Guilt. Pain. Depression.

I sit on my back porch staring at the flower across the yard.

I hear the birds sing in the distance.

I hear my service dog's nails hit the pavement.

I feel the heat of the intense Texas sun on my body, while tears fall down my neck.

I feel numb in this world.
I feel lonely and unfulfilled.
I barely feel alive.

Why do I feel this way?

I fill the day by playing a few games on my phone throughout the day. World Chef and Best Fiends, if you must know. I scold myself that this is the reason I can't get anything done. I vow to wake up the next day with a plan, a list, with focus. I am so behind. I have to get some things done. So I document all the tasks that need my attention, the bills that must be paid, the items that can no longer go unattended. I go to sleep with some hope that tomorrow will be better.

Then, it's not. It is the same as it was yesterday and the day before that, and the week before that.

That's the way it is with depression. Our bodies are suspended in time -- part of today but not fully --while the world continues to race past us with each second that goes by. We ourselves don't move but we constantly feel the wind of being left behind.

I can't do anything.

I have no motivation -- for even fun things, for important things, for myself, for my family.

Even with a list in hand, I have no 'get up and go.' I reprimand myself to get up out of the bed in the morning, and when I am finally out of bed, I long to go back 'home.' That's all I want to do... sleep. Even when I wake from a three hour nap, the relief I feel is brief. 

My mind caves under the pressure of consciousness. I didn't cook dinner. Again. I didn't go to the grocery store, and I didn't order groceries to be delivered. Again. I didn't send my husband a grocery list for him to stop at the store on the way home, because after 13 years together and with a 10-year-old child, he never knows what to buy for us.

I left my child alone again, with only the company of the TV to stimulate her brain and senses. I feel great guilt over this. TV is bad for kids. Video games are bad for kids. Yet what do I expect her to do when I leave her alone during summer? If I can let it go, I do, but on bad days like today, I realize that my poor child has spent far too many days in front of the TV while Mama slept. I realize that is not the priority for worry today, but each of these thoughts weigh me down, trapped in a world of things I can not do and can not change.

This is my life after Cushing's. I don't know how I got here, and I don't know how to get out. I see no glimpse of my old self, of my old life, and yet I see no path forward for me to reach a new level of happiness just as I am.

I feel the weight of the world on my shoulders. Ok maybe not the world but definitely the weight of my life and that of my family. I don't know how to carry this guilt and anxiety about the guilt with me anymore. I don't want it. I want the problems to go away, and I don't want to feel this way anymore. Yet, I don't know how it will ever go away when so much of the load falls on my shoulders. I have outsourced and paid heftily for everything I can. I pay housekeepers to come weekly to clean the house and wash our clothes. I have already perfected saying no. I say no so much that when I want to do something, there is no one around or nothing to do. 

The remaining jobs are mine, and I can't do them. I don't want to do them. They are too hard. I am a wife and a mother, and I don't feel very good at either.

I'm lost in the mundanity of my world. I don't want to be the inventory clerk of my house. I don't want to be responsible for cooking dinner every day and feeding my family and myself three times a day. I don't want to be asked where something is. I don't want to open to mail and pay bills. I don't want this to be the only thing I do with my day, so I avoid it. When I try, I quickly realize the limitations that Cushing's has placed on my body and mind. The chores go undone for another day.

With so much on my "To do but I don't want to do" list, I never get on to anything else, anything that I want to do, anything that piques my interests and makes me smile a bit. You see, I don't have the energy for those things either. On days when the schedule is empty and I could spend all day working on my interests and hobbies, I don't. I don't feel like it. I think about things I want to do when there is no time to do it. My curiosity isn't in sync with my abilities or mood. I feel guilty about that, too.  

As my day continues, so do admonishments I heap onto myself. Why don't I use my time more wisely? I'm such a phony because I am all talk. I have been talking about becoming fluent in French and moving to Europe, for how long? 30 YEARS?! I talk about going to the French movies that play once a month at the local college. I talk about studying the ancestors in my family tree. I talk about all the ways I need to renovate my house, projects to complete in my back yard and my front garden. I talk about how I have several children's books ready to write and how I just need to write them down. I even have a reminder on my phone to remind me daily to "Write for 30 minutes." Yet, I don't. I don't write, and I don't do any of the things on a daily basis that bring me joy or excitement. I feel guilt over that.

Who can make me do what I want besides me? Who stands in the way of me doing what I want to do? Me.  All blaming fingers point to me. I have 24 hours of time every day, just like you do. I am sensitive to all that I am *not* doing every day. I see around me and I hear the messages... "Live today like there is no tomorrow." I know what I am supposed to do, but I just ... can't. I'm burdened by all the living I'm supposed to cram into one day because those days turn into my life. Yet, I do none of those things that I say I want to do. I just don't want to do anything.

The days pass slowly into the next, with the only difference between them is how late I woke up, whether I managed to wear real clothes or even shower, or am I lying down on the couch or in the bed when my husband comes home. There are no other highlights in my day.

