I found an article written for the American Macular Degeneration Foundation (macular.org) on depression written by a psychiatrist. There are 2 parts to his article. I thought that the second part was the most useful so I copied the text of it below. If you’d like to read the first part as well as the second, click here.
Further Thoughts on Depression in People with Macular Degeneration
By Arnold Wyse, MD
Above, I discussed depression, including in people with macular degeneration, as a basic, normal, and potentially adaptive response whenever we perceive that a significant physical, psychological, or interpersonal effort of ours is failing in its purpose or coming to a halt.
This depressive response is accompanied by a set of typical physiological and emotional symptoms. Its adaptive function is to signal ourselves that there is an important problem that requires attention and resolution. Depression aids and protects concentration on the emotional and thinking readjustment that needs to be done to alter or cope with the situation or to recognize and accept a situation that cannot be changed. The potential result is renewal of one’s self-esteem and a greater capacity to move forward in life on the basis of new, even if deeply unwanted, realities.
I will now respond to some questions that your editors have asked regarding depression in general, and as it relates to people with macular degeneration.
Is it possible for depression to make our visual problems worse?
There is no evidence that depression can worsen the physiological and histological changes of macular degeneration. However, to the degree that depression temporarily narrows our attention, interest and involvement in the world around us, we might perceive a worsening in our visual acuity and sensitivity. An analogy would be the difference in brightness and color we experience in our surroundings when we are in a ‘bright’ mood versus the dull or gray appearance that even a beautiful day may have to one who is ‘blue’. However, this will be transient and when the ‘work of depression’ has been accomplished, there will be no permanent physical effects from this perceived worsening of vision.
How long will a person be depressed and is there any way of predicting this?
For the most part, depressive responses arising from unexpected traumatic circumstances such as macular degeneration are relatively short in duration, perhaps a few weeks to a few months. The only way I know of predicting just how brief or long any particular individual is likely to experience depression is to look at his/her previous record in coping with the stresses of life.
Speaking generally, people who have enjoyed a previous high level of self-esteem, emotional resilience in the face of adversity, high levels of support from, and contact with, family and friends, etc., will show a quicker rebound from the initial devastating impact of their visual impairment. Those who, for whatever reason, have been more depression prone in the past and who are more dependent on everything in their life being ‘ideal’ for their sense of their own self-worth and stability may take a longer time to hear and respond to the growth-demands inherent in their depression. Although we all feel good vision as very important to our lives, the degree to which visual acuity is central to one’s career or hobbies can also affect the amount of personal threat one feels when faced with its complete or partial loss. It is important to remember that, for most people most of the time, depression is a time-limited experience with spontaneous recovery the rule.
Is there anything you can advise a person to do, or take, that may alleviate their depression?
Most of us are not especially open to advice when we are in the depths of depression or despair. Usually we simply have to go through a healing process either alone, with the help of friends and family, or with the help of a therapist. However, there are some suggestions that can be made that might be helpful for some. Acknowledge and accept the depressive feelings as real, true, natural, and as a signal of some personal adjustment and healing which needs to take place. Avoid the trap of thinking that your current emotional suffering, anger, and disinterest in life is a sign of personal weakness, badness or failure. Accept it as a sign that the former path in life you were on may no longer go anywhere for you and a somewhat new path must be found. Find a trusted friend or family member with whom to share your feelings about your loss and ask them primarily just to listen and care, not to give you lots of advice or try to push you to feel better until you have gone through your own process of acceptance and adjustment. Don’t be quick to pop every little pill or potion in your mouth that others say was a miracle cure for them! Keep up as many of your daily routines as possible and take good care of your body and spirit through daily exercise to the degree that you can feel motivated to do so.
Are there any over-the-counter vitamins or drugs that a person with depression could take that might help? Or would they need a prescription?
In general, look not for help and healing through the oral and digestive system, but through the psychological/interpersonal system. Your ‘soul’ has been wounded by loss in a personal sensory function that had tremendous value to your sense of your self and your contact with life. Such ‘soul wound’ heals with a combination of time, painful acceptance of what has happened, healing contact with people who care and try to understand, and gradual investment of time and energy in what can still be for you, rather than what can no longer be. This is an internal psychological process, not an oral or chemical process.
