What does depression feel like? Trust me – you really don’t want to know

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Depression, emotions, experience, support, symptoms

What does depression feel like? Trust me – you really don’t want to know

This is Depression Awareness Week, so it must be hoped that during this seven-day period more people will become more aware of a condition that a minority experience, and which most others grasp only remotely – confusing it with more familiar feelings, such as unhappiness or misery.

This perception is to some extent shared by the medical community, which can’t quite make its mind up whether depression is a physical “illness”, rooted in neurochemistry, or a negative habit of thought that can be addressed by talking or behavioural therapies.

I’m not concerned about which of these two models is the more accurate. I’m still not sure myself. My primary task here is to try to explain something that remains so little understood as an experience – despite the endless books and articles on the subject. Because if the outsider cannot really conceptualise serious depression, the 97.5% who do not suffer from it will be unable to really sympathise, address it or take it seriously.

From the outside it may look like malingering, bad temper and ugly behaviour – and who can empathise with such unattractive traits? Depression is actually much more complex, nuanced and dark than unhappiness – more like an implosion of self. In a serious state of depression, you become a sort of half-living ghost. To give an idea of how distressing this is, I can only say that the trauma of losing my mother when I was 31 – to suicide, sadly – was considerably less than what I had endured during the years prior to her death, when I was suffering from depression myself (I had recovered by the time of her death).

So how is this misleadingly named curse different from recognisable grief? For a start, it can produce symptoms similar to Alzheimer’s – forgetfulness, confusion and disorientation. Making even the smallest decisions can be agonising. It can affect not just the mind but also the body – I start to stumble when I walk, or become unable to walk in a straight line. I am more clumsy and accident-prone. In depression you become, in your head, two-dimensional – like a drawing rather than a living, breathing creature. You cannot conjure your actual personality, which you can remember only vaguely, in a theoretical sense. You live in, or close to, a state of perpetual fear, although you are not sure what it is you are afraid of. The writer William Styron called it a “brainstorm”, which is much more accurate than “unhappiness”.

There is a heavy, leaden feeling in your chest, rather as when someone you love dearly has died; but no one has – except, perhaps, you. You feel acutely alone. It is commonly described as being like viewing the world through a sheet of plate glass; it would be more accurate to say a sheet of thick, semi-opaque ice.

Thus your personality – the normal, accustomed “you” – has changed. But crucially, although near-apocalyptic from the inside, this transformation is barely perceptible to the observer – except for, perhaps, a certain withdrawnness, or increased anger and irritability. Viewed from the outside – the wall of skin and the windows of eyes – everything remains familiar. Inside, there is a dark storm. Sometimes you may have the overwhelming desire to stand in the street and scream at the top of your voice, for no particular reason (the writer Andrew Solomon described it as “like wanting to vomit but not having a mouth”).

Other negative emotions – self-pity, guilt, apathy, pessimism, narcissism – make it a deeply unattractive illness to be around, one that requires unusual levels of understanding and tolerance from family and friends. For all its horrors, it is not naturally evocative of sympathy. Apart from being mistaken for someone who might be a miserable, loveless killjoy, one also has to face the fact that one might be a bit, well, crazy – one of the people who can’t be trusted to be reliable parents, partners, or even employees. So to the list of predictable torments, shame can be added.

There is a paradox here. You want the illness acknowledged but you also want to deny it, because it has a bad reputation. When I am well, which is most of the time, I am (I think) jocular, empathetic, curious, well-adjusted, open and friendly. Many very personable entertainers and “creatives” likewise suffer depression, although in fact the only group of artists who actually suffer it disproportionately are – you guessed it – writers.

There are positive things about depression, I suppose. It has helped give me a career (without suffering depression I would never have examined my life closely enough to become a writer). And above all, depression, in nearly all cases, sooner or later lifts, and you become “normal” again. Not that anyone but you will necessarily notice.

But on the whole it’s a horror, and it’s real, and it deserves sympathy and help. However, in the world we live in, that remains easier to say than do. We don’t understand depression partly because it’s hard to imagine – but also, perhaps, because we don’t want to understand it.

I have a suspicion that society, in its heart of hearts, despises depressives because it knows they have a point: the recognition that life is finite and sad and frightening – as well as those more sanctioned outlooks, joyful and exciting and complex and satisfying. There is a secret feeling most people enjoy that everything, at a fundamental level, is basically OK. Depressives suffer the withdrawal of that feeling, and it is frightening not only to experience but to witness.

Admittedly, severely depressed people can connect only tenuously with reality, but repeated studies have shown that mild to moderate depressives have a more realistic take on life than most “normal” people, a phenomenon known as “depressive realism”. As Neel Burton, author of The Meaning of Madness, put it, this is “the healthy suspicion that modern life has no meaning and that modern society is absurd and alienating”. In a goal-driven, work-oriented culture, this is deeply threatening.

This viewpoint can have a paralysing grip on depressives, sometimes to a psychotic extent – but perhaps it haunts everyone. And therefore the bulk of the unafflicted population may never really understand depression. Not only because they (understandably) lack the imagination, and (unforgivably) fail to trust in the experience of the sufferer – but because, when push comes to shove, they don’t want to understand. It’s just too … well, depressing.

