How to be depressed: A guide for users and their colleagues

I offered to write a blog post for mental health day (October 10^th). Those of you who know me will probably know, or have some idea, that I have had the unremitting pleasure of experiencing anxiety and depression for some time.

So, this blog post isn’t going to be about research in the department, around mental health or otherwise. Instead, it’s going to be a brutally honest (for you, not me) account of my experiences of living with anxiety and depression.

It might be hard to read so I’ll try to lighten the mood as best I can as we go. And to be clear, this is just my thoughts and experiences. Others may disagree, in varied and multiple ways, and for good reason.

Some of this post will explain what people seeking help must go through and do to access or get that help, and that, I think, can be important for colleagues and friends to understand. And it also underlines the point that having someone who can advocate for you, signpost, or help in any way can be vital. Lifesaving even. And there are resources and support available, both within the department or wider uni – and it’s actually pretty good in my experience.

Also, I want to be clear that I’m not writing this to garner sympathy for myself, nor to explain my own behaviours. I’m writing in the hope that some of this will resonate with the people in the department who may be experiencing similar problems, or who are able to or are supporting those who are.

There will be references to suicide in this post, some personal, some general, so I want people to be aware of that, but I’m not going to shy away from it, and if it’s not too painful, neither should you.

Spoiler alert: Am still here.

Also, I shall attempt to introduce some humour via the somewhat ironic medium of depression memes…

THis is quote a long post, so buckle up...or just use these links to skip to a section that sounds more interesting...

• What does depression look like?
• What does depression feel like?
• What's it really like to seek help?
• What's help like once you get it?
• Skip to the end...

What does depression look like?

In a lot of cases, to most of the world, like nothing’s wrong.

One does not always do well in society by being honest. People find it awkward, alarming and don’t really know how to respond.

Hey, how’re you doing? Good weekend?”

"Well, I spent a good portion of it laying on the sofa staring into space feeling a sense of boredom so incredibly powerful it was almost interesting, lacking the energy or will to do anything.

Then, to mix things up, I enjoyed a good few hours of feeling sad for no reason, seasoned with a sprinkling of self-loathing for not having a good reason to feel sad. Later, I ate a whole chorizo and a wheel of cheese.”

"Oh…err…”

“Sorry, I may have misinterpreted the social cues here. Yeah, not too bad, you?”

But things are getting better. People are opening up. And I don’t mean the people with depression or other mental ill health conditions – most of us will talk your ear off about it if you wanted to listen. No, I mean the people not experiencing or who haven’t experienced an issue are getting better about it. The taboo is unwinding.

If you want to get an idea of what to look for in a colleague who may be needing support, the MIND website is always good: https://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/symptoms/

What does depression feel like?

Everyone I’ve spoken to about this have things in common. But, and this is important to understand, despite these commonalities, everyone experiences these symptoms differently.

It’s worth noting that some clinicians you might meet get this, others do not seem to. The ones who do are the keepers, the others, you need to find a way to move on from.

Some people do feel a profound sense of sadness, the sort of thing most people think of when they think of the stereotypically depressed person. I rarely do. In fact, I’ve been vaguely jealous of that symptom. At least they got to feel something.

Instead, for me, it manifested insidiously as an inability to feel pretty much anything. To not feel the bad stuff, but also to not feel the good stuff. To not be able to care about anything.

I definitely used to care about people and stuff. But it sort of slowly disappeared over time, unnoticed, like a neglected house plant in some rarely used room. Only when you think to go in there do you suddenly notice most of the leaves have fallen off.

And while not feeling or caring about anything that may initially sound like it could be freeing, it turns out there is quite a big difference between not caring about something (“I’m going to dress like a Jedi and everyone else can like it or lump it…”), and not being able to care about anything.

I first noticed this important difference when someone I loved died. Want to know what my reaction to being told they’d died was?

Boredom.

I think we can all agree that boredom is not the right reaction here. That boredom is not how a normal, healthy person responds when someone you love, and has been a large part of your life, has just died.

At the funeral, surround by people all clearly feeling strong, if horrible, emotions, I still felt nothing. Bored. Rationally, I was aware this wasn’t right, and rationally, I did care about that…

Depression can just suck the meaning out of everything. From family. From work. From hobbies. Anything you’ve ever enjoyed. Instead, it creates a void. A void that is typically only filled with sadness, boredom, or nothingness. Or a mix.

So, while this triggered my first foray into the wonderful world of mental health services (aged late 20s/early 30s), it also unlocked a new feeling: self-loathing.

Yay. A Feeling. That must be progress, right?

In short, depression for a lot of people, and me specifically, feels like not wanting to do anything. Not wanting to be anything. Not wanting to be at all. I didn’t necessarily want to die. I just wanted to have never existed, a subtle but important distinction. If there were a button I could have pressed to do that, I would have.

In honesty, I’d still have to think very hard about not pressing it now. But I think, for me, there’s a big gap between that feeling and feeling like killing yourself.

What’s seeking help really like (in my experience)?

So, you’ve managed to summon enough introspection to think: “Huh, maybe this isn’t how it’s meant to be. Maybe I should get some help.” And then, after an appropriately long period, you’ve managed to summon the willpower to seek it out.

Congratulations! Now you are faced with a new joy: trying to navigate a complex mental health services landscape whilst you are absolutely and completely at your least able to do so.

And this is something that frustrates me SO much!

