Monday, August 1, 2011

Our Guest Blogger Writes About Depression

As mentioned a couple of weeks ago, we have a guest blogger who will be writing a couple of times a month to give us some time to paint, write, do whatever it is that we try to do when not on Twitter (if we can pull ourselves away). We introduced her, Kerry Stott, a mental health nurse and writer, and she introduced herself, in a post a couple of weeks ago:
Today Kerry’s entry deals with Depression, which means we might write about it tomorrow from a personal perspective, maybe; it’s something that one of our alters struggles with, and something we try to help her (Cassandra) with…it’s something she was/we were diagnosed with. If you haven’t read about out multiple (mis)diagnoses and are interested in finding out about them you can shuffle through our blog “pages” or read this entry: [We Discuss Three Mis-Diagnosed Mental Illnesses] … you never know what you might learn around this blog.

Depression is something we’ve been diagnosed with that of course we can’t deny that at least one of us suffers from; the social anxiety, and schizophrenia and manic-depression/bipolar are common mis-diagnoses for someone like us and are illnesses that we will refuse we have (though social anxiety plays a part in Cassandra’s paranoia). We've written about how we know, and have dealt with many people who live with schizophrenia (in our most recent job, actually), and therefore know we don’t have that…people with schizophrenia are generally not able to function in society and we can function quite well, thank you.
Kerry wrote a little something to share today about depression…we're not a fan of anti-depressants, we've been on loads (of all sorts of medications), but we do understand for some people it's the right choice...that`s the only thing we wanted to comment on about her entry.
We happen to enjoy her no-nonsense and humorous approach to mental health...(P.S. she's British, so excuse her delightful language...don't know what something means? There's Google for know, if you don't have the app...)...and we hope you enjoy her writing too.
P.S. We swear, we'll write something funny-ish again soon! (Hopefully)


