Depression

lost [subject #367], Visual snow - let it brighten up your day, 2007. © 2007 lost (larger image see here) [more]

Depression is a common psychiatric disorder, characterized by a persistent lowering of mood, loss of interest in usual activities and diminished ability to experience pleasure. Depression is a serious illness that involves the body, mood, and thoughts that cannot simply be willed or wished away. Having depression is a major risk factor for suicide; in addition, people with depression suffer from higher mortality from other causes. Though depression is a serious illness, it can easily be cured by a qualified medical professional (a GP or psychiatrist, the consultation of the latter being obligatory in a case of severe depression). Depression is usually treated by psychotherapy, antidepressants, or best by a combination of the two.

Vicious circle of stress, persistent aura, anxiety and depression (larger image see here). If the positive feedback loop in which the system responds to perturbation in the same direction as the perturbation runs out of control, it can result in the collapse of the system. This is called vicious circle, or in Latin circulus vitiosus. © 2008 Klaus Podoll

Triggered by the physical stress from an infectious mononucleosis, fashionphoto (subject #361) got her 1st episode of persistent aura without infarction (with visual snow) and developed increasing anxiety and depression that finally matched the diagnostic criteria of a severe depressive episode without psychotic symptoms (ICD-10 F32.2). Bound in the vicious circle of stress → triggering or worsening of persistent aura without infarction → anxiety and depression → more stress → further triggering or worsening of persistent aura without infarction → worsening of anxiety and depression → more stress, she sustained 3 further episodes of persistent aura without infarction in the following 3 months, featuring increased negative afterimages (2nd episode), increased positive afterimages (3rd episode) and trails as well as significant worsening of visual snow (4th episode). It was not until the start of an antidepressive pharmacotherapy with oral S-adenosyl-l-methionine (SAMe), a naturally occurring brain metabolite that has been shown to be effective as a treatment of major depression (Bell et al., 1988; Kagan et al., 1990; Rosenbaum et al., 1990), that her depression showed full remission within another 3 months, during which time no further episodes of persistent aura without infarction occurred. Another 3 months later, she noted beginning partial remission of her persistent perception disturbances, and that improvement continued steadily over the next 6 months.

fashionfoto [subject #361], Vision disturbances at day, 2007. Visual snow "much worse in shadows, not always this intense" (as in right top corner). "Occasional starbursts. Afterimages that are worse in intense light or poor lighting." © 2007 fashionfoto

ChelleWMCN [subject #272], Yesterday, 2007. © 2007 ChelleWMCN

ChelleWMCN [subject #272], Today, 2007. © 2007 ChelleWMCN

ChelleWMCN's (subject's #272) chronic progressive persistent aura without infarction (MAS score = 2) and the uncertainty about its further prognosis threw her into a deep agitated depression (likened to a barren, desolate, empty desert in her poem Yesterday) that "consumed" her, drained "the life" right out of her and made her "lose sight of the future", resulting in chronic suicidal thoughts in which she took comfort in her severe depressive episode without psychotic symptoms (ICD-10 F32.2). There is no doubt that a persisting perception disorder annihilating the sight of the future is complicated by comorbid severe depression. If you become depressed it will become harder and harder to see a hopeful future for yourself (Zung, 1965). Unfortunately, due to a previous bad experience when taking an antidepressant, ChelleWMCN decided against drug treatment. However, as shown by fashionphoto's (subject's #361) story, it may take several attempts to find the drug that works best for you.

On February 27, 2007, ChelleWMCN wrote:

"I think about suicide quite often... a few things keep me going: one is the fear that I won't be successful and will end up comatose or brain dead, which is worse than what I am going through now. Another thing that makes me want to wake up everyday is that I have a wonderful family, but sometimes I wonder if it is fair to push my health problems off on them. Finally, we are expecting our first grandchild in two months... I want to be a part of his life... that helps, too.

I am so afraid that I am going to see the way I do for the rest of my life and it scares me to wonder how long that life will be. Maybe we all do have a serious, life-threatening illness that just hasn't been discovered or named, yet. Think of all the people who died of AIDS or cancer before those diseases were 'discovered.' I wonder if their docs thought they were nuts."

(ChelleWMCN [subject #272], Ezboard forum Visual snow or static - General Discussion - newcomer, February 27, 2007)

"My vision has worsened continuously since the onset four years ago. I have had no remission of the symptoms. Every day, I worry how much worse can it get? I fear total vision loss...from either this malady taking its course or from me stabbing my eyes out during a fit of desperation."

(ChelleWMCN [subject #272], Ezboard forum Visual snow or static - Archive 5 - Amazing update-My trails, April 13, 2007)

The poem she wrote over a half year later expressed her unchanged deep depression.

Responding to IanKC's (subject's #92) comments on her poem ("Great poem, though"), ChelleWMCN wrote:

"Thanks, Ian. I wish I could have a good attitude right now... I really need it.

