“Just snap out of it!” “It could be worse!” “You are not trying!” “If you wanted to, you would be better!” “Think positive!” These types of statements are not very helpful to those who suffer with depression, but are statements that those with depression tend to face daily.
These types of phrases are common with family and friends to those suffering with depression. They are often made with kindness and with the intention of being helpful. Sometimes they come out of exasperation or from the pain and hurt one feels from seeing a loved one feeling depressed. However, these types of statements rarely seem to be helpful. Many with depression actually say that these types of statements make them feel worse and culpable – that they are counterproductive.
The neuroscience today provides a better understanding of why. Family, friends, and colleagues should be encouraged to look for alternative ways and measures to help an individual dealing with depression.
Depression, a state of, but not only, sadness
It is difficult for someone who is not dealing with depression to be able to place themself in the shoes, or understand the feelings, of someone who is. When we try to do it, the thoughts that naturally occur are those of sadness. However, depression is much more than just sadness… it can include the feelings of anxiety, hopelessness, fatigue… a lack of interest, psychological suffering, and low morale.
The negative effects and thoughts are often the most visible part of depression and probably the most “understandable” for society. In the same way people try and sympathize with those that suffer from a physical injury, people often try and sympathize with loved ones who suffer psychological pain, even when they do not understand the cause.
But depression is not only reflected in this excess of so-called negative effects. It also manifests itself in another aspect, which is equally frequent and serious: the lack of positive affects. Psychiatrists have a varied jargon to describe the different symptoms: anhedonia or the inability to experience pleasure, aboulia or the abolition of the will, and the inability to act or a feeling of numbness.
A feeling of low spirits is temporary, but not depression
When people often think of depression and its symptoms, it is common for people to think and remember when they felt a feeling of “low spirits” and periods of discouragement. These types of feelings can be a result from an overload of stress or painful news; however, fortunately, these symptoms, generally, turn out to be temporary.
In fact, when a few days of rest are not enough to get out of this state, loved ones are there to shake and push us to act or change our ideas. But during depression, ideas do not change on demand, as a result of a simple distraction or direction… nor do they change spontaneously. The term rumination, one of the symptoms of depression, precisely defines this inability to “change ideas,” this propensity to concentrate on the same negative thoughts again and again, to blame oneself for the same bad things. Very often, a person with depression is fully aware of their condition… that they are suffering from it, yet they are unable to change their mindset or outlook.
This second component of depression, the lack of positive affects, is not necessarily well treated by current therapies. Conventional antidepressants (including selective inhibitors of serotonin reuptake) appear to be more effective in most patients for treating the excess of negative effects, the first component, according to scientific literature.
A disease that affects the brain networks involved in motivation
The latest research in neuroscience suggests that depression is a also disease involving motivation, that is, it affects the brain networks involved in motivation. This suggests that telling someone who is suffering with depression to “make an effort” or “be more motivated” is just as absurd as telling someone with diabetes for his/her pancrease to “make an effort” or for someone who has broken his/her leg to “feel less pain.”
There are several ways in which a researcher can approach the mechanisms of motivation. Thus, it is possible to ask about its determinants related to genetics or the environment, its neurobiological foundations (at the microscopic level of a cell, its neuroreceptors, neurotransmitters), its cerebral bases (visible through imaging studies, at the cerebral area) or its cognitive mechanisms (related to the functioning of thought).
The team of Cognitive Neuroscience, Brain Motivation, and Behavior at the French Brain and Spine Institue (ICM) is studying this in patients. They use functional magnetic resonance or electrophysiology, taking into account prescription medications.
In this focus, motivation can be defined as the set of factors that determine the behavior of an individual, in terms of direction: choosing one action before another (e.g. preparing dinner instead of ordering a pizza) or in intensity: determining the amount of resources one assigns to an action (the amount of effort or time one devotes to an action).
A comparison between benefits and costs
When we have to choose between several actions and options, our decision is based on a confrontation between two opposing elements: on the one hand, the benefits (the rewards we can obtain) and the losses (those that we can avoid) and on the other hand, the costs (the energy and effort expended or required)
In this context, the notion of a reward can refer to a material good (an object, food, and even money) and to an intangible good (e.g. the pleasure of immersing oneself in a book or self-esteem from compliments). In the same way, costs can refer to both physical and mental costs.
This division into two categories of the determinants of our actions is probably reductive, even simplistic. But it allows for it to point out the origin of a disorder of motivation as part of one of these two main axes: either a decrease in sensitivity to rewards or losses or an increase in sensitivity to effort. These two mechanisms can likely coexist in an individual dealing with depression, in different degrees.
Take the example of a person who faces the action of going out to meet his friends in a restaurant. An individual suffering from depression may be unable to do so either because the prospect of reward is removed (the pleasure of being with loved ones), or because of the increasing cost of each of the actions required to meet his friends (the effort associated with making decisions, getting dressed, styling his hair, and traveling to the restaurant).
