Home Community Chat Transcripts-9/11/00

Depression & Arthritis with Walt Hanks C.H.E.S.

InsightHostKJ> Looks like we're gonna have a full house tonight

Blondie> ayup

Melanie> Subject touches home

hello-parker> yes it does

InsightHostKJ> I think your right Melanie

hello-parker> we have a lot of depresstion in this room lol

Walt> I'm sure we could clear the room if I started talking about mortality again.

InsightHostKJ> LOL LOL Walt

InsightHostKJ> Well I think we can get started

InsightHostKJ> Our guest tonight is Walt Hanks, Health Educator and Person with Arthritis

InsightHostKJ> Please hold your conversations and type a ? if you have a question. DO NOT ask a question until you are called

InsightHostKJ> Walt, do you want to tell us a little about you first?

Walt> Sure Tina. I am a health educator, as she mentioned. I changed to this profession 6 years ago after being diagnosed with RA, FMS, etc. and discovering the importance of knowledge. I have an MS in health education and now live in Maryland.

Walt> I want to mention that I am not a psychologist and can not offer diagnostic or treatment advice. I can discuss the effects of arthritis on depression and deporesson arthritis.

InsightHostKJ> So do health educators get depressed too?

Walt> Yes Tine, but only if they have RA or live in Texas.

InsightHostKJ> LOL LOL

InsightHostKJ> Can you tell us some of the warning signs of depression? When is it the "blues" and when should we seek help?

Walt> The most significant warning sign of depression is the inability to enjoy life. Other warning signs include sleep interuption, dietary changes, weight loss or gain, or memory problems.

Walt> The distinction between "the blues" and depression has to do with the length of time you feel that way. If the blues persist and you can't shake them, then you should consider being evaluated for depression.

InsightHostKJ> Who should we go to?

Walt> Of course, any suicidal ideation is a huge red flag that demands immediate attention.

Walt> Start with your PCP, if you have a trusting relationship, or with a clergy member, counselor, or other mental health professional.

InsightHostKJ> OK ready to go with questions from the room Walt?

Walt> Sure, let's get started.

Dale> I was told that many doctors include an anti-depressant in their pain managment programs..why?

Walt> It's not to treat depression. Many antidepressanst are also good pain meds. But the dose is usually much smaller. The same neurochemical changes that occur in depression also occur with pain, so these medications will help both.

Dale> Taken along with pain medication?

Walt> To Dale, yes, taken together.

RAPBY> I'm taking metho,azulfidine,vioxx,plaquinil, folic acid, and prednisone. Will all this medicine cause depression?

Walt> TO RAPBY, teh prednisone is a well known problem with depression, but NSAIDs can also be a problem. Then again, pain is far more likely to cause dperession that is any medication, so it is a difficult call as to what might be at fault. Fortunately, the

Walt> More for RAPBY. I was trying to say: fortunately, the treatments are the same.

Jeannette> I have been depressed since adolescence, could this have contributed to my getting RA and other diseases?

Walt> Probably not Jeannette. There has never been an association found between depression and getting RA, at least not in any well designed study. There has been an association between prior depression and more severe pain.

Del> How can you tell the difference between being stressed out (with work, RA, responsibilities) and being depressed?

Walt> It can sometimes be hard Del. That's why you should look for any suicidal ideation (thinking about killing yourself, or how much better you might feel if you were dead). You should also look for an inability to enjoy things you always enjoyed before.

Walt> Finally Del, you should consider how long you have felt that way. If the "stressed out" feeling lasts for more than a couple of weeks, talk to your doctor about it.

Donna> what dosage of pred can contribute to depression

Walt> All of prednisones adverse reactions are dose dependent. But, it also interacts with other medications and pre-existing problenms. Generally, anything under 15mg per day is considered relatively safe.

nougiefoo> Can a car accident trigger RA? My mild depression and RA wern't there prior, in fact life was great.

Walt> There is no scientific evidence that a car accident can trigger RA. BUt, there is evidence that a major stressor can aggravate latent or low-level disease.

Walt> There is also evidence that long-lasting a major stressor prior to the onset of RA can make the pain more severe, independent of disease activity.

parker> I ahve been thinking of talking to a counselor I have been to one bfore but I just cant open up to them any suggestions

Walt> "Talk therapy" is only one way to treat depression. Exercise and medications are also excellent treatments. Successful talk therapy is also dependent upon building a trusting relationship with your therapis. Talk to your doctor about your options.

parker> ok i see him in 2 weeks ill ask him about it

Melanie> Therapists are like doctors. May have to shop around til you find the right fit.

