Lupus and Depression

Many people experience situational depression which is a short-term depression resulting from shattered expectations such as the death of a loved one, a divorce, the loss of a career, etc.  Some people experience biochemical depression which results from a mental or physical illness that temporarily or permanently alters their biochemistry resulting in their emotions and rational thinking being skewed.  It is very important to know the difference because, as the Captain of Your Own Health, you will want to ask for medical and psychological assistance from the appropriate professionals.  In other words, it would be advantageous to meet with a psychologist to talk through the pain of loss; however, if the depression you are feeling has a biochemical basis all the talking in the world will not help you feel better.

Autoimmune diseases including Lupus, by their nature, cause a form of biochemical depression.  Remember, autoimmune diseases are defined as diseases wherein the body attacks its own tissues including the brain.  The resulting altered biochemistry causes skewed emotions.  Fortunately, by being open and honest with your medical professionals you can be prescribed one or more medications to help bring your body’s biochemistry back to a more normal state and decrease or even eliminate your depression.  It may take more than one visit and more than one prescription to achieve that result because each person’s biochemistry combined with their illnesses will react uniquely to prescribed medications.  So if you are prescribed a medication(s) for depression and find that it is not helping, go back to your doctor and let him/her know and request a different or additional prescription.  Stay open and honest with your doctor and eventually you should be prescribed the medication(s) that works best for your individual needs.

Once your body is functioning in a more non-depressed state, you can seek out a mental health professional to talk with about the significant changes that the development of a chronic, permanent autoimmune disease brings with it.  A loss or significant change of any kind brings challenges, even for completely healthy people!  Imagine how much more challenging sudden and unwanted changes bring to someone who develops a permanent autoimmune disease and no longer has the health, emotional, mental and other abilities to meet and deal with it!

I am a born optimist with a ‘can-do’ attitude.  I maintained straight A’s throughout my school career, had many friends and activities, and graduated early at the age of 17 to attend college.  I began working full-time at the age of 16 because I liked the challenge of balancing work, school, and my personal life.  The income was nice too!  I entered the U.S. Army on my 18^th birthday, finished Basic Training with a promotion, and went on to a successful military service with an honorable discharge.  When I later began working for Federal civil service I had an ambitious attitude and sought every opportunity to achieve and receive promotions.  I retired as a GS-11 and look back on a very interesting and challenging career.  During this same timeframe I raised 2 children, kept a nice home, attended college part-time and graduated with an AA, had many friends, enjoyed many hobbies, volunteered in my religious community, was a gym rat with a fit body, and more.  In other words, I was an energetic, go-go person and it was rare that I sat still and I loved it! 

At the age of 44 Lupus dropped me to my knees.  My body became a prison of pain and frustration, my emotions began to drop into a deep depression (both biochemical and situational), and my thinking became foggy and forgetful.  Overnight I was unable to rise out of bed and so had to go on extended sick leave resulting in the loss of my career my eventual early retirement on disability.  I could no longer travel, entertain or visit friends, attend church services, hold a thought for more than a split-second, remember to pay bills, accomplish the many tasks that keep a home in order, go grocery shopping, and more.  In short, overnight I became a bedridden, unemployed, lonely mess of depression and pain and had absolutely no idea how to deal with the situation.

Additionally, at the onset of my illnesses the doctor had prescribed a course of prednisone which resulted in my gaining 60 pounds.  My fit body morphed into a blob.  Half my hair fell out.  I felt pain in every part of my body.  Migraine headaches became a daily, debilitating fact and nothing relieved them for the first year of my illness.  My body was so exhausted that I slept most of the time for the first few months of my illness. 

Fortunately, my doctor had also prescribed the medication Placquinil and I still take it daily.  This medication takes about 3 months to become effective and at about the 3 month point after beginning this prescription my mental fog began to lift enough to allow me to take stock of my situation.  I was devastated that my workplace refused to accommodate me and allow me to return to work and continue my career, all but one of my friends found themselves ‘too busy’ to maintain friendships with me, my religious community asked me to resign from my volunteer duties and then I heard not a word from them again, it was impossible for me to do the daily duties required to keep my home in order, etc.  My family, including my spouse, became increasingly angry and frustrated with me and my situation.

