PLEASE READ WITH AN OPEN MIND AND WELCOME GUEST WRITER PHYLICIA SMITH!
SICKLE CELL AND DEPRESSION
The correlation of having Sickle Cell and the other hidden illnesses that accompany it Sept 2016
Dealing with both disorders constructively
Sickle Cell Disorder (SCD) is an autosomal recessive genetic disorder of hemoglobin (Hb) structure and the most common of the hemoglobinopathies (a kind of inherited single gene disorders; in most cases, they are inherited as autosomal co- dominant traits.) SCD occurs primarily in those of African descent, but it also afflicts people of Mediterranean, Middle East- ern, and Asian origins. Most familiar to clinicians are the acute painful episodes known as “sickle cell crises,” thought to be due to acute vaso-occlusion by sickled red blood cells. Recurrent crises represent the most common reason patients seek acute medical care. Dehydration, temperature extremes, infection, changes in altitude, stress, and physical exertion may precipitate crises, but most crises occur without an identifiable cause. Vaso-occlusion causes acute pain in the short run and chronic pain and end-organ damage in the long run, potentially affecting all organ systems with particular harm to bones, kidneys, lungs, eyes, and brain. Complications include acute chest syndrome, avascular necrosis, priapism, ischemic leg ulcers, transient ischemic attacks and stroke, osteomyelitis, gallstones and cholecystitis, and renal insufficiency.
As with most chronic diseases, depression and other psychiatric disorders are common in SCD. Rates of depression are similar to those found in other serious chronic medical disorders, ranging from 18% to 44%,and are increased over rates in the general population even when one controls for illness-related physical symptoms. While studies of depression in chil- dren with SCD have shown mixed results, children experience high rates of fatigue and other somatic complaints, impaired self-esteem, feelings of hopelessness in the context of frequent hospitalizations, absences from school, and the inability to experience a normal childhood.
There are many potential contributing causes to symptoms of depression and anxiety in SCD. These include the chronicity of the illness; unpredictability of crises; chronic pain; overwhelming nature of medical complications, including anemia, fatigue, growth retardation, physical deformities, leg ulcers, renal failure, strokes, and substantially reduced life expectancy; and ra- cial prejudice and stereotyping. SCD may result in social derision, disability, and financial stress as well as stigmatization for pseudo-addiction to opioid analgesics.
Now that has been said, I have both sickle cell thalassemia and major depressive disorder. For many years I thought that I was just tired when I would isolate myself and refuse to communicate my feelings. Being in a southern family, a single par- ent home, I was often instructed to “put on a happy face” and/or “stop making me look bad.” The list goes on and on. I was told to handle real life adult health decisions from an early age, so much so I never really lived life; I always planned for my death. With that and the sickle cell, accompanied with the depression, for many years I had highs and lows – always follow- ing a painful episode – I looked forward to death so that the pain would be over.
Now having to cognitively deal with many storms and bouts of confusion, on top of managing my blood chemical levels, en- suring that I eat a healthy diet, that I am well hydrated and that I get at least 8-9 hours of sleep; many times I am over- whelmed and stressed. The majority of the time I am not great with my diet, due to the depression, I generally do not eat or sleep on a consistent basis. It is a general practice for me to ignore my needs because sometimes I am overwhelmed with the magnitude of things that I need to do for myself daily. That leads to depression and it becomes a cycle that is difficult to get out of.
Now that I am fully aware of the cycle, I am starting to regroup and take time to ensure that all of my needs are met, to in- clude medication, sleep and diet so that I can have the depression and some of the sickle cell crises
under control. But remember, you cannot be stressed at any time because it will trigger the sickle cell
or depression or both.