Each decision becomes a mountain to climb
Many individuals with depression express their difficulties in these similar terms: the slightest decision, the slightest action, become large mountains to climb. In fact, every time it is asked upon someone with depression to “try harder” or to do something that seems minimal, it is actually a large undertaking to them. Even if they do the action that seems minimal to us, like “just going to eat a restaurant,” it is such a huge effort for them that they won’t even be able to enjoy the accomplishment.
In recent years, several teams around the world have tried to measure these two aspects of motivation, in the general population or in individuals with a motivational disorder, such as depression.
What is at stake is so important that a series of arguments seem to indicate that the cerebral and chemical bases of each are different. When we calculate the value of the reward or the cost of effort, it is not the same brain regions, and probably not the same neurotransmitters, that are being exercised.
However, currently there is no validated way for psychiatrists to measure the weight of these two mechanisms in a patient in their daily practice. For the time being, these evaluations are limited to patients who have followed a research protocol and are only valid at the group level.
However, there is a strong possibility that these two main mechanisms of motivational disorders (such as depression) may require different therapeutic interventions, whether medications; brain stimulation, such as transcranial magnetic stimulation or electroconvulsive therapy; or psychotherapy. In the future, it will probably be possible to distinguish, in a loved one suffering from depression, which of the two mechanisms is involved…. until then, we should refrain from overwhelming those with depression with phrases aforementioned.
Still Tired liveing with crohns
When my Crohn’s disease is active, my fatigue can be debilitating. Sometimes I’m forced to stop answering phone calls because I literally don’t have the energy to construct sentences. I don’t allow myself to drive because it doesn’t feel safe. I’m basically unable to do anything except the bare minimum, and when I come out on the other side I feel like I’ve been in the deepest fog.
How can I be so tired?
After experiencing fatigue like this on and off for quite a while, I began to wonder how I could possibly be SO tired. I was ‘sleeping’ ten to twelve hours a night and taking a nap during the day. What more could my body possibly want? I wasn’t working. I wasn’t moving much. In fact, I wasn’t using any more strength than necessary, and yet, it still felt like too much.
Anyone with IBD knows that when you’re sick, it often feels like more than just stool emptying from your bowels. It feels like life is emptying out too.
Fatigue and mental health
I found the fatigue contributed to my anxiety and depression, affecting my mental health too. It seemed like I was trapped in this awful cycle and all I could do is come up for air between episodes.
During that time, I took prescription sleep medication, I worked with a sleep doctor, and underwent multiple normal sleep studies. I even followed suggestions on reducing screen time, creating sleep hygiene and more, but no matter what, I felt exhausted all of the time.
Sleep versus rest
This was when I learned the difference between being asleep, and getting rest. Being in bed, tossing and turning, waking up during the night – they all impact our ability to achieve deep sleep cycles characterized by faster breathing, a faster pulse, and rapid eye movements, or REM. There were times that my body may have been unconscious, but it most certainly wasn’t at rest.
It became clear to me that I had to learn how to dedicate time to conscious rest when I was awake. To be honest, this felt awkward and like something I was embarrassed about. Have you ever sat down to do something like this?
Changes I made
There were three changes I made that over time have significantly impacted my levels of fatigue, and I’d really like to offer them as suggestions to anyone who is struggling.
- Scrolling through social media, even while laying in bed, doesn’t count as resting. When you brain is actively thinking about things you want, need, or are missing out on, it impacts your body’s ability to rest. Schedule in some breaks to put your phone down.
- Guided imagery and meditation are real things that relax your mind AND your body. I rely on the Calm app, but there are others out there as well which offer you these services right from your phone. Quieting your brain quiets your body in a real, lasting way.
- Aromatherapy – certain scents are tied to physical relaxation. Whether you purchase a linen spray, light a candle, burn incense or diffuse essential oils, or take a bath with bubbles or salts or bombs, aromatherapy draws upon the healing powers of the leaves, flowers, stems, bark, roots or petals of plants to stimulate the natural healing action of both your body and your mind.
Tips on Asking for Support During Crohn’s or UC Flares
If you’re living with inflammatory bowel disease, you know that your life, health, abilities, and capabilities can change dramatically in a short period of time. From my experience, no matter how much I plan for the next flare, there are always things I wish I had done, I need but don’t have, or I would really benefit from help.
Asking for help during a Crohn’s or UC flare
I’ve thought a lot about this and about how it feels hard to ask for help. I don’t usually know what to ask for directly so I often keep quiet, and I never know who exactly I should reach out to in the event that I need (or want!) physical things or tangible assistance.
I wanted to share with you some thoughts I’ve put together after a lot of trial and error. To be honest, it’s SO MUCH better for my mental health and my stress levels as my symptoms increase to know that I know how to best ask for support and that I’m not alone in my trials, especially when this disease can feel so isolating.
Things that are helpful when dealing with a flare
In no particular order, here are some things that have worked for me:
- Keep a list in your phone of a few people who are local that you trust, and that might be able to do you a favor when you don’t feel well. Depending on your needs, this might mean stopping at the store, dropping off a cooked meal, picking up a prescription, taking you to a doctors appointment, sitting with you in the ER or visiting you at home or in the hospital.
