Depression 101

Ah, so it comes to this. It seems there has been confusion over my much maligned mental state, so here’s depression 101 to clear some of it up…

NHS Direct‘s entry on depression.

Clinical Depression is something very distinct to feeling pissed off for a few days, or being sad in reaction to something sad that’s happened to you. My boss and I had a discussion a few weeks ago about people being over-prescribed anti-depressants at the drop of a hat; personally, I think there are two types of people with depression – one group feels sad and down, the other group is in the grip of something that only intervention can help. Both are serious issues, but at the moment I’m concerned with the latter group cos that’s where I fall (oh look at me, I’m so ill and important. Yeah yeah).

My life is not fucked up; I do not have Depression because I am a total mess. I am still in the process of figuring out why I do have Depression but, as you can imagine from the nature of the problem, agreeing on the negatives is easier for me than agreeing on the postives 🙂 (Look! I made a joke about it!) My best guess is that the chemical composition of my brain is slightly off, and can perhaps be triggered by external events. Still working on the triggers… if indeed there are any…

So what is Depression? Here, lifted straight from NHS Direct, is the list of symptoms (with what happens to me at the crucial moments):

Psychological symptoms:

  • continuous low / ‘blue’ mood or sadness – check
  • feelings of hopelessness and helplessness – check
  • low self-esteem – check
  • tearfulness – check
  • feelings of guilt – nope
  • feeling irritable and intolerance of others – check, but would you really be able to tell the difference?
  • lack of motivation, and little interest in and difficulty making decisions – check
  • lack of enjoyment – check
  • suicidal thoughts / thoughts of harming someone else – let’s come back to this one shall we?
  • feeling anxious or worried – nope
  • reduced sex drive – aren’t you getting a bit personal now?

Physical symptoms:

  • slowed movement / speech – check
  • change in appetite / weight (usually decreased but sometimes increased) – nope
  • constipation – nope, but why the hell would you want to know?
  • unexplained aches and pains – nope
  • lack of energy / lack of interest in sex – I’ll give you lack of energy
  • changes to the menstrual cycle (in women) – hey! stop this!

Social symptoms:

  • not performing well at work – I thought I was rubbish but nobody had noticed
  • taking part in fewer social activities and avoiding contact with friends – check
  • reduced hobbies and interests, and difficulties in home and family life – meh, not really

There is actually a questionnare based on these symptoms (literally, ‘have you felt tearful in the last week? no/not much/sometimes/all the time’) that helps medical professionals make an assessment of your situation. If you check every single question you’re a basket case and need immediate help – most people have a mixture of these symptoms. I was assessed and came out with ‘mild to moderate’ depression – ie, I felt like shit but could still fake it as a normal functioning human being.

I can only give you my experience of what it feels like to be inside the head of a Depressive, but I’ve read a number of other descriptions and they all sound quite similar. It’s like this: there are two parts of my brain. One is ‘me’ and the other is ‘it’, the Depression. ‘It’ is not under my control, ‘it’ is separate to me, ‘it’ doesn’t like me very much. When I have a bad spell, ‘it’ makes like the Wehrmacht and launches a bid to annex the normal part of my brain. I am paralysed by Depression but underneath is this semblance of normality, the ‘normal’ bit that’s fighting to reassert control and that’s reminding me that this isn’t right, this isn’t real. It’s the bit that keeps me functioning.

The other effect of this war in my head is that I become desperate for peace, for quiet. I remember, after leaving work early (on the one of only two days I took off), walking on Primrose Hill trying to pull myself back together and it was so still, so quiet. It was February, the only other people around were walking their dogs, it was crisp and clear. I could hear the sound of my boots on the tarmac and nothing else. It was beautiful. Silence. Peace.

The pills kicked in soon after that, you’ll be pleased to hear.