Sure, I have my daughter. As much as I love the dickens out of her, she is learning to be independent. As she does that, she realizes that she doesn't have to agree with Mama all the time. She is her own person, with her own ideas and desires. As outspoken as I am, I still sit here dumbfounded that my daughter who inherited this gene wields it against me. I have such a low tolerance for the arguing. I can't withstand the constant questioning of why I said no. With multiple explanations with more depth, she still demands more of me. I snap to break the intensity. No TV for you. No you can't go to your friends. She stomps off. Doors slam. I sit and wonder how on earth am I supposed to adapt or how will she?  I can't pass down life skills like coping when I feel like I can't cope.

My attempt to squelch the increasingly stressful episodes leave me feeling like a failure as a mother. Why can't I be more patient? She is just a kid. Why does she act that way? She must have learned it from me. She sees my inability to cope with stress, and she is talking back and acting out like I do. Either way, it is my fault. I'm the parent. I'm the mom. My child is a reflection of me.

No one cares that I am sick.

I feel like I can't win.

I don't know when it will end.

I think of all the expectations that I don't meet and I don't care about meeting. Yet the expectations I have for myself, for this life, I just can't let them go.

How do I forget everything I always wanted for my life? How do I throw all that away and dream up new dreams that are so small, they are barely an accomplishment? I have no expectations, and I have no goals. Why? Because I have held tight to small, achievable goals, and when the deadline comes up, I'm a no show. I flake. I can't hack it. I've learned not to make such deadlines for myself. 

I've seen the self-help shows and read the books and articles. I need to be more grateful for what I have. I run through all the things for which I have gratitude. I write it down only to completely forget about it a few days later. My mind is like a sieve. With all the things I forget, why won't I let myself forget all the things I never accomplished and the things I've done wrong?

How do I focus on today, when today is filled with no motivation and wanting to check out of this world with a nap? How do I focus on what I want when I have no ability to achieve my goals?

This is depression. 

Depression is the cycle of impossibility that never lets you see the glimpse of the light saying you can. That it will, somehow, happen for you--that you can do it.

Depression is sitting here wondering why you are just sitting here.

Depression is knowing you are not doing enough with your time and your life and not being able to do anything to self-correct.

Depression is spending weeks like this and only realizing later that you are indeed depressed. No other outward signals tell you that this is happening to you. Again, the weight of this discovery is on your shoulders to resolve, next to the heavy load you carry.

Once I realize I am depressed, I dutifully make the appointments with my psychologist and psychiatrist only to realize it is Friday, and I will have to muddle my way through the weekend and next week until 'the next available appointment' on Wednesday.

When the thoughts are swirling around my head so fast I don't know where else to put them, I come to a blog I have maintained for a decade.  I write it all down. On the one hand, I hope that writing it down will remove it from my head space. On the other, I hope someone who reads this blog will see herself in these words so she knows she is not alone.

I'm just hoping for my mind to quiet and to let me see some sparkle of hope that tomorrow can be different, that tomorrow can be better.

I close my eyes and check out of this world, hoping that my respite from the worry over my pain, emotions, and thoughts will give my body a few hours to reset and start again. Technology teaches us that when things go haywire, log out and try again later.

I have to put my faith in naps, because it is the only tool in my tool box that I can grab now.

I'll deal with all the guilt of inactivity and non-accomplishments later.

For now, my brain and my heart need a break.

I reach for the only thing that quiets my mind from the weight of the indignities.

I crawl into bed for a sweet nap and hope that I can tomorrow.

Cushing's Awareness Day 2: Depression Cloud Follows Cushies

Cushing's patients face mental as well as physical changes from excess cortisol and pituitary/ adrenal tumors, making it excruciatingly more difficult to cope.

I logged onto my online Cushing's group tonight. 

Within minutes, I see this poem from Theresa in California.  

Without hesitation, I wrote to her:

This saddens me so much, Theresa. Yet, I related to all the words.  I even felt the same way you expressed in the last line.  I ask you, Please hang on.  It is a dark road, but you can make it. You can survive. Hang on to us here. Together, we will stand strong.

I then asked Theresa if I could share this here.  She was thankful for the support and granted my request.

For Theresa, myself, and all the other Cushies out there who struggle to understand this new world into which we have been completed submerged, I share this poem with you.

Once again I've opened my eyes
to another day of sickening thoughts and silent criesMy mind awakes once more to realizeI must face yet another day of struggling to surviveThe pain sets in and the unrealistic, realistic thoughts pour inI cannot concentrate, focus, just sit and wonder how to beginTo get back the life I once had, so normal and trueLoving family surrounding, yet none with a clueFilled with disease my body began to failTo disintegrate, fall apart and become frailAway from reality, family and friendsIts taken me to hell without any endI've lost my life, my friends are fewFamily doesn't understand, as white trash I am viewedI don't want to go on, each night I lay my headI pray I'll just sink into the ground because I feel I am already dead.

Post #1: Chronic Pain and Incertainty

Cushies are tormented as we struggle with the medical community and face our own bodies and changing identities every day.  It just shouldn't be this way. 

