People with mental health conditions such as depression, anxiety or schizophrenia are being asked to write about their lives online.
People with mental health conditions such as depression, anxiety or schizophrenia are being asked to write about their lives online.
One of the hardest parts of living with CRPS is the not knowing. Not knowing when the fire will ease down, or the icy cold to run warm. Not knowing when the ache will settle or quality sleep will come. Not knowing if you’ll doze off, even when everyone else thinks you’re still awake because you appear to be. Not knowing why you’re being sent to a new doctor, or how the bills will get paid. Not knowing how to support your spouse the way you use to because you can’t work anymore.
Feelings of inadequacies and worthlessness often override feelings of joy and hopefulness.
Yet you still smile… try to make other’s laugh, you laugh yourself.
The title of this blog is just about right for this post. When chronic pain and depression collide we’re left with pain and despair crashing into one another. And a vicious cycle that if we don’t pull ourselves out of either by self or with help will just keep bouncing back and forth. There’s nowhere to go. Chronic pain often causes depression and in turn the depression causes even more pain. Stress will just exasperate the two. What might come of all this? A horrible Flare-up. What can we do? We have to break the cycle. Intervene!
My RSD CRPS fire burns steadily, when I have a Flare-up it becomes a raging inferno, so hot, like a steam burn. There have been times this fire has become visible to the eye. My skin has appeared to burn from the inside out leaving discoloration that very much looks like steam or hot water burns. My bones ache so deeply they are screaming.
An excerpt of an article/essay I first wrote in 2009 (Flare-ups and Flare up Protocol)
“I’ve learned to help myself during these times. Duration, frequency and intensity is something that I have to take control of. We all have to. We truly have to. The tools I use during these times are called my “Flare-up Protocol”. My flare up protocol includes the 3, 20’s.
The 3, 20’s are:
Exercise (ie, Yoga, stretching, walking, if able, light weights, activity, etc)
Modalities (ie, anything that can be placed on the body for pain relief, such as a tens, heat, hands, etc)
Distraction (ie, Memory master system, games, meditation, relaxation, fun, etc.
These can also be considered coping strategies.
My favorite is laughing.
The 3, 20’s mean 20 minutes of exercise, 20 minutes using modalities and 20 minutes of distraction.
These should be done whether or not one is experiencing a flare, but especially during. And up to 3 times a day.
While it’s easier said than done, the worse thing to do for a flare-up is to do nothing at all. Bringing us back to the use it or lose it theory which is quite accurate. Doing nothing can cripple us just as much as the pain itself.
I imagine a few of you might be thinking “You’ve got to be kidding me?! You want me to exercise when I’m hurting this bad? You must not understand” Oh but I do, I’ve said it and thought it a hundred times over myself.
While some will not want to take this to heart, we have to take responsibility for our own pain, everyone has to learn to and implement their own Flare-up protocols to get through these extra overwhelming, overbearing, debilitating flares.
As people we expect our doctors to take our pain away and we become discouraged when there aren’t any answers to satisfy our questions. We become depressed and insecure, yet We have to remember that RSD/CRPS is an incurable illness. Classified incurable because there isn’t a cure to it. There really isn’t anything the doctors can do to fix it. If the injury is correctable, it probably isn’t RSD. Our health care professionals can help us with medications and procedures, and that’s it really… just help us along.
We’re usually directed to pain management when our other doctors are at a loss. Pain management is just that, management. Again, not a cure. An area of practice that helps us manage our pain, not make it disappear. They are intended to help us live some sort of fulfilling life when nothing else can be done. Pain management is usually a last resort and the rest is up to us.
We might not like it but we have to take primary responsibility for managing our own pain because there isn’t enough knowledge or medical and scientific certainties out there to do it for us.
Flare ups are apart of having RSD/CRPS or a chronic pain condition. They’ll never go away, we have to learn to accept this. But, with practice, we can better learn to control them.”
There have been many times I have used muscle relaxation, progressive muscle relaxation in place for exercise laying down. I do simple Yoga stretches. My right calf has had atrophy for 11 years now and continues to worsen. It’s important to help our bodies not waste away. My exercise is also listening to music and moving my body to it the best that I can even while sitting upon my bed.