I feel as if I am on a downward spiral toward nothingness. The longer I am forced to deal with this vision problem, the more I wonder how long I can deal with it. Each and every day I struggle to hold on... it is consuming me... draining the life right out of me."

(ChelleWMCN [subject #272], Yuku forum Visual snow or static - General Discussion - Yesterday (poetry), September 23, 2007)

"I think about ending my life quite often. My symptoms appear to be getting worse and worse every day. I have tried almost every medication and treatment available. I have had almost every test my docs can think to subject me to. My vision distortion isn't episodic... it is persistent and progressive. I can't imagine living like this for another 40 years. I don't want to be a burden to my husband or children (grown).

Is it wrong to commit suicide? I don't think so. As long as you don't harm anyone else in the process, who should care?

Why not leave this world and its resources for those who are fit to carry it on into the future? I am not depressed... I am just thinking logically and analyzing my options."

(ChelleWMCN [subject #272], Yuku forum Visual snow or static - General discussion - think anyone has killed themselves over it?, September 30, 2007)

"In the past six months, we have had seven friends and coworkers die... All of these people were my husband's and my age group... they were too young to die. They had so much life left to live. I am scared to die... to be here one minute and then not the next. Extinguished like a lit match with one puff of air.

I have come to the conclusion that the only way a person can control when and how they are going to die is to take the matter into their own hands. This ideology removes the random-ness of death. This is about control... it is about not letting this monster called 'death' grasp us unexpectedly and whisk us away.

A healthy person would live their life and not think these morbid thoughts... but I am not healthy. Every morning, I awaken to visual distortions that frustrate me, and every night I go to bed without hope of a cure. During the day, I am subjected to situations for which I am having more and more difficulty coping.

I am a list-maker... I make lists, and I plan... that is how I am able to get through stressful situations. Even this week, I am taking off from work to try and settle my vision a bit (although, it hasn't helped yet). I made a list of things I want/need to do this week, to include baking pies and re-potting a plant (I have one that is still green!). This way I can relax and not have to try and remember what needs to be done and when it needs to be completed. I am now doing the same thing for this fear of death that has been consuming me... I have added dying to my list of things to do... that way I won't have to worry about thinking about it... It is not on this week's list, but on my life's list. Maybe that will help me get through this illness or maybe it will just draw me into the darkness even further. I don't know at this point."

(ChelleWMCN [subject #272], Email to Klaus Podoll, October 3, 2007)

"I guess I am also afraid of hurting myself. Sometimes I become so frustrated with what I can't see and what I can't do... I lose sight of the future."

(ChelleWMCN [subject #272], Yuku forum Visual snow or static - General discussion - Fears aroused by persistent visual snow/persistent visual aura, December 1, 2007)

"Good afternoon, I just finished reading the [preview of the] webpage you wrote about depression. You have been very thorough in discussing both hopeful people and people who are seeking hope. You may use my quotes as you see fit to do so.

I am well aware that I struggle with harmful thoughts every day, but I have a brand new grandson whom I adore… I will try to stay strong for him. Right now, I am trying not to take any medication. My doctor wanted me to start all over with meds I had tried several years ago… I told her that I was done being a guinea pig for drugs. Now she wants me to be a part of some new studies… I don't expect to be cured from these studies, but maybe they can find out why my brain is so screwed up.

Thanks for caring, ChelleWMCN"

(ChelleWMCN [subject #272], Email to Klaus Podoll, December 2, 2007; additions in square brackets by Klaus Podoll)

"Wow! I just got done re-reading your webpage on depression. The quotes you used of mine were really 'depressing'... I had no idea that I have been that low. I guess it is true, because I only ever write how I feel. It just seems like you were writing about someone else... as if someone like me couldn't have such dark feelings. I have no reason not to be a happy person. I have a wonderful husband and terrific children; we are financially secure... most would be thrilled to have my life. I didn't think I was a depressed person; I know it truly has to do with battling this vision problem.

Depression must keep building in me like a snowball rolling downhill. I am tired. Exhausted. I have only been sleeping 2 to 4 hours a night for quite a while. I can't turn my brain off. Can't relax. My doctor told me to double up on the Lunesta [eszopiclone, a nonbenzodiazepine hypnotic agent used as a treatment for insomnia, but as it is no antidepressant it doesn't help against the severe depressive episode of which the insomnia is just a symptom and may even be contra-indicated considering recent data (Kripke, 2007) demonstrating that modern hypnotics are associated with an increased incidence of depression]... I am really afraid to do that... you know, side effects, etc. I told her, but she said to try it... couldn't hurt.