Walt> Good observation Melanie.

InsightHostKJ> very true Mel

parker> my insurance wont cover a phyciatrist and I am interested in the confidenciality of a counselor are they required by law to keep it or is the records open

Walt> All licensed therapists are under the same confidentialty laws that a physician works under.

InsightHostKJ> Walt, if we notice a friend seems very depressed...what can we do to help them?

InsightHostKJ> Especially our online friends

Walt> Social support is one o fthe most important preventive and therapeutic agents. Let them know you care. Don't push, unless they start talking about suicide. If that occurs, call a suicide hotline or 911 if you feel they may act quickly.

Kimmy> How about the other side - if a friend keeps suggesting that they think you should try therapy because they "think" you're depressed...can you be depressed and not know it?

Walt> Well Kimmy, it is possible to be in denial about depression. If I had a close friend make those comments to me. I would have to really consider at least talking to my doctor about it.

shari> Is there any link between insomnia and depression?

Walt> Yes, in both directions. An inability to sleep due to pain or some other problem can certainly lead to depressive symptoms. Depression can also cause insomnia.

InsightHostKJ> Walt...what are some of the ways arthritis can cause depression and what can we do to fight it?

Walt> The primary predictors of depression in people with arthritis are pain, poor spousal support, poor social support, and the loss of valued life activities. The best preventive measures are to have or gain good spousal and social support, develop new value

Walt> more... develope new valued acticities, and get the disease under control.. For many people, it is also necessary to take antidperessanst or use some other therapeutic regimen.

InsightHostKJ> So get a new spouse and new friends? LOL

Walt> Finally, physical acticity is good for both the depression and the arthritis.

InsightHostRon> LOLOL

Walt> Many of us have found it necessary to get new friends. A few I know have also found it necessary to discard an unsupportivespouse.

Jeannette> Can a chemical imbalance cause a lifetime depression, even with the help of antidepressants?

Walt> My psychiatrist put it this way. The depression is going to last as long as whatever caused it. In my case, it was the pain and the loss of valued life activities. So, as long as the chemical imbalance persists, teh depression will need to be treated.

Jeannette> Can this go on indefinitely?

Walt> Also Jeannette, if medications are not enough by themselves, other treatments should be explored. Those should include talk therapy and exercise.

Walt> It can Jeannette, but it usually doesn't. For most people, depression is only a problem for a short time. Fortunately, there are good treatments available.

Melanie> I have major life changes going on - some due to RA and others not. I am on an antidepressant, have an appointment to see a counselor, and have gotten an exercise bike to increase activity. No spouse and friends dealing with parents' illnesses and deaths. What else would you suggest?

Walt> time Melanie. It takes time for all of the treatments to work. And it takes time to make the needed adjustments and start finding joy in life again.

Melanie> Okay, just wanted to make sure I hadn't missed something. Time I've got. Thanks.

swimmer> I am not depressed, don't think I have ever been. I am starting to feel like I should be though LOL. Can a person just not let themselves get depressed?

Walt> You may just have a hardy personality swimmer - and that's a good thing. A strong sense of personal worth and personal control (internal locus of control) really helps to avoid depression.

Dale> Right on Swimmer!

InsightHostKJ> How can we build this internal locus of control?

Walt> An internal locus of control is developed by experience. For a person with an external locus of control, talk therapy and group therapy are helpful Journals are also recommended.

InsightHostKJ> some people are just more prone to depression than others?

Walt> I think that it is helpful to take stock now and then, just to remind yourself that there are things you can still do, and life isn't all bad.

Walt> Yes and no Tina. There are certainly risk factors, such as a family history of depression. It is a physical disease afterall. But there is no risk factor that predetermines that you are going to be depressed.

Walt> Understanding your personal uniqueness, and your personal value, are part of an internal locus of control.

InsightHostKJ> Thanks Walt..Ron go ahead

InsightHostRon> The therapist I am seeing nowis big into complementaty medicine. He has suggested some of the eastern philosophy, especially yoga and meditation in addition to the meds

InsightHostRon> your opinion

InsightHostRon> and the lotus position is out of the question

Walt> Meditation has been shown to be helpful, especially when combined with medications and exercise. Yoga can also be helpful as a relaxation technique, but it should not be yuour only form of exercise.