Me: I’ve got clinical depression *dark clouds over my head*
My friend: *beaming grin* Oh daaaarling, you’re simply not any one unless you’ve had depression. Only the best people get it.
Me: Oh, umm errr right OK *confused*.
I said in my last post that depression is often called the common cold of mental illness. A lot of people confuse feeling depressed with clinical depression; same word different meaning. Don’t get me wrong, there are times when we all feel sad, very sad in fact, and that’s perfectly normal. There is no way that you can feel the highs unless there are lows. However, clinical depression is different. There are set symptoms that us mental health professionals look for:
  1. Depressed mood for most of the day, weather subjective (you feel like shit) or objective (other people can tell that you feel like shit).
  2. A markedly diminished interest in all or almost all activities for most of the day, nearly every day.
  3. Significant weight loss. I would also say weight gain due to comfort eating should also be included but hell who am I, just a mental health nurse!
  4. Insomnia or hypersomnia. Not getting to sleep until late then waking early is very common. Or hibernating like bear is common too.
  5. Feelings of restlessness or feelings of being slowed down – observed by others.
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness and guilt that you are not just feeling shit but that you are shit!
  8. You can’t think or concentrate on stuff, indecisive nearly every day.
  9. Thoughts about death, dying and suicide – oh cheery cheery me! (AMA, 2000)
Now for clinical depression to be diagnosed you need at least 5 of these everyday for the past 14 days. Yes, that’s right you need to be feeling THIS crap for 2 WHOLE weeks before we will diagnose you with depression. Please note that if you are displaying these symptoms and diagnose yourself from some blog I will laugh my ass off at you as you burn in that pit of despair for being so DUMB – go to see a medic and get a proper diagnosis – duh!
Patients often describe feelings of a heavy weight on their head or shoulders, or that their heart is heavy; that they are walking through treacle and can’t get going. They often have thoughts of being worthless, hopeless, useless and that they and their families would be better off if they were dead. These thoughts of suicide and be fleeting or they can ruminate and lurk in your brain for hours or days, to the extent where you have a plan to kill yourself. BUT on the outside, you look normal; perhaps friends and family might think that you are a bit more quiet than normal. Scary stuff, you look ok but want to die inside, which is why I take depression very seriously indeed.
8 thing depression makes you do – drawn from my clinical experience not a diagnostic tool but more of the common feature I see daily in my patients.
  1. Ruminate – think about things over and over and over and over again.
  2. Negative thinking – I can’t read coz I am so crap.
  3. Inactivity – it makes you want to sit on your arse and do nothing.
  4. Social withdrawal – you don’t want to talk to anyone (see points 1, 6 and 7).
  5. Procrastinating – putting off doing things because they appear hard or scary.
  6. Shame – thinking that people will judge you for having this illness.
  7. Guilt – general guilt about everything.
  8. Hopelessness – thinking things will never get any better.
So you think that you have clinical depression, what do you do now? Go and see your doctor and get a formal diagnosis. I’m not a huge fan of diagnosis but sometimes it is useful to know what you are up against. And you can get medication from them – which works. OK, ok, I hear all the hippies screaming at me about their body being a temple, blah, blah, blah; whatever. For medication to be on the market it has to go through the wringer of about a kazillion different trials. Allow me to explain. You know that new miracle face cream that claims that if you use it you will stop looking like a cow’s backside? Well if you look at the small print it will say something like 70% of our testers agreed, then you will find that they tested it on only 30 people. Medication is tested on thousands, if not tens of thousands of people before it gets to you. THAT’S how I know it works. FYI all you dumb asses out there who say I only take St Johns Wort; it works in the same way as prozac (AKA fluoxetine) but the active ingredient is not regulated so you don’t always know what dosage you get. Plus, it interferes with the contraceptive pill so you can feel really low and then end up pregnant – oh joy! Rant over.
Ok so you’ve gone to the doctors and got some meds, now what? For most people it is just a matter of waiting, the medication takes between 2-6 weeks to start to work. I tell my patients that the first thing they will notice is that other people might comment that they are more talkative but they will feel the same. Then the next stage is that they will feel less shit than they have done in the past but that they will still feel crap. With medication, mood lifts gently, until one day people realise that they felt ‘normal’. Then, usually for the majority, more ‘normal’ episodes will come, followed by ‘normal’ days. Once you feel ‘normal’ day in and day out then you should stay on the medication for 4-6 months after, so that your brain can get used to producing happy chemicals. So as you see medication is not a short term fix.
That’s meds (very) briefly covered, what else could you do? Tell people you trust that you feel crap. Wankers will tell you to pull yourself together, if you could you would, so that is really no help and if people tell you that I think that you should let down their tyres for being prats! It really makes me grind my teeth when people are so intensive/stupid. People who love you will be gentle with your feelings and be kind to you. Having a support network of kindness whilst you feel vulnerable and exposed is a REALLY good idea if you can. Having someone to turn to when you are low or a shoulder to cry on or someone to shout at the world with you suddenly makes this horrible place that you are in just a tiny bit more bearable. I am aware that when people feel so low that this is very difficult and people are afraid of stigma but by being brave, you may just find the person that will help you out of this hole.
Other than that, activities of daily living. What’s that I hear you cry? Get your arse out of bed, showered, clean your teeth you furry gobbed git, put on clean clothes, eat something healthy instead of that packet of crisps/biscuits/beer/wine. Try and get out of the house. I advise patients, and I do it myself, that if things are getting on top of you, change location and change occupation – i.e. get your arse out of there and do something different. Why? Because it distracts you, even if it’s only for a while, it stops you ruminating, and gives you different stimulation from those 4 walls you have been staring at. Taking physical care of yourself is essential to a faster more permanent recovery.
With depression comes negative automatic thoughts. What are those I hear you cry? Automatic thoughts are thoughts that just pop into your head with no train of thought behind them. Like the ones where I see an alarm button and I want to press it, no chain of thought it’s just there in my (antisocial) head. Negative automatic thoughts (NATs) are usually thoughts about feeling worthless and unloved or unlovable because you are so bad. These have no evidence and a lot of first line therapy will look at if there is evidence to support that thought or if it’s a NAT. If it is a NAT then it can be challenged, this is part of a cognitive behavioural therapy (CBT) approach, to huge to cover in this post but I will tell you later. Having these horrible thoughts of self loathing is a symptom of depression, it is not true that people don’t love you but it is an element of the illness. It is very important to think of depression as an illness because it can be recovered from. However, recovery always takes longer than you want it to and let’s face it, if you’re feeling that low time drags anyway. But have a bit of faith, you will get better.
People are often afraid that the depression will return but I tend to compare it to breaking a bone. You will feel fragile from time to time, going back and doing the same thing that caused the depression in the first place is your choice but you have now been down that road and you know where you will end up. Hopefully after a bout of clinical depression people are aware of the tell tale early warning signs that their mental health is coming under strain again and do something to halt it in its tracks. I advise people that they need to take care of their mental health, at least for a while, before they charge full on at life again. That said, there is no reason not to live life to the full as recovery is normal and expected. Although it feels like forever, please believe me I know, but it does pass and if you look after your physical and mental health properly, it may never return.
American Psychiatric Association (2000). Diagnostic Criteria DSM IV TR. American Psychiatric Association
Good Websites:
You are not alone: famous and depressed
Buzz AldrinWinston ChurchillJohn CleeseMary Shelly – writer of FrankensteinRobbie WilliamsDrew BarrymoreHalle BerryRussell BrandMel CJim CareyPrincess DianaThe QueenColin FarrellHarrison Ford

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