"Suicidal thoughts"… this is the bit that tends to upset people. Not me – I’ve been there and done that and got the t-shirt, you know? But other people… it’s understandable. So, let’s keep it simple. The ‘other’ part of my brain, the bit that has nothing to do with ‘me’ starts to drop in suggestions that the only way I’ll ever find that elusive peace, the only way this will ever be over, is when I’m dead. And the ‘me’ part of my brain goes ‘oh no you don’t fucker, I’m going to the doctor’. (Yes, yes, I know that the ‘other’ part of the brain is ‘me’ as well, but it’s some fucked up parasitical part. On the other, non-psychological, hand the ‘other’ part of my brain may not be ‘me’ at all, it may simply be mis-firing neurons. Ha. Take that, psychologists!)

You now see why I went to the doctor a few months ago, at the first hint of a sign of a possibility of a return? I’m not going back down that road again, my friends.

Therefore. My life is good. My life is excellent. My life has its stresses and its messes, but whose doesn’t? My problem is hard-wired inside my brain but it’s currently locked inside its little box again. Do not rush to pre-judge or assume; there’s very little that annoys me more. *sigh* See what I have to do to spread the word…?

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12 responses to “Depression 101

  1. Nick August 28, 2006 at 9:58 pm

    “It’s like this: there are two parts of my brain. One is ‘me’ and the other is ‘it’, the Depression. ‘It’ is not under my control, ‘it’ is separate to me, ‘it’ doesn’t like me very much.”
    That’s a very good way of describing it and took me years to discover. I always thought it was a case of having ‘surface emotions’ which could be happy, sad etc but the ‘core’ personal state of being was one of never ending unhapiness (or ‘continuous low’ as that list puts it). One of the biggest turning points I found was when it was clear that it actually was something seperate which I think makes it less scary. It is not ‘you’ it is ‘it. I was always suspicious of anti-depressents because I thought it was something that would change you by removing this thing that was a part of you, and you would be left a totally different person, almost as if someone had given you a new personality. But if it is seperate to you then there isn’t that fear because you are not losing anything that is you as it were. In others words I agree but in a very inarticulate way 😀

  2. Will August 29, 2006 at 12:34 am

    I think it’s very dangerous to look at the depressive part of your brain as something separate out to get you. Therein lies the avenue to even more dangerous conditions like schizophrenia.
    Also, it stops you taking responsibility for your condition – saying ‘it’s just a part of me I can’t do anything about’. Because it is you, and there are things you can do about it. Saying your life is good because you’ve trapped that part of you in a little box with help from drugs isn’t really the way out is it? And I think you’re lying to yourself if you think that it is.
    I don’t mean to sound harsh, but I do mean to try to get through to you.
    I would heartily recommend reading this book

  3. Rachel August 29, 2006 at 10:00 am

    But, see, if my depression is actually hereditary and caused by chemical and hormonal imbalances (which I’m starting to wonder if it is; I didn’t used to think so, it’s much easier to think it’s caused by me and my personal issues because then there’s a ‘cure’ through therapy! I would prefer therapy!) then that little part of me isn’t “me” at all. The ‘two parts’ isn’t a metaphor, that’s actually what happens inside my head. I know it’s hard to visualise the inside of someone’s head and how it might work – almost impossible, in fact – but this might be simpler: does everyone have that internal dialogue? Not monologue, but the thing in your head where you have discussions with yourself? Jesus I hope so, otherwise I just outed myself as a nutcase… anyway, imagine the other half of that internal dialogue turning to the dark side. There are other examples of this being described online, but the only one I can remember where it is, is currently exceeding its bandwidth. *chuh*
    It’s like I said at the start of the post. Some people have depression that is caused by external events that they can’t shake off. Others are chemical. Nobody really knows how the brain works, but isn’t it possible that a chemical imbalance can cause the brain to start firing ‘bad’ messages? It sounds crazy (literally) but when I was having the internal battle over the, you know, death stuff – and I don’t want to go into this because people get upset – there were two very distinct voices. One for, one against. Is this low-grade schizophrenia? Are all mental illnesses routed in the same place? I have no idea, I haven’t done the research 🙂 Anyway, this ‘two parts’ theory keeps coming up in independent sources – I find it amazing that people can describe essentially the same thing again and again.
    My life isn’t good because I have the illness under control. My life is good, and the illness is an annoying thing that keeps popping up to try to disrupt it. This is perhaps the key aspect to the two parts. The ‘normal’ part of my brain is always bubbling away with joy at just being alive and living and all the things I’m doing. It’s keeping hold of that part that keeps me sane. And then there’s this other part that spreads a black cloud across my brain, and tries to cover over the normal part so I can’t get to it any more. But so long as I can still access the normal part, I’ll be fine. The normal part is the part that takes me to the doctor, that fights back. Think of the ‘other’ part as the part of my brain that’s going wrong, if you like. But there’s still two parts in there, one functioning normally and the other going haywire.
    And could people stop telling me I’m lying to myself? That’s two people in the last week…

