Depression & Worry

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By Bruce Campbell

So far in this series, we have focused on symptom management, suggesting that you will help yourself control symptoms if you honor your limits and address the stresses in your life. But because long-term illness affects so many parts of life, managing it requires more than symptom management.

The rest of the series discusses three challenges beyond controlling symptoms: managing emotions, getting support, and moving beyond loss to build a new life.

Emotions in Chronic Illness

Strong emotions like fear, anger, grief and depression are common reactions to having chronic illness. Such emotions are a normal and understandable response to being in a situation that isolates, creates tremendous uncertainty, brings loss and imposes limits.

Unfortunately, ME/CFS and fibromyalgia seem to make emotional reactions even stronger than before and harder to control. This reaction seems part of the physical basis of the illness. The strength of emotions can create a vicious cycle. Emotions can intensify symptoms, which in turn may increase worry and depression.

As one student in our program said: "My emotions are much more sensitive than ever before. I cry more easily, and I have less emotional reserve to listen to my teenagers and husband and talk with them about their concerns."

Self-help can play a role in managing the emotional aspects of chronic disease. The stress reduction techniques described in an earlier article in this series may be helpful. Relaxation, for example, can short-circuit the feedback effect in which symptoms and emotions reinforce one another. Also, changing your thinking, as outlined in the next article, may be useful.

The techniques described there have been proven to be especially helpful in counteracting the effects of anxiety and depression. Another general approach is to identify those situations (and sometimes people) that trigger strong emotions and plan a strategy of response ahead of time. Often, avoiding or minimizing stressful situations can reduce emotions.

With those general comments about feelings as background, let's look at several emotions and how to manage them.

Depression

Depression is very common in chronic illness. This should not be surprising. After all, illness turns lives upside down, bringing great losses and tremendous uncertainty. Also, serious illness is isolating.

We spend less time with people and more time alone. In addition, sometimes depression may be part of our illness, with real physical causes. Prolonged stress may alter the biochemistry of the body, causing depression.

Depression is often divided into two types: situational and biochemical. Both may apply to people with ME/CFS and fibromyalgia. Situational depression, which means depression that occurs as a response to a particular set of circumstances, lends itself to self-management strategies such as those described below.

But not all depression is best handled this way. If you are deeply depressed about your illness or you have biochemical depression, which has its roots in the chemistry of the brain, medication and professional help are indicated. Self-management strategies may also be helpful.

There are many things you can do to improve your situation. If you are depressed, you may not want to try, but remember that depression feeds on itself. Your attitude becomes a self-fulfilling prophecy. If you believe you can get better, you will take actions such as those listed below that have a good chance of helping.

Rest: Some depression seems to be associated with physical symptoms such as fatigue and pain. Resting to reduce these symptoms can also improve mood.

Reach Out to Others: Simple human contact is often very soothing. Calling a friend or getting together to talk, share a meal or see a movie counteracts the sense of isolation, preoccupation with problems and the low mood often associated with chronic illness. Just explaining yourself can often give you perspective. Fellow patients can be very helpful.

Get Out of the House: Just like contact with others, getting out of the house counteracts isolation and boredom, provides stimulation and can reduce depression.

Consider Medications: Tranquilizers and narcotic painkillers intensify depression. If you are depressed, it may be in part a medication side effect. Check with your doctor. On the other hand, if your depression is bio-chemical in origin, you may be helped by an anti-depressant.

Exercise: Exercise is a natural anti-depressant. It relieves tension, lessens stress and improves mood. Most exercise also involves being out of the house, thus bringing the adding benefits of a change of scene.

Practice Problem-Solving: Taking action to solve a problem lifts the spirit as well as having practical benefits. Doing something counteracts the sense of helplessness and replaces it with a sense of control and power. In the words of one student, "I handle emotions better if I do something rather than passively suffer."

Do Something Pleasant: Doing something in which you can become absorbed distracts from bad moods and puts you in touch with positive forces. Such activities might include reading, playing or listening to music, sitting in the sun, solving jigsaw puzzles, doing needlework, spending time with friends, being out in nature and laughing.