You seemed upset that I tried the Prednisone and the IV IG... both experimental treatments. Please understand. I am willing to try anything that might make my life normal again. I realize I am apprehensive about taking antidepressants... To be honest, I am trying to avoid a diagnosis of depression. From what I have seen, if a doctor thinks a patient is suffering from depression, he will ignore the true symptoms and miss a possible real diagnosis. I am imagining seeing a doctor and trying to explain my vision problems, only to have him read that I am taking antidepressants, and then have him say that all of my vision problems are mental. I couldn't handle that... I guarantee it would push me over the edge. If I could just fix my vision, the depression would go away... I am certain of that. If taking anti-depressants would give me my vision back... I would take them, even with the side effects... but nothing has even slightly helped.

I know that I said I didn't want to be a guinea pig anymore, but I think desperation will kick in and I will do anything my doctor suggests may work. Stupid, huh?"

(ChelleWMCN [subject #272], Email to Klaus Podoll, December 4, 2007; additions in square brackets by Klaus Podoll)

"Sixteen years old… blind… deaf… a Yorkshire Terrier/Poodle mix. She walked through the doggie door into the backyard at my son's house and she panicked. She lost perception of where she was and couldn't find her way back inside. She made her way over to the edge of the fence line and sat there waiting for someone… anyone… to come help her… at least fifteen minutes in the freezing snowy night… shaking… fearing for her life.

I cried uncontrollably when I heard about my parents' dog's ordeal Friday night. A similar event happened to me last year. When I was skiing and the white snow turned black and foggy in my vision, I couldn't even tell where I was going… I waited for someone to ski with me back to the lodge… anyone… a long fifteen minutes before another skier helped me follow her down the hill. No more skiing for me until my vision is cured.

I am so afraid that my life as I know it is over. These past two weeks have just been awful vision-wise. Exhaustion from having a houseful of company for two weeks. Fearful that I will no longer be able to do what I love. No hope of a cure. No more experimental therapies to even try. Can I live the rest of my life like this? Am I destined to freeze at the fence line?"

(ChelleWMCN [subject #272], Yuku forum Visual snow or static - General discussion - Feeling melancholy about 2008, January 1, 2007)

jruddy [subject #515], Visual snow, 2008. © 2008 jruddy (larger image see here)

After having sustained 3 episodes of persistent aura without infarction within 5 weeks, jruddy (subject #515) developed a severe depressive episode with suicidal crises (ICD-10 F32.2), necessitating psychiatric consultation. With the distance gained by circa 2½ months successful antidepressive treatment with a selective serotonin reuptake inhibitor (Citalopram 20 mg daily), he recalled:

"Many of my negative thoughts are quite personal and I can't share most of them. I found a few that aren't too bad, and I'll share them here.

I really struggled with depression, for some reason Feb 17th was a rough day, I think it was shortly after the anxiety diagnosis for my weakness by the migraine neurologist.

Here is one from Feb 17:

I'm trapped in a box that I've built around myself, no one can see it but I can feel it.
Some days it lets me feel free and alive, other days it squeezes me onto the couch and won't let me move.
It is filled with doubts, fears and self loathing, some days I can't breath for the poison inside.
Though it may be my greatest peril, it is the one thing from which I can not run, can not hide.

Here is another from the same day.

I would like to wake up from this dream now.
Or close my eyes and not wake up at all.
I'm fed up. I've lost patience with doctors and with myself.
I've lost hope. I have no dreams for the future. I seek no pleasure.
I wear a mask once more, but it is thread bare and has worn thin.
I don't want to burden anyone with my problems. I can't believe I'm crazy.
I pity myself. I ignore myself. I push myself. I reason with myself.
These all lead to frustration and anger.
My temper grows short. The boys hear me bark, unfair.
I try to restrain, to be fair, but it makes me more angry with myself.
I wish things would go back to the way they were before.

And another from Feb 17:

If I repent, if I take You back into my heart, will you take me as I sleep?
I will not willingly destroy this home or family, but if it be Your will, I will come.
I can not live like this.
These daemons of self doubt, disappointment and frustration control my thoughts and actions.
I will not watch my life collapse around me.
Please help.

March 6:

There's an empty cavern inside me that I sometimes want to crawl into and hide from the world.
A single atom tossed in the cosmic sea, the only safe harbour that I can find is deep inside of me.

Because VS poses no immediate threat to my life, and the depression has on a couple of occasions posed real, though not immediate threat to my well being, my focus is on dealing with my mood. I do apologise if I over do it here with the Tony Robbins, Power of Positive Thinking thing, lol, but it's what I need to do to remain sane.

Cheers."

(jruddy [subject #515], Yuku forum Visual snow or static - General discussion - Finding inspiration, a way to remain positive, a way to deal with VS, April 10, 2008)

Overcoming depression by adequate psychiatric treatment helped jruddy to regain control by good coping strategies in dealing with his persistent aura condition.

"Finding inspiration, a way to remain positive, a way to deal with VS.