  4. kate August 29, 2006 at 10:21 am

    i talk to myself all the time, don’t worry about it. having an internal dialogue is pefectly normal and i can totally understand how that could turn into a darker conversation. the psychological/chemical thing makes sense to me too. i mean, not all depression is the same, right? in coming generations what we now call ‘depression’ will probably be a lot better analysed and understood and will probably turn out to be several seperate and different things that have historically been lumped together …

  5. Rachel August 29, 2006 at 10:39 am

    Alternatively, according to this article I am obviously unhappy with my life…
    I think, perhaps, what is happening here is the classic mistake of thinking that because the illness is named “Depression” it is entirely the same thing as when people say “I feel depressed.” I’ve always felt it could do with a new name – it’s too confusing and leads to this kind of discussion, ie:
    “I have Clinical Depression.”
    “You must be unhappy.”
    “No, the neurons in my brain are just fucked up.”
    It’s an illness, people! I am not depressed, I have Depression. Big difference.

  6. Will August 29, 2006 at 1:55 pm

    Rachel, I’ve been there and done that so I’m not coming at this from the angle of someone who doesn’t know what they’re talking about. Plus I did study this stuff for a year (when I went to class…)
    The two conflicting voices thing I would be worried about, and I would hope you’ve spoken to your doctor about that. This is not the same as an internal dialogue and is, I believe, what Lithium generally gets prescribed for.
    I don’t think you should look at the causes as one thing or another, because it’s usually a combination of factors. Yes, you may have a genetic predisposition to having your neurones off-whack but that alone won’t cause you to be depressed. It’s most likely a combination of that with perhaps a bad or stressful event in your life and your way of thinking as a response to that.
    It’s not an illness. It’s a mental illness. You can treat the symptons with drugs but you don’t get to the cause that way.
    Trust me, read that book.

  7. kate August 29, 2006 at 2:05 pm

    now you’re sounding like jamie … 😉

  8. Will August 29, 2006 at 2:19 pm

    no not that book…
    although you never know until you try….

  9. Rachel August 29, 2006 at 2:26 pm

    I know you’ve been there and done but there are different forms of depression, as I keep saying. I’ve spoken to my doctor and a number of psychologists about the ‘voices/parts’ aspect and apparently it’s all very normal. As is some other very crazy in-brain stuff that I’m not even going to begin to describe in public, cos at the rate you’re going you’ll be wanting me sectioned 😉
    I’ve read various books that my therapist recommended (and don’t forget, I did actually go to therapy so what you’re saying isn’t new to me!) and they only go so far. I’m still trying to figure out what the deal is and what causes/triggers the Depression, but I think, from what you’re saying, that our experiences of Depression have been very different. Not ‘one was more valid than the other’ but different.
    Bipolar disorder’s a mental illness. Schizophrenia’s a mental illness. I think that classifying mental illness as somehow different from physical illness is not at all helpful, and doesn’t help to break down the old stigmas of the kind I’ve come across at various workplaces.