I can not think of a more perfect way to kick off Cushing's Awareness Month than with this entry by author Toni Bernard.

Really. There is just nothing left to say on this issue. Toni has said it all.

How Chronic Pain and Illness Fan the Flames of Uncertainty

http://m.psychologytoday.com/blog/turning-straw-gold/201404/how-chronic-pain-and-illness-fan-the-flames-uncertainty

30 Major Depressive Disorder Symptoms: Are You Depressed?

It is obvious that Cushing's patients face physical limitations and deformities. Mental and emotional changes are ever present but hard for a patient to point out. There is nothing to "show."

After six years of fighting Cushing's and knowing that word specifically, I know I have battled depression the whole time -- like, every day.

We can no longer live in a world that makes us feel poorly about ourselves for seeking help for depression. Like Cushing's, depression is a medical problem, not something we brought on ourselves. 

This article explains the 30 signs of depression very well. If you are depressed, please seek help. You deserve to seek out the help you need. You are worth it. 

"Depression is much more than feeling sad. It is a mood disorder that can interfere with everyday life. There are six types of depression: major depression, atypical depression, dysthymia, portpartum depression, premenstrual dysphoric disorder, and seasonal affective disorder. Depression with mania is known as bipolar disorder or manic depression.

Having untreated depression can put your life on hold for months, if not years. Major depressive disorder can also lead to thoughts of suicide. Here are 30 of the main symptoms of depression. If you experience one or more of these symptoms, talk to your doctor."

http://m.activebeat.com/your-health/major-depressive-disorder-symptoms-are-you-depressed/

Happy Birthday Rieger kitty

Today, my cat Rieger Magillicuddy, turns 5 years old.

This is newsworthy to include on my Cushing's blog because my husband bought him for me in 2007, just month's after finding out that Cushing's was the enemy. Husband had read that pets help patients with depression, and I was facing the worst of my depressive symptoms at that time. Soon, we searched the Internet to find one that wouldn't make us allergic. This is what we found: a gorgeous Siberian kit cat, new to the US in 1990.

http://www.cfa.org/client/breedSiberian.aspx

After avoiding cats for my entire life, I now fancy them, well, one in particular.


Happy 5th birthday, my sweet kitty cat Rieger. Our family wouldn't be the same without you.

With love,
Mama and family

P. S. 'Scilla Presley spent a lot of time getting her eyeliner to look like this!

Day 1: Cushing's on my Mind

There is no real way to explain how devastating Cushing's is to a patient unlucky enough to suffer from high cortisol. In nearly four years of blogging, I find that this word cloud I made does the best job so far. 

Click on the image to enlarge it.

Yes, it is really this bad, and isn't that so sad for me and other Cushies.

  

I can’t believe I have lived in that cloud for over 60 months now. To be a patient suffering with Cushing’s is to feel and experience all that word swirl of emotion and more. That word cloud isn’t just my disease. Cushing's is the monkey on my back that I cannot shake. Hours and days, then months and years pass without feeling better, looking better, or being better.  When the days carrying moments of relief arrive for a short surprise visit, I am pleased. Looking back, I realize the strength I have in just walking through it, never seeing any light at the end of the tunnel.  May I and the many other Cushing’s patients continue to find the strength to keep going.

Cushing's has altered who I have become, but I can't let it change who I can become anymore.

DEPRESSION: Are you more than just sad or down?

I was up late on the computer, organizing years of digital photos. While watching TV, I was intrigued by a commercial I saw. It was along the lines of, 'How do you know if your depression is as bad as you think it is? The voices pointed viewers in the direction of an online self-assessment that will determine the severity of depression, if any, and direct you to some help. It only took about 15 minutes to complete the WebMD Depression Health Check.

I found this particularly timely. If you've read this blog before, you might have picked up on my internal battle with depression: do I have it? Why can't I be grateful? How can I help people here if I'm down? etc, etc, etc. My depression symptoms from Cushing's went haywire with post-partum depression and even post-op pituitary surgery.

While taking the assessment, it asks if you are taking medication. I said, yes to taking a sertraline/zoloft generic for over a year without much improvement. It asks if you have any conditions that may worsen depression, AND CUSHING'S WAS LISTED. I couldn't believe my eyes! Somewhere in the medical community, SOMEONE IS MENTIONING AND EVEN RECOGNIZING CUSHING'S! I feel a little validated... even though I bet this is only one way for BigPharma to sink their teeth into us and not let us go. Regardless, I will take any help I can get. I feel completely at a loss as to what to do next to help myself, so I am interested to see what they suggest. In fact, to be helpful, I thought I would share what the final assessment showed, in a report for my doctor and me :)

Date: December 6,2009
Patient Name:

Dear Doctor,

Your patient recently completed the online Depression Health Check Health Check at WebMD. This tool is designed to help your patients become better informed about their conditions and compliant with your prescribed therapy. Full clinical references are provided at the end of this document

Impression
Dx major depressive disorder (MDD)
History
30-39yo female dx MDD >6 mo ago. Currently treating with Rx. Sx STB |||| with Tx.
Medications

* Zoloft (sertraline)

ROS positive

* Depressed mood (DSM major)
* Anhedonia (DSM major)
* Anxiety (DSM minor)
* Difficulty sleeping (DSM minor)
* Difficulty concentrating (DSM minor)
* Feelings of worthlessness or guilt (DSM minor)
* Increased fatigue or loss of energy (DSM minor)
* Weight change (DSM minor)
* Recurrent thoughts of death or suicide (DSM minor)

WebMD Healthcheck

You've been living with depression for some time, now. Unfortunately you haven't found a treatment regimen that works well for you. Perhaps it's time to talk to your doctor.

