Depression and Macular Degeneration

from Macular Degeneration–The Complete Guide To Saving And Maximizing Your Sight
by Lylas G. Mogk, M.D. and Marja Mogk

(Originally published September 2004. Reprinted with permission)

Many people who lose vision go through a short period of mild depression as they grieve their loss and adjust their lives. But many others experi ence prolonged periods of depression that are unhealthy for the body and spirit. We know a great deal more about depression than we did twenty or thirty years ago. We know that it’s not a sign of weakness, laziness, or moral failure. We know that depression happens to people who have no other psychological diflficulties. We know that depression can happen to you later in life even if you’ve never been depressed before. And we know that depression is very common among people with low vision. There is nothing shameful about it, but there is something very tragic about living with depression without getting help.

Common Symptoms of Depression

Consider the list below and ask yourself whether or not any of these symptoms are familiar.

  • Frequently feeling apathetic or unmotivated
  • Frequently feeling agitated, empty, or numb
  • Feeling negatively about yourself or frequently pessimistic
  • Withdrawing socially
  • Insomnia or hypersomnia (sleeping too little or too much)
  • Losing or gaining more than your body weight in a month
  • Noticeable decrease in energy
  • Unexplained episodes of crying

What Causes Depression with Macular Degeneration?

Depression with macular degeneration may arise from deep feelings of rage, grief, or frustration, from isolation or loneliness, from prolonged inactivity or boredom, from self-judgment, from fearing the future, or from feeling out of control or without options. Some people may be genetically predisposed to depression. Your diet and exercise patterns may also make a difference. If you live in a car-centered area without good public transportation, like most of the Midwest and many suburbs, and you lose your driver’s license, you may also be more likely to experience depression. Losing your license may initially contribute to isolation and loneliness, especially if you’ve always relied on cars. It may also affect your sense of independence and personal style. That doesn’t mean that everyone who lives in the Midwest becomes depressed when they get low vision, or that New Yorkers never get depressed with low vision, but losing your driver’s license can be a major blow.

Why You Can’t Always Strong-Arm Your Way Out?

Many seniors make the mistake of thinking they should strong-arm their way out of depression. Worse, they think that if they can’t strong-arm their way out, there’s something wrong with them. Worst of all, they think they just have to live with it. People often come to my office to talk about their low vision. They say, “Well, I guess I just have to make the best of it,” then set their jaws, and look away. Sometimes, the gentlest people cry, and sometimes the proudest people cry. They don’t mean they have to make the best of low vision. They mean they have to make the best of being depressed with low vision. But depression is not something you want to put up with and embrace as a partner in life. It’s bad for your physical health, your emotional health, and your spirit. Depression can also nega tively affect your relationships with other people and strain your marriage. Don’t decide that you just have to make the best of depression. And don’t camouflage it.

There are two reasons why you may not be able to strong-arm your way out of depression, and neither of them has anything to do with being weak. First, depression is a real physiological condition, not just a mindset or a bad attitude. Research suggests that stressful situations and significant losses in our lives affect the production and regulation of chemicals in our brains that influence our emotional state and our immune system. Once you are depressed, you may remain depressed if you do not receive professional help and take direct action, because the balance of chemicals in your brain may actually promote your depression, or at least sustain it. Second, if your depression was triggered by loneliness, iso lation, or inactivity, it is unlikely to lift from thinking alone. You need to address the root of the problem.

Treating Depression

The more you do, the better. The first thing you should do, however, is talk to your doctor. Then act on the following suggestions with his or her advice.

Ask your doctor about antidepressant medications and alternative treatments like St. John’s Wort. St. John’s Wort is a mild herbal remedy used for depression that is very popular in Europe and may have fewer side effects than regular medications. It may also be less expensive. However, it may affect your blood pressure.

If you are sensitive to sugar or alcoholism runs in your family, ask your doctor about switching to a balanced carbohydrate-protein diet that is designed to keep your glucose levels stable. Diet may contribute to depression in some people.

Begin a regular routine of physical exercise. Exercise has been shown to be an effective remedy for depression in many people. It actually acts on the chemicals in our brains to help stabilize our moods. Exercise also has many other health benefits.

Attend a visual rehabilitation program in your area.

If you live with family or alone, make an effort to cultivate your own commitments, activities, interests, and friends. Making new friends as a senior may seem difficult, especially if you’ve had the same friends for years and you’re out of practice, and low vision doesn’t make it easier. But when friends move or pass away, or when your husband or wife dies, it’s really important to reconnect with others. And you can do it. Loneliness and isolation are not good for you. You must do whatever you can to avoid them. You may want to consider moving into a socially active senior residence if at all possible, someplace where you can make friends and be involved.

Find and use alternative modes of transportation. Contact your local transportation authority for bus, rail, or subway information. Call taxi cab companies and ask about their service and rates. If you are used to driving your own car, you may balk at paying bus or cab fares. However, the cost of buses and cabs may be equal to–or less than–the cost of maintaining your car, especially when you count insurance. And remember, outside of the convenience of owning a car, there is nothing inherently special about driving yourself around; the richest people in the world have chauffeurs.

Seek professional counseling, especially counseling that complements visual rehabilitation by helping you express your feelings, focus on your skills, and combat self-judging or limiting thoughts.

Editor’s note: Dr. Mogk’s book may be ordered from Amazon Books