Depressive Illness - The Curse of The Strong
We all feel depressed at times. But because we all know how the emotion of depression feels, we tend to assume we know how someone feels who is suffering from a depressive illness, or clinical depression.
In truth though we haven’t the first idea of what a victim of this illness is going through. At its worst it can be a glimpse of hell which the rest of us will never come near to experiencing in our lifetimes.
There are many misunderstandings about clinical depression. One of the most common is that people who get it are in some way weak. This is ironic as in fact the opposite is true. Stress induced clinical depression does not happen to weak people, but is an affliction of people who are too strong. There are several different causes of depression but by far the most common is stress. Life sadly is getting more stressful and as it does so an epidemic of depressive illness is underway.
And yet it can be prevented, is not difficult to treat and can be prevented from recurring in those who are unfortunate enough to suffer an episode.
This illness nearly always happens to a certain type of person. He or she is strong, reliable, diligent, with a strong conscience and sense of responsibility, but is also sensitive, easily hurt by criticism and has a self esteem which while robust on the outside, is in fact quite vulnerable and easily dented. This is the person to whom you would turn to in times of need, and they would never let you down.
Why should this type of person be the one to get ill? The reason becomes clear when one understands what clinical depression is. It is not only a psychological condition but also a physical illness.
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Depression as a physical illness
A depressive illness happens when one part of the brain, called the limbic system, malfunctions. The limbic system is a set of nerve fibres arranged in a circuit. Essentially this circuit acts like a complex thermostat which controls a number of systems and functions in the body. Probably the most important of these is the control of mood. It usually works well with mood returning to normal reasonably quickly after most of the day to day ups and downs of life. But like any other physical system, the limbic system has a limit and if it is stressed beyond this point it will break.
When this happens, the part of the system that fails is the transmitter chemicals serotonin and noradrenaline. These are chemicals which allow the electrical impulse to pass from the end of a nerve fibre to the next. In depressive illness their levels fall rapidly, resulting in the circuit coming to a grinding halt.
Putting 18 amps through a 13 amp fuse
So what happens if you put a whole lot of stress on to someone who is weak, or cynical, or lazy? The answer is that they will immediately give up, so they will never get stressed enough to become ill. The strong person on the other hand, reacts to stress by redoubling their efforts, pushing themselves well beyond the limits for which the body is designed. When they start to get symptoms, because of their sensitivity to failure and fear of criticism, they keep going, with the inevitable result that eventually something must give way. What gives way is the limbic system.
If you put 18 amps through a 13 amp fuse, there is only on possible result. Stress related depressive illness is essentially a blown fuse.
Recognizing the symptoms
The symptoms of clinical depression are depressed mood, feeling worst in the morning and better as the day goes on, and a host of “loss-ofs”. That is the loss of:
- Energy and enthusiasm
- Confidence and self esteem
- Sex drive
So if you have been diagnosed with clinical depression what do you do now. Answer: Exactly the same as you would with any other physical illness; rest and take the prescribed treatment.
The trouble is that on the whole people who develop this condition have overcome every problem they have encountered in the past by extra effort. The concept of giving in is anathema. Yet you wouldn’t try to overcome pneumonia through exercise of resourcefulness. Neither can you with clinical depression.
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Beware of family and loving friends
They will give you the benefit of homespun wisdom: “Go on pull yourself together, get more interests, get out more, get more friends, come to a party, we’ll cheer you up”.
If you take this advice it’s likely that you will only get worse. Rest, especially during the early stages is crucial. This doesn’t mean going to be or sitting in a chair doing nothing, that would give you far too much time to ruminate. It does mean avoiding any unnecessary challenges and only, where possible, doing what is easy. If it is possible to take time off work, do so. If you can get someone to clean up, look after the kids and do other chores, do so. Cancel social events that you are not looking forward to. Watch more TV, read more, or do anything that comes easily to you.
Dispelling the myths about medication
Another difficult issue is antidepressant medications. While there is no doubt that they play an important part of treatment, they have had very mixed press and many people hold strong opinions about them. Again, misunderstandings abound.
Antidepressants are not addictive, though if you come off them too quickly you can get withdrawal symptoms; you doctor will be able to help you put together a gradual withdrawal plan. They don’t work straight away, usually taking a few weeks to kick in properly.
They don’t give you a false high, or make you a better, more creative person. Prozac is a good antidepressant but doesn’t deserve either the cult following or the condemnation it has attracted.
Above all, if an antidepressant helps you get better don’t stop taking it as soon as you feel well. It takes the limbic system several months to heal properly, even though the symptoms of clinical depression may have gone. If you do keep the drug going for long enough you are unlikely to relapse when you come off it, in the same way that, when a plaster cast is taken off a broken leg which is healed you can walk without a return of pain.
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On the path to recovery
Once recovery starts things tend to become a little more complicated. You need to start doing a little more, but how much? The truth is that nobody but you knows. At every stage your body will tell you. You can divide activity into three categories; mental, physical and social. At your body’s physical limit at any point along your recovery you will start to feel heavy and lethargic. For mental activity you won’t take anything in. At social events you may find it difficult to talk sensibly or as eloquently as you usually do.
At this stage, or before, stop! If you do you will continue to recover, if you don’t you may feel ‘rotten’ for the next 36 hours or so. The harder you push recovery, the slower it goes. So take it gently and listen to your body.
The good and the bad days
Even following these steps you will have ups and downs, but they should be minimized. At the beginning there may not be many good days. In the middle of recovery some days are nearly back to normal and others may seem as bad as ever. Nearing full recovery the bad spells become shorter, further apart, less bad and eventually peter out.
Beware extremes of emotions during this period. Your first good day isn’t the end of your problems and the rotten day that follows doesn’t mean you will never be well. Don’t overdo it on the good days and don’t despair on the bad ones, this is normal recovery, the bad days are often a message that what you did yesterday was a bit too much.
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Once you are near full recovery, it is time to ask yourself some basic questions, such as: What is life really for? Do I have to run my life this way? Can I say “no” occasionally? What do I want from life? Why do I always have to be everything for everybody? etc, etc.
These are difficult questions and there are many more. They involve you in identifying the choices you have in your life and making them. If you don’t think you have any choices, because of your commitments and responsibilities you are wrong, but you may have to give in a little on picturing yourself as the perfect mother, father, employee etc, to find them. If you do it will help you to stay well.
It isn’t always possible to achieve this on your own. This is where a psychotherapist comes in. There are a great many different forms of psychotherapy, but mainly they can be divided into exploratory or psychodynamic, cognitive and behavioral.
THE ESSENMTIAL POINT TO REMEMBER is that effective treatment isn’t a matter of drugs or change in lifestyle or psychotherapy, but is often a combination of all three.
After that it’s down to you. If you have changed the way you operate and maybe the way you think, you have a great chance of remaining not only well, but happy too!
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