Nigel 
October 30th,2009Yesterday’s (UK) Independent contains a useful article by Jeremy Laurance entitled ’The Big Question:Is depression increasing,and what is the best way to treat it?‘*
The article is informative and well written,but misses out in two areas. I’ll look at one today,the other tomorrow. This is by no means a complete analysis,but hopefully it will be of help.
All colour has been washed out of the world. It's raining all the time. Real life is just a blur.
What is depression?
Jeremy’s answer is a good introduction given the necessary brevity –it’s just a minor aside in an article focussed elsewhere. Here are some additional thoughts from the point of view of a long-term sufferer married to a long-term sufferer:
Depression is not just feeling down for a few days. It is an illness,a change in brain chemistry which can have devastating effects on both the sufferer and on friends and relatives.
Phrases like ‘loss of pleasure in things that were once enjoyable’is correct but misleading because it gives no sense of the seriousness of the problem. My own depression is controlled to some extent by Prozac,but I can still be knocked out of useful activity for days at a time.
It’s not just a matter of getting less enjoyment from watching my favourite TV programme. I feel weak,like you do the first day of recovery from flu. Often my body hurts,I get headaches and sinus pain. I sleep more hours a day,and on occasion have slept all day and all night.
If I can push myself to do anything I soon feel tired physically and mentally - no stamina. And it’s so hard to start an activity however simple because I can’t imagine enjoying doing anything but sleeping. Usually,with Prozac’s help,once I’m started on something I actually do enjoy it. The trouble is that in the motivation phase I have to take it on trust this will happen.
Taking photos on the North York Moors last weekend was enjoyable even though I was depressed. Some of the photos are here (or two posts down if you’re on the blog home page). Writing this article is hard because my mind is fuzzy and resists being made to think clearly. It’s the mental equivalent of trying to run through knee-deep porridge. And I’m not experiencing much pleasure in the process.
I also can become severely withdrawn and uncommunicative,snapping at Jenny if she tries to help. I can become over-critical of other people,and very short-tempered,very angry. Sometimes I’ll go for hours fighting the desire to cry without knowing exactly why. Anything that involves getting dressed,or leaving the house,or worst of all going out in the evening,feels almost intolerable. Something that works for me at my worst is to withdraw into playing computer games for several days. Sometimes I need to increase the dose of Prozac.
I’m not a typical depressive. I’m not sure anyone is. There are different types of depression and people are affected differently,but real clinical depression of any type can be catastrophic. At least until it is adequately treated. It has altered the course of my own life,although perhaps for the better. It has ruled out many career options,and made what I can do often much harder and less productive.
The first time I was hit with major adult depression I went almost overnight from being a high-flying Maths student to barely understanding anything the lecturers said. I was lucky. Results in the part one finals the year before were good enough to get me a degree,but other people have to drop out of university with no qualification.
A factor often overlooked,especially by medical professionals,is depression fallout. My sister and I were affected in a major way by our Dad’s repeated depression. Mum was affected far more. When depressed he could become demanding,extremely sensitive to anything out of place in the house,bad tempered,unpredictable. He often blamed Mum for everything that was wrong in his life. I was around sometimes when he’d have a knife at her throat and be threatening to kill her. The amazing thing is that she loved him and stuck with him till he died aged 85.
He’d also make sudden changes of mind which hurt other people;for instance one September he suddenly announced that ‘they’had no right to know the details of his finances so there was no way he’d fill in my annual student grant application form. I started my teacher-training year severely depressed with no money.
That’s a brief and highly subjective summary. I’m working on an objective and rather more thorough description of what depression is,but you’ll have to wait for that.
* The Independent article is a response to a couple of recent publications in the UK:
Research has shown that although the number of people suffering depression has stayed more or less constant,prescriptions for anti-depressant drugs has doubled in 14 years. The original BMJ article is aimed at medics but may be found here.
Also our National Institute for Clinical Excellence (NICE) has just published updated guidelines for the treatment of depression in adults. The full report is 580 pages. Even the quick reference guide is 28 pages. This is not for the faint-hearted. Some degree of training and knowledge is needed before trying to apply the guidance. If you’re really interested you’ll find it here.
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