Sunday, 27 November 2011

Sad or Depressed?

It's so easy to overlook, to underestimate. "Cheer up, it might never happen." It's easy to say. Often easy to do, too. Sometimes, however, suggesting that a smile will cure all ills, only shows a lack of understanding. Sometimes it takes a big name, a celebrity, a high-flying politician to be affected enough by something that whatever that something is, suddenly hits the news. 

Gary Speed, a well known footballer and football manager, took his own life. The news only broke today so one can only assume, at this very early stage, that Gary was trying to cope with some unenviable hardship. He was a man who seemingly had everything to live for, a loving family, a place in the history books of both national and international football, a career and direction in life envied by many. And yet, somewhere in the deep recesses of his mind and soul, a dark, endless depression loomed. 

It's a tough one, depression. I see patients practically daily on anti-depression medications. Depression is the only illness named and described with the same word. Diabetes is an illness where a person's sugars are out of control. Hypertension is when blood pressure is too high. Asthma is when the lungs aren't working properly. 

Depression is when a person is depressed. 

The other problem is that depression is a word that is bandied about all too freely. People are depressed when they miss out on a good night out, they're depressed when their boss tells them off, they're depressed when their football team loses. But depression isn't sadness or upset. It's a state of mind caused by one of many factors and triggers, some physical, some chemical, some emotional, where a person can appear happy and content with their lives, and yet not be able to cope with all that is happening around them. 

Often, in the depths of these depressions there is only one viable option, and that's the option that Gary Speed seems to have taken. Some will claim that this is a selfish option, but to be honest, my uneducated mind tells me that for something to be selfish, there needs to be conscious and coherent thought. Depression allows for neither. The mind's inability to cope, to rationalise, to comprehend, leads the body down a path of self-destruction. 

It's also not something that we can solve in a twenty minute meeting in the back of an ambulance. Sometimes, however, just being able to spot the first signs, may be the trigger that leads a patient to treatment and save them and their families heartbreak in the long term. Most of the knowledge I have about depression isn't from books or classrooms, it's from witnessing it first hand. It's not something we're taught as paramedics to really deal with, because most of the time we're dealing with the consequences, not the disease itself. 

We can bandage wounds, or we can pronounce death. Understanding that there's a stage before this, a stage that we should be able to spot, may be the most life-saving action we can perform out on the front line. 


HCA999 said...

Depression is so not a selfish thing...and a lot of the time, neither is suicide. I think we need to take the time to listen to these people. Sometimes, just having an understanding ear is enough to stop someone from taking their own life.

Believe me, I know.

Sam said...

"But depression isn't sadness or upset. It's a state of mind caused by one of many factors and triggers, some physical, some chemical". What a load of rubbish. Were is your scientific evidence that depression is caused by a chemical trigger? Stop hypothesizing and produce some scientific evidence.

InsomniacMedic said...

Sam - Just as a starter, which is where I got some of my info from before writing this post - try here:

I don't claim for one moment to be an expert, but the evidence is there. It isn't just someone who's a little bit sad, and I don't tend to just make things up...

Anonymous said...

Well said.

@Sam, try reading the studies conducted by Dr Jeffrey Meyer from Canada. Depression is something of a catch-all name and is (mis)used to cover a range of things, many of which are likely to not involve chemical triggers. But the general consensus is that some forms of depressions, as for other conditions with more clearly defined names, chemical imbalances are involved. There is however debate as to cause and effect, but as depression is not a simple on/off condition, it's somewhat irrelevant to it starts off with an imbalance, or whether other factors trigger an imbalance which then makes it worse.

Just found this link which may start you off:

Far from "rubbish" and far from "hypothesizing".

Emma said...

"It's also not something that we can solve in a twenty minute meeting in the back of an ambulance."

This is true, but don't underestimate the impact such a thing can have. Depression is a lonely illness. Sufferers tend to hide away; and when they do communicate with someone, that someone often has no idea how to respond - and fluffs it, which is perfectly understandable.

But it's also very easy, for some people, to think "This guy's a paramedic/doctor/counsellor/nurse/whatever, he must understand what's wrong with me", or even just "I can tell from the uniform that I can trust this guy, but I'm probably never gonna see him again, so I can talk to him without worrying about it getting out". In such a situation, that might be the only sympathy, catharsis, or straightforwardly-expressed concern that person gets. No, it won't fix depression; but it can sometimes make things a lot easier, even if only for a little while. Any spark of hope or happiness is a valuable thing, where depression is involved. :)

Sam, where is your scientific evidence of the alternative explanation, that you subscribe to? Because you wouldn't just dismiss someone's debilitating illness without explaining what you believe is wrong, and how it might be fixed. Obviously. That'd just be crass.