Ask About Treatment-Resistant Depression
If you have been on at least two different medications over the past six months or longer and you have taken the medication exactly as prescribed, it is possible that your depression could be "treatment resistant." If you think that might be the case for you, talk to your doctor, because treatment-resistant depression requires a different tactic. Sometimes what is thought to be treatment-resistant depression turns out to be bipolar disorder or another medical illness that has gone undiagnosed. Your doctor can help determine whether you need a different treatment plan or further evaluation.

Don't Get Discouraged
There are many options that can help you control your symptoms and take back your life. Trying different combinations of medication, talk therapy, and lifestyle changes may increase the likelihood that you'll achieve remission, which is the ultimate goal.

Give each combination a thorough try before deciding that it's not working for you. Long-term treatment for two years or more may be necessary. Keep a journal to track your symptoms and responses to medications and other therapies, so you can see your progress over time.

Be a Patient Patient
Medications that treat depression do not work overnight. When first started, many of these medications take at least two weeks to build up in your bloodstream to levels at which an effect may be noticed. If your medication is not working after two weeks, your doctor may increase the dosage, add or change to another medication, or do both to help control your symptoms. Talk therapy often is recommended, too.

Do Be Compliant
To make sure your medication is as effective as it can be in as few courses as possible, it's important that you be diligent about following your doctor's instructions. Take the medication in the amount prescribed and at the same time(s) every day. If you have questions about whether you are taking your medication(s) correctly, your doctor or pharmacist can review your treatment instructions with you and make any necessary adjustments that may make it easier for you.
If you work with your doctor and find a successful treatment plan, it is important to stay on that treatment plan for six to 12 months, even if you start to feel better after one month of treatment. Not following your doctors instructions can increase your risk of relapse. Relapse can be common once drug therapy is stopped or if symptoms persist. And two or more episodes of major depression increase the risks of another episode of depression. Talk with your doctor to determine how long you should stay on treatment.

How Others Are Responding to Treatment
Response to depression treatment can be very personal, but sometimes you just need to know you're not alone. See how your treatment response compares with others, like you, who have been diagnosed with depression, are currently treating their depression, and have recently taken this same WebMD Depression Health Check.

You reported that since starting your treatment that your depression symptoms are
slightly worse.

What Others On Prescription Treatment Are Reporting
Much improved (16%)
Slightly improved (40%)
No change (23%)
Slightly worse (13%)
Much worse (8%)

Be Careful With Supplements
Several types of dietary supplements are touted as mood enhancers, including St. John's wort, valerian, lavender, B vitamins, and omega-3 fatty acids, but there is mixed or little evidence about their effectiveness. In some cases, supplements can cause dangerous interactions with prescription medications. Be cautious, and be smart: Tell your doctor about everything that you are taking, even vitamins! Ask your doctor or pharmacist about any supplements.

Pain and Mood
A common occurrence with depression can be chronic pain (pain that persists over a long period of time). Research presented by Harvard Medical School showed that depressed patients have three times the average risk of developing chronic pain. But chronic pain also leads to depression, as the same research also showed that people with chronic pain have three times the average risk of developing anxiety disorders and depression.

Depression and pain are closely connected. One of the reasons researchers believe this connection exists is because two chemicals in the brain -- serotonin and norepinephrine, which brain cells use to communicate -- affect areas of the brain linked to both pain and mood. Just as being depressed may make people feel more intense pain, being in pain all the time may lead to mood swings, immobility, and isolation, further compounding the feelings of depression.
Depression may contribute to the discomfort associated with back pain, chest pain, constipation, diarrhea, dizziness, exhaustion, headaches, joint pain, lightheadedness, muscle pain, nausea, and stomach problems. Because those symptoms occur with many conditions, specifically linking them to depression is a difficult task for doctors.

If pain or depression symptoms persist, you should see your doctor. After a thorough evaluation, your doctor can diagnose the problem and offer treatment, such as prescription medications, physical therapy and/or talk therapy. A study recently published in the Journal of the American Medical Association shows that people with both depression and chronic pain (of the lower back, hip, or knee) significantly decreased their depression, pain severity, and disability if their treatment included 12 weeks of antidepressant therapy, six weeks of a pain self-management program, and six months of continued therapy.

