Dear GPs

When someone with a history of depression comes to see you, please take the time to actually ask them how they are.  It is not easy to say you are feeling very low, it's not easy to relax your public mask and admit you are struggling.  How much more difficult do you think you make it by a brisk "What can I do for you?"  Clearly you are busy, clearly it is much more convenient for you to just write another prescription and move on to the next patient.  What does it matter that the person you've just hurried out of the door now feels even more worthless than she did when she walked in?  Do you care that she had to hide in the ladies until she had stopped crying enough to go home?  Do you care that she now thinks she is not important enough to be taken seriously?

It is difficult in these days of large surgeries for GPs to get to know their patients as they did when medical practices tended to be smaller.  Surely then it is even more important to ask questions and try and draw out from the patient the true extent of their illness than it was when the patient's demeanour could let you know they were not themselves?  Appearing "fine" is an art perfected by most people suffering mental illness; appearances alone will not tell even the most experienced of GPs how someone is coping underneath the surface.

Of course it would be easy to lay blame with the patient; why did she not just say how bad things are?  After all, the GP is not psychic and cannot be expected to know what is going on in someone's head.  What is the point of going to see a doctor and not telling them how you are?  This point of view totally discounts the difficulty many, if not most, of us feel when admitting we are not coping.  Simply making an appointment to see a doctor about a mental illness is a massive hurdle.  As the appointment gets closer it looms larger and larger in the mind and apprehension means that, by the time the appointment arrives, the patient can be paralysed by their internal turmoil; and yet appear outwardly "normal".

All it would have taken was the right question: "How are you coping?".  Giving an opening is all that is needed.  Let the patient know that they are in a safe place and you want to know how they are really feeling.  Less convenient perhaps, but surely convenience should not be the main focus of a GP's appointment?  Appointment time is limited and GPs often run late so the pressure is always on to keep consultation time to a minimum.  Having someone cry and talk about themselves is messy and time-consuming but if it makes the difference between the patient feeling cared for and valued instead of unimportant, useless and inconvenient is that not worth it?

Looking "fine" does not equate to feeling fine and taking the time to know the difference could not just make a difference to a patient's state of mind; it could, potentially save a life.  Depression may be the most common mental illness but that should not be taken to mean that it is an everyday malady and is not that serious.  Depression can be a severely debilitating and even life-threatening condition and, as such, should always be taken seriously.

So please, GPs, when you have someone sitting in front of you, take the time to ask them how they are.  If you don't ask they may not feel able to tell you and may just leave you feeling worse rather than better.

Bad Days

How do you cope with bad days when you have depression?  Everyone has bad days now and then but when you have depression a bad day can be anything from a general low mood; to hiding away from the world and hoping it goes away; to self-harming or self-endangering behaviour.  Bad days can also last far more than a day.  I don't normally blog when I'm in the midst of a bad episode but I thought this time I would try and convey what it actually feels like.

I have been suffering with a cold for a few days and this has depleted my already low resources, which isn't helping my mood at all.  Sleep has also been difficult for a few nights in a row now and lack of sleep always makes my symptoms worse.  So far this episode has not been too severe but my mood is low, I feel on the edge of tears most of the time, I'm tired, I have little motivation and I'm struggling to cope with my day to day responsibilities.  I feel worthless, useless and hopeless.  Parenting is very difficult when you are feeling this low and it gets difficult to hide how I'm feeling from the children.  The voice in my head tells me I'm a terrible parent and the children would be far better off without me.

How do I cope with bad days?  The simple answer is I don't, I just try to survive them until things improve.  Sometimes that means staying at home, seeing no one and doing little but if that's what it takes, that's what I'll do.  I'm tired, I just want everything to stop, for a while at least, to let me just be.  Life is relentless, wearing and difficult and there is no magic wand to make it better.  Bad days come out of nowhere, with no warning and take no prisoners.  I can't think straight or focus on a task for any length of time.  I can't cope with dealing with strangers or people in authority so leaving the house or even dealing with household business by telephone has to be put on hold until I feel more able to cope.

The rambling nature of this post is an indication of my inability to plan and execute tasks as well as usual.  Thinking is difficult and trying not to just whine and sound self-pitying is virtually impossible.  I have had a lot of bad days over the past few months and somehow I need to convey that to the GP at my appointment tomorrow.  Talking about how I'm feeling is very hard and, as I wrote recently, I'm very bad at telling the doctor how bad things really are.  Maybe tomorrow I'll manage.

Sadness

It's impossible to think of depression and not associate it with feelings of sadness.  In fact, many people use the terms almost interchangeably, saying they're feeling "depressed" when they are experiencing feelings of sadness or low mood.  Feeling sad or down from time to time is perfectly normal and it would be totally unrealistic to expect to feel happy or content at all times in your life.  Depression as an illness however is something far removed from feeling sad or low, although those feelings are certainly part of it. 

When I am in a depressive episode I can wake up in the morning feeling very low, without any apparent cause for my mood.  The darkest days cannot simply be described by the word sadness, that would be like describing Mount Everest as a molehill.  Depressive feelings encompass sadness but also despair; hopelessness, that is a real lack of hope of anything being alright, ever; isolation; confusion; reckless disregard for personal safety; dislocation from the world in general; and, my case at least, anxiety.

Despite my depression, I do not confuse sadness with being depressed; I am only too aware of the difference.  It is quite possible for someone in remission from their depression to feel sad without fearing they are depressed but equally, when I have depressive feelings, it can be hurtful to have them dismissed as "everyone has bad days, it doesn't mean you're depressed", no matter how well intentioned it may be.  I have suffered with depression on and off for nine years, I think by now I can tell the difference!

One of the saddest things about having depression is the fear that I will never know what my 'normal' is again.  Before I was ill I never had to think about what 'normal' for me was; I just was.  Since losing myself to depression I don't really know who I am any more.  I have made decisions whilst thinking I was 'fine' that, looking back, I can see were so far removed from how I would have behaved had I been truly well that I can't really bear to admit to having made them at all.  I over-analyse everything now, trying to find my true feelings and my true self, and typically of depressives everywhere, I find myself to be something I don't want to find.