Major Depressive Disorder (MDD) Common Among Transplant Recipients


By Bob Aronson

gloomy gus

I have written before about post-transplant depression. It is real, it is common and it can be dangerous, but there is help, lots of it. You do not have to live feeling as though you are a drain on society a waste of skin and a burden to your friends and family. Most importantly you should know that there’s no shame in having a mental illness. It is as real as heart disease or cancer or a broken leg, but it is also treatable. You don’t have to live  a life of gloom and doom.

According to Very Well Thttps://www.verywell.com/coping-after-an-organ-transplant-3157200 “There are issues that are unique to organ transplantation that the average surgery patient does not experience. In the majority of cases, a patient who is waiting for an organ knows that for an organ to become available an appropriate donor must die.

There is an emotional struggle between maintaining hope for a transplant and dread, knowing that a stranger will die before that becomes possible. Transplant recipients often acknowledge that they feel survivor’s guilt, having benefited from the death of another.

It is important for recipients to remember that family members of donors report feeling that being able to donate organs was the only positive thing to happen during a heartbreaking time. The correspondence they receive from organ recipients can help the feeling of total loss after a loved one dies.”

As a transplant recipient myself I know the depression I felt prior to the transplant was related to the fear of not getting an organ and dying. A depression hangover from pre to post transplant seems to make sense. You got a new organ, not a new brain and while the reasons may be different, the feeling remains. The most common concern is that “Someone had to die, so that I could live.” But logic dictates that your donor died because it was his or her time to die. Your survival is not even remotely tied to that death. A better more positive thought might be, “I am alive because my donor made the decision to donate while still living. It was a gift to someone who needed an organ and I turned out to be that someone.”  Sometimes, though, it is hard to accept and depression becomes a reality.

This blog is aimed at giving you basic information on what depression is, how to deal with it and where to go for more information. I suffer from it, I understand it and I know it is treatable. I’m hoping the following information is helpful.

Major Depressive Disorder is a common disease whether transplant patient or not. Anyone can suffer from it and the suffering can be severe. Let’s start with a little check list to see if you suffer from MDD and need to see a physician to become whole again. If some or all of the following situations apply to you, it is likely you need some help.

  • Changes in sleep. Many people have trouble falling asleep, staying asleep or sleeping much longer than they used to. Waking up early in the morning is common for people with major depression.
  • Changes in appetite. Depression can lead to serious weight loss or gain when a person stops eating or uses food as a coping mechanism.
  • Lack of concentration. A person may be unable to focus during severe depression. Even reading the newspaper or following the plot of a TV show can be difficult. It becomes harder to make decisions, big or small.
  • Loss of energy. People with depression may feel profound fatigue, think slowly or be unable to perform normal daily routines.
  • Lack of interest. People may lose interest in their usual activities or lose the capacity to experience pleasure. A person may have no desire to eat or have sex.
  • Low self esteem. During periods of depression, people dwell on losses or failures and feel excessive guilt and helplessness. Thoughts like “I am a loser” or “the world is a terrible place” or “I don’t want to be alive” can take over.
  • Depression can make a person feel that nothing good will ever happen. Suicidal thoughts often follow these kinds of negative thoughts—and need to be taken seriously.
  • Changes in movement. People with depression may look physically depleted or they may be agitated. For example, a person may wake early in the morning and pace the floor for hours.

If you suffer from MDD (Major Depressive Disorder) you should know the following.

human brain

human brain

We often hear that depression is caused by a chemical imbalance in the brain. Well, the fact is there is little or no scientific evidence to prove that point. It is a theory that is probably partially true but is really an oversimplification of a very complex disease. The “Chemical Imbalance” description is the result of the pharmaceutical industry’s attempt to make their “Re-balancing” chemicals more popular and desirable.

There are scores of medications that claim to help depression and while some work for at least a short while no one knows for sure how or why they work or how long they might be effective. Attempts at balancing the so-called chemical imbalances are sometimes effective, but not always. That may be because the exact degree of involvement by Serotonin or other chemicals in the cause and treatment of depression is a theory, not a fact. It is far easier to sell a remedy caused by chemical imbalances than one that has multiple causes and interactions.

MDD is a form of mental illness that often requires a multidisciplinary approach. Sometimes pills or capsules will work absent any other form of treatment. Often, though, it may need the broader approach that can only be offered by a Psychiatric clinic. Start with your primary care doc, but if your condition gets more serious seek specialized professional help.

If you suffer from depression as millions of Americans do, it is likely that yourantidepressants doctor has prescribed an anti-depression medication for you like Remeron, Wellbutrin or Cymbalta. Chances are good, too, that if you‘ve been taking anti-depressants for a while you’ve found that after a while they seem to wear out so your doctor will prescribe a new one. There are scores of such medications out there so physicians have a huge variety from which to choose making it is easy to prescribe something different.

Depression is a form of mental illness and for some that’s a shameful problem. They feel they should be able to overcome depression without help. “Depression? Really? You?  You’ve got a great job, family, friends, a new car…wow, what’s to be depressed about?  You’ve got so much to live for,” is probably one of the most insensitive responses one can give to hearing of someone’s depression, yet it is offered thousands of times a day. It is as though it is somehow illegal or immoral to have a mental illness, but when you feel sad, worthless, lose interest in daily living and even have suicidal thoughts, you need help.

