|A quote from Matt Haig's book, Reasons to Stay Alive|
Mental Health Awareness Week. What does that even mean? 'Mental health' is such a broad term and covers so many things that I'm not sure how helpful it is. Mental health is so more than depression but the focus of the week seems to centre on depression, so that's what I'll cover here. (I suppose calling something 'Depression Week' isn't very appealing!) If this post helps even one person, then it's worth it.
In my experience, depression is often a symptom or outward expression of something else that is the root cause or trigger for a depressive episode rather than a disease in and of itself.
The root cause of depression can be nothing at all, just the way your brain happens to be working right now. It could also be triggered by the situation or circumstances you're in; a hormone imbalance (PMT and its more serious sister, PMDD, perimenopause, menopause, post-menopause or postnatal depression where our hormones are just out of kilter), an underlying condition such as ASD or ADHD (which may or may not be diagnosed), financial worries, experience of trauma, bereavement, miscarriage, ill health, burnout, poor diet, vitamin deficiencies, pollution, allergies, relationship breakdown, substance or alcohol abuse, being bullied, work worries, stress, overwhelm, a chemical imbalance or even phobia. And I'm quite sure there are more.
This means depression is often a complex picture and can be difficult to untangle. Our GPs, although well-meaning, are not always equipped with the right tools, knowledge or experience to fully support a depressed patient. GPs mostly offer basic CBT (cognitive-based therapy) or anti-depressants. The addition of social prescribing to the mix is a step forward, but it's only a small step forward.
Where there is an underlying cause, you need to get to the bottom of it and treat the cause otherwise, the patient may relapse. CBT and anti-depressants may not be effective. Some depression lifts without intervention, it just needs time. Other bouts of depression need a different approach.
This is why I'm not that keen on the perceived wisdom that you should 'reach out' and 'seek professional help'. It's not that straightforward. If you really are in the depths of despair, 'reaching out' is just about the last thing you're capable of doing. If you can do it, that's a fantastic achievement in itself. The onus is on others to reach out to you or to make it really, really easy for you to make that call or send that message to let someone know you're struggling.
As for getting professional help... Hmmm. Waiting lists are long. Availability of treatment beyond anti-depressants and CBT is patchy. Counselling, CBT or coaching is not going to work if you have underlying undiagnosed ADHD and/or ASD. Hormone tests for women to check for imbalances during perimenopause are only possible if you're going for IVF treatment (well that's what I was told). And if you've been through the system before, then you know that the GP will likely offer you CBT or anti-depressants. And if that doesn't work for you, then what do you do and where do you go? Sure, you can go privately, but how do you know where best to spend your money? How do you know what kind of therapy or counselling you need? And you're trying to make these decisions in the midst of despair? Oof. It's hard and needs a lot of improvement.
Even so, the GP is still the right starting point, particularly if you have a sympathetic GP. But you're probably going to have to do your own research to complement what your GP can offer. Everyone is different and you know your situation better than your GP.
If you're reading this and you are feeling low, then keep it simple. Focus on the basics first: water, light, nutrition and fresh air. After that, maybe some gentle exercise. A walk to the end of the block and back is a good enough start. When you're up to it, I recommend reading Matt Haig's Reasons to Stay Alive. He's been through all of this and written a book based on his experience that is an easy, thoughtful and uplifting read.
Do talk to your friends about how you feel too. They won't all be able to help, nor will they all understand but someone will and they do care. Keep trying. And put a reminder in your diary to call your GP the next morning at 8am, or whatever ungodly time you have to make that call to get an appointment. Start the journey. Get advice. And take it gently, step by step, hour by hour and day by day. The chances are your road into depression has been a long one so the journey to recovery may take some time.
There's no doubt that a better understanding of depression and ways of tackling it will be helpful to all of us. I hope that by raising awareness of these things as well as sharing insights and experience will lead to better services and treatments. Time will tell. In the meantime, hang in there. Your future self will thank you for it.