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My battle with depression and the two things it taught me

Tags

Depression, medication, stigma

My battle with depression and the two things it taught me

It’s often said that depression isn’t about feeling sad. It’s part of it, of course, but to compare the life-sapping melancholy of depression to normal sadness is like comparing a paper cut to an amputation. Sadness is a healthy part of every life. Depression progressively eats away your whole being from the inside. It’s with you when you wake up in the morning, telling you there’s nothing or anyone to get up for. It’s with you when the phone rings and you’re too frightened to answer it.

It’s with you when you look into the eyes of those you love, and your eyes prick with tears as you try, and fail, to remember how to love them. It’s with you as you search within for those now eroded things that once made you who you were: your interests, your creativity, your inquisitiveness, your humour, your warmth. And it’s with you as you wake terrified from each nightmare and pace the house, thinking frantically of how you can escape your poisoned life; escape the embrace of the demon that is eating away your mind like a slow drip of acid.

And always, the biggest stigma comes from yourself. You blame yourself for the illness that you can only dimly see.

So why was I depressed? The simple answer is that I don’t know. There was no single factor or trigger that plunged me into it. I’ve turned over many possibilities in my mind. But the best I can conclude is that depression can happen to anyone. I thought I was strong enough to resist it, but I was wrong. That attitude probably explains why I suffered such a serious episode – I resisted seeking help until it was nearly too late.

Let me take you back to 1996. I’d just begun my final year at university and had recently visited my doctor to complain of feeling low. He immediately put me on an antidepressant, and I got down to the business of getting my degree. The pills took a few weeks to work, but the effects were remarkable. Too remarkable. About six weeks in I was leaping from my bed each morning with a vigour and enthusiasm I had never experienced, at least not since early childhood. I started churning out first-class essays and my mind began to make connections with an ease that it had never done before.

The only problem was that the drug did much more. It broke down any fragile sense I had of social appropriateness. I’d frequently say ridiculous and painful things to people I had no right to say them to. So, after a few months, I decided to stop the pills. I ended them abruptly, not realising how foolish that was – and spent a week or two experiencing brain zaps and vertigo. But it was worth it. I still felt good, my mind was still productive, and I regained my sense of social niceties and appropriate behaviour.

I had hoped that was my last brush with mental health problems, but it was not to be.

On reflection, I realise I have spent over a decade dipping in and out of minor bouts of depression – each one slightly worse than the last.

Last spring I was in the grip of depression again. I couldn’t work effectively. I couldn’t earn the income I needed. I began retreating to the safety of my bed – using sleep to escape myself and my exhausted and joyless existence.

So I returned to the doctor and told her about it. It was warm, and I was wearing a cardigan. “I think we should test your thyroid,” she said. “But an antidepressant might help in the meantime.” And here I realised, for all my distaste for the stigmatisation of mental illness, that I stigmatised it in myself. I found myself hoping my thyroid was bust. Tell someone your thyroid’s not working, and they’ll understand and happily wait for you to recover. Tell them you’re depressed, and they might think you’re weak, or lazy, or making it up. I really wanted it to be my thyroid. But, of course, when the blood test came back, it wasn’t. I was depressed.

So I took the antidepressant. And it worked. To begin with. A month into the course, the poisonous cloud began to lift and I even felt my creativity and urge to write begin to return for the first time in years. Not great literature, but fun to write and enjoyed by my friends on social media. And tellingly, my wife said: “You’re becoming more like the person I first met.”

It was a turning point. The drug had given me objectivity about my illness, made me view it for what it was. This was when I realised I had been going through cycles of depression for years. It was a process of gradual erosion, almost impossible to spot while you were experiencing it. But the effects of the drug didn’t last. By September I was both deeply depressed and increasingly angry, behaving erratically and feeling endlessly paranoid.

My wife threatened to frog march me back to the doctor, so I made an appointment and was given another drug. The effects have been miraculous. Nearly two months in and I can feel the old me re-emerging. My engagement and interest is flooding back. I’m back at work and I’m producing copy my clients really love. Only eight weeks ago, the very idea that I would be sitting at home tapping out a blog post of this length on my phone would have made me grunt derisively. But that is what has happened, and I am truly grateful to all those who love and care for me for pushing me along to this stage.

And now, I need to get back to work. Depression may start for no definable reason, but it leaves a growing trail of problems in its wake. The more ill I got, the less work I could do, the more savings I spent and the larger the piles of unpaid bills became. But now I can start to tackle these things.

If you still attach stigma to people with mental illness, please remember two things. One, it could easily happen to you. And two, no one stigmatises their illness more than the people who suffer from it. Reach out to them.

Depression doesn’t make you sad all the time

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Depression, happy, myths, sad, stigma

Depression doesn’t make you sad all the time

One of the most popular, enduring, and irritating myths about depression is that it means depressed people are sad all the time – and that by extension, people who are happy can’t be experiencing depression, even if they say they are. It is a skewed and horrible version of depression, and it’s one that further stigmatises the condition and isolates people with depression and related mental health conditions. This is because, put bluntly, depression doesn’t make you sad all the time – though the level of sadness a patient experiences can of course vary depending on the individual and the severity of depression.

When I’m having a depressive episode, I’m not walking around in tattered black clothes, weeping and wailing. I go out with friends. I crack jokes (especially sardonic ones). I keep working, and have friendly chats with the people I work with. I often manage to feed and clothe myself, I read books. Above all, I experience moments of happiness: a flash of delight as I’m walking on the beach with a friend and the sun is perfect and the breeze is just right; a surge somewhere deep inside when I’m surrounded by beautiful trees and it’s raining and I feel my heart swelling to encompass the whole world; a warm, friendly, affectionate sensation at the touch of a friend, a hug at the end of an evening or a hand placed over mine as we lean forward to see something better.

