I was 21 when I had my first breakdown. I’d been suffering teenage depression on and off for six years but not known what it was, never questioned it. Suddenly I was too ill to go to lectures. In those days there was no specialist student health care, but a local GP (family doctor) had become increasingly concerned by the mental health problems he saw in his student patients. A year or two earlier he had decided to specialise in treating this epidemic. I was lucky enough to be referred to him by my own GP.

I don’t know what he prescribed me. Almost certainly a tricyclic antidepressant (this was autumn of 1970). I’ve just looked them up on the net and I certainly gained several recognised side effects: increased heart rate, drowsiness, blurred vision, dizziness, confusion. Mind you I was pretty confused when he first saw me.

The first consultation was weird. Okay so he sat behind a large desk and I had a traditional upright surgery chair. But he offered me a coffee, which was shrewd. It worked in much the same way as being given a drink when you arrive at a party. I had something to hold on to, something to take sips from as if I felt confident and purposeful.

His overall approach was way ahead of its time, perhaps because he had not been trained as a psychiatrist so came at the problem with fresh eyes. The starting point was medication, but he made it clear that the antidepressant was only to give me the opportunity to work hard at learning to cope with depression. So that’s what this was. Depression. Hmmm.

“The trouble is that when you feel down you have only the one escape route: running.”

I was a keen member of the university cross-country and athletics teams, and hell I enjoyed running. Best of all was ten or fifteen miles at relaxed pace through the beautiful countryside around Durham. That’s Durham England. If I felt a bit rough I went for a run. But if I felt seriously rough any attempt to run would be frustrating because the energy was gone. Clinical depression affects you physically. I would try to train and fail. The harder I worked at it the worse I got, which was absurd. Races were a waste of time.

“You try to escape by running and find that route is closed to you. What do you do? Nothing. You do nothing because you have no other escape routes set up apart from friends who are usually not available because they’re working or having a life of their own.”

I must have looked blank.

“When I get home from work I’m often feeling pretty rough. What do I do? I knock hell out of the garden. Do I like gardening? Sometimes. Not always. But I do it anyway, and it helps me feel better even when I don’t think I’m enjoying it. But some evenings it’s too dark or it’s raining heavily.”

What did he do then? Sorry, I can’t remember.

“Now you’re too depressed to run what other hobbies do you have?”

- I write.

“When was the last time you wrote?”

- well, er, I wrote a novel two years ago …

“Are you well enough to write?”

- er … well … I read a lot. I listen to music.

“You just told me you’re picking up books, trying to read them, and giving up after just a page or two. You said music isn’t doing anything for you anymore. In fact you have nothing but friends to fall back on when you’re this ill.”

I doubt I nodded, but he was right.

He told me I must find at least one new hobby. How? Well I could try browsing the local bookshop to see if anything caught my eye.

“This is your homework. You find one new activity to try. I don’t care what it is so long as you try it. No matter whether you find a new hobby first time off, the key thing is to try something. And then something else. And we keep going till you have a battery of escape routes to fall back on when you’re depressed. See you next week. Good luck.” He smiled and shook my hand firmly.

I went to the local bookshop (these days a Waterstones but not then). It was an Aladdin’s cave, but cold and dark and grey with the air like treacle. I kept wanting to cry but I made myself work through every single shelf of non-fiction. I read every title. I took some books off the shelf for a browse.

I have no idea what activity I picked, but I do remember the faint glimmer of light that doing something, anything, left me feeling ever so slightly better. No, I didn’t feel happy. No, I still couldn’t think straight. No, the future was still black. But something eased just a tiny bit, barely enough to notice. I had made a crucial discovery: when you’re depressed doing anything is better than just sitting around thinking about how bad you feel.

Actually there were two other long-term results: a lifelong love of browsing bookshops (which fortunately my wife shares, though it’s cost a lot of money over the years), and a tremendous variety of interests. To focus enough on writing to produce the next book for my agent to try and sell I’ve had to be brutal in sidelining many hobbies.

