It was in the surgery, years ago when I was in my mid 20s, when my GP asked: ‘Do you ever get depressed?’ It was as much as I could do to stop short of answering: ‘Doesn’t everyone?’
That was the first time I was diagnosed with clinical depression and given medication – amitriptyline, if I remember rightly – along with Valium – it still had the trade name, wasn’t yet out of patent – to keep me calm whenever need arose, which was often.
He was a brilliant GP but he was wrong. Or at least, that time, only part-right.
That was 40-odd years back and I’ve read a sight of stuff since then about the condition of DMD – depressive mood disorder. And it ain’t a bundle of laughs. (Boom-boom!)
Some of what I’ve read has been rubbish, but that’s been a very small minority of the books and articles. By far the most of it has had sound common sense behind it, usually combined with wisdom from clinical studies. The best writers of the lot have been doctors (including Keith Stoll – no books I know of, but get hold of his audio tapes if you can) who can stand up in front of a bunch of other doctors and tell them how much that particular speaker has learned from… his patients!
Best one I’ve read lately is called ‘Angst’, by Jeffrey P. Kahn. Right at the end of a jaunty expedition into how mankind came to start worrying in the first place, peppered with jokes and references to the medicinal advantages of beer, Kahn includes extracts from DSM-IV, the fourth edition of the Diagnostic Statistical Manual that psychiatrists use to work out what’s wrong with which patient.
This bit out of DSM-IV winds up with ‘Atypical Depression-Related Psychosis’ (psychosis? moi?) ‘Manic Episode’, item A: ‘A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week’.
Elevated? Not guilty.
Irritable. Flippinbleedineck, mate!!! When was the last time I wasn’t irritable?
On the other hand, the GP was certainly right about the depression. Depression is real enough but it’s never the same for you as it is for me. I’ve read about people who can’t get out of bed for weeks on end. Even talked to them. That’s hardly ever happened with me.
With me, it’s a case of, whatever I do, it’s not enough. Whatever I do, something’s wrong with it. Any time things work out well, it’s dumb luck. Any time they don’t, it’s my fault. So whenever your experience diverges from mine – and it will – you and I nevertheless share the underlying, common, conditioning wiring in the brain that tells you, as it tells me:
Something’s not quite right.
The first thing to do about that is to get real and accept that what’s not quite right is something in your thinking (here on in, when I say ‘you’, I mean ‘me, too’). OK, that sounds like the kick-off whistle in Alcoholics Anonymous, but that’s not to say all of it’s rubbish.
Second thing to do is to talk to someone about it. Doesn’t matter who, except it’s got to be someone you trust. Any thought lurking in the back of your mind saying ‘He/she’s going to think I’m a dork’ rules that person right out.
Third point: one ace person to talk to is your GP. And if your GP is the sort of person you can’t tell that to, then, sorry, mate – change GPs. You’ve got to. Any decent GP will offer you medication for the underlying DMD. Not every DMD med works for everyone. We’re all different. Suck it and see, and go straight back to that GP if it’s not working for you.
Point Four. See if your GP can get you on to a talking therapy – typically CBT, a.k.a. cognitive behavioural therapy. CBT aims to alter the way you look at things and for the people who’ve used it and reported back, it’s way, way better than meds or even in-patient treatment.
Point Five. Avoid in-patient treatment if you can. It looks lousy on a CV – and so does a gap on your CV. But if you can’t avoid it, fine, go ahead. I’ve had in-patient treatment myself because I sure as hell needed it right then, and you might need it, too, depending on circumstances. Ultimately, no shame attached.
Point Six. If you are taking in-patient treatment, think long and hard about ECT (electro-convulsive therapy). Again, I’ve had some, and it made a certain difference for a certain length of time. But you absolutely have to know the pros and cons – and you’ll probably need someone who’s close to you, or maybe some sort of patient advocate, to help you decide. I’m not saying Reject This. I’m saying Think First.
Back to start, then. Yes, I’m psychotic (as I’ve recently discovered). Yes, I’m bipolar (ditto). Where do we go from there?
Right here and now, I don’t have answers. Watch this space.