So how do you survive it? Relax! Try removing worry from your life. Again easier said than done. I know, I continue to struggle with the same issues. The not knowing, the unknown. What will tomorrow bring. For one thing it’s best not to tell ourselves tomorrow will be an awful day. Why? How do we know yet? Tomorrow isn’t here. Positive self talk is helpful. I should practice more of what I preach. Learn how to get Freedom from Pain and Discover Your Body’s Power to Overcome Physical Pain.
I use my imaginary baskets. In my mind I have 3 baskets. 1 for important things, tasks, people, places, issues, etc, 1 for the moderate and 1 for it can wait a bit.
Everything is important to me. So this is difficult. I care so much about people. I often times care too much which causes me to carry much on my shoulders. I don’t know any other way to be. I serve, I give, I care and I love to.
I have to decide what is most important to put into the important basket. I need to learn to put more in the 3rd basket. By putting everything into my first basket I get behind, my moderate basket rarely has enough in it. I end up in a crash and burn. If it’s used right it really can work. Even with kids.
When we’re happy, everyone around us is happy. We all know that saying.
Deep breathing is helpful, meditation, relaxation, guided imagery, progressive muscle relaxation, distraction, modalities, I’ll leave out exercise 🙂 , support groups, not carrying the world on your shoulders alone, aroma therapy, bubble baths and soothing music, practicing appreciation, being thankful.
I’ve been scheduled to see a Pulmonary Specialist based on my sleep study results. No one has given me any specifics… “not knowing”. I admit I’m nervous as I don’t know why. All I was told is that it didn’t seem to show Sleep Apnea which I was tested for.
I do know one thing, regardless of how hard it all is..
I am, so far, surviving the fire…
and I hope you are too!
Our Group originated to help inform, guide and support those diagnosed with Reflex Sympathetic Dystrophy Syndrome aka Complex Regional Pain Syndrome/Causalgia. For the families and friends of. Nearly everyone with RSD/CRPS will also have Fibromyalgia, although not everyone with Fibromyalgia will have ever have RSD/CRPS. RSD/CRPS is a Neuropathic pain Condition, Fibromyalgia isn’t. Fibromyalgia is still very painful (I know, I have it, too)
We are now expanding our group to offer the same support to all those struggling with Chronic Pain. If you are struggling with a chronic pain condtion of any kind or know someone who is, please let them know about us. We look forward to meeting you
We are a caring, loving, compassionate and understanding group of people who have been through a lot, yet we are not our without faults. We’ve not only endured pain, but surgeries, multiple diagnosis’, dealt with depression, anxiety, fatigue, insomnia. We’ve been mis understood, put down, been called drug seeker’s, addicts and more. Many of us have been alienated from family and friends.
A support system is necessary to achieve the best possible chance at a quality of life.
Our atmosphere is often playful, laughing and fun loving. Laughter is the best medicine and distraction ever! We will cry together, encourage one another, lift each other up when we fall. If you have an issue with another, please don’t hold malice in your heart… let it go. The stress and the tensing of your muscles will only cause you more pain. Breathe in, breathe out.
People sometimes have bad days, say things they don’t mean, say things they perhaps do mean, but pain often speaks louder than words themselves. Words can be let go, pain cannot be.
Chronic pain regardless of what the condition, disease or illness is.. is still pain. Neuropathic pain, Neuralgia, Fibromyalgia, Post Cancer Pain, Diabetic Neuropathy it’s all painful.
We want you to have an at ease, calm and peaceful experience.
This Group was created for you the people since it’s birth.
We welcome you, please join us!
Disclaimer: The information contained in the RSD CRPS Info & Support Group is meant to be accurate yet is not intended to replace official sources. Information contained herein should not be considered error-free and should not be used as the exclusive basis for decision-making. Use of our Websites and Group information is strictly voluntary and at the user’s sole risk. Other resources linked from these pages are maintained by independent providers. We do not monitor all linked resources and cannot guarantee their accuracy. We’re a community of patients, family or friends of. We’re not doctors, specialists, or lawyers.