The doctor cum counsellor I saw in Durham from 1970 through 1972 used a range of techniques. The one I’ve described above would probably now be called solution-focused therapy. It was exactly what I needed at the time, and has benefited me ever since. I’ve sometimes used it with people I’ve tried to help, but rarely as forcefully as it was used on me: once I had a really bad weekend and made an appointment to see this doctor. What was I supposed to do when I realised I was getting worse? Anything but sit around moping. What had I done over the weekend? Sat around moping. There’s your answer so next weekend have stuff planned and do it no matter how you feel. Just do it. He then warned me that if I ever came back complaining of being worse yet had not followed this strategy then he’d not see me again. Hard words, but spoken forcefully at exactly the right time. The next weekend I had planned in detail, and I stuck with the plan. I didn’t feel okay. But I didn’t feel worse. Success! Often success for a depressive is entering a bad situation and simply not feeling worse than before.

If your counsellor proposes some action on your part then you have only two rational choices: you can give it a go, or you can stop seeing that therapist. And what harm is it going to do trying out their suggestion? After all, it might work. You’ll be sure it won’t, but give it a go. Give it a serious go, and in so far as you can when ill be open minded. Not every suggestion will work, but you can be almost certain that when you first hear of something that can help you’ll try to reject it; that is part of depression.

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Relax. I'll be bouncing around again in a few minutes.

There are moments when suicide makes sense.

That is, it feels like it makes sense.

In the moment.

Especially if that moment drags on for days or weeks.

Today we heard of the death of influential fashion designer Alexander McQueen. Someone very close to him had just died. It’s not known at this stage if he committed suicide, but the possibility has been mooted.

That got me thinking.

If my wife Jenny dies before me then I’m sure I will be devastated, and I’ll not be at all surprised if I feel there’s no longer any point in staying alive myself. Living with chronic depression is tough, and such thoughts can flitter though my mind. Usually they are weak and comfortably brief. But I have nearly lost Jenny several times so I have a sense of how I may feel.

What I’ve done is promise myself I will allow time to recover from the immediate grief before making any critical decisions such as whether to move house. I guess suicide also counts as a critical decision.

You see when emotions are strong or depression is deep we don’t think straight. During depression is exactly the time NOT to make important decisions. I’m lucky. I know my depression will ease, so I just postpone following through on any ideas till I’m feeling better. It works. Some of the ideas then make sense, and some I realise are just plain silly.

When depression first hit in 1970 and I had no idea what was wrong with me I felt a bit suicidal. I talked to friends and that helped. My Doctor referred me to a specialist and that started me on the road to understanding, learning to cope, and realising depression was only temporary. Mind you that temporary episode lasted over eighteen months, but I survived. And I’m glad I did.

Many years later one depressive episode brought extended thoughts of suicide, and a friend (Peter Jolly) helped me through the suicidal stage.

If you are feeling like death could be an option then please talk it through with a good friend, and if you’re not already receiving treatment for depression then please go and see a Doctor as soon as possible. There are medicines that can probably help you, although some take several weeks before you feel the effects.

Above all else, be patient. If you want to kill yourself now, it will pass. Life will get better. There will be times worth experiencing again.

Afterthought

When I suggest chatting with a friend I’m not suggesting you text everyone in your address book. Some depressed people contact all their friends saying where they are and that they are about to kill themselves. If that’s what you’re doing then you are in a rough state and you do need professional help, but maybe what you’re really doing is trying to attract attention. You may be trying to shout ‘HELP!’ or you may just like the fuss. The trouble is that friends rapidly become fed up with you if you try this more than once. And let’s face it, friends shouldn’t be abused like that. Or to put it from a selfish viewpoint (which is much easier to grasp when depressed) you need your friends to still be there if it ever gets really serious.

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NO ENTRY !

There’s a classic TV sketch in which a one-legged actor turns up to audition for the role of Tarzan and is outraged that he’s not considered quite suitable. (Sorry, can’t remember the source. Probably Monty Python or Not The Nine O’Clock News.)

If you suffer depression it’s easy to think like this. You know what you’re capable of at your best, so why do you need to declare your disability in the job application?

Because it matters.

If you had a single episode of depression ten years ago, got over it, and have coped with a range of stressful situations since: yes it must be galling to have to declare it. On the other hand if, like me, you have repeating depression then you just have to accept that some roads are closed to you.

This is a tricky area. Depression affects individual people and jobs differently. Stephen Fry became an outstanding entertainer (comedian, actor, writer, presenter) despite major depressive problems. Other depressives who try to become actors find that profession makes them even less stable.

There are few solid rules. Obviously you should think very carefully before trying a career in school teaching. The hours are long in term time. Stress can be high. Abrupt switches several times a year from crippling levels of work to several weeks of nothing is arguably bad for a depressive. But it’s possible. It would seem equally daft for a depressive to go into national politics, but Winston Churchill is recognised as a great wartime Prime Minister of this country.