Medical Illness and Depression
Sadness can be a state of mood, and that state could be normal for a person or abnormal, and therefore part of an illness. As an illness, depression is a collection of symptoms and signs that interferes with your normal day-to-day activities. Depression also can occur as part of an underlying bipolar disorder, or secondary to substance use or abuse, certain medications, dementia, or other medical conditions.

Sometimes it is difficult to determine if depression is the result of an existing medical condition -- or the cause of symptoms. A recent paper in the American Journal of Medicine states that depression is increased in most major chronic medical conditions, and explains that treatments for those conditions may increase the risk for depression, too.

Diabetes, Depression, and More
A review of more than a dozen studies reveals that although type 2 diabetes may increase the risk for depression, depression is a much stronger risk factor for type 2 diabetes. Another recent study shows that treating depression improved insulin resistance, which occurs when the body doesn't respond as well to insulin and increases the risks for type 2 diabetes. One link between the two conditions could be cortisol, a hormone related to stress, which is a known risk factor for depression. When stress increases, cortisol is released, and cortisol affects blood sugar metabolism.

Alzheimer's disease also is more likely to develop in people with memory problems who are depressed than it is in people with memory problems who are not depressed, according to a new study published in the journal Neurology.
Other conditions linked to depression, whether by hormones or direct effects on the brain or major body systems, include:

Autoimmune disorders, such as Addison's disease, lupus, and rheumatoid arthritis
Cancer
Coronary heart disease
Fibromyalgia, osteoarthritis and other musculoskeletal conditions
Head injuries
Infections, such as pneumonia, Epstein-Barr virus, HIV, the flu (influenza), and tuberculosis (TB)
Metabolic and hormonal disorders, such as anemia, Cushing's disease, low potassium, low sodium, and thyroid or parathyroid disorders
Neurologic disorders, such as multiple sclerosis or stroke

Some medications that may increase the risk of or symptoms of depression include:

Barbiturates, such as phenobarbital, which is used to treat epilepsy or insomnia
Beta-blockers, such as atenolol or metropolol, used to treat high blood pressure
Chemotherapy agents used for treating cancer
Cholinesterase inhibitors, such as neostigmine or physostigmine, used for treating Alzheimer's disease
Cimetidine (Tagamet), which is used for treating ulcers
Narcotics, such as codeine, hydrocodone, oxycodone, used for treating pain
Steroids, such as prednisone, used for reducing inflammation
Withdrawal from illicit drugs, such as cocaine

Learning More About Depression
You know how depression makes you feel. You've gone through the diagnostic process. You've probably even learned a thing or two about neurotransmitters while dealing with your condition. But you, like many researchers, are probably still curious.

What Causes Depression?
Two neurotransmitters (chemicals that help brain cells communicate) long thought to be involved in mood disorders include serotonin and norepinephrine. A long-standing theory has been that underactive neurotransmissions of these and other brain chemicals cause depression and may be involved in other mood disorders.

Defining Major Depressive Disorder
Since the 1970s, major depressive disorder has been defined by the presence of nine symptoms: sadness, loss of interest or pleasure, feelings of guilt, feelings of worthlessness, trouble concentrating or making decisions, suicidal thoughts, fatigue, abnormal eating patterns, and trouble sleeping.


Depression doesn't have to have such a strong impact on your life. Depression certainly can be a debilitating condition that increases irritability, restlessness, fatigue, and feelings of worthlessness, while decreasing sex drive, energy levels, and sleep. And it can hurt physically by contributing to headaches, back pain, digestive problems, bodily aches, and joint pain. But doctors can help you manage your symptoms. And you can play a large role in managing your condition by staying focused on your lifestyle.

Sometimes treating depression requires you to take a step back and see how far you've come. You won't notice a difference from day to day. If you keep track of your symptoms, such as in a journal or calendar, you'll likely notice improvements month to month. If you do not, please talk to your doctor and make sure you are motivated and willing to give yourself the care you need.


Take Care of Yourself
To reduce your symptoms while following the treatment plan your doctor recommends, be sure to:


1. Reduce Stress. The emotional effects of stress, such as anxiety, panic attacks, and sleep deprivation, may compound the physical symptoms associated with depression, such as headaches, upset stomach, and sexual dysfunction. And having depression may mean you'll feel more stress. Trying stress-reducing techniques like meditation, cognitive behavioral therapy, or yoga may serve a dual purpose. It may help you reduce the stress you feel, and it may reduce the negative effects of stress on your body. If trying to squeeze in a yoga class only increases your stress level, simply sitting comfortably in a quiet room for 15 minutes with eyes closed may let tension and stress have a chance to melt away.


2. Get Moving. We understand that depression may keep you from feeling like exercising. But if you can motivate yourself to do whatever activity you are able, the movement can start to make you feel better. Moving your body triggers the release of endorphins into the body, which are mood-boosting chemicals.
Getting exercise on a regular basis strengthens the heart and muscles, which may help reduce physical symptoms associated with depression, such as pain. Exercise also reduces stress, improves sleep, and wards off anxiety. A win-win all around. And remember, physical activity doesn't have to mean running. Walking, gardening, and playing outside with the kids count as physical activity. Remember to talk to your doctor before beginning an exercise program.

