Fibro depression is in a class of its own.
The way I see depression, there are two types. There’s normal ‘reactive’ depression, or the natural feelings of sadness that are triggered by an event, a happening, something that would make even well people feel down, and then there’s depression that bears no relationship to anything external because it all comes from inside you. It rises up like a tsunami. It engulfs you. It drowns you. This, for want of a better way of putting it, is chemical depression.
When you have fibro, you are very prone to every normal physiological process being unstable. Everything tends to operate in a constant state of flux, and almost nothing comes under the usual mechanism of homeostasis, which is the human body’s standard way of maintaing stability throughout every system of the body. It’s what causes our blood pressure to rise very slightly in order to combat the sudden effect of gravity when we stand up. It’s what enables us to regulate our body temperature effectively. Homeostasis does a trillion different things, most of which operate in a system where a reaction happens in response to something else.
In the blood pressure example, there are tiny pressure sensors inside each blood vessel that register the change in pressure and blood volume when we stand up, which sends a message to the brain, which then sends a message to the adrenal glands to release a particular hormone that temporarily makes our blood pressure rise slightly by making our heart beat a little bit more strongly. The sensors then tell the brain that everything’s as it should be, and the process is reversed so that our temporarily raised blood pressure returns to normal within seconds.
If this process doesn’t happen in its entirety, we may feel dizzy when we stand up. This is called Postural Hypotension, which just means that our change in posture from lying or sitting to standing up makes our blood pressure suddenly drop. I won’t get into all the ins and outs of this, or other homeostatic mechanisms and feedback loops here yet, because the reason I brought it up is only to illustrate that when the intricate mechanism of homeostasis is upset, things can go wrong. Fibro seems to disrupt normal homeostatic mechanisms (in Postural Hypotension it’s usually down to a failure of the adrenal glands to produce the blood pressure raising hormone) and this includes the mechanisms that healthy and well people have that keep their mood stable and cheerful.
Lucky people, if they did but know it!
Depression can be one of the worst parts of dealing with fibro. One minute you’re fine, you are your usual cheery, happy, laughing self, all twinkly eyes and smiles, and the next you’re this hunched up puddle of misery sitting there with water spurting uncontrollably from your eyes. No twinkle and all sprinkle.
The only previous experience I can compare it to is PMS. If you’ve ever suffered from PMS, you’ll know what I mean. If you haven’t, then you’ll just have to trust my description of an internal tsunami of sadness drowning you.
No amount of trying to pull yourself together, cheering yourself up, thinking positive, or any of the other myriad of cliches than un-depressed people proffer, will help in this situation because it isn’t a matter of attitude and outlook, it’s a matter of chemical imbalance.
Because of the new generation of anti-depressants, the SSRIs (selective serotonin re-uptake inhibitors), most people have heard of serotonin. Serotonin is our natural happy chemical. If we fall short of serotonin, we get depressed. It also does other important stuff, like controlling how much our blood vessels constrict or dilate, and inconsistent serotonin levels not only cause vicious bursts of depression, they can also cause migraines.
For some people, anti-depressants help. I can’t take any of them. Not the new ones, not the old ones, just all of them make me ill. I throw up. I get more migraines, sinusitis, upset stomach, weird twitching, all manner of odd side-effects. Some of them in the past made me gain 2 stone (28 lbs) in a fortnight, because they disrupted my normal appetite control (another feedback mechanism controlled by hormones) and I could NOT stop eating. My every waking thought revolved around food. My first thought when I woke up was “Food! Now!,” and my nose was immediately in the fridge. I couldn’t even wait to get food OUT of the fridge, I would just sit there with the fridge open, ramming cheese, yoghurt, apples, whatever, straight in my greedy gob. One night, I sat in front of the freezer and ate an entire 1.5 litre tub of ice-cream. I was full to bursting (I remember that Monty Python sketch coming to mind at the time….”one more wafer thin mint?”) and really felt that I WAS going to actually explode all over the kitchen floor if I put even one more mouthful of food in, but I absolutely could not stop eating! 2st later, and I dragged myself back to my GP in protest. He took me off the anti-d’s.
We tried others. None worked. All had hideous side-effects. I gave up on anti-d’s. They aren’t for me. They’re even on my ever-growing list of “Cannot tolerate” meds in my medical notes.
And no, I’m not one of these super-smug people who can deal with their depression by virtue of mindfulness, or a particular type of meditation, and I don’t go and commune with nature to “get over it”, either (although sitting on a seaside cliff and watching the sunrise to give me some perspective on my silly little life has worked in the past for reactive depression, it won’t work for chemical depression, and my depression anyway renders me physically incapable of travelling further than the bathroom).
