I have a chronic illness that has lately taken control of my life. It’s a digestive illness called gastroparesis. With this illness, I suffer severe nausea, vomiting and pain. Fortunately, over the past 10 years it has come and gone, so I do have reprieves of several months from time to time. This is not one of those times. I haven’t eaten in three days because of my illness. Right now it is more severe than it’s ever been, and I don’t know how long it will last. Months could go by where I have to subsist on protein shakes and simple carbohydrates because that’s all my stomach can handle. The severity of this chronic illness has triggered an episode of my bipolar disorder, so I’m now suffering from depression on top of everything else.
I am not alone in this. More than half of those with chronic physical illnesses also suffer from depression. We all experience it in different ways. Right now my personal agony has mostly come from depressed mood, fatigue, problems thinking clearly, and thoughts of death.
Depressed mood is the first listed symptom of depression according to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). It’s technically defined as “Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful).” My depressed mood has sucked any motivation from me. I spend a considerable amount of time ruminating over how horrible my illness is and how much I hate what it does to me.
Fatigue comes from two different directions. Firstly, I can’t eat. I’ve entered a state of ketosis where my body has to generate fuel from fat stores as opposed to glucose in the blood. This may sound like the diet plan, but mine is neither on purpose nor healthy. I’m finding myself sleeping 10-12 hours a day (also a symptom of depression) because my body needs the rest. Secondly, fatigue is a symptom of depression. Everything requires more energy than normal- energy I don’t have.
The “diminished ability to think or concentrate” according to the DSM 5 is another major symptom of depression. It’s called impaired cognitive function. It affects attention, memory and critical thinking. It’s brain fog. It’s harder to concentrate and make decisions. It’s hard to work. It’s hard to play. My brain just wants to shut down. Part of this is because the brain needs food in order to function, just like any other part of the body. Since my body is currently rejecting food, my brain isn’t getting the energy it needs to think clearly. The other part of my diminished ability to think is due to bipolar disorder. Not only is it part of depression, but people with bipolar disorder can have problems with cognitive function all the time.
I also have thoughts of death. Thoughts of death can be frightening. I’m not suicidal. I don’t have a plan. That doesn’t mean it’s not depression. It could be due to my illness. The mortality rate of gastroparesis is relatively low at around 15%, but it does happen. When I haven’t been able to tolerate food for three days, it scares me that it won’t go away this time, that this is the time it will kill me. It’s not terribly rational, but depression isn’t based on rationality. Other thoughts of death are related to the depressive state I’m in. I just want to stop hurting. I want to stop feeling this way.
I’ve spoken to both my psychiatrist and my gastroenterology specialist about both of my conditions. For now, neither has recommended a change in treatment. They are convinced both the digestive illness and the depression are temporary and will work themselves out in time. This has become a mantra that I repeat when I’m feeling my lowest. After all, they are the experts.
Image credit: Britt-knee