Yet I feel a strange conflicting pressure. On the one hand, I feel like I need to engage in a sort of relentless performative sadness to be taken seriously, for people to understand that I really am depressed and that each day – each moment of each day – is a struggle for me, that even when I am happy, I am still fighting the monster. I feel like I need to darken everything around me, to stop communicating with the world, to stop publishing anything, to just stop. Because that way I will appear suitably, certifiably sad, and thus, depressed – and then maybe people will recognise that I’m depressed and perhaps they’ll even offer support and assistance. The jokes die in my throat, the smile never reaches my lips, I don’t share that moment of happiness on the beach by turning to my friend and expressing joy.

I don’t, in other words, do the things that can help ameliorate depression, encourage people to reach out, and help depressed people with functioning, completing daily tasks of life, and finding a reason to live again. I don’t find and build a rich community of people who can offer support (and whom I can support in turn), because I have to be so wrapped up in performing my sadness at all times to prove that I’m depressed enough – even as I want to scream that this is a reinforcement of stereotypes that hurt people, that by doing this I am hurting not just myself but others.

On the other, I feel an extreme pressure to perform just the opposite, because sad depressed people are boring and no fun, as I am continually reminded every time I speak openly about depression or express feelings of sadness and frustration. I’m caught in a trap where if I don’t perform sadness, I’m not really depressed, but if I express sadness at all to any degree, I’m annoying and boring and should stop being so self-centred. Thus I’m effectively pushed into fronting, putting a face on it even when I am depressed and deeply sad – when I feel like I am choking on my own misery, I put up a cheeky Tweet. When I hate myself and I want to die, I post a link to something fun, or I write up something silly to run somewhere – even though as I write it, I am drawn deeper and deeper into my unhappiness.

Depression is an asshole, and it can become your master, but you can slip out from under it occasionally. And many depressed people in the midst of an episode don’t actually spend it fainting dramatically on the couch and talking about how miserable they are. Some are high-functioning (bolstered by the need to put a face on it), others are into morbid jokes, others try to reach out for help (isn’t that what we’re “supposed” to do?) from friends and try to make their depression less scary. Depression isn’t an all-or-nothing deal – seeing a person who identifies with depression cracking a joke or having fun or dancing with a friend isn’t evidence that the person is faking it, whether the person is experiencing a moment of genuine happiness, or fronting. Conversely, jollying up people with depression to demand that they start being more fun is equally revolting, a refusal to acknowledge that people experiencing a rough day, or a rough week, or a rough few hours aren’t going to be your trained monkeys.

Depression manifests differently in everyone and at different times. Various behaviours are not proof positive that someone is or isn’t depressed, and, as with any armchair diagnosis, insisting that someone is not actually depressed just because of a show of something other than deep, entrenched sadness is actively harmful.

Look at the woman above, joyously cycling on a beach, hair fluttering in the breeze. You can’t judge her emotional state or her larger mental health picture, nor should you.

• This article was originally published on This Ain’t Livin’, part of theGuardian Comment Network

World Mental Health Day: Defeating the ‘Black Dog’ of Depression

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'black dog', Depression, Matthew Johnstone, symptoms, treatment, WHO, World Mental Health Day

At its worst, depression can be a frightening, debilitating condition.  Millions of people around the world live with depression.  Many of these individuals and their families are afraid to talk about their struggles, and don’t know where to turn for help.  However, depression is largely preventable and treatable.  Recognising depression and seeking help is the first and most critical step towards recovery.

In collaboration with WHO to mark World Mental Health Day, writer and illustrator Matthew Johnstone tells the story of overcoming the ‘black dog of depression’.

Darren Eadie: Life after football – depression and panic attacks

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Depression, panic attacks, physical health

Darren Eadie: Life after football – depression and panic attacks

One minute, Darren Eadie was the Premier League footballer who Martin O’Neill had paid out £3.5m to bring to Leicester City. The next, he was lying in a hospital bed, his arm covering his face, trying to take in a surgeon’s words that his career was over.

Later, he would be hit by a depression so deep that it left him driving around the country lanes of his native Norfolk, so traumatised that he had to stop and call his wife out to come and rescue him. The same illness left him unable to go into the sea with his children on holiday, or to complete a birthday meal with his wife when the panic which was regularly seizing him took over once again. But to begin with, it was only the little things that hit Eadie as he went through the motions of packing up his life and career in a bag, at the Leicester City training ground.

“Everybody says you hang your boots up when your career is finished,” Eadie says now. “But you actually take them down.”

His story, which asks questions of whether football does enough to help those players who are thrown out before they are ready, begins in the bed of a private hospital in Leicester in 2003, where Eadie was trying to shake off the effects of an anaesthetic, after his third operation in one year on his left knee. It was surgery carried out to find out the effects of what had been the last roll of the dice – pioneering surgery, carried out on Eadie in Sweden 12 months earlier by the surgeon Lars Peterson, whose technique was to re-grow part of the cartilage in a lab, then inject it back into his knee via three grafts. It was a relatively new operation but it had worked before and it would do so again, notably when Manchester United’s Ole Gunnar Solskjaer needed help.