How about I describe what limitations illness forced on my own career? What no-entry signs were inevitable, even if it did take me years to accept them? I’ll cover them based on the reason they’re there.

I’ve been off ill a lot

Early in my career this would be the occasional half term off following a breakdown. Also depression may depress the immune system. I had more than my fair share of normal illnesses some of which also required sick leave.

In the final dozen years I was generally able to manage things better in the sense that I could usually see a breakdown coming and take a few days off to recharge. As stress built up in the last few years of teaching I was physically ill more often too.

When I was off ill someone else had to cover my lessons. With short-term absence this would be colleagues giving up non-teaching lessons. I would set work and phone it in. They would try to interpret my instructions but most teachers do not ‘teach’ cover lessons. They turn up, set the work, and get on with urgent marking. This is not ideal, but if you’ve ever tried teaching you’ll understand. With long-term absence a temporary replacement must be found from outside the school, but anyone good enough to be teaching Maths full time probably is, rather than sitting at home waiting for someone to be ill.

I was lucky. My various headmasters were sympathetic. It seems they wanted me back so chose to make the school put up with problems. Even so the last Head quite reasonably stopped me returning after my last breakdown and required a full medical report. I was five years from retirement. He offered a part-time teaching job coupled with maintaining pension payments at their full rate. This was a remarkable concession. He thought I was a good teacher, to be kept if at all possible. (Actually my consultant psychiatrist reviewed matters and rightly assessed I’d reached the stage where I wouldn’t cope with even part time teaching.)

Most teachers expect to be promoted during their career. There are a number of options. My preferred one was pastoral. I wanted to be Head of Year. More of that later. The obvious alternative was academic: become Head of Maths. Both roles must have someone who is going to be there pretty much every day. Neither person can do the job if they keep taking sick leave. This is not unfair, it’s in the nature of the job. We did find a unique alternate route for my skills plus illness, but repeated sick leave effectively banned me from reaching deputy head level whether I was otherwise up to it.

My mood changes according to how ill I am

Okay, I’ll be honest. When depressed I’m a moody git, and when stressed by teaching as well I became bad tempered and not entirely rational.

Imagine this:  they make me Head of year 9. John Smith, aged 14, has rich and influential parents who are far too busy with their own careers to spend time with their son. He is mixed up, attention seeking, and frankly lacking in moral awareness. Yesterday he was internally excluded (supervised while he worked but not allowed to go to lessons) for throwing his calculator at a teacher coupled with fairly explicit instructions where to go. It is 8.25am and I am just heading off to take year 9 assembly. Passing through reception I’m accosted by Mr Smith. He has no appointment but demands to speak with me “right now”. He is angry that he’s paying school fees for his son to not attend lessons. He is a busy man so requires instant attention – now I know where his son gets that from.

Okay, that’s the scenario. How do I deal with Mr Smith a) when I’m well, and able to respond calmly and professionally, b) when I’m struggling to stay afloat with depression, my head hurts, my back aches, and my subconscious keeps telling me to snarl at someone?

Enough said?

So what’s the good news?

More of what Nigel Day wrote for the school mag

I was in the right career for me.

I think the problems caused by illness were generally (though not for everone) outweighed by how I did my job.

Because they’ve told me: I know many that people have benefited from my work.

And being someone students knew well who was also known to suffer chronic depression was itself of value to quite a number.

One trick, which admittedly I was slow to learn, is to recognise the genuine limitations imposed by who you are and any problems your body or mind have. This is true for everyone, but more so when the disability is something as powerful as cerebral palsy or chronic depression.

Oh, and in case you missed it: the previous post was about the shame and stigma of depression. It may be just below. It is here.

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Apparently it’s okay to admit to depression if you’re a celebrity, but for the rest of us this admission can just increase our problems.

I guess I’m weird.

From the start I’ve been fairly open about my mental illness. I’ve not encountered significant problems that weren’t actually there because of the depression itself, as opposed to created by telling people. But yes, I’ve met enough ignorant and bigoted people that I do have some understanding. And I believe some cultures are far less sympathetic to mental illness than the one I grew up in.

Good morning world. My name is Nigel and I've suffered chronic depression these past forty years. I don't know it yet but three months from now the illness will force me to retire. Live with it. I can.

