I got into a discussion with my shrink with regards to depression. I flat out asked her if, in her professional opinion, I was depressed (I know I'm having issues trusting my own inner voice but that is for another post). She told me that from her viewpoint the symptoms of CFS and depression overlap too much for her to make an accurate diagnosis. In her eyes I have a lot of the symptoms for depression.
Anyway, we got into the semantics of tiredness vs lack of energy. I told her that in my experience so far I spend most of the day not tired. I just can't do anything. I don't have the energy to move my muscles or body around but I'm not tired and don't wish to go to bed. I don't do the things I enjoy because I can't not because I've lost interest. I still love watching movies, reading books and surfing the net. I'm also still interested in skating and even got a subscription to icenetwork. I would love to socialize but I've missed several events because I've been crashed the day of or it is at the wrong time of day for me. It isn't like I'm hiding in my house as a choice. I'm stuck here because if I go out I end up in bed for days recovering.
I'm also not upset most days. I have the occasional blue mood but I never can tell if that is mental or some weird chemical reaction since my body chemistry is so out of whack. It won't be the first time I have a couple of depressed days right before my period starts (turns out it is due to low vit B levels). This has plagued me for years long before I came down with CFS. I was even on B6 for a while to help with this and of course the B vitamins are typically low in CFS patients so why wouldn't my mood be a body chemistry thing and not a brain chemistry thing? The CDC even warns against antidepressant use for CFS patients due to side effects that often make the CFS worse than it already is.
I keep telling my doc that I'm in a foul mood because I'm in pain. The pain keeps me up at night so I'm extra tired as well as having no energy. I have always been grouchy when I'm tired. So in my humble non medical doctor opinion I'm in a bad mood because of pain not because of depression. Give me some pain meds and I'm betting I'll be in a much better mood.
So how can CFS and depression be differentiated? I'm not sure I have a good answer for this. To my mind I am fine most of the time with some occassional bad days thrown in, which I can fully understand since this is a thoroughly horrible illness. However, I now have my doc, a cognitive psych person and my own shrink telling me that I must be depressed to some degree. I don't have a good argument against this other than telling them "No. I'm not depressed". At that, my shrink started asking me what my resistance is to the diagnosis. Talk about a catch 22. I recognize this as some sort of logical trap but I can't remember the origination.
I don't want to cave on this one. I'm in a happy mood today now that my shoulder pain has subsided. I can even use my arm again. I am not depressed, damn it!! I just can't seem to find the words to convince the docs. I feel like the uppity women who used to get locked up in the asylums when they didn't behave in a way that was socially acceptable but were told they had mental illness. Why are these people so hell bent on slapping this label on me?
On another note, when I read through the CDC entry on depression it said that the diagnosis depends upon the patient's self reported symptoms. What irony!! My LTD won't take my word for it that I have CFS but they will if I have a diagnosis for depression even though they are both self reported. WTF?!?
And in case you are wondering, according to the CDC website on CFS "Research shows that CFS is not a form of psychiatric illness or depression. "
BTW, I just found the Beck Depression Survey which is a self assessment tool and guess what? I'm not depressed!! I'll print this out and take it to my shrink next week. Put that in your Freudian cigar and smoke it!