Am I depressed or just sick? Am I depressed because I am ill? Am I ill because I am depressed?
The National Institute of Mental Health provides the following list as signs of depression:
- Feeling sad, irritable, or anxious;
- Feeling empty, hopeless, guilty, or worthless;
- Loss of pleasure in usually-enjoyed hobbies or activities, including sex;
- Fatigue and decreased energy, feeling listless;
- Trouble concentrating, remembering details, and making decisions;
- Not being able to sleep, or sleeping too much. Waking too early;
- Eating too much or not wanting to eat at all, possibly with unplanned weight gain or loss;
- Thoughts of death, suicide or suicide attempts; and/or,
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.
Think about that list. Most of the items, with possible exceptions of the final two, are fairly common in cases of chronic disease or illness. For the individual, this can create uncertainty regarding mental, or even physical, health. If the root cause is unclear, so too is the treatment plan.
What does this mean for the individual? I think it means that those of us dealing with chronic illness need to take it easy on ourselves when we can’t maintain a positive mental state. It doesn’t mean we should give up, but we shouldn’t feel so guilty.
What does this mean for caregivers? Patients with chronic conditions may need treatment for depression or they may need to be reassured that these feelings don’t necessarily mean clinical depression. Caregivers may need to spend more time talking to patients to get at the psychological and emotional issues, and maybe be prepared for some tears, or guilt, or anger.
What does this mean for family and friends? The person you care for may not be able to be as fun as you want, even during times when the illness seems to be under relative control. Your loved one may need you more mentally or emotionally than physically, but simultaneously may feel an abundance of shame about that. And you may, in turn, be angry or frustrated and need to find someone else to talk to about it.
The interaction between chronic illness/disease and mental wellbeing is complicated, like people are. We can’t expect it to be simple or easy, whether we are the patient or those offering support.