Have you heard/experienced a depression like this?

[TomRipley]

A female family member in their 60's fell ill about 2 years ago with a constipation issue, let's call her 'Sue' for the purpose of this thread.
In the beginning Sue suffered with very strange side effects including confusion, delirium and memory loss.
Sue would have days when she was completely blank (that's the only way I can describe it) then days of clarity and be completely back to their usual self.

Doctors were baffled and following various stays in the hospital couldn't diagnose anything particular but did see a bowel blockage plus Sue suffered with repeat UTI's.
Treatment would include laxatives and enemas and the symptoms did at first improve with these treatments. Days when she had an enema would be a good day mentally. On the good days Sue can't remember much about the bad days and says they're like a 'fog' or a 'dream'.
Lots of other tests have been carried out with normal results.
Other than the blockage and symptoms she's in perfect health.

Over time the blockage cleared and the UTI's stopped occurring but the bad days increased and the good days lessened regarding her mood.
Sue used to have at least one good day a week where she was completely herself but now they're non existent.

Sue has now been diagnosed with depression and takes an antidepressant which doesn't help much with her symptoms. Her adult son has to get her to take it every day with some persuasion. The only difference with the antidepressant noted by her son is that she is more mobile with it (moves around the house more).

For context, as I really know nothing about depression myself and this seems to be brought on rather mysteriously i'll describe Sue before the illness and what she is like now.

Before- gym bunny, health conscious, very family orientated, immaculately dressed, holidays, days out, big family parties, loved cooking and gardening, watching certain tv shows especially reality tv, music and dancing and adored babies and grandchildren, in a long committed relationship for 20 years, lots of friends and very social.

Now- doesn't engage in any conversation with anyone, only says 'no' or 'go away'. Doesn't get dressed or washed without encouragement or help, doesn't cook, clean, garden, listen to music, watch tv or read at all. Doesn't want to see anyone or engage and only does as relative have keys to the house, definitely wouldn't open the door if you knocked.
Never leaves the house or answer the phone. Friends and partner are told to go away or aggressively told to leave.
No interest in children, her new baby grandchild was born recently- she didn't even acknowledge or look at the baby when they were brought round to visit.
She sits doing nothing all day or sleeps.
This is no exaggeration, cannot be coaxed or convinced to do anything at all.

Everyone is obviously desperate for answers and help but doctors are yet to diagnose anything apart from what I've mentioned. She's seen specialists and had CT scans, every type of test.
It isn't dementia, they've very sure of that.

I'll add there were no life events that anyone knows about or could link to this. sue was ok one day and then not the next and has deteriorated from there.

It's a long shot but as the doctor are so stumped I'm just wondering if anyone has experienced anything like this before.

It's so sad, she's so well loved and we just want her back.

Well the gut microbiome does influence mental health, so there could be a link.

Oh gosh @TomRipley that sounds terrible…hoping you get some answers soon

@SirVixofVixHall
That's looks to be how it started- with the bowel issue but the blockage has gone now.

Thanks @Dizzywizz it's so hard to understand it all

That’s so sad, OP. As the only link found was a bowel issue this may be relevant: joinzoe.com/post/gut-health-mood

If it is depression then drugs will be the way out. Does she have an advocate who can push her case forward and get new drugs / doses tried until they find the right one?

Gosh that sounds awful, I'm so sorry.
Did they check for Lymes disease?

Also I wonder if she would be persuaded to have acupuncture? I do think it can do extraordinary things and just wonder if it might help start a recovery process.

Thank you for replies, I'm not sure if they checked for lymes disease but I'll ask and look in to that.

Her children care for her and help with medication, they're pushing for answers definitely. Lockdown obviously had an affect on appointments and referrals but the main thing standing in the way is Sue herself.
Near impossible to get her to help herself in any way shape or form.
Very vacant and doesn't talk about her illness or express any feelings on it whatsoever. Her son is the only one that can get her to take the antidepressant each day and I don't think that it's particularly easy to do.

The MIL of a friend of mine went this way after she lost her husband in very traumatic circumstances. Just went from a very busy, social, ‘glamorous granny’ type to virtually catatonic. So sad.

I’m not sure of the outcome as we lost touch, but I just wanted you to know that it is a thing.

She's tried only one antidepressant? Has she seen a psychiatrist regularly? If she needs an antipsychotic, an antidepressant wouldn't help.
I'm not a doctor but I also wonder about vagus nerve involvement.

Just want to point out I have no medical experience, I am just talking about personal experience.

I have felt at times like I'm going to go into a deep depression. It seems to come out of the blue, no explanation. But then, I will realise I am constipated, and the depression lifts when it is sorted. I do always "snap out" of the depression though, and it appears your family member hasn't.

I would suggest looking at gut health. Fermented foods, like kimchee and kefir are a good place to start.

I wonder if it's a prion disease or something neurological that they haven't hit on.

A really bad psychotic depression might cause something this bad, but regular depression usually responds to medication even if it's just in a limited way. I wonder if ECT would help. They only use this in severe cases where meds don't help.