I felt completely alone and deeply depressed and wondered if life was even worth living anymore.  I was facing the biggest challenge of my life and at the time did not have the tools to deal with it.  I spent the first year of my illnesses simply trying to understand what was going on, working to find the right balance of medications to deal with the situational and biochemical pain and depression that I was feeling, worried that I may die from my illnesses, worried that my spouse may leave me, worried that my home was falling apart without my ability to keep it in order, worried that even my last friend may leave me, worried that I would never again be the fit person I once was, etc.  I even wondered if God was angry with or had abandoned me.  It was a terrible place to be. 

This is a typical experience for people whose lives are suddenly and dramatically altered by the development of chronic, debilitating illnesses of any kind, both mental and physical.  If the correct medical and psychological assistance is not sought and found, the correct and effective medications are not prescribed and taken, etc., these people will not survive.  Approximately 10% of people who develop autoimmune diseases die within the first year of their illness.  A lucky 10% of people will find that their autoimmune illnesses will go into permanent remission after the first flareup.

For the other approximately 80% percent of people whose autoimmune illnesses are treated effectively with medical and psychological help, they can expect to live a normal lifespan and their autoimmune illnesses will be termed ‘chronic’.  How they adapt to their ‘new’ bodies and how they structure their ‘new’ lives is the challenge they face.

At approximately the one-year point of my illness I had realized that at least one of my worries could be set aside:  I was part of the 80% and would not die but would most likely live a normal lifespan.  Then came the question of how to live in this ‘new’ body and with this ‘new’ life?  I literally sat down and began to write a list of ‘what I can still do’ and ‘what I can’t do anymore’.  It was a sad but enlightening day.  I was resolved and angry at the same time.  Stupid Lupus had taken away my ability to live independently.  Stupid Lupus had taken away the future I had planned.  BUT I hadn’t died and so I decided to try to find the positives in my new situation.  I decided that Lupus was ‘just’ one more of life’s challenges that I needed to meet.  Even though it wasn’t fair, I had evidently morphed from a healthy 44-year-old into a sickly 100-year-old overnight.

How does one face this challenge?  Many studies have shown that certain personality characteristics can predict a positive adaptation to life’s challenges no matter what they may be.  Specifically, these characteristics are a person’s commitment to meeting challenges as best they can and a person’s ability to adapt and maintain effective control over themselves and their environment no matter what changes occur.

If a person believes in their ability to overcome life’s challenges, and not to be overcome by life’s challenges, they will move forward to live positive lives no matter what challenges come their way.

Certain external factors also contribute to an individual’s successful adaptation to life’s challenges.  They include:  family and friend support, sufficient financial support and resources, connection to a community (religious, educational, or other) that allows them to feel ‘a part of’ a larger community, a trust relationship with one’s assistance providers (medical, home care, etc.), an understanding that physical/emotional/mental limitations are an eventuality (think old age) for everyone and so can be understood as ‘just’ a part of life, an ability to be appreciative of and accepting of assistance for their limitations, and an ability to take stock of one’s remaining abilities and to make the most of them.

How have I adapted?  I no longer define success as over-achievement in every category of life.  I take each day as it comes.  Some days are ‘pajama’ days during which I catch up on movies, take pain meds to endure, and cuddle my pets; some days are ‘sit on my butt’ craft days during which I sew or quilt and appreciate an absence of extreme pain for just that day; some days are good days during which I can take walks, prepare a dinner, and otherwise be ‘normal’.  I accept that with the development of my autoimmune disease my old self essentially died and my new self was born and I am thankful to still have a life to continue to live.  I pursue friendships with people who are understanding of my limitations; have continued my religious learning with online resources; have continued my education with online college courses; travel by watching such shows as Aeiral America and others on cable TV; visit friends via email, texting, and Skype; and more.  I have let go of societies expectations that as a modern women I must ‘bring home the bacon and fry it up in the pan’.  I live by my own expectations of what defines a successful life.  I have let go of friends and some family members who cannot accept my situation; have let go of hobbies and activities that are now not possible; and have come to the understanding that it is completely OK to do this.

Did you know that depression can be defined as anger and frustration turned inward?  If it is necessary, get angry about your situation in order to move beyond your depression.  Demand help from all and every resource!  Make your needs known to your family and friends and ask them to develop an empathy and understanding of your situation.  LIVE!  You aren’t dead yet and so you are one of the lucky 80%!