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"Celiac and Depression"
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a talk by Dr. Eva D. Olson
summarized by Jim Lyles
Dr. Eva Olson is a practicing psychiatrist in southeast Michigan.
She gave a talk entitled "Celiac and Depression" at the TCCSSG
meeting held on April 3, 1995. What follows are some highlights of
Dr. Olson's talk.
Depression can be as mild as having the blues, or as severe as not
getting out of bed to face the world. Symptoms include feeling
crummy, irritability, inability to get along with others, trouble
falling or staying asleep, waking too early, sleeping too much and
not feeling rested, feeling run down, consistently eating too much or
too little, feeling worthless or inadequate, and even wishing you
didn't exist. The basic definition of depression is when five or
more of these symptoms occur more days than not, and most of the time
during those days.
Diagnosing depression can be challenging. For example, feeling tired
and run down can be due to nutrition or malabsorption. Another
factor that can confuse things, or even cause depression, is
medications. Whenever you are feeling depressed it pays to ask your
doctor about side-effects from your medications. However, if you've
been on a medicine for a long time and only recently began feeling
depressed, then it is unlikely that the medication is the cause of
your depression.
Significant changes in your life or getting away from your normal
routine can cause depression.
The cycle of the year can have an effect. Winter is always a down
time. For some people, the winter blues can become a deep
depression. A new therapy based on certain kinds of lights can help
such people.
Three "hidden" factors can affect a person's mood or anxiety level:
* Alcohol. Occasional drinking is not a problem. When it becomes
a daily habit, with over three drinks a day, then it's becoming
a problem.
* Caffeine. More than four cups of coffee a day can cause anxiety
and can lead to a tired feeling in the long run.
* Sleep medicines. Many of these are habit forming, can cause
withdrawal symptoms, and affect the brain the same way that
alcohol does.
A mental checklist for you to use when you are feeling down for more
than just a day or two:
* Diet. Have you been eating more or less than usual, or
different foods than usual? Is that difference affecting how
you feel?
* Exercise. Have you changed your exercise routine? ("Exercise"
is used very broadly here; it can be as simply as sitting down
and tensing/relaxing muscles; taking a ten minute walk, etc.) It
is important for a feeling of well-being to exercise some.
* Stress. This includes stress at the job, family duties,
caretaking duties, over- commitment to or failure to enjoy
volunteer work, and not leaving time for yourself.
* Spirituality. This can range from just being at peace with
oneself to a fervent belief in God and organized religion. For
some people this is not important. But if this area of your
life was important to you in the past, and no longer is, then
perhaps you need to get some of that back into your life.
At this point, Dr. Olson began answering questions:
Q: How do you associate this with celiac disease?
A: Because of the malabsorption difficulties, the differences
between how each celiac reacts, and which foods each reacts to; the
first thing each celiac must do is become in tune with one's own
body. Determine what really works for you and what doesn't in terms
of what you can eat, what level of exercise you can do, etc.
If you are feeling down, review how you've been eating lately.
If you are cheating on your diet, or have eaten out several times
without being careful about what you ordered, then your mood and
sense of well-being could be impacted.
Remember the mind-body connection. If you feel physically
unwell more days than not, a mild or low-grade depression may be
contributing to your poor health.
To summarize: 1) Be aware of yourself; 2) Push your physician
to address your concerns, and 3) Fire your physician if you don't
feel you are getting what you need.
Q: How do you treat the low-grade depression when the only
physician remedy is "Here's valium. Go take it, and see you next
week."
A: Simply tell the physician that this is not acceptable. Valium
is not an anti- depressant; it is really more of a depressant itself.
It's not going to help. Good anti- depressant drugs do exist. Ask
your physician to refer you to someone who's really going to address
the stress or depression.
Q: How do you find the other kind of physicians?
A: It is up to the patient to find a doctor he can be comfortable
with. From a psychiatric point of view, this means calling people up
and talking to them to see if you are making the right connection.
For a medical physician, you must state what your needs are. If
these needs are not being met, or you are feeling rushed, you need to
tell the physician. Acknowledge that he is busy, but make it clear
that you need more time to figure out what will work. Most
physicians will hear you and respond. If not, then look for a new
physician.
Q: What about getting help for depression from a minister?
A: That is perfectly appropriate. However, if you continue to feel
down and blue, and you've been talking with your minister for a few
weeks or even months, then it is worthwhile to have your problem
checked out even if you don't intend to treat it for a while. For
many people, counseling provides relief. For those that aren't
helped by counseling, there are medications that can help.
Q: What is the maximum time for a person to be on anti-depressants?
A: There is no specific outside limit. Treating moderate to severe
depression ranges from a couple of months to a year and a half or
longer, with an average of about nine months. For people with
chronic depression, meaning they've been treated for depression on
several separate occasions, it may be best to be on anti-depressants
for life.
Q: My 4-year-old daughter has celiac disease. She thinks she will
outgrow it, even though I've told her recently she won't. Should I
be concerned?
A: First, don't get into a big argument with her about it. Second,
realize that children don't like to be different. Throughout her
life she's going to struggle with being different. At some point,
she's probably going to tell you that you are full of it and start
eating whatever she wants. Dr. Olson says this reaction is normal.
Just acknowledge what she's feeling: "Gee, it sounds like you wish
you didn't have celiac disease. So do I!" When she gets older, you
can get into a more rational discussion about it.
Q: Is depression a chemical imbalance in the brain?
A: Yes. Since there is a stigma attached to the statement, "I have
depression;" it is easier to say, "I have a chemical imbalance in the
brain."
A long term depression (weeks or months) results in the brain
chemistry being "set" in an altered state that becomes normal for
that person. Anti-depressants attempt to "reset" the brain chemistry
back to its pre-depression state. For some people, that "reset"
never takes hold permanently, so that the anti-depressants must be
continued just as insulin is used continually by a diabetic.
Q: Celiacs who were diagnosed without getting very ill often don't
have feelings of relief and gratitude at knowing what was wrong and
how to treat it. Instead, they find the diet itself to be
restrictive and depressing. How can they deal with these feelings?
A: In other words, how do you deal with the fact that you have
something you don't want to have? (Laughter from the crowd.) If you
got drop dead sick before being diagnosed, then you tend to be
relieved and to start out by saying, "I'll never stop this diet."
Then six months to a year later, you may experiment a little bit.
Dr. Olson tries not to get into arguments with people, because
they get frustrated, she gets frustrated, and then she can't help
them. So she approaches them looking for areas of agreement. Do
they agree with the list of symptoms they had before the diagnosis.
See if they agree with the diagnosis. She builds an alliance with
people based on all the things they agree on. Then she looks at
choices. If they continue to eat as they have, then the symptoms
they have will continue. If they go on the diet, then the symptoms
will diminish and eventually stop. The big problem is the transition
to the new diet. She tries to negotiate: "Try the diet for two
months and see how it works." If the person cheats, it is them, not
Dr. Olson, that is affected.
Q: You can't cheat on this diet!
A: You can cheat on anything you like cheating on. It may affect
you, but you can always do that.
Q: How do you deal with the ongoing stress of the illness that
doesn't really show itself as depression but as irritability, anger,
and just being fed up with it?
A: There is an early period of doing okay on the diet, then you
tend to start getting fed up with it. First of all, there may be
other things causing you stress, and celiac disease becomes a
convenient scapegoat for that stress. Examples include marital
discontent, job stress. You tend to blame celiac disease for causing
any bad feelings you are having, when in fact it may be a reaction to
other stresses in your life that you just aren't recognizing. So you
need to step back and consider what other things in your life might
be upsetting you.
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