We take threats and discussion of suicide very seriously. If we learn that you are emotionally unstable, even if the cause is chronic pain, we will intervene on your behalf by either notifying family members or calling your local police department. If we learn from your own words, Facebook posts, or from another that you are going to overdose on medications, or harm yourself in any way that could lead to the loss of your life, we will not turn away. This is not meant to interfere in your personal life, but instead to save your life. If you agree to join our support group, you agree to these terms and conditions. You’re not alone!
In the U.S., call 1-800-273-8255 National Suicide Prevention Lifeline
Wishing you pain eased days and nights,
~Twinkle VanFleet Administration www.CRPSAdvisory.com
In the effort to promote awareness, resources and information regarding Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome, aka, RSD, RSDS and CRPS these sites have been created so that understanding might come from them.
RSD Advisory and RSD Advisor are mirror dot.com sites
Here at RSD Advisory-WordPress you can leave comments, add your own stories, and tell the world of anything you might like to add. Just add it to the comment area of this post or one of the blogs that best fits you.
Thank you for supporting my passion to promote education, to date there is still no cure.
Best of wishes to you all
This is the most severe category of depression. In a major depression, more of the symptoms of depression are present, and they are usually more intense or severe. A major depression can result from a single traumatic event in your life, or may develop slowly as a consequence of numerous personal disappointments and life problems. Some people appear to develop the symptoms of a major depression without any obvious life crisis causing it. Other individuals have had less severe symptoms of depression for a long time (such as Dysthymic disorder), and a life crisis results in increased symptom intensity.
Major depression can occur once, as a result of a significant psychological trauma, respond to treatment, and never occur again within your lifetime. This would be a single episode depression. Some people tend to have recurring depression, with episodes of depression followed by periods of several years without depression, followed by another episode, usually in response to another trauma. This would be a recurrent depression. In general, the treatment is similar, except that treatment usually is over a longer time period for recurrent depression.
Professional debate continues regarding whether some people develop “endogenous depression” without any identified psychological causes. An endogenous depression is a biologically caused depression, due presumably to either genetic causes or a malfunction in the brain chemistry. But, all depression involves some changes in brain chemistry, even when the cause is clearly a psychological trauma. After psychological treatment and recovery from depression, the brain chemistry returns to normal, even without medication. To date, there is no hard research evidence to support the notion of endogenous depression. Sometimes this term is used to describe people who do not respond well to treatment, and sometimes it is a rationale to prescribe medication alone, and not to offer any psychological treatment for the depression. In general, the majority of people who require antidepressant medication for their depression respond to treatment better when psychotherapy, particularly cognitive-behavioral psychotherapy, is provided in addition to the medication. Medication treats the symptoms of depression, and is often a vital part of the treatment program, but it is essential to treat the psychological problems that caused the depression.
Research has shown that cognitive therapy is the best treatment for depression, as compared to medication and other forms of psychotherapy. However, many people respond better to a combination of medication and cognitive therapy. It does not make sense to only prescribe medication, without offering psychotherapy as well, because of the added benefits shown in research studies. There are some people who respond positively to psychotherapy, but plateau at a mild level of depression, without complete recovery from all of the symptoms. Often, these individuals are maintained on antidepressant medication after they have completed psychological treatment. Remember, only physicians are qualified to prescribe medication. Your psychologist will refer you to your primary care physician, or to a psychiatrist, for a medication evaluation, if it appears to be indicated.
Symptoms of Depression
A Major Depression is marked by a combination of symptoms that occur together, and last for at least two weeks without significant improvement. Symptoms from at least five of the following categories must be present for a major depression, although even a few of the symptom clusters are indicators of a depression, but perhaps not a major depression.
Persistent depressed, sad, anxious, or empty mood
Feeling worthless, helpless, or experiencing excessive or inappropriate guilt
Hopeless about the future, excessive pessimistic feelings
Loss of interest and pleasure in your usual activities
Decreased energy and chronic fatigue
Loss of memory, difficulty making decisions or concentrating
Irritability or restlessness or agitation
Sleep disturbances, either difficulty sleeping, or sleeping too much
Loss of appetite and interest in food, or overeating, with weight gain
Recurring thoughts of death, or suicidal thoughts or actions
This list is a guide to help you understand depression. It is not offered for you to diagnose yourself. If you have some of these symptoms, don’t focus on how many symptoms you have. Instead, talk to a psychologist about how you have been feeling, to see if he/she can help.
