Tuesday, January 13, 2009

Liver Transplants and Depression: What the Research Shows

Depression is fairly common in the world of liver transplantation. The blues often set in before surgery: An estimated 31 to 50 percent of patients awaiting transplant experience some degree of depression. Even after transplant surgery, with a healthy liver in place, some patients begin or continue to feel depressed. One year after transplant, Hep C-infected patients (like me) experience greater depression than non-Hep C patients (they also have a lower quality of life and less physical functioning than other transplant patients).

As I looked for information about liver transplants and depression, what surprised me most was the lack of information on this topic. Granted, I only can access the research, journals and reports available online to the average layman who doesn't subscribe to medical search engines. Nevertheless, given the prevalence of depression in patients, I expected to find info more readily accessible.

If you have information on this topic, please leave a comment. Information is power... and to people (like me!) who are feeling depressed and tired, it could be a wonderful antidote.

Thursday, January 8, 2009

When It Comes to Divorce, Organs Are Assets

From the "Are you kidding me?!" file is the current news story about a divorcing couple in New York and their bizarre battle over marital assets. Apparently, the husband considers his kidney an asset - that is, the kidney that he donated to his wife in 2001 - and "wants his estranged wife to return the kidney" or pay him $1.5 million as compensation.

What kind of crazy litigious society are we living in? I was divorced and know first-hand how incredibly difficult and emotional the process can be. But to try to leverage your position by asking for your donated organ to be returned? Sick, sick, sick.

This couple has three children. For the childrens' sakes, they need to wrap up the divorce and move on with their lives. Settle, people, settle!

Monday, January 5, 2009

Post-Transplant Depression: My Friends Stage an Intervention

Continued from my last post...

Apparently, my closest friends had noticed my unending depression, so like all concerned girlfriends, they talked amongst themselves. A LOT of them were in on the discussion, it seems - at least six that I know of, so far - and they also conferred with my husband about how I always seemed tired, hardly left the house, didn't socialize much, looked like crap and so on. Essentially, they felt that I was "stuck" and needed help - professional help - to move forward.

And so, one girlfriend called to say that she'd be near my home Friday morning and wanted to stop by for a quick visit. "Sounds good," I said. "Looking forward to seeing you."

On her way to my place Cari called to tell me that she would arrive soon. "By the way, Carolyn is stopping by, too," she said. Wow, I thought, This is great. It's going to be fun to catch up. I'm so gullible sometimes. Duh. It's Friday morning and two of the busiest people I know are skipping work to "pop in and for a quick visit." Yeah, right.

The gals arrived and with coffee mugs in hand, we settled into the living room and chit-chat ensued. Within a couple of minutes, though, the conversation turned serious. They told me how they had observed my blues, the rut I was in, the considerable duration of my depression. Carolyn and Cari confessed that they had spoken to others, including my husband. They explained their wish for me to work through my depression, and their belief that I needed professional help to do so. They told me about a good counseling resource that accepted my medical insurance and offered a few names.

After a few silent moments of pondering, I had to agree with them. I needed professional counseling to help me through my depression. The cost was a concern (we are BROKE!), but I pledged to make the necessary phone calls and obtain the assistance I needed.

A brief aside about friends: I often think about my friends and how much I value them. As stated on a needlepoint piece that was a gift from a girlfriend, "Friends are the family you choose." My friends truly are my family, because outside of my husband and children, they are my primary sources of encouragement and emotional support. Regardless of the need, I can always find friends' helping hands reaching my way. And if the need is extreme, my friends band together and "circle the wagons," as they did during my transplant.

My closest friends also love me enough to intervene, sit me down and tell me the harsh truth, even though it might hurt me to hear it. Not just anyone can get away with that. And there aren't many people I love and trust enough to hear clearly, even when the news is bad. Each of these friends is worth her weight in gold.

So I did as promised. It took about three weeks altogether, but I received authorization from our health insurance company, made an appointment and finally met with a counselor just before Christmas. I'll tell you about the appointment and about a long, difficult conversation with my husband - which proved to be my "Eureka!" moment - in another post. My next post is going to address transplants and depression, and some of the things I've learned about this issue and how it is - or isn't - managed through the healthcare system.

Sunday, January 4, 2009

My Transplant and Depression: Life on the Dark Side

There is a television commercial that starts something like this, "What does depression look like...?"; it continues with sad pictures and images of people lying around with dark circles under their eyes, all the while promoting the merits of a particular antidepressant.

For more than two years now, I would argue that depression looks like me... me living life on "the Dark Side." I'd taken antidepressants on and off for years prior to receiving the news that I needed a transplant; the on-and-off nature of my medicine consumption occurred because when the antidepressants worked, I'd decide that I no longer needed them until a few months (or sometimes years) would pass, I would become depressed again and resume taking them. The transplant diagnosis made me pretty upset (absolutely freaked out, to be honest) and as I became sicker and more worried about the surgery, I became more depressed. So my internist increased my antidepressant, telling me that many or most transplant patients take antidepressants because of the emotional impact of the surgery and recovery.

Six or seven months after my difficult and complicated transplant, I was again depressed, due to seemingly endless health issues, financial problems, inability to be Super Mom (or even Average Mom). The load was taking its toll and I couldn't seem to snap out of the blues. Both my local internist and my hepatologist at the transplant center urged action, so my antidepressant dosage was increased again.

And so for the next 15 to 18 months I dragged along. Whenever my energy level improved I'd feel better, more positive - but then one of the seemingly never-ending "hiccups" would occur, I wouldn't feel so well and then I would become frustrated and depressed once again. It sucked. I stayed home, rarely wore makeup, napped often, grumped "Why don't I feel better?" and fruitlessly tried to exert control over an uncontrollable situation. Yes, depression looked like me.

My internist was concerned. I was taking about as much of my antidepressant as was reasonable, so she recommended cutting back on it and adding a second one to balance out my moods and hopefully help boost my energy and sense of well-being. At that time, however, I was experiencing increases in some of my liver function lab tests - not a good sign. I thought it would be best to delay adjusting any meds until the labs/liver function matters were sorted out, so I bided time by wringing my hands and worrying about my new liver. Finally, after six weeks or so, the labs stabilized and I could consider starting the new antidepressant.

And then came the intervention.

I'll tell you about that on my next post.

Thursday, January 1, 2009

New Year, New Attitude

It's January 1, 2009 and I know many people are elated to see 2008 end. It was a very tough year for me and my family, but there were plenty of bright spots, too. I would categorize last year as "transitional," with lots of changes, challenges and learned lessons.

One of the most significant lessons I learned was about my health and ongoing depression (since my transplant; it worsened over time). I'll be posting about that on this blog over the next few weeks - many, or most, transplant patients (and people with other chronic illnesses) struggle with the blues in some fashion and perhaps reading about my experiences will prove helpful, in a what-not-to-do way.

I look forward to 2009 with a new attitude, with optimism and hope, reflecting on the message I discovered in a fortune cookie:

"Your path may be difficult, but will be rewarding."

Photo credit: Radu Andrei Dan