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Originally Posted by Stellatum
Alice, thanks for this very clear explanation. Your points about the original poster's symptoms being untreated are right on, and I have nothing to add but my agreement. Anti-depressives are no substitute for proper medical care.
Your distinction between reactive and pathological depression makes a lot of sense to me. I also really like what you say about the personal and social role of appropriate emotional response to tragic situations. I can see that using drugs to suppress normal grief could be a mistake, even if it worked, because the experiencing and expressing of grief is part of the emotional healing process.
I think what I am asking is this: isn't it possible to suffer from reactive and pathological depression concurrently? I understand that the definition of pathological depression is depression that occurs outside of a reasonable context. But can't (for example) normal grief act as a trigger for an emotional reaction that isn't proportional to the grief, even though it's triggered by the grief?
So if I get a chronic disease that takes from me things that used to give me joy, it is normal and appropriate to feel sad. That is reactive depression, and it's not an illness of any kind. But if this sadness overwhelms me to the point that I can no longer enjoy the good things I still have, then could you say that my reactive depression has triggered pathological depression?
I'm not sure I'm expressing this well, but maybe you'll know what I mean. I appreciate this exchange very much.
Abby
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First the answer is that yes, medicine is not an exact science and many patients have more than one disease or medical problem. Having MG, obviously, doesn't protect you from having pathological depression.
It is not always easy or trivial to differentiate between a normal reactive response to a pathological one. And (like many other things in medicine you can err both ways). One ominous sign for me is when a person detaches himself socially , another is when he loses interest in fighting his/her illness postponing treatments etc. not as a one-time thing. Not enjoying things as you did before, is a normal response in my opinion, because it takes time to learn how to enjoy them in a different way. The pain of that loss, is also the trigger to rebuild your life. You can only be sad about losing something that caused you joy, so this duality is inherent in the grieving process. When fighting an illness, remembering yourself healthy (as painful as it may be) is what motivates you to withstand unpleasant treatments and medication side-effects or what ever it takes to recover from your illness.
From my experience (as a physician and as a patient) it makes an enormous difference if you have a physician that understands all this complexity and is a true partner in helping you go through this process. One that understands that dealing with a chronic illness is not just a physical burden, but also an emotional one. But, unfortunately many physicians in the modern world don't see it as their "job description" to deal with emotions.