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My friend suggested that a recent and ongoing flare of my autoimmune disease was causing my ongoing depression.

She is a very close friend, and I love her dearly, but she is much less educated than I am -- I am not at all saying she is not intelligent. I am a retired psychiatrist. She suggested I see a physician. I see a board-certified psychiatrist once a week, and have seen this physician, who is more intelligent than I am, for 15 years. I am on medication and have psychotherapy.

My friend knows all these details. I was shocked, as my friend knows my depression is complicated, and the recent problems have been going on over a year.

My autoimmune flare has been going on for 6 weeks, and it is being treated with medication that I already have for flares. Needless to say, I was flabbergasted, expressed some shock, but just mumbled something.

So how could I have responded (in a reasonable manner) to this friend?

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I think you, as a retired psychiatrist, no doubt are well-versed with these principles of which you may perhaps wish to remind yourself from time to time:

  • When a friend shows her care in a way that is unhelpful, it does not mean she would want to burden you or impose some sort of solutions on you. It probably means she is so desperate to help you out the dire situation that she still wants to show she stands ready to offer even when no such viable means avail to her. It is her thoughtfulness that counts as your blessings. If you love her, bear with her. If your mind and mood permit, tell her you tried her ways and those didn’t work.

  • As a veteran psychiatrist, you would be in a better position than anyone else, particularly those less educated, to explain in layman terms the difference of expertises of a physician and of a psychologist, the causes for depression and autoimmune flares, the mechanism of action of the medication and other cognitive therapies.

  • As a chronic patient, you too should know that you should take care of yourself and work towards your own well-being before you worry about your carer or those who care about you. Being less-educated does not mean she is unable to take care of herself in case your response to her feedback hurts her, as she knows you are unwell.

  • I believe that psychological disorders are one of its kind as there may not be well-grounded physiological causes for them, yet most of them can be affected by chemicals in some part of your brain. Simply by the strength of one’s will power is insufficient to alter such disturbed balance of chemicals, which your brain would have the inertia to remain the status quo being the new equilibrium. So you would need time and persistent intervention by medication and cognitive therapy, and new approaches to treatment supported by empirical findings to give you hope to recovery.

Dr Golam Khandaker from Department of Psychiatry of University of Cambridge carried out a study in 2014 to find that biologic drugs were an effective treatment, especially for the people that do not respond well to current antidepressants which target only at a particular neurotransmitter in the brain. The study found that anti-inflammatory medication for rheumatoid arthritis and other autoimmune diseases could also help the symptoms of depression. The administration of several anti-inflammatory agents used in autoimmune diseases treatment is positively correlated with a reduction of depressive symptoms. (https://doi.org/10.1016/j.pnpbp.2019.109678)

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  • -- I will try to do the first, although I admit this is a bit taxing. What I would like to tell her that I know what ways to try, and what ways will work. This is not a chicken and egg situation at all. I know my illnesses well, and I know what came first in this case. -- I did do this eventually. I have explained to her many times my medical school experiences, my residency rotations, what my 2 extra rotations in internal medicine were (rheumatology and endocrinology -- the physicians who were my attending there still treat me.) – Lori Adams Oct 2 '20 at 0:05
  • I'm sorry not enough room to finish my response to your second bullet point. I have aided her for years in dealing with physicians treating the psychiatric and physical disorders of her family, even speaking to her physicians, in order to better explain things. I draw diagrams. I write things down. I ask the doctors to do so. Have the time the doctors don't even give her a card with their names. That was now how I was trained! I have explained many times about my depression, my autoimmune flares, how medication works (she is on an SSRI) too, I am on addition meds and vitamins. – Lori Adams Oct 2 '20 at 0:09
  • continued. I do not know what you mean by other cognitive therapies, unless that you are implying that all therapies are cognitive. And what does "cognitive" mean, in the sense you are using it -- are you saying that they are conscious? I don't agree, and some of the therapy that I use with my depression is based below the conscious. I do have insight. I do get frustrated when my friends want to come up with solutions that seem ill thought out. If you mean CBT, that would be inappropriate for me at this point, as I have had a lot of therapy, and that would not address my issues. – Lori Adams Oct 2 '20 at 0:12
  • continued. I studied a lot of therapy, a lot on my own, and I was quite good at it. And so is my psychiatrist. I'm old enough, of course, that this was before the pendulum went so completely to biologic psychiatry that other therapies were not used with biologics, even though they should be in cases were depression or anxiety is not short-term. I have explained that my autoimmune flares are usually due to stress, and she also knows that I have been under stress, off and on during this depression. She not only knows the people who are causing it, including her family. – Lori Adams Oct 2 '20 at 0:16
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    One point not addressed beyond the attitude that "if my IQ is high, I am more likely to be right" is that it is easier to see things from the outside. It is possible that the friend has insight the patient does not have. Could you not say, "Perhaps you're right. Let me think it over. Thank you"? – Yosef Baskin Oct 15 '20 at 16:59
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I have, myself, several health issues (both mental and physical) and people keep coming to me with well-meaning advice that are, in fact, unwanted and totally useless.

They have a lot of theory about why I am the way I am and what I should do to get better. However, these people have no real understanding of how it is to be me, that things aren't as simple as they believe and that their advice are completely useless (because things aren't that simple) and that those advice are honestly annoying (no, doing yoga won't fix my issues).

My mother in particular would give a lot of such advice (how I should do more sport, eat healthier, sleep better, etc..) and would keep giving those exact same advice from one conversation to the next one. Here is usually how I deal with her:

If I'm feeling patient, I will try to explain things to her. And in those cases, it is very important to keep to the facts. It doesn't matter that I already told her this XX times. She tends to forget the details (everyone does. You are the only one who remembers those things perfectly because it's about yourself), that's why I need to keep repeating it to her and be as clear as possible.

Here are the facts A, B and C. This leads me to conclude X.

I present things that way so has to give as little room as possible for arguments. I don't really want to talk about this, so the shorter the conversation, the better.

In your case, you could say something like:

I already see a physician. I have had my depression for a year now and the flare for only 6 weeks. So, even if the two may be linked together, the flares can't be the primary cause of my depression.

If I'm not feeling patient, I would just say:

Is this what you wanted to discuss with me? Because I don't want to talk about it. So, if there is nothing else, I will put an end to this phone call/conversation.

Remember that this is your health and you don't have to talk about it with anyone if you don't want to.

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