Depression and Mental Health Disorders
Sometimes they are primary, sometimes they are secondary - finding out which is critical to proper diagnosis and treatment of chronic neuroendocrinimmune disorders
©2003 Melissa Kaplan
People with CND are often misdiagnosed as being depressed, bipolar, obsessive-compulsive, ADD, ADHD, and other mental health disorders. The problems with being misdiagnosed is that the patient isn't receiving treatment that will actually help with the symptoms.
Mental health disorders, while being increasingly recognized as an organic health problem, is still highly stigmatized both within the health profession and society at large. As a result, when a patient's doctor can't figure out what is wrong with the patient (or don't want to take the time, or can't due to pressures imposed by managed care and HMO practice models), the doctor writes out a psych referral, in effect, dumping the patient on someone else. Just as a carpenter sees a hammer or saw as being the solution to every problem, a mental health professional sees the head as being the problem.
Unfortunately, they are usually looking at the wrong parts of the head! Mental and CND orders both affect the brain, neurochemistry, and, ultimately, behavior, but the causes are very different. People with CND who are treated only as if their condition is "mental" will not get better. And who does a health care provider blame when the patient doesn't get better? The patient, of course, not the practitioner.
There is something else that compounds the problem of getting properly diagnosed and treated: the patient's own bias against mental health disorders. Many refuse to recognize or accept the fact that, along with having CND or other health disorder, they may also suffer from depression. The depression may be secondary to the changes related to being sick and unable to be the person they once were as illness socially and financially isolates them. But the depression may also be due to a biochemical disorder resulting in depression, anxiety, panic, and other behavioral disorders that further impact the patient's ability to get through the demands of their already altered life.
So, while depression doesn't cause CFS, FM, MCS or any of the other CND, depression may be secondary to it and so benefit from being properly addressed and treated with short term therapy (drug only, or drug and short-term talk therapy with a therapist experienced in working with the chronically ill).
We can't lose sight of the fact that, just as we can have CND and develop diabetes, breast cancer, hypertension, or any other disease and "healthy" people get, so, too will some of us develop a mental health disorder. Some may have been seeing it's slow onset prior to getting sick with a CND, while others will see it starting to manifest after onset of CND.
A number of people with CND experience panic and anxiety after onset. Many people with CND are diagnosed with PTSD. Many are survivors of early childhood abuse, or children of alcoholic parents. There are more people with CND who have not developed post-onset panic and anxiety, and who had Normal Rockwell childhoods. What is a common thread between CND and the traumatic experiences in survivors is that we are now finding that trauma does alter brain chemistry and, in some cases, the development and size of some of the brain's structures. The astute medical practitioner and patient will recognize that a patient presenting with CND and another disorder needs to have both disorders address appropriately.
This means that the astute patient will approach taking appropriate medication for mental/behavioral disorders in the same spirit as they approach taking medications for physical disorders: to correct a chemical imbalance.
The same goes for talk therapy. Even if you aren't depressed and don't have a mental/behavioral disorder, coping with the changes in our lives as a result of chronic illness that disables us to the point of being unable to work any more, talking out your riotous feelings and anxieties, all normal under the circumstances, can help the adjustment process. Some people find the help they need by participating in online forums, in local support groups, or seeing a therapist occasionally.
The same also goes for some forms of cognitive behavioral therapy: anything that can help you learn to deal with your new, greatly restricted life, and to help you accomplish such now difficult tasks as grocery shopping, will help you function better and help reduce the anxiety and anger that can otherwise build when you can no longer do you used to be able to do without thought.
Science and the Emergence of a New Disease
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