  10. Rachel August 29, 2006 at 2:44 pm

    Incidentally; I’m never going to pull again am I? There’s no man on earth would read this and think ‘ah yes, she sounds like a nice, stable girl, I think I’ll take that third date’.
    🙂

  11. Amy August 31, 2006 at 3:11 pm

    Will, I disagree with you, for a change 🙂
    Point 1) What are the causes of mental illness – well, you have the psychological (e.g. bad thought patterns that you can treat with behavioural therapy and drugs etc) and you have physiological problems, e.g. where your brain is wired wrong, dopamine receptors are inhibited or whatever, and/or your levels of seratonin are causing the problem, in which case therapy is pointless and you need the “happy pills”. (Why are you so anti drugs, btw? If someone had arthritis, would you tell them they should take responsibility for their condition? If someone had a broken leg, would you tell them to walk on it? Just because you can’t see the illness doesn’t mean it’s not real. Why not have the psychological equivalent of a plaster cast _and_ physiotherapy?) Sometimes these things can’t be “fixed” and controlling them is the best – and most sensible – thing to do. From personal experience, I used to be very “we need to get you off these drugs” until actually the person in question did try coming off them and whooo-eee that was not much fun. Only then did I really appreciate just what the drugs do and how important what they do is, in the right circumstances. We could have long “One Flew Over the Cuckoos Nest” style debates about treatment, but i don’t think that is really relevant when we are talking about actual people who we actually know and care about.
    2) Loosely speaking, there are 2 key types of mental disorders, which you may know if you’ve studied this, but anyway – the two key types are Neurotic and Psychotic. Now that’s not psychotic in the axe murdering sense (necessarily!), but the basic difference these labels address is that a neurotic disorder means that the person is aware that their condition is not “normal”. This is why e.g. people who are anorexic/bulimic hide their behaviour, they know it’s not normal, even though they can’t help how they behave. If it is a psychotic disorder, the person has no idea that their behaviour is not normal, the world as they experience it is the normal world – even if that world means wearing a tin hat to keep out radiowaves – and they can’t see why anyone would think they are weird, and they generally don’t function well socially. The fact Rach can recognise her symptoms puts her firmly in the neurotic camp (and I mean that in the medical sense!) Lithium gets prescribed for bipolar depression, where you get your manic episodes, and this is in the psychotic camp where you don’t recognise your behaviour is odd. Lithium can be part of treatment for schizophrenia, but only if there are affective symptoms such as mood changes/depression accompanying it. Schizophrenia is a biological, genetic condition, and a CAT scan would show serious brain abnormalities in a way that is very different to the depressive brain. And I think you are misunderstanding the nature of girl’s internal monologuing… frequently I have internal “debates” – e.g. “shall I have that cake?”, “No it’ll make me fat”, “but it looks so niiice”, “i’ll hate myself afterwards if I eat it”, “sod it I’m eating it anyway”… this does not make me schizophrenic! At least no one has told me that so far!!
    3) I agree that a genetic predisposition to depression doesn’t mean you will be depressed all the time, and it is often triggers that set it off. Recognising the triggers and avoiding them is all well and good, but if the trigger is say, a hormonal PMT imbalance on top of seratonin deficiency, or lack of vitamin B, or potassium, or any of the other biological triggers, then you need biological treatments. Likewise if the trigger is beyond your external control, e.g. job is stressful, pet dies, whatever. You could quit your job I suppose, but why should you if you can control the condition? Why let your life be run like that? And besides, if you have had depression once, you will probably get it again. Fact. You can’t hide from all triggers always. You can partially “rewire” your brain via NLP and behavioural therapy but not to the stage where you can “fix” the underlying “causes” as you call them.
    4) I am not knocking whatever issues/conditions you have experienced and are basing your judgements on, however what you need to recognise is that just because you have had a different experience of depression doesn’t mean it is the only experience of it, or that other people’s are “wrong”. Things are rarely as black and white as you are trying to make out, in my humble opinion.

  12. Rachel August 31, 2006 at 3:25 pm

    Wow. Why can’t I make my points like that? (That’s EXACTLY what I’ve wanting to express, by the way, and backed by the knowledge that I was lacking!)

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