You’re just lazy

One problem is that of wilful misunderstanding. A friend recently mentioned that her father is quite sure there is no such thing as depression. He believes people who say they’re depressed are just lazy. Well thanks. So when I used to force myself out of bed at twenty to six every morning, fight intermittent desires to lose my temper or cry during the day, worked ten hours at school and then marking, and came home almost too tired to eat, I was just being lazy. Neat analysis. If my reasoning was that dodgy would I want people to know?

Yes of course there’s a laziness element in depression. Part of recovery is to develop ways of overcoming this learned lethargy. That needs its own article. But it may or may not be what most people think of as laziness. You might as well accuse someone with brain cancer of just having a headache. Yes, they may have a headache, but they may not, and it may or may not be caused by the cancer.

You and any doctors you consult are wrong!

Another problem is denial. “There’s nothing wrong with our family. We do not get mental illness.”

Fair enough. Presumably you’re immune to other illnesses too. Must be nice to never catch a cold or break a bone.

Come on, get real. Depression may or may not be inherited. All sorts of people contract it. There is no medical reason why someone in your family can’t become clinically depressed. And to say that none of your ancestors suffered depression is plain silly. How do you know? How far back do accurate records go? What about Aunt Ethel who was a bit of a character? Might depression explain her strange behaviour?

Mental illness is just too shameful

Part of the article Nigel Day wrote

When I had to retire early a friend at work wrote the valedictory article for the school magazine.  The editor, bless him, contacted me urgently to ask if I’d seen the proposed article. He was very worried that it contained information I would not wish to have published: it stated clearly why I had been forced to take ill-health retirement. We found this amusing. I used to give talks to years 10 and 11 about depression, using myself as a key example.

In the old days – most of the history of the human race – when depression was not understood it was interpreted in one of four ways. If you were in fact clinically depressed with faulty brain chemistry then one of the following must apply:

• you’re lazy – to be despised,
• you’re a nasty person – to be avoided,
• you’re mad – to be locked up,
• you’re possessed by an evil spirit – to be exorcised or maybe just killed.

It’s sad that now we have a well-publicised biochemical explanation, and medicines that usually help, people cling to the emotions which only made sense before modern understanding. Trouble is we’re not rational beings. We pick up these daft ideas so easily, and cling to them so fiercely whatever the evidence. It’s as if we think changing our understanding somehow removes a bit of who we are. I’d call it growing up, but there you go. Try to be patient with such people.

But…

There is no logical or scientific reason why depression should be shameful, although it is oh so understandable that we feel ashamed. However stigma is a social reality. If you admit to depression in a job application how likely are they to interview you? Obviously you’re unpredictable, unreliable. There’s no telling what you might do. After all, depression is one of those ‘mental illnesses’, isn’t it, and everyone knows one leads to another. You might even kill someone. That’s what you schizophrenics do isn’t it? (Er, no. Most schizophrenics are no more likely to murder than you are, though in your case I might be tempted. In any case I said I suffered depression and that medication has it pretty much under control. )

But there are opportunities depression may deny you, and this can feel both crippling and demeaning.

There are no hard and fast rules. People need to get to know you, and you need to get to know your own limitations, but actually that is true of everyone.

Next article I’ll describe what roads have been closed to me by my own depression, why, and how I responded.

PS

This is the 100th post.

I thought of making it something special.

I considered making key changes to the style of the blog.

I decided 100 is only a special number because we happen to have a total of 10 fingers on our two hands (thumb-obsessed people don’t quibble) so we count in tens, and a hundred is ten squared. If we had one arm with eleven fingers on it then we’d not think anything of a hundred but go crazy over 121.

You gotta pity us mathematicians

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I lived with a chronically depressed dad, and reading this helps me make sense of my childhood and understand both my parents better.

Jenny, my wife, has severe attacks of depression which have no obvious cause. I cope using a range of strategies I’m still learning, and because I love her very much. Anne Sheffield’s book has rejuvenated my efforts to help and support Jenny, and has provided a wealth of useful information. Despite forty years of study I found this book a revelation. Thank you Anne.

During the eighties Jenny became frighteningly depressed with occasional manic phases and a brief period of mild catatonia. Over six years she spent two and a quarter years in psychiatric hospital making no progress. Most of the doctors either ignored me or treated me as an irrelevant annoyance. After a couple of years I was at my wits end trying to support Jenny, cope with my own depression, and look after our two sons. Someone at the hospital arranged for me to see a psychiatric social worker who came across as tired and distracted – certainly over worked. I asked if there was any way we could be helped as a family. “Are you asking to have the children taken into council care?” he asked. “Hell no!” I said. “In that case there’s nothing we can do to help. Good bye.”

