This summer should have been the best time of Jackie Fyock’s life.
The 52-year-old Latrobe, Pennsylvania, resident and her engineer husband, Sean, recently adopted their first child, a 9-year-old boy they fostered for more than a year. A 2015 diagnosis of stage 1 breast cancer had become a distant memory, one blurred by negative annual mammograms and MRIs after tumor removal and radiation therapy. Fyock hadn’t suffered an epileptic seizure in five years, the first time she’s been free of the frighteningly disorienting, debilitating events for such a stretch since she had her first one as a child.
Yet Fyock is battling mild depression — a disorder that she had been managing more or less successfully with an antidepressant for almost two decades.
“Now that [my son] is settled in and things are slowing down in every way, I would think that I should be feeling happier,” she says. “But I’m not. I’m feeling kind of like, Ugh!”
The results of a brief questionnaire revealed the reason why.
In June, Fyock’s Cleveland Clinic neurologist consulted a graph that charted her scores on the Patient Health Questionnaire. In 2008, the clinic’s Neurological Institute began requesting patients complete the survey right before every appointment.
The questionnaire asks respondents to rate the frequency of nine symptoms over the previous two weeks, along with the degree to which those symptoms interfere with their ability to function in daily life. Four options — “not at all,” “once in a while,” “half the time or more” and “nearly every day” — add 0, 1, 2 and 3 points respectively to the score. Any score of 10 or more suggests a diagnosis of clinical depression.
A tentative depression diagnosis results when the respondent rates the frequency of at least five symptoms — including “little interest or pleasure in doing things” or “feeling down, depressed or hopeless” as well as “thoughts that you would be better off dead or of hurting yourself in some way” — as “nearly every day” for a minimun of two weeks.
In addition, the respondent must describe those symptoms as making daily life “somewhat difficult,” “very difficult” or “extremely difficult.” Questionnaire results revealed that 34.4 percent of patients seen within the Neurological Institute between January 2012 and November 2016 scored over 10, indicating at least moderate depressive symptoms. Another 17.5 percent had scores over 15, indicating at least moderately severe depressive symptoms.
“Depression is a very common comorbid condition in patients with neurological disease and patients with any kind of chronic illness,” explains Dr. Adele Viguera, a Cleveland Clinic psychiatrist. “So it’s very important to recognize that and to treat the depression so that, for instance, they’ll be more engaged in treatment, more likely to adhere to their medication regimens.”
Today the Cleveland Clinic’s pain anesthesia, primary care and rheumatology departments, along with the Taussig Cancer Center, use the questionnaire to screen patients for depression.
Fyock recalls that her neurologist compared the dates of her completed questionnaires and the resulting scores with the times various medications, including those ordered by her general practitioner and oncologist in Pennsylvania, were prescribed, discontinued or changed. The neurologist noticed that Fyock began scoring higher on the questionnaire in mid-2015, after the general practitioner took Fyock off Lexapro and put her on another antidepressant. He made the change because of an adverse interaction between Lexapro and the estrogen-modulating breast-cancer drug tamoxifen she was taking.
“My mood changed and then it stayed the same,” Fyock says.
Fyock is all too familiar with adverse drug side effects. When the frequency of her seizures increased from every few years to every month, a Youngstown neurologist changed her anti-seizure medication to a counterpart that put her in a near-constant state of anxiety that worsened when she had to leave the house, even to run errands.
When the neurologist refused to change her medication, Fyock sought treatment at the Cleveland Clinic in late 2011.
“I remember thinking that I was going to end up in a mental institution,” she says.
A drop in anxiety and questionnaire scores accompanied a gradual transition to another anti-seizure drug.
She also knew antidepressants weren’t a cure-all. She’d experienced an increase in symptom severity when she and her husband moved from Ohio back to their native Pennsylvania in mid-2013. But learning that her current state was related to the change in antidepressants truly surprised her.
She looks forward to switching to a more effective counterpart approved by her oncologist and appreciates the questionnaire as a medical tool. “There’s a firsthand example of just how valuable it is,” she says.
