Depression and ALS

by Gail Houseman, APRN

We all get depressed at times. Tragedies, losses, change---all these factors can cause us to feel blue.  Even happy occasions, such as marriage, retirement, or a new house, can create sad feelings because with change comes loss. Loss of neighbors or work associates that we know, loss of a lifestyle that is familiar.  A few weeks or months, and most of us recover from feeling depressed.

Folks with ALS are forced to deal with losses throughout the course of their illness; ALS is a progressive disease.  Some of these losses may include: loss of physical strength, functioning and mobility, loss of speech and/or swallowing, loss of self-care and independence, possible financial losses, perhaps loss of your home, losses related to role changes, and of self-perception/how you see yourself. Is it any wonder that most people with ALS report a “depressed mood,” when asked? Or that many PALS (Persons with ALS) are taking anti-depressants?”

Medication is not the only treatment for a depressed mood.  Antidepressants are most effective when combined with some sort of talk therapy. This can be done either formally, such as seeing a therapist, or informally as in a Resource Group.

Simply stated, antidepressants are prescribed to combat depression (“anti” meaning “against”). Commonly prescribed antidepressants include (but are not limited to) Prozac®, Zoloft®, Welbutrin®, Paxil®, Celexa®, Lexapro®, Remeron®, and Elavil®. Antidepressants usually take several weeks to work, as they have to build in your system. They will not make you feel happy. They will not take away the pain or reality of the losses involved with ALS. If the medication is effective, and it usually is, then what you should feel is more like yourself and better able to cope.  As with any medication, side effects can occur.  Side effects can range from mild complaints of dry mouth or constipation to more severe problems with dizziness, sedation and occasional sexual dysfunction.

Some folks are resistant to taking antidepressants. Some typical objections that this RN hears are as follows: “I can fight this on my own,” to “I don’t want to get addicted,” to “I don’t want the side effects,” to “I don’t need it.”

It’s your choice whether or not to take any medication, including antidepressants. But in making your choice, please keep in mind that most PALS taking antidepressants report an improvement in mood. Also, antidepressants are not addicting. While side effects can be a problem for some people taking these medications, most report minimal or no side effects. If you develop a side effect with one medication that is not tolerable, another drug may help that does not have an adverse effect. Finally, for some folks, depression doesn’t always look like depression; other symptoms such as anxiety or excessive worrying, and/or anger and problems with your temper, can be the prominent symptoms of depression.

A further suggestion: limit alcohol if you feel depressed. Alcohol is a depressant and will make you feel more depressed. Also, if you are taking an antidepressant and essentially drinking a depressant, then the antidepressant is not going to be as effective.

If you feel depressed, let your physician and/or mental health nurse know. They can determine if medication may be helpful


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