Anti Depression drugs anyone?
 

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.

Can crashing after mega-prednisone dose bring on depression?
 

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? :confused: I'm NOT having fun yet :eek:

Exodus, how much medrol were you on?

..Thanks all for your replys!
I really do want to know whats causing the swallowing to stop. I feel the anti depressants would just shut me up about it.

But there are days that I feel so confused about what is happening to me that I think maybe being a zombe for a while might not be such a bad thing, even though it's not helping the problem to be able to swallow again. ( I am not looking forward to the big family Thanksgiving dinner ) All kind of thoughts come into mind, should I sit at the table when everyone sits down to eat, should I go sit in the other room and pretend I'm watching TV and not seeing and smelling all the wonderful food, or should I just not go and tell them I'm not feeling well, but then that would not be nice for my husband.

The 2nd opinion Neuromuschular doctor called today to set up an appt. on Dec. 22. The women who called said they would first do an office visit and then at 1:00 they are going to do a Stimulation test.

I heard that test is very painful, I don't need more pain:(
I have had a EMG and SFEMG but the doctor said those tests were normal.
Those test wern't to painful and was over quickly. I did have a EEG that came back abnormal, but my neuro didn't think that had anything to do with my swallowing problem.

I have to check if the 2nd opinion Doctor and hospital even takes Medicare, I'll call tommorrow to find out. If they don't I don't think I'll even be able to afford going there.

The strange part of this is that I can swallow in my sleep state at night, but as soon as I awake my mouth fills up with saliva and I can't swallow and the choking begins. I go thru the whole day not swallowing at all, just spiting which I find digusting and tiering.

I am praying for an answer and Trusting He hears me!

It sounds very hard and frustrating.

I think the clue is in the fact that you do not have those symptoms when you sleep.

Many times in medicine unusual symptoms that don't fit are the clue to the diagnosis.When I was a resident I made a "brilliant" diagnosis that everyone else missed, just because I didn't think my patient was an excentric old man, that surrounds himself with boxes of tissue paper, but asked him why he is doing this.

In the early days of my training, I had an excellent teacher who told me that being a physician is like being Sherlock Holmes. You have to pay attention to every small detail, even those that seem unimportant or irrelevant, and be cautious not to jump into conclusions just because you see the butler's finger prints on the knife. He told me that if you want to be a good physician you have to learn how to combine art, science and detective work.

I later learned that as a patient you have to do the same. I gradually put together all my "unexplained" symptoms that didn't fit my MG expert's paradigm of MG. I meticulously documented them, checked when and how they appear. At first it was total chaos, like scattered pieces of a jigsaw puzzle, but with time it made more and more sense.

My repeatedly normal SFEMG was a clue, my "unexplained" response to steroids was a clue, my "unexplained collapse like episodes" was a clue,
My "anxiety attack" during a very simple blood test, etc. etc.
It took me more than a year (in which I was nearly bed-ridden and even reading a short paper was a major task) to gradually figure it out.

And yes, I too had days in which it was so confusing and frustrating that I just wanted to get away from it somehow. The thought that it may all be just some emotional problems that could be fixed with some "talking" (not that I was able to talk much at that time) was very tempting.
I could understand how people could eventually accept those psychiatric diagnoses, just sink into it, and stop fighting for what they know is right.
How long can you keep on fighting windmills and dragons at the same time?

As to your question regarding thanksgiving dinner. I personally kept on being with my family and friends as much as possible. I tried to preserve as much of my normal and healthy self and normal social life as possible.
I had (and still have) occasional days of despair, in which I just wanted to be left alone in my room, and not see anyone, but most of the time I participated in social activities just like before.

A Google search "symptoms disappear during sleep" yields results heavily laden with movement disorders.

MS can cause movement disorders. Worth asking about, IMHO.

sounds like it could definitely be a step in the right direction. :)

Dear Grannyjo
 

I agree with another post here. Please be careful if you decide to take an anti-depressant. some of them can cause swallowing difficulty, you don't want to make your problem worse. Did you receive an upper GI endoscopy? I have difficulty swallowing also, due to barretts esophogus. They took me off serequel, because it is counter indicated for people with swallowing difficulty. I am sorry this has happened to you. I know how uncomfortable it is not to be able to swallow well. Tell your family the truth, maybe there will be some support for you, and some compassion. Allow them to help you through these difficult times. I will keep you in my thoughts and prayers. ginnie

..Thank you all for your support and replys.
To Ginnie, When the Gastrol Doc. put in my feeding tube he went down thru my mouth and while he did this he was checking out my esophogus and stomach area. He said everything looked healthy inside.
My swallowing problem is differant from a esophogus problem I think because I can't get the message to my throat to swallow. I put in the food or drink and there is no click for it to swallow. The drink will usually run down my windpipe and the food will just sit there in my mouth until I spit it out.

