Chronic Illness and Depression

Q. I am in acute kidney failure, on dialysis, and have been put on a transplant waiting list. I am struggling with fatigue, irritability, and a generalized sense of pain. I really am ready just to throw in the towel and give up. My nephrologist wants me to see a psychologist and to consider a prescription for an antidepressant. I don’t want to add another drug to my current “cocktail,” and I talk to my sister regu­larly. Isn’t this enough? Do I really need to follow the advice of my doctor?

A. It is not unusual for a person living with a chronic illness and its accompanying pain to feel depressed from time to time. Dealing with constant physical symptoms takes a great deal of energy. Sometimes you get to a point at which you are fed up with it all.

As long as the feelings are temporary — two weeks or less is the benchmark — you are probably OK. If the emotions last longer, you may be moving into a depressive episode that can make dealing with the demands of the kidney failure much more difficult. High-quality research suggests that people in your situation may be responsive to a combination of medication and talk psychotherapy.

Good antidepressant medicine can help mobilize energy, and newer drugs may reduce the impact of physical pain. Regarding therapy: Talking with a family member such as your sister can help relieve some of the burdens you are experiencing. Mental-health professionals, however, are trained to listen in particular ways. When you feel fully heard by a good therapist, you can work strategically to create new ways of caring for yourself.

I always recommend that people who are waiting for a transplant have a good counselor to rely on for consultation, particularly for situations like the one in which you find yourself now. Once your transplant is complete, you will have a new lease on life and will regain feelings of autonomy and a sense of being in charge of your day-to-day activities.

Want to learn more about chronic pain and emotional health? Read “Surviving the Dark Side of Pain,” “The Power of Support Groups for Chronic Pain,” and “Your Self-management Toolbox.”

Our expert: Jackson Rainer is a board-certified clinical psychologist who practices with the Care and Counseling Center in Decatur, Georgia, helping people living with chronic illnesses. He consults with a variety of experts to answer a selection of readers’ questions in each issue of Pain-Free Living.

Have questions about living with and managing chronic pain? Email questions to [email protected]. Please put “PFL Q&A” in the subject line.

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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