A nuclear bomb doesn’t just affect where it explodes. When I’m badly depressed there is fallout. Other people suffer and have to cope. I’m very fortunate to have known so many people prepared to live with my mood swings – not least Jenny and the boys (sorry guys, we know you’ve been men for a long time but we can’t help thinking of you as our ‘boys’).

If you live with someone who is depressed you know exactly what I’m talking about. The trouble is that most people around you do not understand, and this includes a frightening number of medics. The situation is improving. Medics are better trained now. People are beginning to understand. But having someone close to you depressed will never be easy.

Anne writes with knowledge based on experience of being depressed and living with depressed people. She includes many true examples from people she knows and has interviewed. I think every aspect of the situation is covered, and the result is an eminently readable book full of useful information, great coping strategies, and hope.

If you live outside the USA then you do need to allow for a natural bias towards the situation and culture in the States, but that should be no problem. Inevitably there are sections which are incomplete or slightly biased, but that doesn’t matter. My experiences living with Jenny when she is depressed bear little relation to the scenario described by Anne, which makes me feel extremely fortunate and blessed. There are forms of talking therapy Anne is not familiar with. But her writing has expanded my understanding and clarified a lot of stuff that was scattered and confused in my head. The book was first published in 1998 so a few parts are now slightly out of date.

The book is aimed at anyone who lives with a depressive or manic depressive (bipolar) person. It has sections specific to you if the depressed person is a parent or a child. It looks at the differences between male and female depression, between child (up to about 25) and adult depression, and between different types of depression. It looks at the range of treatments available, both chemical and non chemical. It does all this using simple language and considerable human warmth.

Anne has not just based the book on her own experiences and those of people she helps at the Mood Disorders Support Group in New York City. She’s also gone to a great deal of trouble researching the facts, and has had her writing checked by medical professionals.

If you live with a depressed person buy and read this book, and keep it to hand for reference and encouragement.

If you are depressed then get this book for the person closest to you, and when you’re feeling well enough try reading it yourself.

Anne Sheffield’s related web site is here.

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How can you treat depression?

This depends on the person, the type of depression, its severity, and its cause. Do not try to treat yourself. See someone who is medically trained and experienced. If you have clinical depression and they do not specialise in psychiatry they should refer you for treatment to someone who does.

The world is grey and it's always raining, but there's hope.

Treatment with medication

Severe depression needs medication first before the patient is likely to be able to cope with or respond to any kind of talking therapy. Some cases which feel like the end of the world but are less severe (such as atypical depression and the early stages of reactive depression) may well respond to the right talking therapy.

There is plenty of advice on the net about what medication to use. Be very, very wary of this. If it helps you understand the problems and how anti-depressants work that’s great. But you need someone medically qualified to diagnose the problem and identify the most likely medication to work. Even then you have to wait weeks, maybe a couple of months, to experience any effect. The dose may need to be adjusted. It may turn out the obvious treatment doesn’t actually work for you and something else needs to be tried. And then of course there are usually side effects. Almost all side effects are worth living with! Do not buy medicine over the net.

Since I was first diagnosed with depression in 1970 I’ve been prescribed a range of different medicines. Some had little or no effect and needed to be changed. One mood stabiliser made food taste like cardboard. Since throughout most of the five years I took it I was stabilised at a fairly depressed state I finally persuaded a psychiatrist I should come off it.

Warning: once you are taking any medicine for depression only reduce or stop taking it under competent medical supervision. Stopping too fast or at the wrong time can have devastating effects.

A previous article on medication for mental illness is here.

Treatment with talking

I’ve had a range of talking therapies (counselling, psychotherapy). Cognitive Behavioural Therapy (CBT) and Mindfulness Therapy have been very helpful. I also use some related stuff from Neuro-Linguistic Programming (NLP). At one stage eighteen months of psycho-dynamic therapy was highly effective. Don’t expect the therapist to do all the work, and don’t expect quick results. And by the way (note especially to Jeremy Laurance of The Independent) the old Freudian style psychoanalyst might ask you to lie down on a couch, but I doubt any other counsellor would. Also psychoanalysis seems to be unhelpful with depression.