First Person Description of Major Depression
It takes the greatest effort to get out of bed in the morning.
I am tired all day, yet when night comes, sleep evades me.
I stare at the ceiling, wondering what has happened to my
life, and what will become of me. Nothing is getting done
at work. I have projects to complete, but I can’t think. I try
to focus on my work, and I get lost. I keep wondering when
the boss will discover how little I have accomplished. My wife
does not understand. She keeps telling me to “snap out of it.”
I’m irritable all the time, and yell at the kids, then I feel
terrible later. Nothing is fun any more. I can’t read, and the
music I used to enjoy so much does nothing for me. I am bored,
but I feel like doing nothing. There are times, when I’m alone,
that I think that life is hopeless and meaningless, and I can’t
go on much longer.
Sleep problems, difficulty with concentration, chronic fatigue, irritability, feelings of hopelessness, loss of interest in pleasurable activities – the list of symptoms does not convey the despair of depression. When you feel lost, hopeless, and don’t know what to do, you might be depressed. Even if you have just a few of the symptoms of depression, talk to someone who can help, consult with a psychologist, and find out what can be done to help you change!
Differences Between Major Depression and Other Depressions
The differences between Major Depression and other depressions, such as bipolar depression, dysthymia, or reactive depression, are primarily intended for psychologists planning treatment, and are of less concern to the average person. When you review the list of symptoms for major depression, and you have four symptom clusters, instead of five, you should not ignore it or forget about it. There is no diagnosis of Moderate Depression, other than to call it “unspecified.” Instead, ask yourself this question: “Does the depression interfere with my life, my relationships, my productivity or my happiness?” If the answer is yes, then don’t wait, talk to a psychologist soon.
Reactive depression is called an Adjustment Disorder with depressed mood. This means that something traumatic occurred in your life, such as a relationship breakup, or loss of a job, and you became mildly to moderately depressed as a result. Psychological treatment can definitely help you to feel better, and will help you get your life back on track sooner, rather than later, but you can still manage okay. If a life crisis occurs and you develop symptoms of a major depression, then it is a major depression, even if it is also a reactive depression.
Dysthymic disorder is a chronic, low level depression, that continues for years. Occasionally, individuals with dysthymia also experience a major depression, when a life crisis occurs. If you are depressed all the time, even if only mildly depressed, you should consult with a psychologist. You don’t have to live your life in depression. Often, a person has been mildly depressed for years, and a crisis occurs, and he/she finally consults a psychologist. In such a case, the treatment will probably take longer, because of the chronic depression underneath the major depression.
Depression, not otherwise specified, is a category used by psychologists when the symptoms do not fit neatly into one of the other categories. For example, a person has been mildly depressed for a long time, but not long enough to diagnose dysthymia. The specific pattern of symptoms and duration of symptoms will determine the proper psychological treatment.
Less severe hypomanic and mini-depressive periods follow an irregular course, with each period lasting a few days. Cyclothymic disorder is commonly a precursor of bipolar II disorder. But it can also occur as extreme moodiness without being complicated by major mood disorders. In such cases, brief cycles of retarded depression accompanied by low self-confidence and increased sleep alternate with elation or increased enthusiasm and shortened sleep. In another form, low-grade depressive features predominate; the bipolar tendency is shown primarily by how easily elation or irritability is induced by antidepressants. In chronic hypomania, a form rarely seen clinically, elated periods predominate, with habitual reduction of sleep to < 6 h. Persons with this form are constantly overcheerful, self-assured, overenergetic, full of plans, improvident, overinvolved, and meddlesome; they rush off with restless impulses and accost people.
Although cyclothymic and chronic hypomanic dispositions contribute to success in business, leadership, achievement, and artistic creativity in some persons, they more often have serious detrimental interpersonal and social sequelae. Cyclothymic instability is particularly likely to be manifested in an uneven work and schooling history; impulsive, frequent changes of residence; repeated romantic or marital breakups; and an episodic pattern of alcohol and drug abuse.