Melanie> Walt, what is a locus? not familiar with the term

Walt> "Locus of control" refers to how you view the events of your life. Do you see the world as acting upon you, or do you see yourself as interacting with the world? "Locus" refers to the metaphysical place that you ascribe control in your life.

InsightHostKJ> Wow..deep...lol

InsightHostKJ> Walt do you have some general advice we can use in our everyday lives to avoid depression?

Walt> Well Tina, I think we have covered a lot of that already. Stay involved with life. Maintain or build friendships and connections to life. Get proper medical care. Exercise, and find new activities to replace the ones you lose. Finally, value yourself

InsightHostRon> that last one is tough sometimes walt

InsightHostKJ> I think thats tough sometimes when you have arthritis

Walt> I know it is Ron. In the western society we value and define oursleves too much by what we do. When we can't do that any more, we lose our sennse of self. We have to fight that.

Melanie> Have to redefine "self"

Walt> Yes Melanie.

InsightHostKJ> so true melanie

Giggles> My husband is here at the moment and wants to know what steps he can take to help me out when I do let it all get to me.

Walt> First, don't try to fix everything for her. Hug her, let her know you care, but let her succeed where she can.Make sure she gets the rest, medical care, and exercise that she needs. But most importantly, give her your love.

InsightHostKJ> sounds so simple

Giggles> he does that...thanks

InsightHostKJ> OK...time for one more..Tra...go ahead

Tra> Sometimes, I'm so miserable that I can't even stand myself, let alone being around other people. I just want to sleep, but seem to have trouble with even doing that. I don't really think I'm depressed, just sad and mad. Any suggestions?

Walt> How long has this been going on Tra? If it is more than two weeks, please talk to your doctor about this. Depression comes in all shapes and sizes, but it is not something you have to just live with.

Tra> I'll do that. I see her this week.

Walt> Tra, start tonight by keeping a journal of your activities and how you feel about them. That is very therapeutic.

InsightHostKJ> good idea walt

Tra> Thanks so much, Walt and KJ.

InsightHostKJ> Walt...any closing thoughts for us?

Walt> I just wanted to throw out some numbers for you all. One of the questions I get asked a lot (but not tonight) is how many people with arthritis are also depressed. Let me try to answer that.

Walt> First, it depends upon how you ask the question. If you ask, have you ever been depressed (or exhibited depressive symptoms), betwee 60 and 80%% of people with RA will say yes.

Walt> But, if you ask, are you currently depressed, the number drops to between 15 and 25%%, depending upon which study you read.

InsightHostRon> I would say by the number of people here for this chat Walt, that it is a topic near and dear to many of us..

InsightHostKJ> the 80%% figure about matches with our survey result

Walt> I say that because I want everyone to understand that depression is common in people with arthritis, but it is not inevitable and it is not a permanent state. It is an illness, just like the arthritis. It can be treated, and it can be overcome.

InsightHostKJ> You do not have to "live with it"

Diane2> May I ask a question?

Walt> No KJ, you don't and you shouldn't. Demand proper care, from yourself and from your doctor.

InsightHostKJ> Walt do you have time to take Diane's question?

Walt> Yes, but this needs to be the last one.

Diane2> Thank you

Diane2> It seems to be there is still alot of stigmatism associated with depression. What can we do to help overcome this?

Walt> First, we have to get over it ourselves. If we feel ashamed of being deppressed, others will echo our shame. I'm not saying that you need to broadcast the news to the world, but you shouldn't feel ashamed about it either. It is a physical disease, and that's all it is. Treat it, cope with it, and get on with life.

Diane2> Thank you

InsightHostRon> May I reemphasise one thing that you said walt, If you have serious thoughts or feelings of suicide, don't wait, get help immediately.There are suicide hotlines inalmost every major city. If necessary, go to the Emergency room of your local hospital..

InsightHostKJ> Excellent advice Ron. Walt, thank you so very much...I think we've learned a lot tonight. Remember folks, if you didn't get to ask Walt your question, you can always ask via our Expert Advice page.

Donna> Thank you Walt.

Tra> Thanks for the advice, Walt.

Walt> And Ron, suicidal thoughts include thinking about not taking your meds and letting yourself go.

Nicole> Thank you Walt

InsightHostKJ> Good point Walt!

Cindy> Thanks Walt

Walt> Thanks Tina. As always, I enjoyed the experience. See you all next time!

Barb> Thanks Walt

InsightHostRon> Thanks Walt

ORM> thanks, walt

InsightHostKJ> Night Walt

Giggles> Thanks walt

KenA> thanks Walt!