To Alice md, Another strange thing or clue is I have so much drainage post nasel that I can't swallow, along with my saliva But before the feeding tube was put in I Always had my nose dripping on the outside so I always had a tissue in my hand to dab it away. Why now is the drainage Only running down my throat and trying to choke me? I wonder if the Gastrolagest moved something in the back of my throat when he put the scope and then the peg tube down there.
I also wonder if I should go to a nose throat specialist. It's all so crazy, maybe thats why they want to shut me up with antidepression meds.

I went for a musk blood test, it should be back in a couple of weeks, maybe another clue to whats going on with me.
My neuoro said he's not questioning the M.G. dx. he's just dosen't think thats why my swallowing is gone, hence the 2nd opinion.

Hello granny
 

I now understand the difference. Your brain is not sending the correct message to swallow. This must be very hard for you. I hope there is a solution to the problem so that you can enjoy food once again. Have they given you any reason for this? You didn't have a stoke or something like that? I will keep you in my prayers, and hope that your doctors can do something to make your life easier. Loosing the function of our bodies is very difficult to live with, and can make a person depressed. I know they want to give you that kind of medication. Most of them do not make you spacy or have bad effects. Please try to be good to yourself. I will keep checking back with you to see how you are doing. In the meantime I will pray that there is resolution for this swallowing problem. I also hope you are able to have a peaceful thanksgiving, surrounded by love and support. ginnie

Can Prednisone Overdose bring on depression?
 

Drugstore was OUT OF MEDROL (the 4mg dosepaks) that's how I ended up on thoughts - no sleep - ready to leap tall buildings in a single bound - even after the 3 week taper. That was 3rd of July . . . now - I'm at the opposite end of the pole - have to literally drag myself out of bed to accomplish anything at all - amotivational, bigtime :mad: :confused: :eek:

Hello exodus
 

prednisone does cause all kinds of side effects.
everything from feeing depressed, to being super hyper. It has to be tapered off, when you have been on it long term. It can effect sleep and your appetite. I hope you don't have to take this medication a long time. I had an experimental protocal for an auto-immune deficiency in the 80's. To calm the effects of the drugs I was taking, DNCB a topical immunosupressant, I was given prednisone. I hated that drug more than the DNCB treatment. It is a medicine to be careful with. ginnie

There is a place for antidepressants in depression and a place for psychotherapy and what seems to work best in the long run is psychotherapy or both. My family has a history of serious depression. It is chemical and responds well to chemicals. Without antidepressants there is overwhelming sadness, intrusive thoughts, and difficulty functioning, even when you know you are basically happy.

Regarding Alice's comments, although doctors didn't attribute my symptoms of MG to depression, I did, not the unexpected weakness, but others. For many years the doctors I was seeing just didn't think anything was wrong. I did attribute to depression symptoms that I now know were due to MG. The difficulty starting jobs I really wanted to do was one of them and having to break tasks down into parts. I have learned that when I stand and stare at a job that needs to be done, it is my body telling my mind there is a very good reason that I shouldn't be doing it.

When treatment for depression interferes with solving problems instead of giving you the energy and tools to do so, then that is not helpful. If you can function and problem solve better with treatment that is good, if you are numb, that is not. nc

..Thank you all for your good thoughts. It is such a strange time for me, not knowinging if my swallowing stopped from the M.G. or the M.S. or some other physical problem OR my subconscious is too Afraid to allow me to swallow. Every time I choke or have to spit out my saliva or clean the area around my feeding tube or look in the mirror and see this strange thing hanging out of my stomach or take my feeds, water and meds thru the tube , it reinforces the idea that I I Can't swallow. I have decided for now not to go on a anti depression drug until I know what I'm dealing with. I do take xanax at bedtime and klonapin once or twice a day if I'm getting to worked up. I think the anti anxiety meds are working o.k. for me right now because I just take them when I really need to. Again Thank you all for your support! :grouphug:

GrannyJo, I am happy to meet you. Hello. :)

Thank you to everyone who responded to this post, has helped me a lot.

My neuro is also insisting I take antidepressants and I don't think I need them. I don't have clinical depression, but I am facing financial troubles because I am unable to work and am soon reaching a time when I will have no money left to live on, and no medical insurance either. I really need help of some kind and not antidepressants.

I've applied for social security disability and would love to work, but can't find any job that I can do that will work with my MG issues (can barely find energy to even look for a job). I am feeling deperate and asked my neuro what I CAN do, that I need to figure out a source of money to live on, either a job or disability...he offers no real suggestions, tells me my MG is too mild for disability, refuses to fill out any disability related forms, and he tells me to take antidepressants! That solves nothing at all. Maybe I actually do feel depressed now but the reason is because I feel like no one is supportive.

Anyway, I don't want to go on about my troubles here in your post, other than to say I have issues to solve that are causing me to be angry, stressed and scared...not depressed! I'm really working hard at solutions.

