Post-Polio Health (ISSN 1066-5331)
Vol. 15, No. 3, Summer 1999
Recognizing Depression
Editor's Note: Fatigue is one of the three major symptoms described by the survivors of polio along with pain and weakness. Fatigue has many causes including overuse of muscles and joints, deconditioning, side effects of medications, and underventilation. Fatigue is also a sign of depression. Studies conclude that most polio survivors (see Vol. 14, No. 3) do not experience depression more than the general population in which 3.3% are affected by major depression. The articles in this issue are for those who do.
PHI welcomes any comments and will keep such information confidential. Feel free to email editor@post-polio.org or call 314-534-0475.
Linda L. Bieniek, CEAP, Chicago, Illinois
Linda L. Bieniek is a certified employee assistance professional (CEAP) who augments her professional ability with her personal experience as a polio survivor and ventilator user.
Depression varies in its form, symptoms and severity. Whereas common symptoms include fatigue, irritability, and difficulty concentrating and remembering, bipolar depression manifests itself through both manic and depressive characteristics. Any of these symptoms can impair an individual's functioning, health, careers, relationships and financial stability, as well as adversely affect the lives of loved ones.
For polio survivors, recognizing and treating depression effectively is critical because depressive symptoms like fatigue and sleep disturbances can exacerbate symptoms of the late effects of polio. One study reveals that none of the polio survivors who clinically met the criteria for depressive disorders were in counseling or taking antidepressant medication (Kemp et al., 1997). Outcome studies prove that depression is treatable (Gilbert, 1992), with the greatest improvements coming from a combination of psychotherapy and pharmacology (Hales, 1995).
Depression may develop from:
- Physiological causes such as a chemical imbalance;
- Ongoing or accumulated distress which depresses the brain's neuro-transmitters (Hales, 1995);
- Chronic emotional or physical illness, addictions, neglect or abuse in one's family history (Gilbert, 1992);
- Responses to losses such as a decline in functional abilities or loss of a job;
- Reactions to present day situations which relate to unresolved feelings from past experiences (Westbrook, 1996);
- Difficulties from an original illness or its effects later in life (Hale, 1996);
- Separations from primary caregivers during infancy and critical developmental stages (Plimpton & Rosenblum, 1987);
- Traumatizing experiences such as intrusive medical procedures;
- Certain medications, physical illnesses or use of substances such as alcohol (Hale, 1996).
Historically, polio survivors are recognized for their achievements and adaptations to their disabilities. However, these same individuals who value being perceived as strong need to understand that depression is not a character defect and that seeking professional assistance requires courage and inner strength.
Those who deny feeling depressed may reveal the presence of symptoms when telling stories or answering open-ended questions. For example, patterns of over-eating, drinking alcohol, sleeping excessively and overworking are ways of sublimating feelings – irritability, loneliness, anxiety or even excitement – that may mask some level of depression.
When depressive symptoms exist, a thorough assessment by a behavioral health professional is needed to identify the underlying causes of symptoms. These professionals, who vary in their approaches, include psychiatrists, psychologists, social workers, employee assistance professionals and other counselors.
Treatment options that have demonstrated value include individual and group therapy using non-judgmental approaches; non-addictive medications such as antidepressants; trauma resolution therapies and various interventions. Complementary resources range from support groups to workshops, self-help books and alternative therapies (Bieniek & Marshall, 1997), but any approach that claims to achieve absolute results signals a need for caution.
Recognizing Depressive Illness
Clinical depression is a "whole body" disorder that affects body, feelings, thoughts and behaviors. Depressive illnesses come in various forms. Some people have a single episode of depression; others suffer recurrent episodes. Still others experience the severe mood swings of bipolar disorder, sometimes called manic-depressive illness, alternating between depressive lows and manic highs. Others have ongoing, chronic symptoms.
When four or more of the symptoms listed below for depression or mania persist for more than two weeks, an accurate diagnosis and professional treatment should be sought.
Symptoms of Depression
- A persistent sad, "empty" or anxious mood
- Loss of interest or pleasure in ordinary activities, including sex
- Decreased energy, increased fatigue, being "slowed down"
- Sleep disturbances (insomnia, early-morning waking or oversleeping)
- Eating disturbances (loss of appetite and weight, or weight gain)
- Difficulty concentrating, remembering, making decisions
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Thoughts of death or suicide, suicide attempts
- Irritability
- Excessive crying
- Chronic aches and pains that do not respond to treatment
- Symptoms of Mania, ranging from moderate to severe
- Inappropriate elation or irritability
- Decreased need for sleep
- Increased energy
- Increased talking, moving, and sexual activity
- Racing thoughts
- Disturbed ability to make decisions
- Grandiose notions (National Institute of Mental Health, 1992)
References
Bieniek, L., & Marshall, M. (1997, June). Trauma resolution resources. Presentation at Gazette International Networking Institute's Seventh International Post-Polio and Independent Living Conference, Saint Louis, Missouri.
Gilbert, P. (1992). Depression: The evolution of powerlessness. New York, NY: The Guilford Press.
Hale, T. (1996). Spiritual response to traumatic illness. Polio Network News, 12(3), 6-7.
Hales, D. & R. (1995). Caring for the mind: The comprehensive guide to mental health. New York, NY: Bantam Books.
Kemp, B., Adams, B., & Campbell, M. (1997). Depression and life satisfaction in aging polio survivors versus age-matched controls: Relation to post-polio syndrome, family functioning, and attitude toward disability. Archives of Physical Medicine & Rehabilitation, 78, 187-192.
National Institute of Mental Health. (1992). Depression awareness, recognition, treatment fact sheet. Washington, DC: DHHS.
Plimpton, E., & Rosenblum, L. (1987). Maternal loss in nonhuman primates: Implications for human development. In J. & S. Bloom-Feshback (Eds.) The psychology of separation and loss (pp. 63-86). San Francisco, CA: Jossey-Bass Publishers.
Westbrook, M. (1996). Early memories of having polio: Survivors memories versus the official myths. Paper presented at the first Australian International Post-Polio Conference.
Future issues of Polio Network News explored emotional issues that
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Emotional Bridges to Wellness by Linda L. Bieniek, CEAP Polio Network News, Vol. 17, No. 4, Fall 2001 |
A Guide for Exploring Polio Memories by Linda L. Bieniek, CEAP, and Karen Kennedy, MSW, RSW Polio Network News, Vol. 18, No. 3, Summer 2002 |
Improving Quality of Life: Healing Polio Memories by Linda L. Bieniek, CEAP, and Karen Kennedy, MSW, RSW Polio Network News, Vol. 18, No. 1, Winter 2002 |
Pursuing Therapeutic Resources to Improve Your Health by Linda L. Bieniek, CEAP, and Karen Kennedy, MSW, RSW Polio Network News, Vol. 18, No. 4, Fall 2002 |