- Then, add to the bottom of that list, a few people who might not necessarily be nearby, but who understand your heart. People you can call or facetime or text when you want to cry or vent or be distracted. One important note here: don’t leave out your other friends with IBD! I’ve often avoided telling them that I was doing poorly because I knew they had struggles of their own, and in retrospect, they wished they’d been able to be there for me. They understood my plight directly and agreed they’d tell me if whatever I was telling them or asking them in terms of support felt like too much at any given time.
- Think about your necessities during a flare: what foods or meal replacements you can tolerate, what clothes and basic household items that you both need and that would make you more comfortable, and anything that might cheer you up.
- If you have a roommate, live with family, have a spouse, children or pets, think about if they can help and/or have needs of their own while you are down and out.
- In the event that a friend or family member reaches out and asks what they can do for you, or what they can bring you or send to you, I’ve found politely declining over and over is a loss for both myself and the other person. They genuinely want to help, and I honestly could use it. I have found it to be easiest to have direct and tangible items I can ask for – such as groceries, prepared meals (or meal delivery), conversation to take my mind off of things or company when I don’t have the energy to talk.
Living with inflammatory bowel disease is hard enough, there’s absolutely no reason to decline help or support simply because you don’t know how to ask, or don’t want to inconvenience someone who has already offered.
Inflammatory Bowel Disease
What is Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease is a group of chronic lifelong conditions affecting the digestive tract. It includes both Ulcerative Colitis (UC) and Crohn’s Disease (CD) which are similar but affect different parts of the intestine. UC affects the inner lining of the large intestine while CD can affect any part of the digestive tract from the mouth to the anus. You can read further information on IBD in this patient information leaflet.
Clinical features of Inflammatory Bowel Disease
The main features of IBD are bloody diarrhoea associated with frequency, urgency and abdominal cramps. In severe attacks patients may suffer weight loss and anorexia.
In addition patients may have symptoms from outside the digestive tract including:
• Arthritis (large joints)
• ankylosing spondylitis
• erythema nodosum
• pyoderma gangrenosum
• iritis and episcleritis (inflammation of the eyeball)
• primary sclerosing cholangitis (75% pts have IBD, Geonzon –Gonzales 2006)
How common is IBD?
• 15,000 people in Ireland have IBD
• Incidence in Ireland – 6,000 UC
– 3,000 CD
What causes IBD?
The cause of IBD is unknown but is thought to include: Genetic susceptibility
A familial tendency
Environmental factors -smokingstress
non-steroidal anti-inflammatory drugs
history of appendectomy
history of infection with mycobacteria
activation of the immune system
possibly diet but not proven
• Infective agents
• Seasonal changes
• Stress – implicated in aetiology of disease (Mawdsley & Rampton 2005)
Treatment of IBD
Treatment for IBD is often simple and includes both local and oral medications, often the condition can be managed in the community by the patient’s General Practitioner after consultation with a Specialist. Regular review by a specialist is recommended for complex therapies and disease. Surgery may be required in difficult cases.
Mary Kennedy is the IBD Clinical Nurse Specialist at TUH. The IBD nurse is often your first point of contact if you require any advice regarding your disease. She provides a rapid point of access for IBD patients, in particular she can provide support, advice and information on your inflammatory bowel condition. Also, she will play an active role in disease and drug education and management. Treatments such as Infliximab (Remicade) and Adalimumab (Humira) are administered by the IBD Nurse.
An advice line is run by the IBD Nurse and the contact number is 01 414 3855.
TUH Gut Therapy Programme for IBS
The chronic diarrhoea pathway aims to provide patients with diarrhoea symptoms of Irritable Bowel Syndrome (IBS) with fast access to the most appropriate investigations and management of their condition. Patients aged over 45 with chronic diarrhoea of more than one month duration will be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.
Patients aged under 45 with chronic diarrhoea of more than one month duration with red flag symptoms such as bleeding, weight loss, anaemia and family history of bowel cancer or IBD will also be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.
Patients under 45 who do not have red flag features will have blood and stool tests done. If these are normal they attend the dietitian led gut therapy clinic, if an abnormality is detected they have a colonoscopy and are managed as appropriate after that.
Its most notable attribute is its effect on wound management and healing. Manuka honey also has antibacterial, antiviral and anti-inflammatory properties that may help treat numerous ailments, including irritable bowel syndrome, gastric ulcers, periodontal disease and upper respiratory infections.
Honey is well known for its anti-inflammatory and antioxidant capacities, which may be useful for the prevention of chronic inflammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti- inflammatory and antioxidant properties of honey
What is the fastest way to get rid of inflammation in the body?Follow these six tips for reducing inflammation in your body:
- Load up on anti-inflammatory foods. …
- Cut back or eliminate inflammatory foods. …
- Control blood sugar. …
- Make time to exercise. …
- Lose weight. …
- Manage stress.
Does b12 reduce inflammation?Vitamin B6, folate (B9), and B12 can lower your levels of homocysteine, an amino acid that’s linked to a greater risk for heart disease and rheumatoid arthritis. But we can’t say for sure that lowering homocysteine will also lower your risk for disease. The same is true for C-reactive protein, a sign of inflammation.
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