Do you know a very depressed person who doesn’t think they are depressed?
You’d think that of all mental illnesses, depression would be the one that the patient is well-aware of.
But in the case of my mother, she was in denial, or at the most, attributed her profound depression to “the pain,” that is, pain from carpal tunnel syndrome!
My mother had a bad case of carpal tunnel syndrome in both hands, but her depression symptoms were alive and kicking well before the carpal tunnel syndrome began making its grand entrance, and the depression symptoms continued well-after carpal tunnel surgery.
However, if you have joint or nerve pain, clinical depression can amplify your perception of it.
My mother refused to try an antidepressant, and my father, oddly enough, felt the same way.
After six weeks, I finally convinced him that my mother needed an antidepressant, and that evening, my mother took her first antidepressant. The next morning she awakened feeling wonderful, and no longer did her whole body hurt.
Pre-antidepressant, my mother often said, “I’m depressed about all this pain,” but then would become teary-eyed over trivial issues.
Carpal tunnel syndrome doesn’t make you sob spontaneously throughout the day or want to stay in bed all day.
Major depression does. And I told her that — both pre-antidepressant and post-antidepressant.
Despite the antidepressant’s marvelous effect, she continued insisting that she didn’t have clinical depression.
It’s important that a person with depression have insight into their situation, rather than deny it. Otherwise, they won’t be as amenable to treatment.
I explained to my mother numerous times that her depression was present before the pain from the carpal tunnel syndrome developed, and before her shoulder pain developed, and that physical pain that’s localized would not make her completely shut down, lose interest in things that were once pleasurable, and have feelings of wanting to go off into the woods and die. “Only depression can do that,” I’d say.
I’d continue: “Since you’ve been taking this antidepressant, you’ve had no complaints of your whole body hurting. That’s all disappeared since you’ve been on Cymbalta. The drug has suppressed your perception of your shoulder pain, which is why you no longer cry when you have a pain attack.”
Several times my mother wanted to go off the antidepressant, but I kept reminding her about the key points:
“The reason you feel so good now is because you’re ON the drug. You have to stay on it until everything blows over, until you are completely out of the woods. It’s helping you through all of this.”
Keep reminding your depressed loved-one: “The reason you feel so good is because of the antidepressant. The drug is working. Go off it and you’ll relapse.”
My mother found it hard to believe that if she stopped taking the antidepressant, she wouldn’t continue feeling so good.
If your depressed loved-one announces they’re ready to stop taking their antidepressant, and they haven’t been on it for long, and any stressors that triggered or aggravated their depression are still present — then never be afraid to tell him or her the raw truth:
“If you stop taking the drug, you will relapse. You will sink back into that ugly dark hole and your entire body will feel crummy all over again. You’ll be crying and feeling like you’re dying.
“You won’t know how to smile or feel joy. Think of how wretched and miserable you felt before you began taking the antidepressant.
“You’ll return to that hell hole if you stop taking the drug. You absolutely must stay on this medication for a while, and then when everything blows over and you’re stabilized, THEN we will get you off of it. Trust me.”
This kind of talk sunk a little more into my mother with each time I gave it. Eventually, she was diagnosed with hypothyroidism, and must take a thyroxine pill every morning.
All evidence points to the depression being secondary to the hypothyroidism. An underactive thyroid can cause many symptoms including clinical depression.
My mother lost weight because the depression minced her appetite; suffered hair loss; and often complained of feeling cold even though everyone else felt fine — and nobody picked up that these two latter symptoms suggested early hypothyroidism.
And then the depression swept in with a 1-2 punch, even though there were subtle signs of its beginning for weeks beforehand.
“I feel so great now,” my mother told my brother, after being on the thyroxine for a while, and still taking the antidepressant, “that I no longer need these drugs. Why can’t I stop taking them?”
My brother responded: “The reason you feel so great is because you are taking two medications: thyroxine and Cymbalta. If you stop taking them, you’ll go back to square one, and it may take a whole week to get you back to where you are now. The reason you feel so good is because you are on two medications.”
At that point, my mother finally realized that she needed to stay on the antidepressant for a little while longer, and that the thyroxine pill will be very long-term.
Because it’s apparent that the depression is secondary to the hypothyroidism, and because the thyroxine’s effects are now fully kicked in, my mother is now in the process of tapering off the antidepressant, which eventually was switched to Effexor due to an insurance coverage change.
(Original publication date: January 2010)