Lowered Mood in Pituitary Conditions - It's Not All Depression!
By Dr Sue Jackson, Chartered Psychologist specialising in the impact and treatment of chronic health conditions
One of the things that’s been annoying me for a very long time is the lazy way mental health problems tend to be described. It’s always the same two conditions that get mentioned: anxiety and depression. When I first started working in adult mental health, people would ask us not to put any mental health diagnosis on their notes. Attitudes have shifted and people are now more willing to admit to being stressed and, to a more limited extent, suffering with the various forms of anxiety, but attitudes towards being diagnosed with depression remain largely unchanged. It’s not a diagnosis that anyone wants – it’s seen as putting a question mark against your name that will negatively affect your employment opportunities, and is regarded by many as the first step on a steady descent into a forced stay in a mental health facility. Depression has become a kind of short-hand catch-all term encapsulating all the different experiences of lowered mood, but there are other terms which are far less stigmatising that we could usefully use instead, and this article describes the most common that people with pituitary conditions are likely to experience.
Most of my patients with chronic health conditions are adamant that they’re not depressed and are very confused and, in some cases, angry about the label they’ve been handed for the way they’re feeling. Some healthcare professionals will say that such patients are in denial, I would say that if they don’t recognise it then there’s probably something else going on and it’s my job to help find a more accurate description so that we can work together to improve things. I’m not alone in having these experiences with patients; back in 2005, Michael Weitzner, Steven Kanfer and Margaret Booth-Jones described how their pituitary patients with apathy syndrome, a neurobiological illness, tended to deny feeling depressed instead reporting chronic fatigue combined with a marked lack of motivation. Their paper makes the important point that the symptoms and reported patient experiences of depression, apathy and chronic fatigue overlap quite considerably. Indeed, just as in depression, patients with chronic fatigue (marked by non-restorative sleep) struggle with their memory and have problems concentrating (also known as brain fog). Chronic fatigue saps your enjoyment of life as you feel like you’re wading through treacle, and you just don’t have the energy to do the things you want to do. This overlap of symptoms and experiences with those of depression is something that is also true for the other possible terms of disappointment, demoralisation and despair that patients with pituitary conditions can experience.
Pituitary conditions can have a profound impact across all areas of someone’s life including, but not limited to, significant changes in their employment, relationships, and life prospects. Rather than depression, this could result in profound disappointment. Often associated with strong feelings of loss, grief and sadness, Margaret Wehrenberg talks about how disappointment is as much about things that we have had and lost, as it is about things that we were looking forward to having and/or experiencing but which we will now miss out on. Disappointment, like depression, is difficult to articulate to others and the overlap doesn’t end there. Coupled with a lack of hope, disappointment can be long-lasting and can be accompanied by a marked lack of interest in your usual activities as your brain is distracted by its need to focus on processing the ramifications of what’s happened to you.
Individuals with pituitary conditions who experience a reduced social role in the workplace and/or home might be feeling demoralised. Demoralisation is defined as a persistent inability to cope, accompanied by feelings of helplessness and hopelessness. Affected individuals feel a perceived lack of meaning in their life, as well as subjective incompetence and diminished self-esteem. And then there’s despair, which Viktor Frankl describes as suffering coupled with loss of meaning; when no matter what we do everything feels like it’s going against us, and we feel that we’re getting nowhere. It’s associated with obsessive thinking full of negativity and helplessness which mixes with emotions such as sadness, anguish, anger, and frustration.
Pituitary patients are not immune to depression, but I think it’s probably over-diagnosed partly because it can also present with a variety of other symptoms such as nervousness, irritability, phobias, bodily aches and pains, sleep disturbances, and a feeling of numbness. Recognising it is not always easy, but its two key components are:
1) feeling sad, blue or empty most of the time; and,
2) no longer enjoying things that used to give pleasure.
If you’ve been experiencing one of those two over a period of at least two consecutive weeks, then you need to consider whether four or more of the following also apply:
- Being unusually restless or finding that it takes a lot of energy to move
- Very low on energy most days
- Feeling worthless and prone to self-blame
- Sleeping quite a bit more or less than usual
- Unexpected gains or decreases in either weight or appetite
- Finding it hard to concentrate, be decisive or think clearly
- Feeling hopeless and/or having thoughts about dying or suicide.
Pamela Stephenson Connolly in her book Head Case: Treat Yourself to Better Mental Health says that if most of the above is true and you are finding it hard to live life effectively then you are probably suffering from depression. If it has happened before then it could imply either major depressive disorder or dysthymia, a chronic, but less severe, low mood.
It can be very difficult to talk about these issues with family and friends, never mind taking the risk of trying to discuss them with a healthcare professional. We need to get better at listening – not believing someone’s account of their inner world is profoundly unhelpful and can lead to them feeling alienated, socially isolated and very lonely, all of which puts additional strain on their mental health. While we have names for different types of anxiety, the constant use of the term depression to describe the range of experiences of lowered mood isn’t helpful. Having other terms to use might enable some people to start to have helpful and constructive conversations with others.