My doctor is suggesting that I need to be one. He tried one. I stood on it for two weeks and then went off because it made me more anxous and not able to sleep, which is the only time I am comfortable.

If you are on one, which do you think has done the best for you?
Thanks for your replys in advance!

I deal with M.G. and M.S. and had to have a feeding tube put in.
The doctors still arn't sure why or whats causing the swallowing to slow down so much and then stop. I'm going for a second opinion, just waiting to get the appt. made.

Be very careful coming off antidepresants... you want to do that under supervision. I'm on Citalopram 20 mg myself.

This is just my personal opinion. It is not that I am categorically against anti-depressants. But, when I was "offered" psychiatric consultations and anti-depressants because my physicians didn't know what was wrong with me, I refused to take them. I realized that for them it was the easy way out, but not very constructive for me.

I asked the psychiatrist if she honestly thinks it will improve my medical symptoms. She said-no, I think you are very ill, but it will make it easier for you to deal with it. I asked her- deal with what, the ignorance and arrogance of my treating physicians?

Instead of taking anti-depressants to make it easier for me to accept this reality, I refused to accept it. Instead, I started learning as much as I can about this illness (from the medical literature, patients and consultations as well as e-mail discussions with leading experts), and continued to search for a physician who would be ready to think and find the best management approach together with me. It was a very long and frustrating journey, with many moments of despair, but had I been in the same situation again, I would have done the same.

Depression is an illness, just like any other illness, it is not a "waste basket" in which you throw anything you don't understand. Being sad, frustrated, angry, anxious and even desperate about being ill and not receiving reasonable treatment is a very normal emotional response, that I personally do not think should be suppressed.

I'd like to distinguish two completely different points here. The first is that some people with an undiagnosed illness are told that their symptoms are being caused by depression, and their doctors give them anti-depressants instead of trying to figure out what's wrong with them. You were in that situation, and your response makes a lot of sense to me. I hope that in your situation, I would have done the same thing.

The second point, the one I've quoted above, that feelings of sadness etc. are a normal, healthy response to a very sad situation, is different. GrannyJo4 is diagnosed. She is being treated for depression in addition to receiving medical treatment for her MS and MG, and not instead of it. I want to think about your point in this situation, too, as well as in the first.

I once talked to someone whose husband had left her, and she'd been thrown into a state of despair. She was taking anti-depressants to help her function at all. I suggested (this sounds really tactless, but she took it well and I learned something) that her emotions were normal and not pathological, and thus shouldn't be treated. She said, "Well, if your hand got cut off you'd be in terrible pain. Pain is there for a reason. It's a healthy response of your body to a trauma. But you'd still take pain medicine."

Depression is not the same as grief, sadness, anger or anxiety. Depression is when some central part of your personality, what makes you you, isn't able to function properly. Depression can be triggered by things happening in your body (like chemical imbalances) or by things happening in your emotions (like being discouraged about the way your illness is affecting your life). But in either case, the depression is something distinct from its trigger, and it is good to explore ways to address the depression itself as well as (not instead of!) its underlying cause.

So: does it make sense to take anti-depressants when the cause of the depression is healthy, appropriate, normal emotional reactions to something tragic? Maybe not, as you say, if the point is only to suppress these emotions. The emotions themselves aren't the problem. But if the point is to suppress the depression that is a secondary effect of these emotions--then yes, if it works, it makes a lot of sense.

I hope this is coherent. I'm sort of thinking out loud here--I'm always trying to figure this one out myself.

Abby

IMO (of course )

It comes down to time. It is perfectly normal to feel blue, sad, upset etc. Especially when dealing with the symptoms of MG. It is not normal to feel this all the time for an extended period of time (length of time is up for debate). When it becomes a struggle to put a smile on at all and you don't remember the last time you easily laughed, it is time to look at a medical solution to a medical condition.

I went from casually being able to pull the occasional all nighter and easily working 14 hour days to being barely able to cross my living room under my own power. Radiation therapy, pneumonia, MG all contributed to a real change in my condition and view of self. Depression is not unusual for this. It really isn't just a matter of "pulling up your socks and moving on"... it is a real condition and there is nothing wrong with taking medication for it.

Brian.

Abby,

You raise two important questions: one is that of diagnosed (vs. undiagnosed) illness. and the other is pharmacological treatment (vs. no such treatment) for painful (and even at times debilitating) normal emotional responses.