However, the process can be supported through continuing good nutrition (including vitamin supplements if one’s loss of appetite diminishes good nutrition), regular physical exercise, and sometimes even prescription anti-depressant medications. The latter, prescribed by a psychiatrist or your family physician, can for some people assist in re-establishing the balance and function of neurochemicals in the brain that have functioned less effectively as a result of prolonged emotional/psychological depression. They will not, however, be needed for most people dealing with depression in response to a life stress or trauma and should be seen as adjunctive (added to), rather than central, to the healing of the ‘soul wound’.
What can family and friends do to help alleviate the depression?
Like the victim of macular degeneration themselves, family and friends can help most by not being alarmed at the initial depressive response but to recognize that this response creates, by its various reactions, a frame of mind and a physical state promoting the work of re-adaptation and regrouping. A caring and understanding ear should be offered rather than impatience at the individuals temporary withdrawal, loss of appetite and sleep, sadness and anger.
Working creatively together with the victim of macular degeneration to find treatment where indicated, and to find ways to support what vision the individual has as well as to compensate for what is lost will be helpful. The victim’s need for maximum independence in the face of greater dependence in certain ways should be recognized and supported.
If the depression remains deep and unproductive for weeks on end or includes unrelenting suicidal thoughts, wishes, or behavior, a friend or family member should firmly press for professional help for the depressed person.
At what point should the AMD patient seek professional help?
In most cases this won’t be necessary as the potential for ‘recovery’ is present in everyone, especially where solid interpersonal relationships exist prior to the onset of the macular degeneration. However, sometimes the traumatic situation and resulting depression or anxiety, including preoccupation with death and suicide, becomes so overwhelming and protracted that professional help is indicated. To seek such help when the frame of mind and physical reactions of depression have not spontaneously remitted is a sign of strength, not weakness.
Often, the very decision to get professional help or the first meeting with a professional expert who is experienced in helping people work through their loss and regain their interest and enthusiasm for life will already lead to relief from the worst feelings of hopelessness and despair. Generally speaking, it is better to be sooner rather than later in obtaining professional help as it becomes harder for most people to seek such help when their depression becomes severe and unproductive to the point of feelings of hopelessness and despair about future possibilities for meaning and happiness.
What professional options are available to the patient? What are some benefits and drawbacks to each option?
If one has an ophthalmologist or family physician who is sensitive to the emotional experiences the patient is likely to go through who has just been diagnosed with macular degeneration, that physician can help a great deal by spending time listening about and discussing those typical emotional responses. Frequently, that is all the professional help that is needed. In addition, an ophthalmologist or family doctor who is experienced and judicious in the use of anti-depressant medications may prescribe them when indicated.
If more intensive psychotherapy is indicated however, the patient should seek the assistance of a clinical social worker, psychologist, or psychiatrist who is trained and experienced in the special skills that good listening/interactive psychotherapy requires.
The current managed health care environment makes obtaining such psychotherapy over an extended time much less available to the average person, especially if done with a psychiatrist, but just pills or a session or two of advice will often be insufficient to help the person regain optimal psychological growth and health from their traumatic loss. A psychiatrist who is trained and experienced in psychotherapy offers the added benefit of being an expert on psycho-pharmacology, but many other mental health professionals are also highly skilled in offering individual, group, or family therapy. In some locations, the patient may also find excellent self-help groups led by either a professional or a skilled lay person who him/herself has experienced macular degeneration.
Are there any good books or articles on depression that one might read?
Although depression is such a natural, common and universal response to unresolved loss or stress, it is also very unique in some respects for each individual because each person is unique. Therefore, I am not fond of recommending reading in the field for the person currently suffering the loss of traumas such as macular degeneration. The path of recovery will come, not from books and articles, but from one’s own inner process, relationship with significant others, and, where indicated, a caring and skilled professional. For readers of this article who are interested in reading an excellent book written for professionals and educated laypersons, I would suggest Productive and Unproductive Depression, Success or Failure of a Vital Process by Emmy Gut, Basic Books, Inc., New York.
Brief Biographical Sketch
Dr Arnold Wyse, a native of Michigan, is a board-certified psychiatrist and psychoanalyst who received his specialty training at The Institute of Living in Hartford, Connecticut, and at New York Medical College in New York City. After twenty years in private practice in Hartford and as Associate Clinical Professor at both the University of Connecticut School of Medicine and New York Medical College, Arnie joined the Indian Health Service. From 1992 until 2000, Dr Wyse served as Director of Mental Health Services and Medical Director at Northern Navajo Medical Center in Shiprock, New Mexico.
If you’d like to read his first article, click here.
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