I agree with the other posters here, sometimes feeling stressed or upsed is a motivation to fix things in our lives, for me it certainly is, and there is no reason to suppress depression if there is a logical reason for it. It is part of a grieving process for me, as I have lost my old self and can't see a new way into the future yet.

I did go see a therapist recently, because my neuro has recommended this as well, one I've seen before and trust, because I also have PTSD...and he wants me to take anti-depressants, too. I do think he will support my decision not to take them but he asked me to consider it.

In my opinion, unless you (and I) are clinically depressed, we don't need anti-depressants.

Honestly, if I had either a job that I could do that would pay my bills or some other source of income that would cover the basic necessities in life, I'd be happy. In fact I'd be happy immediately, I don't have some sort of imbalance causing a depression. I've started learning how to live with MG and seem to be stabilizing and feel good about thiat, I've even FINALLY accepted that I have limits and will never be my old strong and energetic self, I'm happy to be my new MG self and it does feel good (except when I do some part time temporary work, then I crash for a while and regret trying to work). I love my kids and family. I don't have any reason to be depressed other than the fear of the future and lack of mony. My kids haven't had any christmas presents for two years because of the MG and probably not this year either, I haven't had any new clothes or anything besides food for over 2 years.

If antidepressants will put money in my bank account, I'll take them gladly, but in all honesty, they cost money and I have no medical insurance, I think they will only add to my burden. I need a real solution! I hope the disabilty works out but if it doesn't I am out on the street or more likely asking relatives if they will care for me and my kids, I imagine they will but I hope I don't have to ask...it is really that desperate for me.

What is this thing about doctors and anti-depressants? Why can't the doctors help with actual solutions? I hope this therapist will offer some other solutions, I do have hope in him...

I see from reading this post that I am depressed...hopefully my feelings will motivate me to find a solution soon.

GrannyJo, I do see how having a crisis could make your mind somehow be afraid of swallowing. I have anxiety issues myself and have discovered that there is a mental aspect to my symptoms. Even though I am diagnosed with MG and have antibodies, my stress level can trigger symptoms, maybe if I solve my issues my MG will become less severe, I can only hope, for me and for you...MG is so complicated and unique to each individual, seems as if no one really understands how it works.

I hope you feel better soon.

Hi Desert flower
 

[You are right, not everybody needs anti-depresants. I think the doctors sometimes don't know how to help, then offer those because they can think of nothing else. Do you have a womans resourse center in your neck of the woods? We have them here, and sometimes they can lead to jobs, and or some help with your bills until you find some kind of job. I know so many in this situation, that have no insurance, and no job. Gosh I hope something comes through for you. Look into A womans resourse center. If you can't qualify for Social security disability, you need a job, not another pill. If you were going to try for disability, then maybe I would consider the medication offered. As far as cost goes, the manufactures often have programs for those who do not have the money for their medications. For several years, before I qualified, I received several of my medications free. Sometimes your doctor can provide them to you from office samples if they know your financial difficulties. I sure know about that too. So sorry you are going though this. Ginnie

Ginnie, thank you. I hadn't thought to ask for office samples or contacting manufacturers. I'll consider the pills. It seems kind of silly that it might help get disabilitiy if I take more drugs. I'll also look for a woman's resource center. Great ideas. :)

I do want to note here that my kids have state covered insurance, but I do not qualify for it due to the money in my bank account that I am using to live on, money I saved in a retirement account but had to withdraw after getting MG.

I wish you well with your own healing and treatments.

Hi desertFlower
 

I hope thinks work out for you. I was in the situation of having no insurance eithor. My retirement was destroyed because I had 6 surgeries with no insurance. I hope and pray that does not happen to you. My doctor did give me samples for years. The anti-depressant drugs are considered when you get an evaluation for SS. The more you have in your case about your condition the better it is. I do take anti-depressant, zoloft. I had considered my depression due to the stress of having severe medical conditions. They do work a bit, but are no means a magical solution to feeling low. You said you MG is not bad enough for retirement, or SS, but you mentioned how difficult it was for you to work. It seems like you pay a price for working. I will hope that you find something, maybe through that womens center that can lead to some kind of position where you won't upset the MG. I was a single mother of two also, so I know how hard it is to stay on top of things. Not being able to provide for your family can weigh so heavily on a persons heart. I do wish you all the best, and I will try to think of another avenue that you may be able to persue. ginnie

Thank you Ginnie.

MG means so many life changes, it is overwhelming at times, all I can do is deal with one at a time.

A little Advice:-)
 

Hello there,

I have flip flopped from depression med to depression med...either they didn't work or they made me sick. I was put on Zoloft 100mg twice daily about 9months ago by my Nuerologist and it has done wonders:-) I suffer form epilepsy, and have had a few surgerys. Zoloft has been the one to work, if you haven't tried this, I would recommend it:-)
I will be praying for you, and hope my advice helped...