First: You say that GrannyJo is diagnosed and treated for MG and MS, but according to what she says her major current symptom is neither diagnosed nor properly treated.
Also, she didn't say-I feel that I need to be on an antidepressant because of debilitating emotions, but "my doctor is suggesting that I need to be on one"
The point I was trying to make is that (according to my personal opinion) she doesn't need to be on one just because her doctor thinks so (most likely because he doesn't understand or know how to properly manage her physical symptoms).

The answer to the other question you have raised is much more complex and controversial.

Reactive depression is normal sadness, which means that the vast majority of people would have a similar response under similar circumstances. (such as the loss of a loved one or the diagnosis of a serious illness) Pathological depression is a psychiatric illness (just like schizophernia) in which overwhelming and debilitating emotions occur out of any reasonable context. The severity, pain and debilitation can be similar.

There are two major approaches in psychiatry to this-one approach is that which you cite-it doesn't matter if the depression is pathological or reactive, one has to treat those symptoms. ( Interestingly, even those that take this approach would not treat the normal grief of losing a loved one, unless it is beyond a reasonable period of time). The only distinction they make is among depression and normal grief over the loss of a loved one.

If you are interested in this topic there is an excellent book

http://www.amazon.com/Loss-Sadness-P.../dp/0195313046

The other approach is that reactive/normal depression has a role. Which is personal and social. It stems from a very complex cognitive and behavioral process, with social ramifications. This process, if uninterrupted should gradually help you and those around you come to terms with your loss. It also leads to finding constructive ways to deal with it. There is a reason why it is manifested in ways that can be seen by others (such as tears, facial expression etc.), as it makes those around you understand your vulnerability and need for support.

There are studies that show that labeling normal grief as depression and intervening , only lead to a much longer healing process.
The need to suppress those emotions is not always because of unbearable pain to the individual but a social need in a society that constantly advocates being happy and having positive thoughts (and therefore intolerant to unpleasant emotions) .

My opinion on the matter, based on my experience, is that more times than not, reactive depression does not require any medical intervention, if given proper place and support. Just like any other reactive process it is self-limited. And just like I would not treat an enlarged reactive lymph-node with chemotherapy, I wouldn't treat reactive depression (which I prefer to call normal grief) as depression.

But, as I have said there are others who think differently.
The psychiatrist I consulted thinks differently. But, she respected my approach, just like I respect a patient who wants to take anti-depressants. She has been enormous support to me, mostly by encouraging me not to accept the unreasonable explanations and non-substantiated psychiatric diagnoses of some of those who were supposed to take care of me over those years. Even though we differ in our opinion regarding the optimal management of reactive depression, she and I share the opinion that people are free to make their own decision, as long as they are well-informed and understand what it is based on.

Bottom line-In my opinion, If GranyJo feels that taking anti-depressants would be helpful to her, she should definitely take them. But, if she is given anti-depressants by her physician (as was my impression) because it is the "easy way out" then she has the right to refuse them.

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

I tend to agree with AliceMD. So many doctors seem a little too eager to push anti-depressants when they don't know what's going on with their patients. My first neuro actually prescribed an anti-depressant that is on the "do not take" list for MG! Granted I wasn't dxd at the time, but he suspected it (ordered my first AChR binding that was just barely negative). For me, it was a no go. I tried it because he felt it would help my FMS pain. What it did, and others before it (many years ago), was left me lethargic, slow, and foggy. If I saw any pain relief I don't know, cause I didn't care about anything. I stopped after only about 3 days. Personally, I don't recommend it unless you are truly convinced that you are suffering from true depression.

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.

I have Sjogren's, Hystoplasmosis, FMS, PN, etc. On the fourth of July, in the midst of a severe respiratory condition, I drew the on-call substitute doc instead of my regular provider. The drugstore was out of the 4mg Medrol dosepak, so they & the doc agreed to substitute 80MG straight prednisone instead. Needless to say . . . I was gianormously wired (to put it mildly) for four days until I was able to see my provider who put me on a taper for three weeks.

Now . . . I'm at the other end of the spectrum in some sort of pit or other . . . not wanting to get out of bed, or cook, clean, bathe, or anything for that matter.

Of course doctors all consider the half-life of prednisone and say there's no way it could be still affecting me, but with autoimmune wierdness and atypical drug reactions galore . . . my mind & emotions tell me otherwise . . .

Am I off the wall in my thinking or could this be the reason for my depression? I'm NOT having fun yet