Once clinically depressed talking therapies are unlikely to be of any help until the depression has been eased at least a bit with the right medication. If your therapist tells you medication is never needed for depression you need to find another therapist. They may be very good at what they do and mean well, but in this one statement they are dangerously wrong. Mild forms of depression can often be helped a lot by the right therapist using the right talking therapy well, but not so severe biological depression.

Two previous articles on counselling/psychotherapy for mental illness are here and here.

Treatment by other methods

I find it helpful to use light therapy. We noticed my depressive cycle is often related to time of year so bought a light box (the psychiatrist was cynical), and it works for me as part of an overall treatment plan. It should be used only in the mornings to avoid it causing sleep disturbances. I start using it on dull days well before autumn (fall) kicks in. My own light box uses fluorescent tubes. These need to be of the right type because ordinary fluorescenrt light does not contain the part of visible light I most need. Also after a year or two of use the specialist tubes wear out; they still provide plenty of light, but have lost the bit I need and I have to replace them. I haven’t tried the newer type of ‘blue’ light available. Light therapy is intended to help boost serotonin levels in people who from Seasonal Afferctive Disorder (SAD). A good introductory Wikipedia article is here. Skip the irrelevent bits.

In extreme cases of depression which do not appear to respond to medication a course of ECT may work. This involves the painless electrical stimulation of parts of the brain. I had it many years ago, and found it a perfectly acceptable form of treatment. I recovered from that depression fast as a result but later relapsed. For me a longer term treatment involving both medication and counselling was needed.

There are many ‘alternative therapies’ on offer. These include acupuncture, homeopathy, feng shui and aromatherapy. My own feeling is that these include a mixture of total junk with some stuff of value. I haven’t read up thoroughly on most of them. If you want to know more a Wikipedia article to start with is here.

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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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I've had a good day but tonight I may end it

(Friends please start at the end.)

There are times when I wish I was dead.

Life just seems to be so hard I wish I didn’t have to carry on. Death feels attractive.

What I am not considering though is actually killing myself.

I did once. It was the summer U2 came to Leeds with their Pop tour. Good concert – the music was much better live than on the album, but that’s often true with U2. Like Kaiser Chiefs they’re a live band. I was beginning to get somewhere with how I felt, thanks to a lot of help from Jenny, and our sons, and an incredible guy called Pete Jolly. A month earlier I’d been sitting in my tent at the school Scout camp. The day had been good, instructing climbing down on Shepherd’s Crag. Now I was staring at a bottle of tranquillisers thinking I really really wanted to take the lot. It got worse before it got better.

Would I have gone ahead with a suicide attempt without all the support? I have no idea. Since then I’ve worked with a number of school students who seemed quite serious about topping themselves. Might they have done? I don’t know. You see it’s not that simple.

I’m going to have to oversimplify here, and I need to warn you I’m not a qualified psychologist. I have experiences and I have read a certain amount on the topic. But there is much I don’t know. Actually that last is true of qualified psychologists. There’s much we don’t know about human minds. Minds are complex organisms, and can be unpredictable. If you are feeling suicidal then please talk to someone. If your friend is feeling suicidal please do your best to get them to contact a medical doctor.

I’ve come across three basic types of feeling suicidal. Beware. They blur into each other.

There is the person who wants to get attention. One version I’ve come across is the person who texts a friend giving their location and saying they’re going to kill themselves. This usually gets a quick response with several friends arriving fast. It works. It gets attention. But it is a stupid short-term fix. After a while friends suss out what is happening and take the messages less seriously. Maybe one day you’re seriously down and can feel the push towards suicide getting stronger and stronger. You’re terrified you’ll give in. You contact friends. No one responds. Heard of Peter and the wolf?

Now for where this blurs into the next basic type. Depression can feel so bad, make you feel so desperate, that you’ll do almost anything to shake people up and get them taking you seriously. This can include doing an attempted suicide with little real intent to actually die – though part of you may be serious, which increases the danger. This can work in either of two ways. It can succeed in getting needed medical help fast. It can also succeed in either causing permanent physical damage or death. Not good. Given the risk involved in this approach it’s very much worth looking for safer alternatives even though they may be slower.