Anonymous said...

I’m not going to reply to Sam’s comment as I think there are enough dealing with that but actually on the content on the post. Unfortunately ‘depression’ as a label is very much stigmatised. A lot of people don’t understand it and remains a taboo subject. If someone has a broken leg, people can make them their meals or drive them around – it is tangible and therefore in our society easier to deal with.

Depression is a terrible illness, it is debilitating and like you mention, the word is used too flippantly in everyday life. I would even go as far as to say the things people think is depression is actually the pre-cursor to a true depressive bout. For me anyway (and I can only use my own experience), when I am in the depths of the illness, I don’t feel. It is like I am in a void. I don’t even have the want or motivation to lift my head. My self care is abandoned and just getting up to go to the bathroom takes extreme effort. This is not felling sad or upset, those feelings are far gone, this is true depression.

The other thing I want to briefly touch upon is the myth of selfishness. This is my opinion and therefore if people disagree then fine, but it is my opinion and therefore cannot be wrong. I always try and look at peoples intentions. Take a superficial example of someone telling you that they don’t like what you are wearing. The same comment said with 2 different intentions have completely different meanings. One is your partner who wants you to look your best for your own benefit. The other is a jealous associate who knows you look good (and better than them) and doesn’t want that.

The same is true here. The intention of someone who is suicidal is not to upset their loved ones or as an act of selfishness – it is one of ‘no other way’ and a lot of people actually feel they are doing friends and family a favour by not being around! You are exactly right that when in a depressive episode, your mind does not allow you to consciously process thoughts. I just wish more people would understand (or at least acknowledge) this view point.

Your post, as always, says it as it is and I believe gives a true and fair perspective on the issues that have been brought to light today!

Anonymous said...

A beautifully written sympathetic piece. As one of the many who have suffered from depression for many years but been lucky enough to have support and treatment so am continuing with my life, I really appreciate that this debilitating illness is talked about more openly now and many more people are starting to understand how to help a little better.

HCA999 said...

@femaleptsd I couldn't agree more...I know precisely what it's like and I wish more people would understand, too. For someone to simply say, "I understand" and have a listening ear is all it takes sometimes.

Some may call it attention-seeking, but sometimes we just desperately want somebody to tell us, "it's going to be alright" or, even, "don't be silly, I'm sure that's not the case."

Sure as hell worked for me...

Tom said...


A cracking piece that I full well understand. My old Man did the very same some twenty or so months ago. That depression can either be long standing or brought on in a few hours as my Dad's was. A very well written piece that deals with the subject so very sensitively.


Steve'nLubbock said...

Depression cannot be explained to one who hasn't experienced it. I've had bouts in the past, but meds help me stay healthy... but only most of the time. There are still times when life gets so bleak there isn't a viable solution, or so you think... hopefully you make it thru a few more days without harm, and get thru the crisis. This time of year is especially hard on some folks, too.

TomVee said...

Hey IM,
I have been in the unenviable position, once, for three of four days, to feel suicidally depressed when a new SSI I was taking backfired. Spectacularly so - I was a sobbing heap of miserableness. Several times, I would actually freeze in mid-movement out of sheer hopelessness.
During that time, I was thinking quite clearly though.

In fact, I think rational thought in that position was both making suicide look like an improvement as well as stop me from doing it.

Let me explain: most of you will have been devastated, non-clinically depressed, very sad, though circumstances such as the death of a beloved person for example. And you may well remember how you felt then, the despair, the abyss, the crushing feeling on your chest, the bleakness.
No imagine feeling like that _all_the_time_ . Whilst knowing full well that there is no external reason for you to feel like that - your family's fine, the car is new, the house paid, everything is hunky dory. You know that crystally clear.
Yet that makes it only worse, doesn't it? Because your feeling like that is decoupled from outside stimulus, there is no hope that this is ever goung to go away like it usually does. In fact, 'no hope' is the name of the game.

Well, I was like that, and I even had a a little bit of myself standing in a corner of my mind, arms akimbo, demanding that I pull myself together. Yet that is the point where I understood why people can go and kill themselves.

To reiterate, I knew full well that what was going on was an illness,a chemical imbalance. Nonetheless, only the knowledge that it was the drug that was causing it and that I could wait it out was what was keeping me alive. I remember looking up the drug's elimination rate on the internet. But I also knew that, if that had not been the drug and that instead this was going to be my life now, I would have conciously and clearly decided that this was not a life woth living, and that death would be sweet in contrast to living hell.