3. Eat Well. The foods you eat may affect your mood. Too much sugar may alter the balance of chemicals in the brain, contributing to mood swings and symptoms of depression. And one recent study potentially links a low level of omega-3 fatty acids with both depression and coronary heart disease. And depression is known to be a risk factor for coronary heart disease in those who do not have heart disease, and it is known to worsen outcomes in those who do have heart disease.
Maintaining a healthy diet may help lower your risks for other health problems. Choose fresh fruits and vegetables, whole grains, low-fat dairy, and poultry or fish, and make sure you eat them in proper portions. Limit highly processed foods, red meats, high-fat dairy products, and sweets. Avoid alcohol and foods containing trans fats.

Because you've been diagnosed with depression, it's especially important to pay close attention to what you eat. Depression may make some people turn to food for comfort and gain weight, whereas others will lose their appetite and lose weight.
If you have excess weight to lose, reducing your body weight could improve your symptoms of depression. A recent study done at the University of Pennsylvania shows that people with symptoms of depression who took part in a 6-month behavioral weight loss program not only lost an average of 8% of their body weight, they also significantly reduced their symptoms of depression. In addition, they improved their glucose and cholesterol levels and reduced their triglyceride level, thereby cutting their risk of heart disease and stroke, and they also significantly reduced their symptoms of depression.

4. Be Aware of Alcohol's Effects. Alcohol dulls symptoms and pain because it depresses the central nervous system. That means it affects chemicals in the brain. For example, alcohol reduces serotonin, which increases symptoms of depression. Alcohol abuse or dependency can be associated with major depressive disorder. Eliminating the intake of alcohol is an important part of your treatment. Avoiding alcohol altogether is best if you are taking prescription medications, as mixing alcohol with medication may result in serious side effects.

5. Find Shoulders to Lean On. Sometimes a good friend with a great ear for listening can help relieve some of the pressure depression brings. Spending time with friends and family members who make you feel good or working one-on-one with a therapist gives you a place to vent.

Beyond family, friends, and your therapist, joining a support group can help you connect with others who are experiencing similar problems. Support groups allow you to share the ups and downs you experience while trying to manage your depression, and may allow you to learn some new coping solutions from others in the group. Check local hospitals as well as state and local chapters of the National Alliance on Mental Health for support groups in your area. Some support groups are online, as well.


The more you know about depression and treatment, the better equipped you'll be to make wise decisions about your health. You answered 10 out of 10 questions correctly, or 100%. HEY, WOW--maybe being smart will make me feel better about myself?! :)



Depression can make you feel pain more intensely, and having chronic pain can make you feel depressed. True or False?
The answer is TRUE.
Depression is not just an emotional condition, it's very much physical, as well. People who are depressed are more likely to experience sleep disturbances, headaches, back pain and continuous dull aches and pain. Although depression can increase a negative response to pain, some of the chemical messengers to the brain for pain and depression are shared, making it possible for the brain to associate depression with pain, and vice versa. In fact, depression and chronic pain have a reciprocal relationship: People with chronic pain experience three times the average risk of developing psychiatric symptoms, including depression, and people living with depression have three times the average risk of developing chronic pain.
A Harvard Medical Center review found chronic pain to be both an emotional and physical condition, resembling depression and affecting mood and behavior and leading to isolation and immobility. Medications are available that alleviate both the mood symptoms and the pain. Eating well, reducing stress, and exercising also help keep pain and other symptoms at bay.


Depression medications may take several weeks to achieve their full effect. True or False?
The answer is TRUE.
Medications prescribed for the treatment of depression do not reduce symptoms overnight. It takes time for the medications to interact with the body, anywhere from four to eight weeks, as the medications increase chemical messengers in the brain. Not all medications interact with individuals the same way: What may work well for one patient may not work well for another. If one medication, taken for eight weeks, does not reduce symptoms of depression, doctors may try increasing dosages or try different medications altogether, again requiring additional weeks before knowing if they work. However, once the right course of treatment is found, depression symptoms can be greatly reduced and depression can go into remission. It's worth the wait.


Depression medication together with talk therapy is usually more effective than either type of treatment alone. True or False?
The answer is TRUE.
The goal of treatment is to put symptoms of depression in remission so that you can do what you enjoy and enjoy what you do. For some people, remission occurs after a course or two of antidepressants. For others, it is achieved with psychotherapy and no medication. For some people who have depression, psychotherapy may be recommended as the initial treatment. An antidepressant medication should be started if psychotherapy doesn't improve symptoms. For those who have severe depressive symptoms when diagnosed, antidepressant medication is recommended as the initial treatment.

At least a dozen studies show that the combination of psychotherapy and antidepressant medication is more effective than either alone, especially for those who have recurring depression or who have had severe depression for more than two years. Regardless of which type of treatment is being used, taking the medication exactly as prescribed and not missing doses is necessary, as are regular follow-up appointments and open, honest communication with the doctor at those appointments.