Then there is the person who toys with the idea of suicide. That was probably me. When I got home I gave the bottle of tranquilisers to our friends next door for safe keeping. Just in case. I kept enough to last a week. They knew the maximum number I should take in a week. This worked. But some people toy with slitting their wrists or hanging themselves. They may cut the skin at their wrists repeatedly without (they hope) ever going deep enough to rupture an artery. They may make a noose, attach it, stand on a chair with their neck in the noose, try putting pressure on. They may make a mistake, slip, apply enough pressure to accidently cause unconsciousness. I can understand people touching the idea of suicide in this way. I would strongly advise against it. If life is so bad you’re risking death in order to try to cope then contact a medical doctor as soon as possible. You need to be able to see there is a way out.

That blurs into the final type.

Some people are genuinely determined to actually kill themselves. They may delay doing it for days or weeks, and they may appear normal and happy to those around them, but inside they may only be able to keep going like that because they know they’ll soon be able to stop pushing themselves. They may have become psychotic and believe that for some reason that doesn’t make sense to the rest of us they have to kill themselves. They may have planned the method in detail, gathered everything they need, and set the exact time. Does it need to be said? This is very dangerous. And it may be the hardest to detect. If you feel like this then please tell someone. You may have something extra in your mental anguish which is separating you from reality, twisting the way you think. This is temporary. There is help available. Why not try the help and see if you can feel differently. You clearly have not always felt like this. You can feel better once more. Tell someone how you feel. Check out with someone whether or not you just have a temporary madness.

Final thoughts

Is feeling suicidal dangerous? Yes. Should it be taken seriously? Yes. What can you do? Talk to someone. Tell them exactly how you feel and what you’re thinking of doing about it. Make contact with a local medic (in the UK ring your GP). There is other contact information below.

If your friend tells you they’re feeling suicidal then I’d recommend taking them seriously. Enter to some extent into their world by listening carefully. Ask questions if there’s anything you don’t understand. Try not to pass any kind of judgement. Aim to show them that you accept them just as they are, that you care, that you are really trying to understand. Spend time with them, and be sensitive about how much you say. They may need company but not conversation. There’s a post here that explains this a bit more.

Should you get help? Hard one that. First make sure you’ve understood as much as possible. While you’re there they’ll be coping better. Make sure they know you have genuinely understood at least some of what they are feeling. Then do your best to persuade them to let you involve someone with more expertise. You could suggest you make the contact for them and seek the advice without giving their name. You could help them use one of the contact links below.

If they refuse to allow anyone else to be consulted you have the agonising decision to make. Are they at risk of actually killing themselves? If the answer is ‘yes’ then in my view you have no choice. More likely the answer will be ‘perhaps’. If they have taken thinking about suicide as far as making detailed plans then they need medical help. If they haven’t, do they have the means to kill themselves readily available? Ultimately you must weigh the risk to their life against the possible loss of a friendship. If you’re a real friend….

Sorry, I can’t make the decision for you. I have been in this situation a number of times. I have read up on it. I am no expert. You have to decide. But if they’re in any sense serious about suicide as an option and there is no logical reason (such as an incurable illness causing great pain despite medical intervention) they need expert help.

Some contact information

At the moment this information applies to England, and probably the rest of the UK. We will add to it.

If you live elsewhere and can provide contact suggestions for your country, or if you have contacts worth adding to this list, then please let us know. You can e-mail me or add a comment to this post.

United Kingdom

Contact NHS direct:  http://www.nhsdirect.nhs.uk/ or 0845 4647

The Samaritans: http://www.samaritans.org/ or 08457 90 90 90

Childline: http://www.childline.org.uk/Pages/Home.aspx or 0800 11 11

Note to friends

It’s okay, I’m not feeling suicidal at the moment, and for me it’s both rare and unlikely to be dangerous. Right, now you can read the post.

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Stop all this rubbish about cats and music. Just tell me how to cope when my wife is suicidal.

It is. That’s the point.

The blog is mainly about being alive at the same time as either suffering depression or living/working with someone who gets depression.

In my final year at University I had a major breakdown. It was the first I realised there was something seriously wrong, though I’d no idea then it would remain chronic right through life. In those days (it was 1970) Durham University didn’t have a specialist health centre, and my GP there was more used to dealing with normal people (normal as opposed to student).

Fortunately one local medic had become worried by the large number of students with mental health problems. I don’t think he was a psychiatrist but he did shift his work towards helping students in a bad state. Mind you if he’d tried to help all the depressed ones he’d have been totally overwhelmed. For some reason I was lucky and he not only agreed to help but continued seeing me over a long period.