Eadie had encountered problems with his knee before but had always overcome them. A crunching tackle by Scott Parker, 40 minutes into Leicester’s game at Charlton on 1 April 2001 was different, leaving him sidelined for months and unable to get back playing. He never would get back. The knee never felt right after the Swedish surgery. When running one day he felt “something go” in it and it emerged that one of the grafts had fallen out of place. A repair took place, Eadie went back to the gym, but he felt the same problem. All three grafts had fallen out and that was when more exploratory surgery – in the Leicester hospital – brought him to his moment of truth with the surgeon and Leicester physio Dave Rennie.

“I just knew by the look on their faces that the news wasn’t good but the words ‘I’d advise you that it would be in your best interests to give football up’ were shattering,” Eadie says.

His wife, Kelly, was told by Rennie that she should get to the hospital as soon as she could. She immediately knew that the situation was not good. “I can remember walking in and seeing Darren lying on the bed with his arm covering his face,” she recalls. “It was a massive blow for him, knowing that his football career was over, and it affected all his family too, as our family life was also based around Darren’s footballing career.”

Eadie’s first instinct was panic. He was a top Premier League footballer at the time, earning good money. “When I got home and spoke to all my family on the phone, I wasn’t sure what to do. My first thoughts were that money would be an issue and I’d have to sell everything to get by. It was unrealistic to be driving around in a Porsche any more. Everybody did their best to keep my spirits up, but the unknown was frightening.” He recalls his final day at Leicester when he said his goodbyes, collected his belongings and walked into the boot room to take that pair of his down off the peg.

“That was probably the worst moment,” he says. “Being told in a hospital environment wasn’t great but going to gather my football bits together, knowing I was going to leave, was the hardest moment.” It was after selling up in Leicester and moving back to the family home in Norwich, that he was finally confronted with the enormity of what lay in front of him.

“At first I was OK. It was nice being back among family and friends. I just thought I’d be able to sit around and do my own thing. But things started to change. People I’d started to trust in life let me down. In football and inside the changing room, everybody is pretty much in the same boat and same position in life. You all trust each other and the camaraderie in the team brings everybody closer.

“On the outside, things are different and you soon realise that you can’t trust everybody. I was involved in a couple of business ventures that didn’t work out. People that I thought had my best interests at heart didn’t. It is hard when the only thing you know is football. I would go into Norwich and walk around and see everybody else was happy and it depressed me even more. It was a vicious circle. Then the panic attacks started and it was completely debilitating. I’d end up having to call Kelly to come and get me. It was really scary and it paralysed me at times. It would happen up to three times a day, and cause pain in my arms and other places in my body.”

The news that his mother had been diagnosed with breast cancer – and had been made redundant – was another blow. “That was devastating, of course. Thankfully, she has had an operation and treatment and is making a great recovery. But… depression is a very lonely place, even with all the support around you. It’s only in your head. I can remember driving one day in the country lanes around Norfolk and not being able to go any further. I had to phone Kelly up to come and get me.” Had he considered taking his own life? No, he says. That is something he could not put his family through.

His wife lived through the depression too. “It was like looking after another child,” Kelly says. “I didn’t really have anybody to seek guidance from. It was very lonely and it certainly put pressure on our marriage. I didn’t realise depression could make you so physically ill at times.

“What Darren was going through shocked me, and at times it made me feel numb. I wanted to run away but I was the one keeping the family together. I needed help how to deal with the illness. Football ruled our lives when Darren played. He told me one day in the middle of all this that he could never see himself being happy again. He wasn’t able to go running for four years after he finished football. He couldn’t even go out in the garden and play with our son, Taylor. Even on holiday in Cornwall he wasn’t able to go in the sea with the kids.”

Her birthday meal, when the two of them went out together, is one of the moments she remembers. “Halfway through, Darren started to get really upset and panicked. I had to quickly get him out of the restaurant and pay myself. It wasn’t the birthday that I expected but the bigger picture was more serious.” Eadie knew he needed to seek help. “I saw doctors and other people as well. Everybody was really good with me, especially Leon McKenzie, the former player, who had been through a similar experience.”

But the help that came from within the game was not all it could have been, he says. “I was disappointed with the help that came from within the game. I spoke with Professional Footballers’ Association chairman, Clarke Carlisle, who was great, but overall I found the PFA disappointing. When Gary Speed died, the PFA said they would be sending out leaflets to all ex-players about life after football, but nothing ever came through my door. I found myself waiting every day for it to arrive. There needs to be a place sportspeople can go to sort their heads out. Treat the early stages of depression and it could stop the addictions like gambling, drink, drugs starting. People start these when they are feeling at a low.”

Like most people fighting depression, it was the solace of his family which helped most, although Eadie was astonished to discover so many others had been through the experience. “People have a perception about footballers being egotistical big-heads. Don’t get me wrong, there are some of them, as in any walk of life, but most of them are not like that and depression is not an exclusive club. Wealth, race, age, gender – it can affect anybody at any time. It really is so important to talk and seek help. You will be amazed at the response.”

Eadie has made it through and today finds himself in a better place. He works in local radio, enabling him to keep a close eye on his former teams Norwich and Leicester, and also for Sky Sports and other media. He has established a charity website – www.sellebrity.org.uk – auctioning celebrities’ clothes and other items they no longer need. Beneficiaries include the Prince’s Trust, of which he is an ambassador. He has also been involved in an enterprise to launch a new energy drink, EQ8, made from natural ingredients.

