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  1. by Chelsea Goldstein, Dysautonomia Information Network Mental health conditions, like depression, are often difficult to talk about because of their stigma. If you live with dysautonomia and depression you may be even more hesitant to talk about your mental health needs out of fear that your dysautonomia will be dismissed as "all in your head." Unfortunately, this can lead to improper treatment of dysautonomia, depression, or both. However, we rarely discuss how it is normal to live with BOTH depression and dysautonomia. In fact, research demonstrates that about 25 to 33% of people living with chronic illness also have depression, and understandably so (1). Dysautonomia is a life-altering condition that can bring about sudden changes in careers, relationships, physical ability, and identity. Feelings of despair, grief, and sadness are typical for anyone experiencing such dramatic change and loss (2). This article provides a brief overview of the types and symptoms of depression, and how depression may present with dysautonomia so that you can work with your medical providers to get appropriate treatment for your physical and mental health. Types and Symptoms of Depression These are general descriptions of depression, and each person's unique experience may not fit within these exact categories. If you suspect you may have depression, you should seek diagnosis and support from a qualified medical professional. Clinical Depression Clinical depression refers to a group of conditions that are long lasting and not necessarily triggered by a specific event or stressor. They can interfere with a person's ability to engage in everyday activities, including work, school, self-care, and family. People with clinical depression will generally experience five or more of these symptoms (1): Difficulty sleeping/sleep change Inability to enjoy activities Agitation or extreme lethargy Feeling worthless/self-hatred Extreme guilt Suicidal thoughts Extreme weight loss or gain Increased irritability in children There are several types of clinical depression. Common types are (3): Major depression - a low mood is regular and all-consuming Persistent depressive order - a low mood for at least two years that may not be as severe as major depression Bipolar disorder - episodes of depression AND high energy Seasonal affective disorder - depression due to shorter days Perinatal/postpartum depression - occurs during pregnancy and/or in the first 12 months after birth Situational Depression Situational depression can occur after a major life event, such as a divorce, job loss, death, or significant change in health. Some sources report that symptoms usually surface within the first 90 days after the trigger (4), and subside within six months (5). The symptoms of situational depression can be very similar to symptoms of clinical depression with the differentiating factor being a specific triggering event (1). It is normal to experience depressive symptoms after such profound loss (1), and you may experience them throughout your adjustment to your new life situation (4). It is also important to note that situational depression is different than post-traumatic stress disorder (PTSD), which usually lasts longer than situational depression and is characterized by anxiety, flashbacks, and reliving traumatic experiences. However, depression and PTSD can co-occur (5,6). Depression and Chronic Illness As mentioned above, it is normal for people with physical chronic illnesses to experience depression. It can be difficult, however, to understand the relationship between your physical and mental health when you are dealing with multiple conditions. Most people with chronic illness will experience some type of mourning as they adjust to their circumstances of living with their condition(s). Feelings of grief, loss, mourning, and sadness may or may not be related to clinical or situational depression (1). Regardless of the cause, it is important to remind yourself that there is no shame in experiencing a full range of emotions no matter your life circumstances. While only a qualified medical professional can diagnose depression, it is important that you are aware of its symptoms so that you can seek appropriate professional support if needed. This is particularly important for people living with dysautonomia and related chronic conditions because common symptoms of these physical conditions, such as fatigue, appetite changes, brain fog, and insomnia, can also be symptoms of depression. Unfortunately, people with chronic condition(s) and their loved ones frequently dismiss these symptoms as "normal" parts of living with chronic illness when they may be related, in part, to depression (2). A strong understanding of your underlying physical and mental health is critical to getting appropriate support. Individuals living with dysautonomia should also be aware of medication-induced depression, or depression that results as a side effect of specific medications. A thorough review of your medical history, an inpatient exam, and even lab work to confirm the amount of the suspect medication in your bloodstream are the best ways to determine if you are experiencing medication-induced depression. If you are starting a new medication, it may take your body about four weeks to acclimate. You