The situation is absurd. It’s like many of these services are built to dissuade you from using them. Like they are some secret hidden resource you must prove yourself worthy of before you can access them.

I want to say here, that this is why having a department or workplace that truly cares about wellbeing is so important. We have here in Primary Care not only the Mental Health First Aiders, but also a generally compassionate and understand team who can help point you in the right direction for help, including the services offered by the University. Services that I can personally recommend as a great starting point whether this is your first contact with such a thing, or you are, for want of a better word, an expert…

It has, fortunately, got better, generally. But, in my experience, it’s still far from good.

When in the midst of depression or other ‘mental ill health’ episode, you are at your least able to think clearly (add in a psychotic episode to this and it’s about 5 times worse). You are the least able to put the extra effort into trying to sort through the contradictory advice, to push, and to advocate for yourself.

Nor will your bits be especially tickled to learn that the local ‘Improving Access to Psychological Therapies’ (IAPT) service has a wait list of three months, and you can only see your GP (well, a GP, or prescribing nurse) in about the same time frame*, unless you are actively on the edge of doing something irreversible to yourself.

Sometimes, even that isn’t enough to get help, even now.

(*No shade at our clinician colleagues here – I fully get this isn’t your fault and know the compassion with which you entered into and are carry out your clinical roles, and how the situation is far from how you would choose it to be.)

So, I’d like to be clear that to any of you who have been able to reach out for help: I have huge respect for you. Not just because of the personal challenges involved in doing that, but also because getting help isn’t a one and done thing. It’s an ultra-marathon in and of itself. And I don’t think people get that unless they’ve been through it.

What’s help like once you get it (in my experience)?

Variable.

My first contact was with a very good prescribing nurse, who prescribed me citalopram and referred me to the local IAPT service (back in rural Norfolk). The nurse was compassionate and amazing. The IAPT service took a long time to access but was actually pretty good. I went through an initial 8-week course of CBT with a therapist that was enlightening and genuinely gave me some useful tools.

My experiences with the drug were, in hindsight, not great. The way I look at most of the drugs I’ve tried over the years is that they can help to dampen or mask the symptoms you might be feeling. That can be a really useful and important part of recovery, lifting some of the worst things and allowing you heal.

But, importantly for me, it did nothing about the thoughts. In my case, that meant I now had the energy to get up off the sofa/bed and give some serious consideration to how I might best kill myself.

I told you this would be honest.

I drove around for six weeks with my ‘suicide kit’ in the car. The feeling was oddly liberating. And, to be clear, this was not an impulsive thing. This was a reasoned choice. Faulty and difficult for others to understand reasoning, maybe. But certainly not impulsive.

To outside eyes, it looked like the drugs were doing wonders. I was interacting more with people, going out more, doing more ‘stuff’. Generally, being more ‘normal’.

Inside, from a mental landscape perspective, nothing had really changed. But I’d decided I should at least give the CBT a go, so duly waited.

I say both these things because:

• if you’ve just gone onto (a new) medication and feel the same way, please wait. Please still try to find the energy to hold on and talk to others; and,
• to say to those of you supporting people like me, appearances can be deceptive. Do not think that a drug has just resolved everything, especially if people suddenly, or quickly, start to seem ‘their old selves’.

Finding the right or effective treatments is arduous. It can be a marathon. It’s horrible, and filled with failures:

• Medications that don’t work, or have intolerable side effects;
• Long periods of having to cope between drugs, as they taper off one set and the other set ‘beds in’.
• General failures of health and care systems (e.g. not getting back in touch with you when they said they would, not having a record of your appointment, not doing something they said they would).
• Trying/talking with different therapists (some will suck, others just won’t resonate with you on a personal level, others are amazing but are about to migrate to Canada but their colleague is good (they’re not)…).
• Re-telling people the same story of your life, over and over and over. Having to relive any trauma again and again. It’s tiring.
• Relapsing, then going through it all again.

To conclude…

There is so much more I want to say on this topic, from the struggle to understand how to interact with people in ‘normal’ situations, to my profound distaste for the term ‘low mood’ (ask me, I will rant), and the constant annoyance of filling out unhelpful and non-nuanced PHQ-9 forms. I’ve barely scratched the surface….

For me, the journey continues. I’ve been on and off various drugs now for almost 20 years. Most recently, in the last few months, I’ve tapered off fluoxetine.

I’m now having to relearn, again, how to deal with feelings previously masked by the drug, good and bad. And both are difficult to deal with.

Personally, I find a bit of dark humour about these things helps me, but I’m conscious other people find it alarming

How am I, right now? I’m ok. Not great. But not terrible. Tentatively positive, even.

Anyway…

What I want to tell you and what I want you to know is that despite how you might feel right now or in the future, I’d rather you stick around. And I’m willing to bet your colleagues, friends, and family want you too as well.

Even if you can’t see your value, I guarantee others do.

If you’re having problems with mental health no matter what they are, from anxiety and depression, to mania and psychosis, big or small – and depression will tell you you’re a burden or your specific problems are not worth talking about – reach out.

Speak with one of the department’s Mental Health First Aiders – they are all friendly and compassionate people who have the time for you now, if you need it.

Use the University’s counselling service (I found them to be pretty good). Check out the wellbeing information on the department and uni websites.

Or, if you want, and I am but one person, reach out to me too. Even if I don’t know you, I will want to help you, even if that’s just an ear to bend.