Where the future is concerned, it is still “one step at a time for me, so early on,” Eadie says. But he has found focus. “I want to be just as successful in something else as I was at football. I am now working with some lovely people and I’m determined to make it all a success for them as well as myself. Things like this make you better and stronger.” The last few years have been long but now he can really say that he has taken those boots down.

New fathers’ depression is not narcissism

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Children, Depression, fathers

New fathers’ depression is not narcissism

What is your response to learning that there is a treatable but often undiagnosed medical condition that could mean that a baby is significantly more likely to require medical intervention for speech and language development? What if research had found the same condition led to the child being vastly more likely to develop behavioural problems and peer relationship problems? What if it could be affecting one in 30 newborn babies, or about 25,000 children every year in the UK alone, while minimal efforts are made to intervene?

If you’re a compassionate, empathic human being you probably feel a twinge of concern, maybe think more should be done to investigate, identify and treat the problem at the earliest stage. If you’re a national newspaper columnist, you might feel differently.

Harsh? Not if the condition we are discussing is paternal depression. It was the Daily Mail’s resident GP Robert Lefever who set the tone last week, reporting on a small study by Oxford University scientists that compared the communications of depressed and non-depressed fathers with their newborns. Lefever misreported the study’s findings as being that 5% of fathers develop post-natal depression. He went on to sarcastically ask whether men would get pre-menstrual tension next, and revealed his true colours by worrying that “politicians, of the bleeding heart tendency, will say that these men should be treated sympathetically – at the expense of their employers”.

Not to be outdone, Barbara Ellen of the Observer chipped in with a piece of almost breathtaking heartlessness. “I would have been more concerned that the mothers in question were having to put up with such exhausting narcissists as partners,” she opined, “men incapable of hiding their sulky self-absorption, even while being watched by researchers for a period of, wait for it, three minutes. Even serial killer Ted Bundy managed to look ‘normal’ for longer than that.”

Let’s clear up a few misconceptions. Postpartum or postnatal depression (PND), as clinically understood, is a complex and extremely serious mental health condition affecting somewhere between 10% and 30% of new mothers. Although it has some social factors, the primary causes are widely believed to be physiological, notably hormonal fluctuations triggered by pregnancy, childbirth and lactation. Men do not get PND by that definition, and that is why the scientists working in the field rarely, if ever, use the term. Instead they talk about “depression in the postnatal period” “paternal depression” or in the case of the latest study, “background depression in men”. The assertion that these men are suffering from PND, directly equivalent to maternal PND, seems to be the invention of journalists, not scientists, and certainly not the men themselves.

Can fathers of new children be depressed? Of course they can. Some may have been living with the illness long before the birth or pregnancy, others may slip into depression as a consequence of the stress and lifestyle changes brought about by the new arrival. Nobody with the faintest awareness of mental health should be surprised by this, and nobody with understanding of depressive illness should be glibly dismissive of the possible consequences.

Both Lefever and Ellen strongly imply that paternal depression is little more than whiny men wishing to jump aboard the PND bandwagon. Their prescription would appear to be: man up and suck it up. The reality emerging from medical and psychological research is precisely the opposite. Again and again, researchers point out that the biggest problem is that many men will not admit to depression and will not seek help when needed. The results are not only huge developmental risks to children, but also unnecessary suffering to the individual and raised risks of physical illness, self-destructive behaviour, loss of employment and in severe cases suicide or even murder-suicide. Researchers like Sethna, Ramchandani and Nazareth are pressing for greater diligence and awareness of these issues among health workers, precisely because of the tendency of fathers, and men more generally, to simply “man up”, often with disastrous consequences for everyone.

With a heavy heart, I’ve come to accept that there is a significant minority of both women and men who simply do not care about men’s health and welfare beyond its impacts on the female partners who might have to “put up with such exhausting narcissists” or the poor employers who might have to fork out sick pay for seriously ill employees. Those who genuinely feel like that can wrestle it out with their own consciences. But when such people use national newspaper columns to disparage and undermine medical research that strives to address tragic impacts upon tens of thousands of children, the rest of us should surely unite in revulsion.

Sparx 3D Computer Game Beats Teen Depression

Tags

anxiety, CCBT, computer game, Depression, mental health issues, Teens, Therapy

More ccbt:

http://www.huffingtonpost.co.uk/2012/04/20/3d-computer-game-beats-depression_n_1439577.html?ref=uk

Playing a 3D computer game could be just as effective at treating young people with depression as face-to-face counselling, new research has suggested.

The study, published on British Medical Journal website bmj.com, found that many adolescents are reluctant to seek help for mental health issues.

To tackle that problem, researchers developed an interactive fantasy game called Sparx, which sees each player choose an avatar and then face challenges to restore balance in a virtual world overrun by ‘Gnats’ (Gloomy Negative Automatic Thoughts).

They found that the self-help game, which uses cognitive behavioural therapy techniques to help young users, had as much benefit as more traditional treatments, reducing symptoms of depression and anxiety by at least a third.

Of the 187 young people in New Zealand studied as part of the trial, significantly more recovered completely in the group playing the computer game. A total of 44% of those who completed at least four of the seven modules in Sparx recovered, compared to 26% of those who were receiving face-to-face treatment.

