This one’s all about Depression

All about Depression (or tell me to get over it and so help me I’ll…I’ll…cry)

Andrew Solomon calls it ‘The Noonday Demon‘, Dr Tim Cantopher ‘the curse of the strong’ .  Matthew Johnstone brilliantly illustrates it in ‘I Had a Black Dog’ and Stephen Fry describes it very eloquently here .

Ten years before I was diagnosed with Bipolar Disorder I received a diagnosis of Major Depressive Disorder (because who seeks help when they’re on top of the world?) and although bipolar depression seems to have its own peculiar quirks, I can’t really make much distinction, having only suffered with my own particular breed of ‘black dog’.

So when I talk about depression it is in a broad sense; I am familiar with a variety of available shades  *studies sample chart * Hi, do you have any more rolls of  the ‘Matt Depression’ design in ‘Deep Indigo’? Excellent, I’ll take five please… Oh and I’ll take the velour border in ‘Tar-Pit-Suicide’ Great.  Thanks. See you in six months.  I’m going to burble about symptoms and ‘types’ of depression.  I’ll also link to people who really know what they’re talking about because…well…they’re smart.

Depression brings with it a number of symptoms and indicators, psychological, physical and social. The NHS has a useful list here and a self-assessment tool which can give some guidance.  The DSM-IV criteria for MDD is available here.  The list below is made up almost entirely of my own experiences (over a number of depressive episodes) so do bear in mind that, even though I am a veritable fount of wisdom and knowledge,  I have limits (just keep it to yourself):

  • Feelings of hopelessness & worthlessnes…or
  • A complete lack of feeling, a sense of numbness
  • Preoccupation with death or thoughts of self-harm
  • Decreased motivation  ( urgh, who wants to do stuff?)
  • Lack of interest in things you usually care about
  • Persistent low self esteem
  • Anxiety  – or a growing sense of dread
  • Paranoia
  • Delusions
  • Guilt
  • Uncharacteristic indecisiveness (argh, stop asking me, I can’t decide!)
  • Insomnia (can’t sleep) or…
  • Hypersomnia (sleep too much/always feel sleepy)
  • Constant feelings of sadness
  • Confusion
  • Detachment, feeling disconnected from everything –  a bit dreamlike but not in a good way.

  • Lethargy, that walking-through-treacle feeling
  • Greater sensitivity to noise & brightness.
  • Being less able to manage aches and pains.
  • Slowing down (move slow, think slow, talk slow).
  • Irritability
  • Eating noticeably more or less than usual/swift weight gain or loss
  • Crying, or feeling that you are about to cry, regularly
  • Finding it hard to speak (really)

  • Withdrawing, hiding, hibernating, dropping out (avoiding people and activities – even ones you really like).
  • Doing poorly in your job (by your own or others standards).
  • Finding people hard work – again, even ones you really like.
  • Finding social situations overwhelming.

The key factors in determining depression using this list, or any other, are time and number eg. a cluster of the above symptoms which persist over weeks and  cannot be explained by any other illness would indicate a depressive episode. That’s when you need to see your doctor, quicksmart.

Depression can be a thing that just lands on you, and it’s easy to tie yourself up in knots looking for a specific cause when there is none.  For me it’s part of the cycle of bipolar disorder.  Reactive depression, however, is a response to an outside event, such as a change in personal, financial or social circumstances.  Often the pathway out of such depression can involve ‘coming to terms’ with the event.  Which is not the same as ‘getting over it’ and is of course easier said than done.  Particularly when the event to ‘come to terms with’ is bereavement.  To be honest, I really struggled to imagine the line between grief and depression  so I turned to an article in Nursing Times (Feb 2009) and this is what I read:

‘Even though grief and depression share many of the same characteristics, there are important differences between them. Grief is an entirely natural response to a loss, while depression is an illness. However, sometimes, it can be hard to distinguish between feelings of grief and depression.

People who are grieving find that feelings of loss and sadness come in waves, but they are still able to enjoy things and are able to look forward to the future. However, those who are depressed have a constant feeling of sadness; they do not enjoy anything and have little sense of a positive future.’

{I won’t presume to discuss the grieving process any further, but I know there’s some support services out there so I’ll leave this link here as a starting point for anyone who needs to know more.}

From what I can gather, it is the obvious definable cause, and likelihood of recurrence, that differentiates reactive depression from non-reactive depression; the treatment of either can involve the same range of therapies, support and medication.  Even if it ‘makes sense’ to you that you feel depressed, it doesn’t mean that nothing can be done to ease it.  Be kind to yourself, go see a doctor person.

 Post-Natal Depression is a different beast.  Ironically I never suffered with this.  I was wobbly, tired, mildly traumatised and smelled faintly of baby-sick all the time, but I was pretty steady for a while post-baby.   Having said that, I was not immune to the pressures of being a new mum and I do not dare imagine what it would have been like to be clobbered with depression during that time.   So at this point I am going to hand over to PANDA’s who know all about post-natal (and indeed pre-natal) depression.   They also have the facts on Post-Partum Psychosis which seems to get missed too often still.  So yeah.  PANDA’s.  Important stuff.

Since I’ve wandered my way into Psychosis (not literally, I hope…) I should probably burble a little about Psychotic Depression.  I experienced this once leading up to my diagnosis of MDD and once again leading up to my diagnosis of BPAD.  It’s a bad boy.  The symptoms are included in my list at the top of the page.  Namely Delusions, Paranoia (linked, delightfully enough) Detachment and hideous Anxiety. Now this experience of psychosis is probably considered to be part of my bipolar disorder, and it looks an awful lot like mania gone bad to me, but hey, great news!  you don’t have to be a manic depressive to enjoy it!

Some people who have severe clinical depression (sometimes called major depressive disorder) experience hallucinations and delusions. They are said to have psychotic depression.

http://www.mentalhealthcare.org.uk/psychotic_depression

Seriously.  Psychosis.  .Would not recommend.  I would have let them zap me to make it stop.  I have some black holes in my memory from those episodes so, frankly they could have done and I wouldn’t know.  The trouble is, most of the time, the last person to know you’re psychotic is you…but if you get a hint of it press the red button.

Anyway, I’m well past 1000 words now, and I have tried to only talk about stuff I know a bit about.  But there are lots of ties between depression and other disorders so I’ve linked to some below in an attempt to be, y’know, helpful, rather than just verbose.

Anxiety will bring you to your knees, fast. Ok, I’m going to give anxiety its own special page.

PTSD  –  it’s not just a veterans disorder.

Substance abuse

Seasonal Affective Disorder – I thought I maybe had this, until I spent a heat-wave- summer feeling suicidal.   So probably not.

Hypothyroidism

PMS

Peace x

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