may want to work with your medical professional to switch to a different medication if you are experiencing depressive symptoms after four weeks that onset with the new medication. While situational depression is common and expected among people adjusting to life with chronic illness, it is also normal for people to live with multiple chronic conditions, including clinical depression. If you find that your symptoms of depression are long-lasting, try to remember that you cannot force yourself to "just get over it" no more than you can will your body to magically cure your dysautonomia. Instead, recognize that these longer-lasting symptoms may be an indication that you are living with clinical depression, and you deserve access to support and management strategies to be as well as possible. Similarly, it is important to understand that you can experience more than one type of depression at a time (1). Living with chronic illness and depression in a society full of stigma is tough, to say the least. Dealing with dysautonomia can bring about depressive symptoms that, in turn, can impact the management of your dysautonomia (1). Try to be kind to yourself as you navigate these complexities. Management Options These are a few general management options. You should work with your medical professional to tailor a plan specific to your needs. Early diagnosis of depression among people with chronic illness has been shown to lead to overall improvements in health, better quality of life, and stronger adherence to medical management plans (2). These results demonstrate that it is best to seek professional support and treatment as soon as possible if you suspect you may be living with depression. Some management options include: Medication: Medication is not right for everyone, but can be an effective management tool for some people. It is not fully understood how antidepressants work, but they are believed to effect the brain chemicals involved in depression (2). It may take some time and a strong understanding of your overall health to find a medication regimen that works for you. Psychotherapy: Psychotherapy, also referred to as simply "therapy," is an umbrella term for a number of techniques used to treat depression, and other mental health concerns. Goals of psychotherapy may include understanding major life events (e.g., illness, family issues) that have contributed to your depression, identifying behaviors, emotions, or thought patterns that feed depression, and regaining a sense of control and joy in life (2). Support: While medication and/or psychotherapy may be appropriate options for managing your depression, it is also important to surround yourself with supportive environments where you feel you can discuss your mental health openly, either in-person or online. The DINET Forum is one space where you can virtually connect with other people living with dysautonomia, as well as provide support to fellow members. It can be surprising how much helping someone else can positively impact your own mental health. Combination management: It may take time and open communication with your medical professionals to find the management plan that works for you, and you may find that your ideal plan is a combination of medication, psychotherapy, support, and/or other lifestyle adjustments such as diet, meditation, and exercise. In fact, it is quite normal to manage depression with multiple techniques, just like dysautonomia. Just remember that it may take some time to figure out what works for you, and what works today may change over time. If you or a loved one are experiencing suicidal thoughts contact the National Suicide Prevention Hotline at 1-800-273-8255. Resources Article Citations MacDonald, H. (2020, February 20). Mental Health and Chronic Illness. Dysautonomia Information Network (DINET). https://www.dinet.org/info/newsletters/mental-health-and-chronic-illness-r232/   Chronic Illness and Depression. (2017, January 17). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/9288-chronic-illness-and-depression Merz, B. (2018, June 9). Six Common Depression Types. Harvard Health Publishing. https://www.health.harvard.edu/mind-and-mood/six-common-depression-types Higuera, V. (2018, September 28). Situational Depression or Clinical Depression? Medical News Today. https://www.medicalnewstoday.com/articles/314698 Mental Health and Adjustment Disorder. (2018, October 18). WebMD. https://www.webmd.com/mental-health/mental-health-adjustment-disorder#3 Tull, M. (2020, March 27). The Relationship Between PTSD and Depression. Very Well Mind. https://www.verywellmind.com/ptsd-and-depression-2797533 Additional Resources DINET Forum https://www.dinet.org/ National Suicide Prevention Lifeline. https://suicidepreventionlifeline.org/ National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml Anxiety and Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/living-chronic-illness Creaky Joints. https://creakyjoints.org/support/depression/ NOTE: This article is available in pdf format below. Printed copies for support or community groups are available by request to webmaster@dinet.org Please include the purpose, name of the group and number of copies requested. PDF link: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:9e6036eb-16ba-41a1-9bf8-09af8c281b48
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