One time early on he commented that outside my degree I seemed to only have one interest: running. When I became depressed I couldn’t run properly so I lost that single life-line. Stupid, he said. Find at least one other pastime you could become interested in and start doing it. Have this sorted within a week so you can tell me at our next appointment.

Where could I start? How? My head was fuzzy, confused and frightened. I didn’t understand what was going on. I couldn’t handle lectures, couldn’t solve any Maths problems. Almost all the time I was feeling seriously sad. Life seemed pointless. I kept wanting to cry. And now I had to find a new pastime.

They had a good bookshop in Durham. It’s now a branch of Waterstone’s, so still good. I dragged myself out of the scruffy accommodation we were renting above an antique shop and walked slowly a few hundred yards to the bookshop. Checking every single shelf in some detail took some time, but it did introduce me to a wide range of options. I cannot remember what I picked. The task was to pick something and commit to doing it for a few weeks at least. I presumably did that.

What I can remember is realising that doing something easy enough to handle had made me feel better. Not well you understand, but not so bad. It also felt good to be doing something with a view to getting myself recovered. It was an important lesson. I remained crippled with depression for almost a year and still quite badly depressed for nearly a year after that, but I was learning some coping strategies.

Don’t laugh: I did come away with one unexpected lifelong interest: browsing bookshops. Fortunately Jenny has the same passion. Soon there won’t be room for us in the house.

My aim is to make about 40% of the posts here directly to do with depression. Look in the column to the right under the heading topics. These depression posts are filed under monochrome and blue. Click on that phrase in the right hand column and you are into the ‘living with depression’ archives. There’s a post here explaining why the topic has that name.

Originally I’d planned to have almost all the posts on that topic, but two things struck me. My life is far from just about depression. And a blog about just that could be rather, well, depressing. Part of living with depression is training yourself to do some normal living, whether you feel like it or not.

Let me give some examples of what I’ve found it helpful to do:

 - If there’s a nice sunset I make myself pause and look at it. Enjoy it, at least a little bit. Focus my attention on the sunset rather than on how I might be feeling.

 - Look around wherever I am. See what is there. Be varied: notice the bus in the distance and pick up the coin someone left on the pavement where I’m walking.

 - Be curious. When walking beside a road I consciously notice the cars. How old or new are they? How are they being driven? What expression is on each driver’s face? Warning: you’ll be shocked when you start noticing normal drivers. They’re doing the weirdest things behind that wheel.

 - Try new things which might be appealing. I don’t paint any more but I did complete a course of evening classes, and could go back to (rather amateurish) oil painting very easily now. It is another escape route.

 - Try new kinds of music. I didn’t like jazz or blues. With help from friends I experimented with listening to both. There’s still some I don’t like, but there’s a lot I do and if I can’t get my head round someone with a good reputation I assume I just haven’t understood their music yet. Currently I’m getting into Roxy Music for some reason. It’s mainly new to me and it’s great.

 - Notice people, particularly people worse off than myself. The other Sunday walking across the bridge to church we passed someone I imagine is homeless (we have a centre that works with homeless people underneath the church). I made eye contact and smiled. He said something. I stopped and asked him to repeat it. He was totally out of cash and asked if I could spare any change. He looked like he needed it. I apologised I didn’t have any money on me, which was true. He smiled and reached out his hand. We shook. I felt different after our meeting, somehow blessed by our brief conversation. He was a human being, every bit as important as me. We’d communicated, touched in far more than just a physical sense.

When down find something you can cope with doing and do it. It can be anything. It can be walking down the road to that cafe and having a cup of tea. It might be selecting one small area of the garden and weeding it. Maybe just go window shopping (but be sure not to take any money or cards!).

Whatever you do, unless your depression is very severe you’ll find it becomes easier to do simple stuff. There is a post about this here. The photo was taken while we were recording a Roxy Music track There’s another post here you may find helpful.

And this is kind of why there’s so much other stuff on this blog, why monochrome and blue only gets 40%.

Roughly another 30% is about the weird ways our human minds work. It’s fun, and some of it can help if you live with depression. I’ve called the topic wet super computer .

The rest is to lighten things up, because it’s interesting, because I enjoy it. I’m putting into this blog some of the stuff that enables me to have a life at the same time as having chronic depression. There’s more on my web site here.

What I’d really like is to get some feedback, either by comments or by e-mail. I won’t quote e-mails without permission. Click on the CONTACT tab above. I’d love to hear from everyone about everything, but especially from people trying to live with depression. And it doesn’t have to be your depression.

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