It doesn't matter if you miss a dose of medication now and then. True or False?
The answer is FALSE.
Antidepressants balance levels of chemicals in the body that regulate mood. There may be a lag before the medications relieve your symptoms. Your doctor's prescribed dosage is meant to work over time to reach the level in your body that will regulate your brain's chemicals. Even if you feel better, do not discontinue your prescribed antidepressant without talking to your doctor. This can result in a relapse of your symptoms or can be associated with symptoms of withdrawal, such as nausea, dizziness, and trouble sleeping. It is important to follow your doctor's medical regimen closely to put depression into remission.


If depression recurs, it is best to treat it with a different medication. True or False?
The answer is FALSE.
If you get your depression symptoms under control, are weaned off the medication by your doctor, and then have a recurrence of depression, many times your doctor may resume the medication that worked previously to manage your symptoms. Of course, the antidepressant you took in the past may have a similar response as you did before; if not, your doctor may consider other treatment options. Because depression tends to run in families, another medication option may be one to which a first-degree relative (mother, father, sister, brother) has had a positive response. Responses to medications often have a genetic component, too.


You can tell if someone is depressed just by looking at them. True or False?
The answer is FALSE.
Many people fear the thought of others knowing that they are depressed, and therefore often do not seek a diagnosis or treatment for their feelings. That is unfortunate because others will not know if you or anyone else is depressed unless you tell them. Although depression is considered to be a medical illness, like arthritis, heart disease, or diabetes, people with depression do not have a physical characteristic that "gives them away." Depression does not make a person have a certain look, nor does it cause any outward signs in the way that, say, arthritis may cause apparent red, swollen joints or a limp.


Once you start feeling better on medication, you can stop taking it. True or False?
The answer is FALSE.
Some patients taking antidepressants may feel so good they assume their depression is in remission and believe they no longer need antidepressants. Patients who abruptly stop taking medications may experience a return of depression symptoms and may also experience symptoms of withdrawal. Researchers examining the effects of abruptly coming off a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) have found that patients felt serious physical and emotional effects, including flu-like symptoms, vomiting, fatigue, and dizziness. It is important to remain on treatment until your doctor recommends slowly weaning you off of medications. Your doctor will lower dosages over time and phase out the medications slowly, so as not to cause withdrawal symptoms or trigger a relapse of depression.


Depression always causes the same symptoms in everyone. True or False?
The answer is FALSE.
Depression is a common medical illness, associated with biologic changes in neurochemistry in the brain. It is associated with both emotional symptoms (mood changes) and physical symptoms, such as fatigue, headache, abdominal pain, and muscle tension, but not everyone who is diagnosed with depression has all of the symptoms. To diagnose major depression, either depressed mood or a loss of interest/pleasure in activities that were once found to be enjoyable must be present most of the day nearly every day for at least two weeks in a row, in addition to changes in sleep, appetite, weight, psychomotor activity, energy level, or ability to concentrate. Thoughts of worthlessness, guilt, death or suicide may also be present.


If the first medication you try doesn't work, no antidepressant will help. True or False?
The answer is FALSE.
Just because one antidepressant doesn't work for you does not mean that another one won't or that your depression can never be treated. If you've been taking a medication exactly as prescribed -- that is, in the proper dosage and not missing any doses -- for at least eight weeks, then tell your doctor that the prescribed medication doesn't seem to be working. Knowing that people can respond differently to the same medication, your doctor will understand. Your doctor may increase your dosage, prescribe a different medication altogether, or suggest that you add talk therapy (one-on-one counseling or support group), which can improve the effectiveness of antidepressant medication. Once you and your doctor find the right course of treatment for you, your symptoms of depression may subside, and your depression may go into remission.


Most people with depression will have it only once in their lifetime. True or False?
The answer is FALSE.
Major depression is a relapsing, remitting illness in most patients. Following a first episode, there is a greater than 40% rate of recurrence over a two-year period; after two episodes, the risk of recurrence within five years is approximately 75%. Ten percent to 30% of patients treated for a major depressive episode will have an incomplete recovery, with persistent symptoms or dysthymia.

Fighting My Way Out of the Funk

I'm sorry. I haven't been posting here. I realized I didn't want to share any bad news. People don't expect that from me. People really don't want to hear bad news. They have their own problems. In this economy, people are taking a beating in all aspects of their life. I find that the more I keep it all to myself, the better everyone else feels around me. I don't want to be Debbie Downer. Who does?

However, I have realized in the last two weeks that I can't keep it all in anymore. I physically can't keep it in. Emotionally, I can't keep it all in. I miss "telling" my experience to "someone." It really doesn't feel like anyone really listens in my "real" world. I can't blame them. There are far more interesting things to discuss than what my latest ailment entails. While I don't blame them, I have been feeling increasingly sorry for myself. That's unfair, and it is a tremendous load to care alone. So I decided that I will try to put it out "there" so that I don't feel like I am keeping it all pent up inside. Maybe this will help. Something has to. Soon.

It's therapeutic, somehow, to know that someone else may have experienced or might experience what I am going through now. So here it goes. Shorter posts, hopefully helpful, even if just to me.

