This is a description of clinical depression from the Mayo Clinic's literature. If someone was diagnosed with PSP, would they assume they had depression from this list of symptoms (if they showed these five symptoms 2, 4, 5, 6, 8)?...........
For a diagnosis of clinical depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a guidebook used to diagnose mental illness in the United States.
Clinical depression symptoms may include:
1.Depressed mood most of the day, nearly every day
2.Loss of interest or pleasure in most activities
3.Significant weight loss or gain
4.Sleeping too much or not being able to sleep nearly every day
5.Slowed thinking or movement that others can see
6.Fatigue or low energy nearly every day
7.Feelings of worthlessness or inappropriate guilt
8.Loss of concentration or indecisiveness
9.Recurring thoughts of death or suicide
To meet the criteria for clinical depression (called major depression in the DSM), you must have five or more of the above symptoms over a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Keep in mind, some types of depression may not fit this strict definition.
Interesting Strelley. There are lots of parallels with PSP and clinical depression I can see and it is also interesting that the ONLY medication the medics can come with for PSP at the moment is an anti-depressant.
Incidentally, we have an appointment with a psychogeriatrician who is coming to the house next week to talk with us about my husbands moods and aggression.
The other observation I would make is that, in the absence of a cure, perhaps the concentration should all be on a proper diagnosis as soon as a patient presents, none of this going down the Parkinson's route and wasting time. Perhaps all neurologists and gp's should be made to look at our blog and see where they are potentially going wrong , from the people who really know, ie, the sufferer and the carer.
Then ALL possible aids, care, support and anything else that is needed to help us can be put in place immediately instead of this drip-feed approach to everything.
I am interested in what you say about antidepressant being the only medication prescribed for PSP. My hubby is on very low dose antidepressant, don't think it does much for depression. But he is on sinemet (parkinson's med), and at bed time, he takes clonazepam (restless leg syndrome med) and gabapentin for nerve pain. If he were just prescribed an antidepressant, he would not be able to function at all. When he needs to get up at night, he cannot walk, I thought it was due to the bedtime meds, but he is worse in the morning when all the meds have worn off. I give him his sinemet in bed and it takes about 15 minutes to take hold, then he can get up and walk (with the aid of his walker). He takes the sinemet 6 times throughout the day, or he's no good at all.
Hope your meeting with the psychogeriatrician brings positive news to you!
I've never been sure how to sort out clinical depression from feeling very depressed because of objectively awful life situations - like being diagnosed with psp. It's depressing! I knew someone whose postpartum depression took the form of uncontrollable temper, which she always had a situational justification for, so she didn't see herself as depressed, and neither did the people cowering around her. It was an awful slog getting her past it. Our GP offered zoloft as possibly helping not only with my guy's sadness but with physical symptoms like stiffness and poor balance. It's early days yet; but I'd be glad to see him happier. I don't know whether he's depressed or understandably sad. Can zoloft fix that? - - This note was interrupted by another awful fall. Nothing cheerful about that.
I feel that number two is apathy which is known in PSP. While 4,5,6, and 8 are known effects because of the effects of PSP on the brain and not necessarily depression. Can't put effects on the brain into depression. Perhaps someone else can distinguish the difference, I can't.
Jimbo
Just to answer my own question. It has been shown that many clinicians (mis) diagnose depression when first seeing patients who later are diagnosed with PSP. Recent studies have shown that PSP sufferers display some of the symptoms of apathy (about 90%) rather than clinical depression. Thus, the symptoms 2, 4, 5, 6, 8 as noted above, are caused by other areas/mechanisms of brain damage not related to damage that causes clinical depression. (However, depression can occasionally co-exist in PSP damaged brains)
As mentioned previously, it was serendipitous that clinicians found that some types of antidepressants helped with a few symptoms of PSP, and had nothing to do with their role as antidepressants. They do not know why they work in this way.
It's troublesome: the mix of apathy and emotional incontinence with psp, compounded by fixed gaze, physical stiffness and delay in mental processes, makes teasing out my guy's true moods challenging. Strelley, I'd really like to know whether depression caused by chemical inbalances and depression caused by unhappy life events are usefully treated in the same way. I know that's asking for a big generalization, but when one has reason to be sad, are medications helpful? Many of the usual non-medical approaches - endorphin-producing vigorous exercise, for example - aren't available to us, so if a pill will help, I'm all for it. I just am wondering about the limits of that kind of prescription in a general way. For me, I better get with the exercise!
I have very little knowledge with respect to the subject of depression. There are several types of depression, but when discussed with respect to PSP, I think it is "major or clinical" depression that is meant. As mentioned before, most recent studies indicate that a PSP sufferer is more likely to be showing "apathy" rather than clinical depression (despite some similarities in symptoms).
Clinical depression has been associated with low serotonin levels and treated with antidepressants (like selective serotonin reuptake inhibitors). This has been shown recently to be only partly true. It appears that such antidepressants take a long time to act because they are associated with new neuron growth (neurogenesis) in region of our brain (hippocampus) that involves (apart from memory) mood and emotional responses.
So it all becomes very complex with conditions like PSP where many parts of the brain are damaged. Some damage has been noted to parts of the hippocampus at autopsy in PSP patients.
Clinical depression is quite different from mild depression caused by unhappy life events and uncomplicated grief. While some doctors treat the latter with medications, it has been shown to be totally unnecessary. The prognosis is good for such people without resorting to medications.
My general approach to PSP is "the less medication the better" (except when controlling excessive pain). However, this is the personal view of an old medical scientist that I would not thrust on others!
Thank you very much, T. You have shed some light, as usual! Very helpful. I'm with you in preferring less medication in general - I'm glad to have a scientific opinion validating my bias! However, the low, trial dose of zoloft doesn't seem to be doing him any harm, and his GP has increased the dose. (In consultation with our neurologist, who has a great deal of experience with psp.) My guy is having a first meeting with a counselor today, something he asked me to arrange. I have hopes of that. Along with all the other complicating aspects of psp, his stoicism makes it hard to read his emotional state, so that he asked for help strikes me as both brave and indicative of how hard a time he is having underneath it all. I wonder how all the other psp sufferers manage. It's so scary, but we go on, and do enjoy life quite a bit in between falls.
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