Recognizing Depression

By Debbie Schlossberg, LMSW

A topic of frequent discussion with PALS and CALS is depression. It almost always comes up at some point in our meetings, either because I inquire or because the PALS/CALS initiates the conversation.

As a matter of fact, I’ve been asked countless times, “Wouldn’t anybody be depressed in this situation?” So it seems there is a widespread belief that depression is a natural reaction to the reality of living with ALS. I’ve been giving this idea much thought and although I don’t want to refute the essence of it (that ALS is often devastating), I have to wonder what, if any, lessons, can be learned from the assumption that actual depression is a universal reaction to a demanding life challenge. What about people we’ve met who don’t seem to be depressed? We know them- the super-copers or people of such enviable faith that they always seem to have a smile on their face. I know that they, too, have their moments, their days, their tears. It does not mean that they are depressed per se, but then perhaps, many of the other PALS who suspect depression may not be really depressed either. Can’t one have moments, days, tears, without labeling oneself as depressed? I don’t think there is an immunity that some people have. Conversely, there are factors which may predispose some of us more than others. Some of the most common “risk factors’ are previous episodes of depression, depression in the family, and substance abuse.

Clinical depression is a complex condition. The symptoms I tend to look for- sleep and eating changes, withdrawal or mood changes, fatigue, can all be physiological effects of ALS. And where does one begin and one end? So even if it sounds like an overused cliché, it really is important to self-assess carefully and to discuss with a care provider for further assessment.

Then, of course the question becomes what to do. I know our docs are very amenable to prescribing anti-depressants when indicated and sometimes they really do help. But sometimes they don’t. And I tell myself that this makes sense. Meds have efficacy in terms of perhaps giving a person a sense that their load is lighter or help with some of the aforementioned symptoms. But it doesn’t take away the trigger for the depression, nor does it help the sufferer learn new ways of coping. That is why study after study show that the best results for treatment of depression come from a combination of medication and psychotherapeutic counseling. Our PALS and CALS often have so much on their plates that the idea of committing to counseling feels like just another task to take up precious time and money. But the rewards can be great: the negative thinking diminishes, sleep patterns improve, and slowly people re-engage in life around them.

So what have my musings taught me? Sadness is not always depression-true depression is not a universal reaction, but if one suspects that they may be clinically depressed, it is important to explore it fully with a trained professional (docs, nurses, or social workers at your ALS clinics) and then aim to treat it with a combination of medication and counseling.