I think I might annoy a few folks here, maybe not. I do have bad moments, days, sometimes weeks, but I try not to share my thoughs when I'm in them anymore. I have a personal journal for those moments.

I do have one person to thank as an inspiration, and no it isn't Jesus, or Mohammid or Buddha, though from what I've read they're all inspirational in their own individual ways.

My uncle David, who was born in 1958, is my personal inspiration and also he source of many of my personal demons, especially with my falling out with God, but that's another story...

David was a very active young man. He hiked, backpacked, camped, hunted and fished. He skiid, both alpine and nordic, and snowshoed. He attended mining school and travelled to the far north of Canada to prospect in his summer before becoming ill. David developed rheumatic fever while at College and this was misdiagnosed by the local rural hospital and so went untreated for weeks. By the time it was observed to be rheumatic fever, the damage was done to his system and he was afflicted with severe rheumatoid arthritis. He continued his studies but a career in prospecting was not possible with such an affliction.

Through the years he kept up his good humour, continued to hunt and fish and enjoy the outdoors experience while he could. Though crippled and in pain, he spent many cold wet mornings in a swamp waiting for the ducks to come in or on the water, fishing for walleye, pike or bass. He got married, only to have his wife leave him. With the drug coctails he was on, children were out of the question. There may have been other reasons, I really don't know.

I rarely heard him complain, only on really bad days or shorty after one of his knee replacement surgeries when I visited him in the hospital. The nurse was coming with the 'torture device'. The physio-therapy contraption that would force him to move his knee. He made jokes, yet knew the extreme pain was coming. I told him I could stay, but he became serious and told me to go.

He got out hunting one more time before he died. He was deer hunting with a friend. He never left the truck but didn't care. He just enjoyed nature. He was that kind of outdoorsman. Not the gung ho red neck kill everything, but rather more of the David Suzuki, respect nature kind of man. He needed shoulder replacements and knew this would be the end of hunting for him. By then his kidneys had started to fail as well. This was an expected effect of the drugs he had been taking for 20 years. We all offered our kidneys to him, but he knew better than us, he wasn't a good candidate for a transfer.

Still, with Dialysis every other day, he managed to make the 5 hour trip to my wedding, sandwiching it between two dialysis sessions. He was so thin, but so very happy to be there. Still making bad puns, still the same David that took me hunting when I was five. (I saw a Ruffed Grouse, 'Look uncle David, a wild chicken!')

Later that year he went into the hospital for his first shoulder operation, but his other organs had started to shut down. My mother spent his last month visiting him in the hospital. It was the ice storm of January 1998. He was 39 when he died.

There were a lot of strangers at his funeral. Young people from the local pool hall, old people from the arthritis physio-therapy pool, people from the dialysis clinic.

One by one they spoke of how David touched their lives and in some way saved them from themselves. One man from the pool hall credited David for helping him turn his life around. The arthritics said he was a shining beacon and the highlight of their day. The people on dialysis said their treatment was cold and depressing before David showed up. Now it's a social event.

I guess what this taught me is life is life. You only get one shot at it. The only thing you leave behind on this earth is your legacy. If God gives you arthritis, go fishing and play pool. If you see someone in need, help them, even though in some ways you may worse off than they are. Actually that's what the guy from the pool hall said. Here is this guy on disability, on dialysis with crippling arthritis, playing pool, trying to help him out. Talk about inspiring.

I don't think it's making the best of a bad situation. It's making the best out of life, period.

Thank You David.
Rest Well."

(jruddy [subject #515], Yuku forum Visual snow or static - General discussion - Finding inspiration, a way to remain positive, a way to deal with VS, April 9, 2008)

SamyFire [subject #268], Do not risk a fatal timing! Stay alive!, 2007. © 2007 SamyFire (larger image see here) [more]

References

Bell KM, Plon L, Bunney WE Jr, Potkin SG. S-adenosylmethionine treatment of depression: a controlled clinical trial. Am J Psychiatry 1988; 145: 1110-1114.
Kagan BL, Sultzer DL, Rosenlicht N, Gerner RH. Oral S-adenosylmethionine in depression: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry 1990; 147: 591–595.
Kripke DF. Greater incidence of depression with hypnotic use than with placebo. BMC Psychiatry 2007; 7: 42. [PDF]
Rosenbaum JF, Fava M, Falk WE, Pollack MH, Cohen LS, Cohen BM, Zubenko GS. The antidepressant potential of oral S-adenosyl-l-methionine. Acta Psychiatrica Scandinavica 1990; 81: 432–436.
Wacogne C, Lacoste JP, Guillibert E, Hugues FC, Le Jeunne C. Stress, anxiety, depression and migraine. Cephalalgia 2003; 23: 451-455.
Zung WW. A self-rating depression scale. Arch Gen Psychiatry 1965; 12: 63-70.

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