Patients should be taught how to live with the extremes of their temperamental inclinations, although living with cyclothymic disorder is not easy because of the resulting stormy interpersonal relations. Jobs with flexible hours are preferred. Patients with artistic inclinations should be encouraged to pursue such careers because the excesses and fragility of cyclothymia are better tolerated in such circles.
The decision to use a mood stabilizer depends on the balance between the functional impairment produced by unpredictable mood swings and the social benefits or creative spurts the patient may receive from hypomanic swings. Divalproex 500 to 1000 mg/day is better tolerated than equivalent doses of lithium. Antidepressants should be avoided because of the risk of switching and rapid cycling.
Dysthymic Disorder is characterized by chronic depression, but with less severity than a major depression. The essential symptom for dysthymic disorder is an almost daily depressed mood for at least two years, but without the necessary criteria for a major depression. Low energy, sleep or appetite disturbances and low self-esteem are usually part of the clinical picture as well.
People who have dysthymic disorder will often report that they don’t recall ever not feeling depressed, but they may be relatively functional in managing their life, although the symptoms are severe enough to cause distress and interference with important life role responsibilities. It is important to have a complete physical to rule out any physical illnesses that might be causing the depression. Also, if the person has a chronic medical condition that appears to be the cause for the depression (such as any chronic debilitating condition), then the correct diagnosis might be a Mood Disorder due to a general Medical Condition, even if all the criteria for dysthymic disorder are met. The question is whether the medical condition is physically causing the depression, rather than creating chronic psychological distress that is causing the depression.
Despite the long term nature of this type of depression, psychotherapy is effective in reducing the symptoms of depression, and assisting the person in managing his/her life better. Some individuals with dysthymic disorder respond well to antidepressant medication, in addition to psychotherapy, so an evaluation for medication may be appropriate. You should consult your psychologist if you have questions about treatment.
Identifying Dysthymic Disorder
Depression causes changes in thinking, feeling, behavior, and physical well-being.
Changes in Thinking – Many people experience difficulty with concentration and decision making. Some people report problems with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism, poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during more serious depression.
Changes in Feelings – Many people report feeling sad for no reason. Others report that they no longer enjoy activities that they once found pleasurable. You might lack motivation, becoming more apathetic. You might feel “slowed down” and tired all the time. Sometimes irritability is a problem, and more difficulty controlling your temper. Often, dysthymic disorder leads to feelings of helplessness and hopelessness.
Changes in Behavior – You might act more apathetic, because that’s how you feel. Some people do not feel comfortable with other people, so social withdrawal is common. Some people experience a change in appetite, either eating more or less. Because of the chronic sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity and household responsibilities suffer. Some people have trouble getting out of bed.
Changes in Physical Well-being – We already talked about the negative emotional feelings experienced during depression, but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping is common. Some people can’t sleep, or don’t sleep soundly. These individuals lay awake for hours, or awaken many times during the night, and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose their appetite, feel slowed down by depression, and complain of many aches and pains.
Now imagine these symptoms lasting for months. Imagine feeling this way almost all of the time. This may be dysthymic disorder, if several of these symptoms are present most of the time, for the past two years. Remember, all of the symptoms do not need to be present! Of course, it’s not a good idea to diagnose yourself. If you think you might be depressed, talk to a psychologist for a consultation. A licensed psychologist can assess whether you are depressed, and can determine the proper treatment for your depression. Remember, depression is treatable.
Treatment for Dysthymic Disorder
Psychotherapy is the treatment for choice for this psychological problem. Often, antidepressant medication is also recommended because of the chronic nature of the depression in Dysthymia. Psychotherapy is used to treat this depression in several ways. First, supportive counseling can help to ease the pain, and can address the feelings of hopelessness. Second, cognitive therapy is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to learn how to accept the life problems that cannot be changed. Third, problem solving therapy is usually needed to change the areas of the person’s life that are creating significant stress, and contributing to the depression. Behavioral therapy can help you to develop better coping skills, and interpersonal therapy can assist in resolving relationship conflicts.
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