I hate to blog and run, but I've got to put the baby to sleep. ~Melissa

********************

I am always encouraging people to take charge of their own lives, especially their own healthcare. So for now, I wanted to share a book I just saw mentioned on the Dr. Oz Show from Dr. Lisa Sanders. I'm gonna download it on my Kindle on my iPhone now. Good. Something new to do. I am looking forward to reading this book: Every-Patient-Tells-Story by Dr. Lisa Sanders

Click here to read an excerpt from the book Every-Patient-Tells-Story by Dr. Lisa Sanders

I also found this from the Oprah.com site:
Every-Patient-Tells-Story by Dr. Lisa Sanders

How to Help Your Doctor Help You
By Naomi Barr

Gregory House, MD, the main character of the Fox TV show House, isn't like other TV doctors. While they obsess over emergencies, surgeries, and affairs of the heart, House is all about the subtle art of diagnosis. That's no surprise given the inspiration for the series—the New York Times column "Diagnosis," by Lisa Sanders, MD. In her new book, Every Patient Tells a Story, Sanders uses puzzling medical cases to illustrate how narrative can help you help your doctor. Here, she shares some pointers:

O: How do I know what to tell my doctor?
Sanders: You're telling your story even before you call a physician. You share it with your friends, your mother, your spouse. You tell them about the pain you're feeling—what makes it worse, what makes it better, how it affects your life. Use this info, and then be prepared to answer the questions that doctors ask.

O: What kinds of questions?
Sanders: Actually, the first question is one that I find doctors rarely ask, though they should: "Do you have any idea what this is?" Patients usually do have a sense of what is ailing them. So if your doctor doesn't ask, speak up. I had a patient with fever, low blood pressure, sore throat, and maybe diarrhea. I took a good history and did a thorough physical exam. But 48 hours later, all the tests (Lyme disease, various other bacteria, salmonella, etc.) were negative. As I was giving her the results, she said, "Oh, I think this might be dengue fever because I was just in Puerto Rico visiting relatives and everybody in the neighborhood had dengue and felt just like this." Sure enough, that's what she had. Another important question: "Has anything like this ever happened to you before?" Patients often overlook this. If something strange happen to you once, okay, everybody has one freak occurrence. Twice? That's a pattern.

O: What happens if your doctor doesn't take the time to listen?
Sanders: If your doctor interrupts before you are through, indicate to her you're not done. We have no idea which detail is going to be useful until we hear them all. When you get a chance, say, "I'd really like to go back to my story. I still have some thoughts about what's going on." You are the expert on your experience, and no one but you can describe your area of expertise: your body.

DEPRESSED: Withdrawal from steroid cortisol replacement

My body is not making any cortisol on its own. Cushing's disease made my hypothalamus-pituitary-adrenal axis off kilter. Now, I am taking steroid hormone replacement in pill form--hydrocortisone--to restore the proper amount of cortisol my body stopped making once the benign pituitary ACTH-secreting tumor was removed.

I have been feeling all of the expected symptoms that are related to dropping my dose of hydrocortisone weekly.

* severe fatigue
* dizziness
* nausea
* headache
* joint aches
* back aches
* depression

Lying down and closing my eyes gets me through the first three. Darvocet, my pain killer friend, gets me through the aching pain. The last one bothers me more than the others. Even taking 200 mg of Sertaline/Zoloft, an antidepressant, doesn't help me combat the depression brought on by low cortisone. Even a friend said she couldn't cry at all on 100 mg--it helped her that much. I'm on double and it's like I'm not on anything.

This got me thinking of the mind bender that is as debatable as the Chicken v. Egg case.

If a tree falls in the forest and no one is around to hear it, does it make a sound?

I am wondering if the same is true about me and my recovery.

It is day 24 after pituitary brain surgery.
Yes, they went through a natural orifice to access the part that hangs from the brain. The docs didn't do a craniotomy. They did not shave my head, and I did not lose my hair. For that, I'm thankful. However, they did get pretty darn close to my brain... like a centimeter or so. They gave it a little tickle. I've never liked being tickled.

So, I must ask:

If a Cushing's patient struggles after surgery and no one asks her how she is doing, is she really even sick?

~ Cushie Melissa

P.S. I admit a large degree of self-pity in this post. I feel needy and disappointed and unaccomplished and helpless. I am really even reluctant to post this now, and you may come back later and this post will be gone. If I can publically confess and own my uncomfortable feelings of being a weak, sick patient, then this post will remain here for others to read.

I post my true feelings because that is what I promised myself I would do. Strong or weak. Good or bad. Happy or sad.

I want to show those fighting with Cushing's that coping with this "rare" disease is difficult. People do not understand. It is not just you, your family, your friends. It happens to all of us. I understand.

So let's know that this is the case.
Let's keep moving ourselves forward.
It makes no sense to wallow.
I hate to wallow.
I do wallow, but I don't like to.
When I get sick of myself, I stop.
Like now.
I'm done.
Happy birthday, America.

:)