Major Depressive Disorder (MDD) is not only common it is getting worse. Estimates suggest that about 16 million Americans are victims. MDD is a psychiatric disorder that goes well beyond feeling sad or “down.” It can become so severe as to cause you to become disabled or even to want to take your own life. Part of the problem in identifying and treating MDD is that it lives in that shadowy world of mental illness that still carries with it a certain stigma or shame.

Anyone who has suffered from MDD knows how debilitating the disease can be. It isn’t just feeling “Blue” or out of sorts — it is feeling totally useless and without purpose or value. It is feeling as though you are a waste of human organs and skin, have no right to exist and represent a drain on society. It is beyond feeling that you are inferior, it is knowing that you are and therefore knowing there is no hope. It is knowing you are a burden to others and that there is no hope – that’s how bad it is.

A senior couple talking with a marriage counselor.  Could also be a salesman in their home.

A senior couple talking with a marriage counselor. Could also be a salesman in their home.

While talk therapy has always been available, the pharmaceutical companies saw the need for a quicker fix like a pill that could somehow miraculously change your mood. They did a lot of very expensive research and came up with several medication approaches and several of them work very well. Nearly all of them based on the theory that depression was at least in part caused by chemical imbalances in the brain. The pharmaceutical company scientists determined that Serotonin was one of the major chemicals affecting depression and it therefore became the one most often targeted.

The first group of anti-depressants included brand names like Prozac, Paxil and Zoloft. They come from a group of medications called SSRIs (Selective Serotonin Reuptake Inhibitors) and are generally safe and effective.  The important fact here is that most if not all anti-depressants are aimed at regulating brain chemicals and there are lots of them. I counted 82 different brand names in an ever so brief internet check on the number of anti-depressants on the market.

The problem is that these drugs don’t always work right away or at all for that matter and it can take time to figure that out. Anti-depressants can also get expensive, Pfizer’s Pristiq, for example can cost over $100 a month with insurance – far more without. On the other hand Duloxetine or Cymbalta can be cheap. I just paid around $10.00 for thirty 30 milligram capsules. Many of these drugs have generics that sell for a lower price so be sure to ask. One thing you can count on is that if you begin to use anti-depressant drugs you will, over time, use several different kinds.

There seems to be three approaches to dealing with MDD. Obviously there is medication and finding the right one could take some time. There’s also Cognitive Behavioral Therapy (talk therapy) and Electroconvulsive Therapyelectroconvulsive therapy (ECT). Yes, ECT is sending electrical shocks into the brain, but it is not like the Shock Therapy of the old Boris Karloff movies or more recently, “One flew over the Cuckoos nest.” It is brief, painless, has few side effects and can be very effective. To the best of our knowledge most MDD therapies are covered by Medicare and other insurances, but check before you agree to be treated. It is not unusual for some patients to participate in all three forms of treatment.

For more information on depression we recommend the following links.

Selecting the right anti-depressant http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273

Cognitive behavioral Therapy http://www.nami.org/Learn-More/Treatment/Psychotherapy

Electroconvulsive Therapy http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,200 member Organ Transplant Initiative (OTI) and the author of most of the nearly 300 posts on this site.  You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love. You can register to be a donor at http://www.donatelife.net.  It only takes a few minutes. Then, when registered, tell your family about your decision so there is no confusion when the time comes.

 

 

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About Bob Aronson

Bob Aronson is a former journalist, a Minnesota Governor's Press Secretary and talk show host. For nearly a quarter of a century, he led the Aronson Partnership, a Minnesota-based communications consultancy that prepared corporate and government executives for crisis situations, regulatory testimony, media interviews and Presentations. Among his clients were all three U.S. Mayo Clinic locations, 3M, general Mills, CH2M Hill, the U.S. Department of Energy and scores more. In 2007 bob had a heart transplant after suffering from idiopathic dilated cardiomyopathy for 12 years. Shortly after he got his new heart he founded the now 4,300 member Facebook support group, Organ Transplant Initiative. At the same time, he established the Bob's Newheart blog where he has posted nearly 300 columns on organ donation, transplantation and other health related issues. The Viewpoint blog was started in late 2016 and bears the name of the Radio Talk show Bob did from 1966 until 1974, when he resigned to become Minnesota Governor Rudy Perpich first Press secretary. Bob and his artist wife Robin, live in Jacksonville, Florida with their two dogs, Reilly and Ziggy. Bob is also a woodworker and makes all of the furnishings for Robin's art festival booth. He also makes one of a kind jewelry or "memories" boxes that he donates to select transplant patients, caregivers, donor families and others who have somehow contributed to making life easier for the ill, the elderly and the less fortunate. Bob is in the final stages of editing two full-length novels that will be available on Kindle when ready for release sometime in early 2017. One is a sci fi novel about an amazing discovery near Roswell, New Mexico and you will be surprised to find it has nothing to do with the Roswell story everyone knows. It features a woman scientist who investigates impact craters for the U.S. Department of the Interior, Dr. Rita Sylvester and her female student intern. The other book is a political thriller that introduces a new hero to the genre, Fargo Dennison.

Posted on August 25, 2016, in Healthy Living. Bookmark the permalink. Leave a comment.

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