Get Help: If you are seriously depressed, suicidal or have been depressed for some time, get help now. Phone a suicide prevention center, talk to your doctor, see a psychologist or call a friend. If your problems are less severe, consider seeing a psychotherapist.

Look for one who has experience working with people who have chronic illness. A therapist can provide an outside view of your situation, help you to accept your illness and support you in your efforts to improve. If you have family tension because of illness, you might also consider couples or family counseling.

Establish Good Daily Habits: Keeping to a daily routine regardless of how you feel can help counteract depression. Your daily round of activities will depend on the severity of your illness, and might include things like getting dressed every day, making the bed, cooking meals, taking a walk and watching a favorite TV program. Forcing yourself to do these things even if you don't want to counteracts the inertia of depression.

Help Others: Get involved with something larger than yourself to counteract the isolation and preoccupation with symptoms that often accompany illness and to rebuild self-esteem. We usually feel better if we do something for another person. Helping others might involve a regular commitment like helping to lead a support group or something as simple as a phone call to an older relative or checking in with an old friend.

Manage Your Stress: Controlling stress can help you manage your emotions, because stress tends to make emotions more intense. Living within your energy envelope and managing the stresses in your life will make emotions more manageable.

Fear and Anxiety

Fear and anxiety often accompany chronic illness. These reactions are common in situations in which we feel an increased vulnerability in combination with a decreased sense of power. Because of having a serious illness, we experience a loss of control over our bodies and over our ability to plan and predict.

Our illness brings uncertainty about the future. We may be unclear about our prognosis and wonder whether we will improve and, if so, how much. We may worry about how far down we might slide and about becoming dependent or financially destitute.

Strategies like those below are often helpful with fear and worry reactions. For more suggestions, see "Fifty Tips on the Management of Worry without Using Medication" in the book Worry by Edward Hallowell.

Use Problem-Solving: Taking action to solve a problem has a double payoff. You reduce or eliminate a practical concern that is bothering you. Also, the process of taking action often reduces worry.

Practice Stress Reduction: Learning relaxation and other stress reduction techniques can help reduce the intensity of your emotional reactions and, by doing so, reduce the echo effect in which emotions and symptoms amplify one another. A regular stress reduction practice can also lower "background worry," the ongoing anxiety that results from long-term stresses like chronic illness.

Change Your Thinking: If you have a tendency to think of the worst that might happen, you can take steps to short-circuit the process in which your thoughts increase your anxiety. One antidote is to retrain yourself to speak soothingly when worried, saying things like "I've been here before and survived" or "this is probably not as bad as it seems." For more on this, see the next article in this series.

Connect with Other People: Feeling that you are part of something larger than yourself counteracts worry. Also, contact distracts you from preoccupation with your problems, and provides reassurance.

Exercise: One of the best treatments for worry, exercise is both relaxing and distracting.

Pleasurable Activity: Reading, music, good conversation and other activities in which you can become immersed help change mood.

Don't Worry Alone: The act of sharing a worry almost always reduces its size and emotional weight. Discussion may help you find solutions, but almost always makes the worry feel less threatening. Putting a worry into words translates it from the realm of imagination into something concrete and manageable.

Medications: Just as drugs can help with depression, some people find that medications help them deal with anxiety. A drug will not be a complete solution to problems of anxiety, but it can be an important part of a comprehensive response.

Panic
About 10 percent of people with ME/CFS experience an especially severe and frightening form of fear called panic attacks. These are brief episodes of terror in which a person may feel he or she is about to die. Symptoms may include chest pain, heart palpitations and dizziness.

In spite of overwhelming fear, people survive but may live a life of dread, apprehensive about when the next attack may occur. This kind of fear is treatable. For discussions on how to conquer panic, see Edward Hallowell's book Worry or Martin Seligman's What You Can Change and What You Can't.
 

Summary

In sum, you aren't crazy to experience strong emotions in reaction to having your life turned upside down. It would be surprising if you didn't respond that way. Emotions like depression and anxiety are common responses to situations of loss and uncertainty. But there are many things you can do to reduce the strength of these emotions. Like other aspects of chronic illness, emotions can be managed.