I was even concious of the devastation a suicide would have broughtt over the people around me, my family and friends. But faced with the crushing despair, witnessing yourself turning into some kind of crying zombie (no oberstatement), there is no other way out. This is not selfishness, this is the realisation that you can't win this battle. You can't fight your own emotions - not for long. You can't summon up courage - the illness is preventing it. You can't summon up hope, because hopelessness is the no 1 feeling that is choking you.
Of course, there are therapies and medications available but those take ages to go into effect, and also I know people who had them to no effect.
So it is actually possible that you can sit there and consciously analyse the situation, finding yourself in a position where going on like this is the worst of all options. You MUST have an exit. And if the only safe way out is death, then so be it.


TAZ THE AMBO said...


The post and all but one of the comments touch the reality of what we see and hopefully help people with.

Anonymous said...

I sometimes wish I could wear a sling, or a big plaster on my head so that people would realise that depression is a real illness!

I've come across a website of blog entries about depression and anxiety disorders:

Hope it helps some people.


Anonymous said...

Could this tragic event have been induced by a prescribed medication eg anti-depressant? As one of the posters above described. There are a range of medications that can cause suicidal ideation/emotion.

I know one person who hung himself soon after a prescription for a SSRI drug. I'm fairly certain the drug itself caused this. I believe this is an over-looked adverse effect in some cases, how many I have no idea.

Emma said...

Last Anon, yes, drugs can be a cause. The fact is that whenever we're messing with certain bodily functions, we risk adverse effects: whether that's nausea or hair loss or suicidal feelings, just depends on the mechanism of the drug, and how an individual's body responds to it.

SSRIs do carry a risk of inducing this kind of thing. Similarly, I have a good friend who is sworn off hormonal contraception, after her first experience with a particular combo of hormones left her suffering a complete breakdown, and suicidal, until the effects wore off. Luckily, such cases are easy to treat: and often someone who suffers such a reaction, or their doctor or another person, will realise that this all started when they started taking the drug, will make the connection and will stop.

In fact, in some cases patients are encouraged to take a drug (thinking of SSRIs now) even though it's known that they react this way: if the reaction is temporary, and the long-term effects of the drug are sufficiently significant, the attitude might be that they have to grin and bear it for a week or so.
I'm undecided when it comes to my opinion on this approach: but it is definitely easier to cope with such things when you know that they have a cause, and will pass. In fact, that's how a lot of "recovered" depression sufferers get through rough patches.

Anonymous said...

Its the degree of risk which is not clear with many drugs which is of greatest concern.

The FDA estimate they get 10% of the probable numbers of serious adverse reactions and deaths from prescription medicines. I'm not aware of our MHRA giving a similar figure but could well be similar.

From personal experience I was prescribed contra-indicated drugs (a fluroquinolone and nsaid) by an NHS Doctor. I didnt need either since I had a sports injury. The drugs are dangerous given together. The effect was 6 months out of work and another 6 months on I'm unable to go back to my previous athletic lifestyle. I was offered other neuro/pain drugs which I discovered also have poor safety records. Prior to my experience I trusted medicine and doctors. I had limited experience of the health care system. Since I've discovered thousands who have also been harmed by drugs like fluroquinolones (even when not given with other drugs) and despite a growing advocacy movement regarding the real dangers of many prescription drugs, medical specialists are oblivious to dangers. The real risk of harm I've learnt is not known in many cases.

I work with Travellers (of various ethnicities), many of whom are precribed a high level of medications. They are forever informing me of often horrendous symptoms which begin after taking them. While I encourage them to report these effects, they rarely do.

Re suicide
Is anyone documenting how many individuals who commit suicide are taking medications which are known to induce this?

Anonymous said...

Re contraceptive drugs - I know a newly qualified doctor who died recently, cause - the synthetic chemical she took to prevent pregnancy. Luckily this has been logged with MHRA.

Golden Psych said...

It can be clinical but it can be the case where it's not. Either way it's debilitating and you can lose everything that makes you think in a rational way. It's near on impossible to explain to people who have not experienced depression what it is like. It's not just feeling sad or low there is so much more to it.
Sometimes it's just impossible to get on with your life and it has landed me in hospital. I'm now on my second admission since august and have been in coming up 3 months now. Being in hospital has helped and would hate to think how things would have ended up should no one have intercepted.