The authors of the study, who are based at the University of Auckland and the University of Otago, said Sparx was an “effective resource for help seeking adolescents with depression at primary healthcare sites”.

They added: “Use of the program resulted in a clinically significant reduction in depression, anxiety, and hopelessness and an improvement in quality of life.”

The game treatment could prove a cheaper, and more accessible, way for some teenagers with depression to get help. In the Sparx group, 95% of the adolescents said they believed the game would appeal to other teenagers.

GPs devise new treatment to beat depression. It’s called gardening

Tags

anxiety, Depression; Gardening, Exercise, stroke

http://www.independent.co.uk/life-style/health-and-families/health-news/gps-devise-new-treatment-to-beat-depression-its-called-gardening-7584583.html

Doctors are to swap pills for the potting shed under plans to prescribe gardening on the NHS as a way to help patients beat depression.

Time spent planting, pruning and propagating can be more powerful than a dose of expensive drugs, according to Sir Richard Thompson, president of the Royal College of Physicians.

He claims the Government’s health reforms will give GPs more choice in how to treat patients, and allow them the freedom to embrace the physical and mental health benefits of horticulture.

“Drug therapy can be really expensive, but gardening costs little and anyone can do it,” said Sir Richard, who is a patron of Thrive, a national charity that provides gardening therapy.

The idea is the latest in a long line of offbeat ideas aimed at improving the nation’s health, from dance lessons that can combat obesity to sending depressed people on camping trips. Under the coalition’s health reforms, clinical groups led by GPs will commission services and Sir Richard, who spoke out in favour of the changes, believes patients could benefit more from gardening classes than extra medication.

“I have, for some time, thought doctors should prescribe a course of gardening for people who come to them with depression or stroke,” Sir Richard said. “The new commissioning structures about to be introduced might allow more innovative treatment approaches to be put in place, including the opportunity to try gardening rather than prescribe expensive drugs.”

Too often, appointments are rushed and doctors are unable to spend time talking to their patients. “There are definite benefits to longer consultations – I would much rather a doctor had time to listen to patients and, instead of prescribing anti-depressants, prescribe a course of gardening.”

Half an hour spent working in the garden can burn off some 200 calories, according to a study published last year. Sir Richard added: “I always wonder why people go to the gym when there is a ‘green gym’ outdoors for us all – and, what’s more, it’s free. Gardening burns off calories; makes joints supple and is fantastic exercise. It is a physical activity that has been shown to be helpful in the treatment of anxiety, depression and dementia.”

Ian Rickman, who suffered a stroke at the age of 40 which left him paralysed down one side, has since been helped by Thrive.

He said: “At first, I burst into tears a lot. I couldn’t see a way I would ever be able to live my life again, to walk out into a garden, let alone work in a garden. Therapy through gardening is a powerful tool – it helped me come to terms with my stroke, and it helped me learn how to live again.”

The idea of gardening as a therapy is gaining high-profile backing from other quarters. The TV presenter Alan Titchmarsh has hailed horticulture for being “great as a therapy” that can “make a real difference to disabled people’s lives”. And the Health minister Paul Burstow added: “There is plenty of evidence to show the benefits of exercise on people’s health and well-being. I’m sure gardening brings those benefits.”

Just the job: How you can enjoy the health benefits of gardening this weekend:

Seedy business Sow vegetable seeds such as carrots, turnips, radishes, rocket and lettuce outside, and try some herbs in pots or trays.

First cut Take advantage of the warm weather to fire up the mower for the first time. It will help create a denser carpet for the summer.

Dead ends Finish pruning any roses, and remove dead leaves and old stalks from perennials. Cut back ivy.

Carry the can Consider buying a water butt: it may be a long dry year.

Water works Clear ponds and reinstall pumps and lights.

Heatwave Enjoy the sun!

Normal Grief vs Depression In DSM5- Medicalizing Grief

Tags

Bereavement, DSM, Grief, Major Depression

http://www.psychologytoday.com/blog/dsm5-in-distress/201003/normal-grief-vs-depression-in-dsm5

The recently posted draft of DSM5 makes a seemingly small suggestion that would profoundly impact how grief is handled by psychiatry.  It would allow the diagnosis of Major Depression even if the person is grieving immediately after the loss of a loved one. Many people now considered to be experiencing a variation of normal grief would instead get a mental disorder label. For example, take the case of a man whose spouse unexpectedly dies. For two weeks after the death, he feels sad, doesn’t want to go to work, loses his appetite, has trouble sleeping and concentrating. Currently, this is normal grief. The DSM 5 suggestion would have this be major depression.

Undoubtedly, this would be helpful for some people who would receive much needed treatment earlier than would otherwise be the case. But for many others, an inaccurate and unnecessary psychiatric diagnosis could have many harmful effects. Medicalizing normal grief stigmatizes and reduces the normalcy and dignity of the pain, short circuits the expected existential processing of the loss, reduces reliance on the many well established cultural rituals for consoling grief, and would subject many people to unnecessary and potentially harmful medication treatment.

Grief is an inescapable part of the mammalian experience and a necessary correlate of our ability to attach  so strongly to other people. Though grief is universal, there is no one right way to grieve. Different cultures prescribe a wide variety of different behavioral and emotional reactions and rituals. Psychiatry needs to tread lightly and have compelling reasons before encroaching with its own rituals  on such time honored and usually effective practices.

