If the bogeyman should try to play tricks on your sacred mind

July 24, 2008

I was going to start this post with my own experience of depression (and hence antidepressants), but instead I think I’ll come over all self-righteous and start with the statistics. Which are well-known, but truly frightening when we think about how much this disease is still stigmatised and misunderstood. Read and cry, people, read and cry.

Depression is an extraordinarily horrible thing. I have never forgotten listening to Margaret Tebbit* on Desert Island Discs, saying that if she had to choose between her past depression and her present quadriplegia, she would choose the latter without a second’s hesitation. Not everyone has it this badly, but I think a lot of people would recognise this.

I have had depression twice. Both times I have been treated with SSRIs and they have worked for me. I took them for six months each time, and at the end of this time I was able to stop without any trouble. And in that time, I was able to get out of the vicious circle of pain and make the changes I needed. Some were external changes (get a new job, stop taking the pill), and some were internal changes (get some rest, stop crying at work all the time and get some stuff done, forge some relationships). If I were to get depressed again – and I was this close, less than two years ago – I would go straight back to the doctor and say, medication nao plz.

SJ and I were talking about this yesterday. (SJ, please shout me down in comments if I have misinterpreted, and I will edit accordingly.) She is struggling to understand how antidepressants can work for endogenous depression. She gets it for reactive depression, because she can see that it gets you out of a temporary bad place. But she currently sees antidepressants for endogenous depression as being like insulin – one is okay as long as one takes them, but then the problem comes back exactly as it was before.

I’m fairly certain that there are other ways to look at this, because I know that mostly people don’t take antidepressants for life even if they have endogenous depression. But I am struggling to find a good way to explain it. I started thinking about water – when I spill a little water on the counter washing up, it soon evaporates. But when I spill a lot (yes, this does often happen, why do you ask?) then it stays there and I have to clean it. I wondered whether depression was like this – if it’s possible to switch back from ‘a lot’ to ‘a little’ through medication, the rest will evaporate? But I can’t support that scientifically. It’s just what I’ve seemed to notice.

I am still thinking about it. I have a problem that’s not completely dissimilar – an unexplained pain in my side that’s so painful it keeps me awake at night. And I was talking to another friend yesterday about taking painkillers for it. And she said ‘I just don’t see why it has to hurt when it doesn’t have to’.

This seems like a good mantra to me. A lot of things hurt. Some have to. But probably more don’t. I’m not an advocate of medicating reality, but I don’t think this is quite the same thing.

I am not here to tell SJ what to do. In SSP we believe that one size does not fit all, and I will support her whatever she chooses.

But I will be working with that idea for myself. Quite a lot is hurting in my life at the moment, and maybe, just maybe, it doesn’t have to.

* Margaret Tebbit is the wife of British ex-Tory cabinet minister Norman Tebbit, and was paralysed from the neck down in 1984 in a terrorist attack on a hotel where the party conference was being held.


6 Responses to “If the bogeyman should try to play tricks on your sacred mind”

  1. coughingbear Says:

    On ‘I just don’t see why it has to hurt when it doesn’t have to’ as far as physical pain goes – yes, oh yes. I know someone who is a pain relief nurse, and she says that once pain has alerted you to a problem, research shows that it’s mainly counter-productive; it makes you tired, and in fact the longer you are in pain the more sensitive you may get to it, so it’s harder to control. She has lots of problems convincing doctors to prescribe enough pain relief, and thinks this is partly because there is a vague feeling that it is virtuous to suffer. (I still get angry when I think about the GP telling my mother to take paracetamol – to which her notes informed him she was allergic anyway – as pain relief for what the surgeon eventually described as one of the worst knees he had ever seen.) So my vote would be for taking more painkillers and talking to the GP about the correct dose.

    I don’t know how much that translates to mental pain. In principle, I agree that one could approach anti-depressants in the same way, but I understand SJ’s misgivings because I would be very very reluctant to take them myself (& was last year, at a point when I probably could have used the help). Part of this is my lack of trust in drug companies and the research on these things. Of course they make the painkillers too, but I think there is a longer history of using and better knowledge about them.

  2. Sarah Jane Says:

    I’ve been talking about this to another friend, and I think I can see what you’re getting at. What I’ve said to her is:

    I think it might be worth a try. I think that there’s a lot I need to do too. And of course that’s what I’ve been trying to do, time and time again over the last eighteen months, and every time I slide back into the depression. Maybe that’s what F means when she talks about antidepressants helping one to get out of a vicious circle?

    Am I on the right track?

  3. John Says:

    “Margaret Tebbit* on Desert Island Discs, saying that if she had to choose between her past depression and her present quadriplegia, she would choose the latter without a second’s hesitation”

    Both seem relatively trivial compared to being married to Norman Tebbit

  4. coughingbear Says:

    It pains me to admit it, but both F and I have met Norman Tebbit (on separate occasions) and found him very pleasant. Of course I loathe and abominate his political opinions, and imagine that any serious conversation would rapidly degenerate into a row, but assuming that Margaret Tebbit doesn’t in fact disagree with him, he’s probably charming to her too. Not to mention the looking-after-in-sickness part.

  5. Francesca Says:

    Answer to coughingbear: Yes. And, with physical pain, the pain itself can actually stop your body healing. For example, with muscular pain, the bits that need to go back to normal can be so busy trying to protect your body from immediate pain that they refuse to go back to their normal place and hence cause more pain. It’s a bit like the credit crunch.

    I wonder if this is also true with depression and similar – that the pain itself makes it harder for us to embrace the possibility that there might be another way? Certainly I know that we often get attached to our pain – even though it hurts, we are unwilling to explore new possibilities because it means leaving familiar territory, or admitting that our beliefs and ways might have been wrong until now.

  6. Francesca Says:

    Answer to SJ: Yes, that’s part of it, I think. Depression leaches away the energy to change things that need changing (both internal and external) and also attacks motivation, through our beliefs about ourselves (see posts passim) and the feelings of hopelessness and despair – that nothing can be changed and nothing is worth changing.

    I also think there might be a chemical systemic effect – that if we move into a new place, then being in that place is intrinsically different and therefore we operate in a different way. God, that reads awkwardly. I have emailed my father to see if I can clarify, and will ask CB if she knows more.

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