Dreams are often a good indicator of where our needs in life are. The brain has an amazing ability to work through problems and issues while we sleep which is where the phrase - sleep on it - comes from. Sometimes the mind needs to work through our emotions while we sleep which is when my most vivid dreams seem to emerge.
I love the water. When swimming, I feel as though time stands still. The water passing over my shoulders as I lie on my back and kick a lap or two feels great. The gentle stretch overhead in a backstroke is rejuvenating. Going without contacts and having my ears underwater takes away spatial references enough so that I'm in my own world.
However, I have a dream which comes to visit occasionally. There is nothing in this dream besides me being underwater and pulled down into the depths of the ocean. Rays of light are shining through the surface, but they seem to be pulled farther and farther away. At first I struggle to rise, but then it doesn't seem to matter. I lose all desire to reach the surface, even for a breath of fresh air.
This dream appears when I need a gentle message to examine my mood and mental health. It is the point at which I no longer pay attention to the dream that I'm in trouble, a sign of a major depression episode that has engulfed me leaving no desire to climb out of it. I've been in this place more times than I care to count. Never suicidal, mind you; just really in a very dark place.
According to the National Institute of Mental Health (NIMH) nearly 10% of the general American population will experience a depressive illness during any given one-year time period. Estimates of those experiencing a depressive disorder at any time over the course of their lives is appropriately 20% for women and 12.5% for men.
The most commonly talked about form of clinical depression is the major depressive disorder, often simply called major depression. When doctors are diagnosing a major depressive episode, they look for at least five out of nine common symptoms to be present in the patient for more than two weeks:
1. A depressed mood for most of the day, nearly every day
2. Loss of interest or pleasure in all, or almost all, activities for most of the day
3. Significant change in weight or appetite
4. Insomnia or excessive sleepiness
5. Observable agitation or lethargy
6. Fatigue and loss of energy, nearly every day
7. Feelings of worthlessness, low self-esteem, or excessive guilt
8. Difficulty concentrating or indecisiveness
9. Recurrent thoughts of death or suicide
I haven't talked about it much here on HealthCentral, but I suffer from chronic depression, also called dysthymic disorder or dysthymia. I do not like the term suffer, but it does describe what it is like to live with the disorder at times. A significant difference between major depression and chronic depression lies in the length of time during which symptoms prevail. Whereas a major depressive episode will last more than two weeks, the symptoms of chronic depression will last more than TWO YEARS during which time the symptoms may be somewhat less severe. In diagnosing dysthymia, at least two of the following symptoms must be present:
1. Poor appetite or overeating
2. Insomnia or excessive sleepiness
3. Low energy or fatigue
4. Poor concentration or indecisiveness; memory problems
5. Low self-esteem
6. Feelings of hopelessness
A person living with dysthymia (or chronic depression) can also experience major depressive episodes (like I have). To be clear, neither of these forms of clinical depression are the same as having "the blues" and are different than the normal emotional response and grieving process brought about by a life-changing diagnosis such as multiple sclerosis.
Depression is a common comorbidity (co-existing disease) with multiple sclerosis. In fact, the National MS Society shares that "studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions. Depression does not indicate weak character and it should not be considered something shameful that needs to be hidden." Individuals with MS have a greater risk of experiencing a depressive episode at some point in time. Fifty percent of individuals with MS will become depressed during their lifetime, compared to less than 20 percent of the American population.
Did you notice that several depressive symptoms listed above are also symptoms of MS? Examples of shared symptoms include fatigue, insomnia or excessive sleepiness, and cognitive difficulties, as well as restlessness or slowing down. Because many of these symptoms mimic typical MS symptoms, they may not necessarily indicate depression for someone with MS. The similarities in symptoms do in fact make diagnosing depression challenging in MS patients. In fact, MS patients may not recognize the symptoms of depression, particularly if they are experiencing irritation and anger, rather than a depressed mood.
It's a complicated issue, certainly. Just look at the responses in our recent discussion surrounding mood swings, medication, hormones, and multiple sclerosis.
Next week's post will focus on the causes and impact of depression in one's life and available treatment options and strategies to help alleviate it.
Have you been diagnosed with depression in addition to multiple sclerosis? What do you do to stay mentally healthy? Have you been diagnosed with any other mental health disorder besides depression?
Sources: Understanding and Treating Depression in Multiple Sclerosis: Recognizing the Symptoms and Learning the Solutions written by Allison Shadday, LCSW
© Multiple Sclerosis Association of America, 2007
"Depression" by National Multiple Sclerosis Society
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