Having found out about serotonin, and then finding that I can’t tolerate SSRIs or any of the other anti-ds, I had no option but to investigate other options, other ways that I could find to boost my serotonin levels as and when I needed to.
Serotonin is at the end of a whole pathway of different substances. It starts with an amino acid called tryptophan. Tryptophan converts, via a conversion enzyme, into 5-HTP, or 5-hydroxy tryptophan. That then converts into serotonin. There’s another, parallel pathway that starts with tryptophan and ends in serotonin, too. If your body is short of B3 (niacin), the body’s priority is to urgently make up the shortfall – apparently, B3 is so critical to human mental health that if we had no B3 at all, we would be psychotic within a fortnight. If you have enough B3, the pathway towards serotonin continues, BUT it needs B6 (pyridoxine) in order to make serotonin.
So, you can see from that explanation that a number of things can go wrong even in the production of enough serotonin to keep us happy and mentally fine. For starters, you need enough tryptophan, B3 and B6.
My fibro goes back to when I was a child, so my depression does, too. At some point in my teens, when one anti-d had made me throw up, get dizzy, and pass out, my then GP put me on B6. At the time, they had me down as suffering from PMS, and it had been recognised that B6 was helpful for PMS. Anyway, I remembered this, years and years later, and when another GP saw the same rotten reactions I was having to standard anti-ds, I discussed it with him and was put back on good old pyridoxine again. It definitely helps. I have to take between 50mg and 100mg a day. If I miss a dose, I feel it that same day.
But a year or so ago, my local NHS rules changed, and in my area at least, you can no longer get it on prescription from your doctor. Crazy, but the new rule stops doctors from prescribing “nutritional products or substances” – I can’t even get a Vitamin A based eye ointment that I find helpful for my damaged dry eyes. I can get the eye ointment without Vit A on prescription, but not the one with. If I lived in the next county, I could – I checked online.
I tried taking tryptophan supplements, but they gave me migraines. I tried the next step along the pathway, which is 5-HTP, in case I wasn’t producing the first conversion enzyme and was therefore getting toxic from tryptophan, but I got the same miserable effect. I already take B3, and I take it to the point that it makes me flush (this is your body’s way of indicating that you’ve supplemented as much as it needs and can use, and for that reason I won’t use the popular non-flushing type because that won’t tell me if I’ve put enough in). I dug around a bit, and found that tryptophan is particularly high in turkey, and cottage cheese. Turns out I can tolerate it in cottage cheese, which is lucky, because I haven’t had enough energy to cook for years now, so raw turkey wouldn’t have been much use to me!
I had one particularly evil year, depression-wise, because not only was I dealing with the usual bouts of chemical depression, I also had a hefty dose of reactive depression, too, because my personal life was in tatters. I became suicidal. I never had myself down as ‘the type’ to feel suicidal – or, at least, not the type who would ever actually try to DO something towards achieving suicide, yet I became that person. It was terrifying. Truly. I trawled the web, desperately searching for a painless, quick way of ending it all, without any risk of only making my lot worse by surviving with damage. A very dark place to be. I went to sleep at night, praying that I wouldn’t wake up. When I woke up, I was even more depressed that I hadn’t died.
I never want to go back to that place.
I got through that time by eating cottage cheese.
I recommend it to anyone suffering from recurrent depression, of whatever type, reactive or chemical. It works for both. You have to eat a standard size (UK) pot of it to make a difference, or at least I had to, and sometimes I ate 3 pots a day. I stocked up on it, choosing the tubs with the very longest use-by date I could find, because mobility/disability issues aside, when I’m depressed, I can’t go to the shops. I can’t go anywhere. I can’t think. I can’t make decisions. I feel paralysed and powerless. So I bought heaps of the stuff to eat straight from the fridge. No prep, no cooking (two other things I can’t do without wiping myself out), just open fridge with spoon in hand, get cottage cheese, sit down and eat it. Bloody marvellous stuff. Choose whichever variety you like – chives, plain, pineapple, it doesn’t matter as long as you can eat it. I never recommend any of the popular “zero fat” food products – cottage cheese is naturally low fat anyway, and I hold the opinion that a) we all need some natural fats, and b) I don’t think it’s ever a good idea to mess around with a food by processing it so that its original nutritional components are altered. I don’t like processed, altered food. So, go for the ordinary stuff, and not the mis-named “healthy, zero fat/fat free” variety. For all I know, the minimal fat content in ordinary cottage cheese is what helps the tryptophan into our systems, and the zero fat variety may not have the same beneficial effect.
I’d be interested to hear from anyone who tries the cottage cheese “treatment”, even if you go for the no fat variety!