Within a given culture, normal individuals also vary enormously in the content, symptoms, duration, and impairment of their grief and in their ability to draw consolation and sustenance from others.  There is no bright line separating those who are experiencing loss in their own necessary and particular way from those who will stay stuck in a depression unless they receive specialized psychiatric help.

The numbers on each side of the normal/mental disorder divide are probably very lopsided-most people who grieve do not have a mental disorder. Ever since the dawn of man, humans have had frequent occasions to grieve. Almost all of us come to terms with the loss and the altered conditions of a new life without the benefits of psychiatry-and do just fine on our own. The change in DSM5 would attempt to identify the very small percentage of people who have a complicated grief that goes beyond the average expectable in severity, symptom pattern, and duration – those who would not remit as part of the natural evolution of their grief. But when you use a big shovel to capture a small needle in the haystack, what you mostly get is hay. Any change in the way DSM5 defines grief may gather a very large proportion of false positives who would do better avoiding psychiatric help.

The rationale given by DSM5 for its radical proposal is brief, cryptic, and fails to provide anything like a risk/benefit analysis of  potential effects. DSM5 states that there is no evidence that the depression triggered by the stress of losing a loved one is any different than  depression triggered by other severe stressors (such as job loss or divorce)- thus claiming that there is no justification to withhold the diagnosis of major depression after a loss. This  rationale places the burden of proof in the wrong direction.  DSM5 should make so consequential a change only after a careful and considered evaluation proves with compelling evidence that it will do more good than harm.

Such evidence is simply not available.  The research in this area is interesting but in very early development and we don’t know many essential things. We have no idea how any proposed criteria set would work in the general population.  What percentage of grieving individuals would get the diagnosis (especially once drug companies raise awareness of it)? Among the people who would be diagnosed, we don’t know what percentage truly need psychiatric help, what percentage would do better without it.

Pies and Ziskind (in a recent commentary in Psychiatric Times) have  gone far beyond the meager DSM5 rationale to present the strongest possible case for allowing the diagnosis of Major Depression in grief situations. They cite several lines of argument:

1) There is a clinical need- some individuals have severe, complicated grief that looks just like severe Major Depression and does not get better spontaneously. The longer that diagnosis and treatment are delayed, the greater their suffering, impairment, and risks (eg job loss, injured relationships, lowered treatment response, suicide).

2) The loss of a loved one is not essentially different from the many other serious stressors that abound in life.

3) It is impossible to predict the future misuse of the DSM5 system so we should make decisions based only on the best possible science.

4) The criteria for complicated grief could be tightened to reduce false positives.( They suggest two useful ways described below and I add two others).

5) Education can solve the problem of false positive diagnosis and the risk of providing medicine in milder cases when time, support, and/orpsychotherapy would be more indicated.

The  excellent proposal made by Pies/Ziskind to reduce false positives could be strengthened even further if two additional exclusions were added to the  two(#’s 1and 2 below) that they   suggested . The entire package differentiating grief  from depression would require:

1) An extended duration of one month.

2) A particularly severe presentation that  includes some combination of unreasonable guilt, worthlessness, hopelessness, self loathing, anhedonia, a focus on negative memories of the departed, alienation from others, and inability to be consoled.

3) To recognize the different cultural expressions, the diagnosis of depression would not be made if the person’s grief is within  cultural norms.

4) An exclusion could be added that would take into account the person’s own past experience of grief and its previous outcomes.  If the individual previously had severe grief symptoms, but recovered spontaneously (without going on to a major depression), this would suggest they are now grieving their own way and do not require diagnosis or treatment.

DSM5 has made many poorly thought through suggestions that can be fairly easily dismissed. Though I continue to disagree with the  Pies/Ziskind proposal, it is reasonable and deserves serious consideration. Here are the opposing points:

1) Re clinical need: In appropriate cases displaying  clinically significant impairment, distress, or risk, the diagnosis Depression Not Otherwise Specified covers their false negative problem.

2) I believe there is a difference between losing a loved one and most other life stressors. This  explains why grief is the universal target of communal healing rituals.  It would be unfortunate forpsychiatry to prematurely roam into problems usually better handled by family and other cultural institutions. Cultural biases would be very hard to surmount in making this diagnosis.

3) My disagreement with Pies and Ziskind is strongest on this point. All decisions for DSM5 should follow the injunction-“First Do No Harm.”Although it is impossible to predict precisely how any DSM5 change will eventually play out once the manual is in general use, that doesn’t reduce DSM’s responsibility for the problems that occur, even if they are unintended. All potential risks have to be thought thru and factored into a thorough risk/benefit analysis.  The argument that we should just go to where the science takes us ignores that the science is (as they point out) not definitive, is subject to different interpretations, and is not readily generalizable from research to real world settings. Once the genie is out of the bottle and DSM5 makes it easy to diagnose depression in grief situations, this could easily become an industry propelled fad diagnosis.

4) The tightened criteria would help reduce, but certainly not eliminate, the grave potential harm caused by the massive misidentification of false positives.
False positives and excessive treatment are not be a problem for skilled and cautious clinicians (like Pies and Zisook), but in the real world most of the prescriptions will be written by primary care physicians who have six minutes with each patient, don’t know the fine points of the criteria sets, and want the fastest solution.

