Depression is surprisingly common, affecting around 3 in every 100 people at some point in their lives. It’s just not really commonly discussed, so it feels like a hidden illness. It can have a massive impact on your quality of life, and the journey through the course of the illness can be varied and, for some long. But there is hope you will come through it. There is no ‘normal’course for depression, no textbook example – as a doctor, I tell my patients that you are you, and your condition is its own. But your condition may share a common trajectory with others before you reach a state of recovery: let’s take a look.
We should start with the symptoms of depression – again, these will be individual to you, but you will share some with others suffering from depression. Usually, it is characterised by persistent low mood or lack of enjoyment for things most days for at least a few weeks. There are usually some other supplemental symptoms that go alongside such as changes to your sleep either sleeping a lot more or waking up very early. There may be difficulty concentrating, feelings of worthlessness or hopelessness, changes to appetite, and finding normal daily tasks more difficult. Work may suffer as concentration and motivation can be difficult, and relationships may suffer. Depression can come on gradually, or it can be sudden. Sometimes there are situations that make mood and mental health difficult to manage – bereavement of a loved one, a new job, financial worries or changes to a relationship. It can also be present with no clear cause, and my patients often tell me they "have no reason to be depressed". They tell me this as a justification that they shouldn’t be feeling how they are feeling - but sometimes emotions and mental health are more complex, and your feelings are valid.
If you have had symptoms of depression for more than a few weeks and it is not getting better, or is affecting your life and relationships, your doctor will want to know. Your doctor is the perfect person to give you some time to discuss your feelings and give an external view of your condition. They can suggest ways to help, and together you can come up with a plan. You may also wish to discuss if time off from work would help you to rest and put effort into strategies to recover. Some people find that the routine of work helps take their mind off depressive thoughts, and is therapeutic in itself.
By talking to someone, you have taken the first step. Your doctor can talk you through the different options. Talking therapies, such as cognitive behavioural therapy (CBT) may help, or medication. With time, you will naturally come up with your own strategies to cope and help yourself, these therapies, where medication or talking, help you get there. Your doctor is the best person to discuss and weigh up the options that could work best for you. CBT is based around the concept of helping a patient understand their thoughts and behaviours closer. The aim is that through understanding, you can learn to identify negative thoughts and behaviours, and make adjustments. Antidepressants might be appropriate. The newer version is most commonly used as they are both safe and effective, with minimal side effects, but some may be more suited to your particular needs. Most people feel worse for the first two to three weeks, before they give a more positive effect.
When engaging with treatment for depression, or indeed any mental health problem, it can be difficult to work out if you’re actually getting better. You live with yourself day in, day out, and depression can also leave you very lost in your own thoughts. It’s hard to gain perspective on yourself. Your doctor is a good person to be able to see things more clearly and help give feedback on progress. They sometimes use objective scoring systems or benchmarks to assess your progress. Some simple things to look for may be improvements to symptoms. Day to day tasks may be a little easier. You may be able to accomplish a little more with your day. Keeping a diary – either of thoughts or tasks – can help keep tabs on yourself. Expectations of treatment should be set at the outset. If you are put on anti-depressants, it can take up to 3 months to see a good effect, and you need to stay on them for at least 6 months after you start to feel better. Some people stay on anti-depressants for months, or even need a low dose for years, others need them just once, or return to them at various points in their lives. Talking therapies need time to work – you may be set homework, such as in CBT (a bit like a physio would set you a programme of home exercises to get better). If you are talking about emotive subjects, possibly that you have tried to bury previously, this may be upsetting and tiring after sessions, until you begin to work through issues and resolve them. As a doctor, I try to tell patients that my personal opinion is that we are aiming for ‘work in progress', rather than a finished article. Depression and mental health is something we should be conscious of our whole life. Don’t just wait for things to get bad, engage with a constant assessment of how you’re feeling and how the gauntlet of life is affecting you at that moment. Regular check-ins, and conversations with friends, family and our doctor about how we are feeling should be seen as normal and healthy. I regularly see patients for their ‘annual check up’. Well maybe I should be more proactive too, and be adding a mental health check-up to my own list of tasks? * Written by Dr Tom Bracewell, Caidr's Chief Medical Officer and practising GP