Coping with Depression

A Guide to What Works for Patients, Carers, and Professionals

Costas Papageorgiou, Hannah Goring, Justin Haslam

• Publisher: Oneworld Publications
• Year: 2011
• ISBN:
  9781780740126
• Topic: Psicología
• Subtopic: Psicología anormal

Depression is the most common psychological problem in the UK with 1 in 5 people requiring treatment during their lives. Coping with Depression is their essential first port of call. Depression can be an incredibly debilitating and isolating condition, with episodes recurring throughout a person's life. However, the good news is that with the right guidance it is possible to make a complete recovery. Drawing on a wealth of clinical expertise, the authors have created an easy-to-use manual that explains everything you need to know about the condition, from how to recognise the symptoms to the range of treatments currently available, including behavioural therapies, professional support, and medication. Individuals suffering from depression, as well as those around them, are encouraged to take an active role in getting better and are provided with the vital tools for staying well.

1

A journey in and out of depression: a patient’s perspective

When I became ill with depression a few years ago, I read everything I could lay my hands on as part of my many attempts to get better. In most of the books I read, authors were telling me about their patients, the problems they had and the progress they had made, and occasionally there might be a few quotes from patients themselves. But these people never seemed ‘real’ to me. Did they actually exist or were they an amalgam of several patients mixed together for the benefit of the book?

What I needed was to read an ordinary person’s account of what had happened to them, their experiences of treatment, what worked and what didn’t, and how they had got better, but in their own words not somebody else speaking for them. So, when Dr Costas Papageorgiou asked me if I would be interested in writing a chapter for this book from a patient’s perspective, I was delighted and saw it as an opportunity to provide something that would have been enormously helpful, comforting and positive to me when I was at my worst. What I haven’t written about here are the signs and symptoms of depression as this is covered comprehensively in chapters 2 and 3 of this book. I have written about my unique and individual experiences of depression, which, of course, may be different for other people. So, here it is, the story of my depression and my recovery in my own words.

Becoming ill

I was in my early 40s when I was first diagnosed with depression. It took my general practitioner (GP) some considerable time to convince me of this. I had been seeing him with all sorts of ailments for a couple of years, such as irritable bowel syndrome, stomach problems, headaches, lethargy, insomnia and so on. He had checked out everything and could find nothing physically wrong with me.

The problem was that I didn’t want to be somebody with depression. In fact, I couldn’t be somebody with depression. I had a nice life, a happy marriage and a very successful career. People with depression didn’t ‘look’ like me. They were ‘weak’ and ‘unable to cope’. Not me at all, quite the opposite in fact.

As all other explanations for the way I was feeling were ruled out, I reluctantly had to accept that my GP might be right and I started taking Prozac. It worked well for me. Within four to six weeks I was feeling massively better and after about nine months I came off the medication.

Now and again, I wondered why I had had depression. There were several stressful things going on in my life at the time, which I assumed had caused me to be depressed. But I had taken the medication, got over it, it was history and I could now get on with the rest of my life. How wrong can you be!

About three years later, I suffered another episode of depression and this one was quite a bit worse than the first. I went to see my GP who prescribed Prozac again. It took a bit longer to work this time and I stayed on it for about eighteen months but I did get better. Once again, there were a number of stressful things going on in my life to which I could attribute the onset of the depression. But I did wonder how other people managed to cope with these events in their lives without becoming clinically depressed.

By this time, I had discovered the word serotonin and concluded that I was just unlucky, as my body simply didn’t produce enough of it – so it was really a physical problem not a mental one. Of course, I felt very comfortable with this explanation because, as I mentioned earlier, I didn’t want to be seen as weak and unable to cope. But this serotonin idea enabled me to attach a logical explanation to why I had become depressed.

About three years later, I began to be ill again and this time the symptoms were even more severe. Although I didn’t know it at the time (thank goodness!) this was the start of a very long and deep depression. My GP was on sick leave and the locum was determined not to prescribe me anti-depressants but instead told me to try St John’s Wort for a few months.

My symptoms became worse and three months later my own GP, to my enormous relief, put me back on Prozac. My relief was short-lived. I waited in vain for the Prozac to kick in and for me to start to feel better. After three months, I went onto a higher dose and after a further three months a higher dose still, but with no effect. I was very poorly by this stage so my GP took me off Prozac and started me on Efexor. I waited for the Efexor to work but it didn’t. I was prescribed a higher dose and it still had no effect.

During this time (about two years), my GP also tried other approaches. He arranged for me to see two different counsellors. He sent me to see a psychiatrist who told me that my GP’s diagnosis was incorrect, that I wasn’t suffering from depression and to stop the medication. This terrified me because if this wasn’t depression then what on earth was it that was making living so horrendous? Also, although the Efexor wasn’t lifting my mood in any way, perhaps it was preventing me from sinking to even worse depths?