The false positive problem is too unknown and potentially far too large to ignore. At a minimum, there would need to be field trials to determine prevalence, reliability, false positive, and false negative rates. I doubt that DSM5 has the time, money, and skill to pull this off.

5) It would be naïve and unwise to rest our hopes that any educational  program  would reduce over diagnosis and the overprescription of medication in grief situations. To the contrary, most of theeducation would go the other way. The drug companies devote enormous resources to “educating” physicians to be quick on the draw in prescribing medication.

I respect the arguments made by Pies and Ziskind  and believe they  work well when applied by experts like them. My worry is the misuse of even reasonable ideas in the real world  situations where most diagnosis and treatment is done. Loose diagnostic and treating habits could lead to the widespread medicalization of grief well beyond what Pies and Ziskind would themselves recommend. There are two ways of avoiding this. The first is to keep things as they are and not to diagnose Major Depressive Disorder in the first two months after the loss of a loved one.

The second is for DSM5 to allow for the diagnosis of complicated grief but with a  criteria threshold set high and including all four protections against false positives outlined above. As recommended by Pies and Ziskind, there should also be a  physician and public education campaign normalizing normal grief and  sharply delimiting the small group of grievers who need psychiatric
help.

Weighing the pluses and minuses, my call is to keep things as they are and not risk an “epidemic” of psychiatric grief.

When Ruby Wax opened up about depression, so did her fans. Now she’s uniting them online

http://www.guardian.co.uk/society/2011/dec/12/ruby-wax-depression-online-website

Four and a half years ago, Ruby Wax found herself hospitalised with what she calls “the tsunami of all depressions”. After many months of treatment – sandwiched between sitting in a chair, staring catatonically into space – she recovered sufficiently to write a show, Live from the Priory, with her friendJudith Owen, which they performed in both private and NHS mental healthinstitutions.

For a couple of years it was all quite low key, until Wax inadvertently became the mental illness celebrity, after allowing her face to be plastered all over the London Underground on Comic Relief posters, with a caption saying that she suffered from depression. “I hadn’t quite anticipated the level of response,” she admits. After initially feeling rather overwhelmed, she soon came to embrace it, because for every one crass comment about her “looking too well to be depressed”, there were dozens more from fellow sufferers, thanking her for coming out the closet.

“There is still a huge stigma attached to mental illness in this country,” she says. “Being depressed has become the modern-day witch trials. People can’t see it and they don’t understand it: some are worried it might be catching. For those who do come clean about their illness, the consequences can be catastrophic. While some industries are now more relaxed about it, there are still many in which your career is effectively over. You can’t run a company once you’ve declared you’ve been diagnosed as clinically depressed. So the pressure to keep it to yourself, to try and tough it out, can be overwhelming. And, almost invariably, the longer you wait to get help, the worse the problem gets.”

Once installed as the poster girl for depression, Wax and Owen sharpened up their act and took it around the country, culminating in an extended runin London’s West End. The first half of the show was pretty much what you might have expected: a funny (mental illness is a much-underused comedy resource) and informative tour of depression, with a little Obsessive Compulsive Disorder (OCD) thrown in for good measure. The second half, a question-and-answer session with the audience, was anything but.

“We wanted to give people a chance to share their experiences and ask questions,” says Wax, “but we only imagined one or two people at most speaking out before it petered out with everyone making for the exit. Rather than finding it hard to get people to talk, our real problem was getting them to shut up. People shared the most extraordinarily intimate details of their lives.

“A man from Newcastle said he had been on antidepressants for 10 years and didn’t know how to tell his wife: she was sitting right next to him. A distraught mother blamed herself for passing on the illness to her child. A woman who had been driven to the show by friends said it was the first time she had been out of her house in 20 years. The theatre became a confessional.”

After a while, the venues in which Wax and Owen were appearing opened weekly forums where the public could listen to talks by leading mental health professionals and get information and help from the mental health charity Sane, but Wax was never under any illusion she was doing more than a sticking-plaster job. “One in four people suffer from mental illness at some point of their life,” she says, “so even if we filled every theatre in the country we were never going to reach everyone.”

At which point, Wax met up with another old friend, internet entrepreneur Nina Storm, and Black Dog Tribe, a social networking site where people with depression could chat anonymously and get information about where to get help, was born.

When I was institutionalised with depression, I wasted hours of everybody’s time in therapy sessions trying to find out whether anyone had the same symptoms as everyone else and becoming extremely anxious when they didn’t. Black Dog Tribe hopes to eliminate this kind of problem, by both reassuring people that their symptoms are normal and helping them locate others who are feeling the same way.

The beta version of the site went live last month – and promptly crashed on the first day. Not from existential ennui or depression but from overuse. “It’s still very much work in progress,” says Wax. “The aim is for everyone to be able to immediately find a like-minded sufferer. So there’s a place for everyone – from those who can’t get out of bed to those who are too ashamed to take medication – and you can switch tribes depending on your mood.

“When the website goes properly live in the new year we want users to shape it to their own needs. If there isn’t a suitable existing tribe for you, then we want you to create your own: a sort of non-sexual dating service, if you like. Eventually we’d even like the different tribes to meet up in person rather than online. If a bunch of drunks can take over the church halls and coffee bars of the world for Alcoholics Anonymous meetings, then surely the combined forces of the mentally unwell can do something similar?”