I had a great aunt that went something like this during menopause. It was quite sudden and she just stopped functioning so she had to go to the mental hospital, but treatments were limited back then.

I assume they tested for MS ?

@TellmewhoIam
I couldn't say how many they have tried or what dose. How long before they switch an antidepressant if it doesn't work?
Yes to the psychiatrist but not regularly. She won't speak to them, doesn't engage and during lockdown over the phone was offered and as she won't speak on the phone at all it was pointless.

@TolpuddleFarter
It definitely started that way. I never knew about the link between constipation and mood.

@mybrainhertz
I suggested having her sectioned but they won't do it.
As far as we can tell she's no danger to herself or others so for that reason it's not an option which is fair enough.

@Noluthando
Not MS. There are no physical problems and mobility is fine. No pain expressed

Utis can cause confusion and delirium and if she has them repeatedly made need long-term antibiotics to shift. Its unlikely to make her back to normal but might reduce some of the symptoms. I found it much easier to get help privately than via NHS if that is an option.

Has she had blood tests for iron / folate etc, I think a multi-vitamin maybe with iron if low in it may help a bit.

@TomRipley one to two months for antidepressants to 'settle', and this might be a series of small returns to functioning rather than a big cloud lifting. Under lockdown I've known people with similar-seeming surface symptoms (to a layperson or some general practitioners) need different things (antipsychotics vs antidepressants). I would also be wondering MS/something neurological, like other posters. So sorry you are all going through this! Go gently and don't burn out!

The confusion caused by utis goes away once the infection is treated. I've never known it to persist.

Very severe vitamin B or D deficiency might go some way but not 100%.

Depression can be somatic. Depression can certainly make someone forgetful, even catatonic. What precipitating events might there be for a depressive episode? Major life events etc? How old was she when this began? Have they checked for anything endocrine such as thyroid?

(Mental health nurse)
This sounds very much like a severe depressive episode, often seen in type 2 bipolar. Has she ever experienced a period of mania to your knowledge?
It could certainly be a depression without bipolar.
Either way, alongside the medication she would likely benefit from some behavioural activation provided by MH professionals on an intense level.
People coming in every day to work on her motivation to do basic tasks.
Is she under a community mental health team? They usually have support workers who will do the behavioural activation alongside nurses monitoring medication (concordance and efficacy) and arranging regular reviews if meds aren’t working.
Pp mentioned ect and this is often the treatment of choice in catatonic presentations, but the person needs to either capacitously consent to it or be detained due to lack of capacity and be treated under the mental health act.
If her capacity to make decisions about her treatment is impaired, a family member can request a mental health act assessment via social services.

Thanks @TellmewhoIam
It's definitely pushing a year with antidepressants, I've not heard that they've changed or upped dose but it could have been, only her children would know that.

Again, I'm not sure about thyroid but she's had lots of blood tests and all were normal. No deficiencies in anything.

Anything anyone mentions on here I'll be looking in to and talking to family about. We've all been Googling over the past two years and obviously have expected doctors to diagnose something but it isn't happening.
No one thing fits the drastic onset of symptoms or their persistence

Thank you @MeAndHimAndHer that's really helpful, she isn't receiving any of those services currently and they haven't been offered.
Is this something we need to request? Where do we start that process?

I hate to be the bearer of bad news, I have hormonal depression and took months to get the right antidepressant .
Without I don’t function, I’d be stuffed without, was constantly tearful and ached, with it everything is brighter

GP
They can refer into community MH teams and are usually happy to.
CMHTs can have long waiting lists depending on where you are. Some areas have interim teams, like Access & Well-being team here (North Yorkshire). A crisis team would be unlikely to pick her up due to the lack of imminent risk of harm, but they might be worth a call for advice. Local crisis team phone number should be google-able.
To request a MHA assessment, which is carried out by 2 independent doctors and a social worker, you need to contact social services. They provide this service 24/7 so you can call at any time. Family members can request Mental Health Act assessments, usually due to a perceived lack of capacity in the individual to make choices relating to their healthcare needs.
In this area, you can self refer into any MH team including crisis team, but that isn’t the case everywhere so often GP is most direct route.
Google behavioural activation too. It’s very straightforward, starting with the absolute basics of supporting someone to feel able/motivated to see to the most basic task and moving on from there.

I've had severe depression several times. The description of her as unable to do anything, unable to dress, wash, show interest in life at all is sadly very common. From my perspective it was a very physical illness, which people who don't suffer it don't seem to get. My brain would be whirring with messages: get dressed! have a walk! but I just couldn;t get them to translate into physical action. It was as if the pathway was broken, like when a computer can't connect to a website and just spins a rainbow wheel for ages.

Sadly, ots of ADs also create lethargy so it can be hard to break that cycle but I would recommend you try her on a different type of medication.

I've heard of the gut bacteria connection to mood, but never heard of that constipation issue before. It would do no harm to get her to drink an Actimel every day and also maybe to take some lactulose as well to make sure that she doesn't get constipated again. You can also try iron supplement (use Floradix as it doesn't cause constipation - all the other ones do) Vitamin D spray and B-complex. Might be a bit of a battle to get her to take them.