In addition to the help from my doctor, I went privately to two other counsellors, I tried reflexology, yoga, meditation, reiki, hypnosis and so many Indian Head Massages it’s a wonder I have any hair left! For eight months, I went three times a week on a 120-mile round trip to see an acupuncturist, I brewed and drank three pints of Chinese tea each week and I have lost count of the number of self-help books that I tried. I joined a gym, I did voluntary work, I booked holidays and my diet included every foodstuff known to prompt the production of serotonin. Some things lifted my mood slightly for a brief period, but two years from the onset of this episode of depression I was very ill and unable to function normally in practically every aspect of my life.

The fact that both the medication and everything else I had tried hadn’t worked had another effect. I began to believe that I couldn’t be helped, that I was incurable. The impact on my depression of knowing that this was as good as I was ever going to be was huge.

I had been suicidal on a number of occasions and now started to stockpile medication. Perversely, at these times I actually began to feel a bit better, perhaps because I had a plan of action and knew, if I had the courage, I could bring an end to the misery.

My GP then referred me to Dr Justin Haslam, a consultant psychiatrist working at the Priory Hospital Altrincham, Cheshire, UK. He had heard good reports about the treatment provided by Dr Haslam, in conjunction with Dr Papageorgiou, a consultant clinical psychologist, for patients with persistent depression. I went to see Dr Haslam but not with a huge amount of optimism. My previous experience with a psychiatrist hadn’t been great and after four counsellors the thought of even more ‘talking therapy’ didn’t fill me with enthusiasm either. My lack of confidence was misplaced. Thank goodness I kept that appointment!

Getting better

I knew, from my first meeting, that this was an approach that was going to help me. It felt as if I had been given a gift. Within a few weeks, I began to improve. Not dramatically or rapidly, but for me any uplift in my mood, however small, was precious. The first thing Dr Haslam did was to change my medication from Efexor to Zispin. As it happens, Zispin was no more effective than the two previous anti-depressants I had been prescribed and after seven weeks it was changed to Dosulepin, which did work. The very fact that Zispin was stopped so quickly made me feel that I was in safe hands, and that there was now a sense of urgency around getting me better. Chapter 4 in this book, which was written by Dr Haslam, provides a very clear and helpful summary of the medical/psychiatric treatment of depression.

In the meantime, I had started work with Dr Papageorgiou and had also agreed to become an inpatient at the hospital. I was hesitant when Dr Haslam first suggested this, partly because it seemed to underline just how ill I was and also because of the stigma attached to being hospitalized for a mental health problem. However, the first concern rather overcame the second and I spent three weeks as an inpatient. There were several benefits to this. Dr Haslam was able to see and monitor me almost daily and make changes to my medication. I was able to see Dr Papageorgiou three times a week and this meant I could immerse myself in the treatment and begin to make real progress.

My psychological treatment with Dr Papageorgiou is what turned my life around. This therapeutic work, which involved behavioural and cognitive therapies, is described in chapters 5, 6 and 7 in this book. This is my interpretation of what he explained to me about the cause of my type of depression. Childhood experiences create beliefs that individuals have about themselves, their world and their future, which they carry through life. Depending on what the experiences were, some of these beliefs can be negative, damaging and self-destructive. During life, events occur which continually bring to the surface these distorted beliefs that individuals have about themselves. Distorted beliefs trigger distorted thoughts, which in turn trigger negative emotional responses and you feel sad, angry, anxious etc. When you feel bad about yourself, you generate more negative thoughts, which in turn produce more negative emotions. There you are, stuck on this mental Ferris wheel and unable to get off.

At every session in the early days, Dr Papageorgiou reminded me of this link between negative thoughts leading to negative emotions. Once he had established in me an understanding and acceptance of this process we moved on to the next part, which was to give me a way of challenging these negative thoughts and replacing them with more realistic ones. This wasn’t a new concept to me. I had read about negative thinking in several of the self-help books I had acquired in the previous two years. My problem was that I couldn’t make it work on my own. But with professional help, a structured approach and close monitoring and follow-up I was able to use this tool effectively, and eventually automatically, to control the negative thinking that had become such a destructive force in my life. The process started with me having to write down a situation or event in my current life, which was leading to a negative feeling or emotion. Then, in the next column of a thought diary I had to write down the sort of negative thoughts created in me (useless, failure, for example), which were giving rise to my negative feelings.

I then had to write down all the reasons I could think of to justify this view that I had about myself or about a situation. I took these numerous sheets of paper to my next therapy session and we would start on the first one. This required me to come up with reasons why my negative thought might just not be true! I can remember looking at Dr Papageorgiou in disbelief the first time he suggested this to me and saying something along the lines of ‘Well what’s the point of that? Of course, it’s true. I’ve put all the reasons down, and anyway I wouldn’t be feeling like this if it wasn’t true would I?’ We persevered and bit by bit I began to recognize that my thinking was distorted and that there were in fact more reasons that contradicted my negative thinking than supported it.

