Understanding Depression

http://www.kidney.org/atoz/pdf/UnderstandingDepression.pdf

This is the transcript of an audioconference from the NKF. It is an interesting read.

This is a lot to read. This is a small excerpt:

Depression After Transplant

Unfortunately, depression after transplant is extremely common.

People who were prone to depression before their transplant are equally at risk afterwards, if not more so because of the added stress from the transplant. Studies also show that up to one-quarter of people who are depressed after a physical illness had depression before they became ill.

So in many cases, a transplant recipient’s depression may have nothing to do with his or her illness. However, in some cases, transplant can actually trigger depression. As we mentioned earlier, people are often more likely to develop depression when life gets harder, like after a transplant. But on top of that, there are some transplant medicines that can cause depression as a side effect. For instance, steroids such as prednisone, which many recipients take to avoid rejection of their new organ, can cause depression.

Prednisone may cause a range of other side effects, such as violent mood swings. Some people may get a feeling of euphoria from prednisone.
A small number of people also have psychotic episodes from the drug. So it’s a drug that can save a transplant recipient’s life, but it’s not always
an easy process.

The stress of having a transplant can trigger depression. Having a transplant is a life-altering experience. The range of emotions people feel
as a result of the procedure can definitely trigger depression in those who are susceptible to it.

It can be incredibly difficult for people to accept that one of the organs they were born with no longer works. For many, organ failure can feel
like a profound loss. Some really grieve over it, which is totally understandable.

Unfortunately, this grief can also lead to depression. Having a transplant can create another loss, by changing recipients’ lives in an irreversible way. They may grieve that they can no longer lead the same life as before, now having to rely on doctors and medications to stay well. That can be hard to accept.

Some recipients may also find it hard to accept that they are more dependent on their families. They may feel like their illness disrupts their families’ lives, and they are dependent on them emotionally and sometimes financially. For recipients who are used to being the sole
providers for their families, that can be really tough.

Financially, many transplant recipients also worry about their futures and how to afford the medicines they’ll need for the rest of their lives.
People with kidney transplants often worry about their health insurance, knowing that they lose Medicare after three years.

Many transplant recipients worry about their futures in general. This may be the first time they have faced a serious health risk, and that can
be very scary. And when they feel bad physically, that makes all the fear, frustration and uncertainty even harder to bear.

Some people say they feel pressure to be happy all the time after their transplant. There aren’t enough donor organs to go around, and people
say they feel they need to be grateful all the time for theirs. But it’s not possible to feel happy all the time. Recipients are, indeed, blessed to
receive a new organ. But that doesn’t mean they have no right to feel sad ever again, or to get discouraged about the burden this organ places
on them.

Having a transplant does not mean a recipient is cured, which the average person may not understand. For that reason, friends, family and
co-workers may think recipients are now good-as-new, and all their health problems are solved. It will take time for people to understand
that recipients have a new set of challenges.

Some recipients also say that they feel guilty for taking an organ from another person. If it’s a kidney, maybe they got this wonderful gift from
a loved one. They can never thank their donors enough, or repay them enough. Some recipients feel sad that someone had to die to give them
their new organ. They don’t like the fact that they are benefiting from someone else’s tragedy.

All of these feelings—which are totally natural reactions to transplantation— also come on top of anything else recipients are dealing with at
the time, another reason why depression is so common after transplant. Family, career, finances—these make life challenging for everyone,
transplant recipient or not.

However, a recent study sheds light on what it means to be happy with a chronic illness. The researchers asked people on dialysis how happy they were, then asked the same question of people not on dialysis. Both groups of people gave the same ratings on a happiness scale.

This suggests that people both on and off dialysis are equally happy. However, the researchers also asked dialysis patients to say how
happy they thought they would be if they had never developed kidney disease. On average, they all said they thought they would
feel happier.