal stuff, disability benefits, insurance etc. But maybe almost as important would be how people look at the patient.

Let's take for comparison people can prove that they are severely ill, e.g. MS, severe Rheumatoid Arthritis etc. People look at them with the feeling "omg, how horrible to have such a disease."

With respect to CFS, it's is always like "we don't even know what (if anything) you have".

Example: My mom. She always tells me that I should discontinue all medications and supplements and just wait and it would get better. I tell her that this is super-ignorant. I have been ill for 10 years and it is steadily getting worse. I'm not going to get better by doing nothing. No one would say that to a MS or HIV or RA patient or to any patient that can prove they have a progressive chronic illness.

And I can't even blame people for looking at CFS this way. It's impossible for a healthy person to understand how a CFS patient feels and it is also very difficult to accept that someone is in fact so terrribly sick and no doctor in the world can find a cause or even any major abnormality that could explain the symptoms.
 

Runner5

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What is frustrating for me is working my hardest I have modestly improved, then I see old Rosco down at the Mini Mart and he has a fifth of cheap Jim Beam whisky and a bag of corn chips and he's a regular weight, can eat anything he wants and work a ten hour day. I just got to wonder, does the Jim Beam kill off SIBO? Should I take up alcoholism?

I was seriously considering whisky today.
 

Dan_USAAZ

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What is frustrating for me is working my hardest I have modestly improved, then I see old Rosco down at the Mini Mart and he has a fifth of cheap Jim Beam whisky and a bag of corn chips and he's a regular weight, can eat anything he wants and work a ten hour day. I just got to wonder, does the Jim Beam kill off SIBO? Should I take up alcoholism?

I was seriously considering whisky today.
I could not agree more with your frustration. Many of us try to live the most perfect lifestyle in order to limit our illness and we often appear to be the least healthy.

My longest living grandparent was a "functional" alcoholic. He drank between a pint and a fifth of whiskey/bourbon every day for several decades. He lived into his late eighties, outliving all other family members of that generation by 8 to 20 years. Even so, I do not think I would recommend the whiskey diet.... :meh:
 

Wolfcub

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....I dunno :D Sometimes a glass of Brandy has had me feeling a lot better. A glass, mind you, not a quart!
But it's hard to tell until after the event if it's going to be one of my "happy alcohol days" or one of my "OMG I just drank poison" days.

But about the depression issue...I would challenge anybody to be desperately ill, with no understanding, for even weeks, never mind years (as some people have to bear) -and not get the teeniest bit depressed about it.
In my view that is "reactive depression" which is a whole different thing.
 

alex3619

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Not only doctors. I have stopped discussing my symptoms with anyone including close relatives.
Just three days ago I was have lunch with two of my old friends, both very science literate. I mentioned some of the CPET findings and at least one understood instantly. Most people do not have the cognitive framework to understand. In the past the first person I met who understood was a two time cancer survivor. Its possible for others to understand, but its definitely not easy for them to understand.

The question I like to ask, of every patient, is how long did it take YOU to understand, and you were living it?
 

alex3619

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In my view that is "reactive depression" which is a whole different thing.
I think most of us will get at least a little reactive depression from time to time. In my case its just for a few seconds, its not how I typically think.

The other issue is that its possible to think about suicide even if one has no interest in committing suicide. When we are this sick we search outside the box, and outside all the boxes, looking for answers.
 

Wishful

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Their study missed an important category: suicidal thoughts caused directly by imbalances in kynurenines (especially quinolinic acid) due to immune activation. There were some studies (Australian) showing this link. I certainly experienced it. I certainly agree with the 'suicidal ideation without depression' conclusion.
 
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Their study missed an important category: suicidal thoughts caused directly by imbalances in kynurenines (especially quinolinic acid) due to immune activation. There were some studies (Australian) showing this link. I certainly experienced it. I certainly agree with the 'suicidal ideation without depression' conclusion.
I don't think their study 'missed' this - more that what you're stating above is an unproven hypothesis that may apply to a sub-group of depression generally and not necessarily be specific to ME/CFS. (There's an increasing amount of evidence tying gut inflammation to 'depression', and we know that gut bacteria play a very important part in 5-HT metabolism, of which quinolinic acid is a product.)
 

Wishful

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The research seemed to be about alternative causes of suicidal ideation, so biological causes should have been at least mentioned. Not mentioning it makes it appear that there are only psychological causes, which would bias further research (and funding) to ignore biological causes. Hmmm, is competition for funding so strong that this might be done intentionally?

Unproven yes, but the evidence for the QUIN/suicide link seems fairly strong, and there are quite a few more articles supporting that since I last checked. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022080/ seems to cover it well.
 
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Gemini

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The research seemed to be about alternative causes of suicidal ideation, so biological causes should have been at least mentioned.
Agree @Wishful.

Interferon can also cause it, scientifically proven with the interferon drugs used for Hep C infection.

For years mention of "endogenous" interferon has appeared in the ME/CFS literature in genetic and cytokine studies so it would seem reasonable to include it.