Another important piece of homework during my early treatment sessions with Dr Papageorgiou was to keep a detailed activity diary. The activity diary helped me to become more active, less pessimistic and less depressed. It enabled me to keep a good balance between pleasurable or enjoyable activities and those where I could get a good sense of day-to-day achievement or accomplishment. As I became more competent at challenging my negative thoughts, I was able to put more balance in my life. I allocated time for work, time for enjoyment, time for relaxing; and I managed to stop doing things like watching the television, reading a book and making a list all at the same time!

I was now able to move on to the next stage of therapy. This was to identify the particular unhelpful assumptions I held about myself, which caused the distorted thinking to appear in the first place. We established the two most damaging and started work on the first one – feeling in some way defective, unlovable and worthless. I would never have identified this as an unhelpful assumption, but as soon as I began to talk and read about it I recognized myself immediately.

The following few months were spent recognizing the ways in which this unhelpful assumption shows itself, understanding what had caused it and finding and practising ways to change it. The journey was not easy. It required a huge emotional commitment, willingness to face some distressing facts and a determination to change behaviour learnt over fifty years. Once we had dealt with the first assumption, we moved quickly on to the next one and began the painful but helpful process all over again. One of the things that kept me going was the absolute conviction that this was the right thing for me. My belief in the process has never wavered. I knew that I was getting better and that life was becoming something to look forward to instead of just getting through.

What worked for me

Being given an explanation of my illness was a big help to me. Some of the things I learnt were a complete revelation and got rid of many of the naive assumptions I had made. This knowledge helped me understand what I was dealing with. Like many things in life, if you don’t understand the cause or nature of the problem it’s very difficult to change anything. Once I understood the nature of my depression I found myself able to understand the treatment that was being proposed. It sounded logical and it made sense. This in turn led to a recognition that I was in the care of experts. I now know that counselling was never going to solve my problems; neither were some self-help books. In fact, in my opinion, some self-help books were actually dangerous for me as they unearthed truly difficult memories but gave me no way of dealing with the emotions that surfaced at the same time. My depression was too deep, too resistant to medication and too complex to be resolved using some self-help methods. However, although some self-help materials were not helpful to me, I do not believe that this is necessarily the case for all individuals.

Another factor that helped was having a framework to work within. I always knew what stage I was at in the treatment programme and what was coming next. There was usually some homework to be done before my next session and I knew that if I didn’t do it (and I frequently didn’t want to) I would make less progress and my recovery would be delayed.

An important part of the therapy is that I have never felt that I was having something done to me. From the outset it was very clear that I had a part to play in my recovery and as I got better I began to feel that I owned more and more of the process. That in turn made me feel more in control of my life and of my future, and with that my confidence started to return.

Being supported and guided by skilled people has made me feel safe and protected. I have been pushed when necessary but held back when appropriate. Some of the most distressing issues I have faced have been dealt with in the latter part of the programme, whereas my natural inclination would have been to go directly to the most difficult problems. It has meant that I have been able to deal with the hardest topics from a position of stability and knowledge and by using the tools I had learnt in the earlier stages of therapy.

What I learnt about myself

I learnt to look at my life as a whole rather than seeing the depressive episodes as isolated, stand-alone incidents that could be ‘cured’. I know that my depressions have been caused by something fundamental in my life, not by specific events. I now understand the link between my childhood and the rest of my life. I knew growing up had been stressful and unhappy but I believed I had left that behind and that my adult life was solely down to me. I can now see what a massive influence it has had on the rest of my life. I recognized that to have any quality of life I needed to confront and acknowledge the emotions I felt as a child and which I had hidden for so long. I learnt that having done this I have to move on and accept responsibility for my own happiness and well-being. I learnt that I am actually a very nice, normal, loving and much loved person.

Where I am now

I have recovered from the most recent episode of depression, which was about five years ago. I am totally confident that it will be my last (chapter 9 provides a helpful guide on how to stay well after recovering from depression). I do have to watch out for the negative thought cycle returning. When it does, I go back to what I learnt with Dr Papageorgiou and challenge my thinking. I have also learnt to recognize that feeling a bit down on some days does not mean that the depression is returning. It just means I am feeling a bit low, perhaps because something stressful or unhappy is going on in my life. I feel in control of my life in a way that I have never previously experienced. I am more selfish but also more caring. Over the course of a year, I gradually stopped taking medication and have stayed well. I am happy and I really hope that, with the guidance of this book, you or someone you care about will become happy again.

2

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