Wednesday, January 19, 2011

I've never thought much about 'mental health' seems like a bit of an oxymoron to me but I've been reading quite a lot lately about depression and bi-polar disorders since the symptoms really fit a friend of mine.

Strange, I read that 1 in 7 people have depression or bi polar. I remember feeling very depressed just after I lost my job in 2008. Tears, lethargy, worthlessness and I ticked all the boxes on those online questionnaires. Clare said "Mum, you're not depressed, you're just sad and it will pass." She was right, I was sad. Probably for about a year and it did pass. So how do you tell the difference between the disease and sadness? Worse still, how do you get someone to recognise their symptoms and do something about it?

The symptoms of a major depressive episode include:

  1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (definitely evident at the moment)
  2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective report or observation made by others)
  3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), a decrease or increase in appetite nearly every day. 
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
  10. Sexual interest, appetite, and general interest rapidly drops. Stops answering the phone, stops visiting friends/relatives, stays secluded.
Criteria: Five (or more) of the symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

This is from a reputable psychiatric site, not just a 'mood' questionnaire. Apparently most 'depressed' people are taken to their doctor or therapist or both by friends and family.  I hope my friend's family have the stamina to take that step.  I'm too far away to be of use on that level and it tears me apart.

How were you persuaded to seek medical help?


River said...

My L has all of those symptoms and has had for most of his life.
"Help" doesn't help him, antidepressants only make him agitated and violent.
I tried to keep him stable, but couldn't in the end.
Underneath all that is a heart of gold and much talent.

Grannymar said...

Baino, the problem is, that most of those symptoms can be applied to several medical conditions. Menopause for one! One of the major drawbacks to cyber-diagnosis, is that patients often present convinced that they have a particular ailment. At times they can mask or hide a vital detail that leads to correct diagnosis.

I do not know your friend, nor am I saying that he does/does not had the problem you say.

i beati said...

Every bi polar I have ever worked with is nearly impossible to like for any stretch of time.. Seems when they go to that other place so mean.

Sarah Lulu said...

I've spent my entire career working in mental health ...dealt also with my own issues as well as family members.

The bottom line dear friend, is that people need to want to be better ...heal thyself ...we can't take a horse to water ..

Sometimes hmmmm trying to advise ...or influence ..someone has the opposite effect. Like trying to lecture a group of people who are on another planet ...just makes them want to run back.

It really only shows up our own need?

If you can pray, pray. If you can wish for them, wish. If you can hope ..hope and then let go.

People can and do make wonderful recoveries from all kinds of mental health issues and disease ..but they need to ask for help a part of the solution themselves and often, very often, we must wait until they are ready. Until they are ready.


Ces said...

Depression manifests itself differently between the genders too and also in age ranges. It may be easier to diagnose bipolar disorder in childhood than teenage years because parents always think that the teenage problems will go away. Males tend to demonstrate aggression. Patients with bipolar disorders may lead productive lives. Some are very smart. They tend to be artistic or writers. There is a successful female writer who has bipolar disorder and she includes it in her biography. There is is still a lot of stigma associated with mental illness. I hope that changes. Depression is the same as diabetes, we can talk about the chemical imbalance but why it happens on a particular person, we still cannot pinpoint. Mental health care in this country still is not readily available. There was a recent article published lately that stated 1 in 5 Americans is mentally ill.

It is easy to say that a patient has to agree to be treated but there are those, especially teenagers and children, who need someone to take the initiative. That gunman in Tucson, Arizona for example, needed to be taken to the hospital. He was having hallucinations. Incidentally not anyone who wants to go to a psychiatric facility for treatment will be accepted, unless one is very wealthy and will pay out of pocket. One has to
1. Be a danger to him/herself and has attempted suicide
2. One is a danger to others and is homicidal and shows intent
3. Hallucinations

They have to set these criteria, otherwise the facilities will be filled.

Good luck with your friend. An adult does have to recognize the need for help for effective treatment unless one is schizophrenic.

Bipolar disorder is more common than we think. Families just do not advertise it.

laughingwolf said...

went thru massive depression when ex took kids from west coast to east, did not see them for 7 1/2 years!

Gledwood said...

Being unable to sleep (rather than tending to sleep too long, as I do now when depressed) was what got me in the drs surgery and to a psychiatrist... when I was 19 or had just turned 20

i don't think he realized how paranoid i was even back then.

yeah i smoked cannabis, which he knew about. i also fully understood the implications of a question like "do you trust people?"

i don't remember consciously lying to anything but a lot of minimization has gone on over the years. plus scrupulously not mentioning anything that could possibly be construed as bipolar

i once did to a psychologist in training who said "you don't look manic to me" (i wasn't claiming to be manic, just feeling hyped up. on prozac). interesting that somebody i shared a house with, who had a mother and sister with manic depression told me i was acting manic and that was back in 1996

but "manic" on prozac, just to confuse the issue. technically you cannot be diagnosed bipolar for a reaction to an antidepressant, even though most people WITH it do overreact at least sometimes to some but there is a small contingent who aren't bipolar who still over-react. but i had symptoms on heroin detox (markedly, but it's a marked condition, fair enough, but i was way more extreme on the mental scale so i barely noticed any physical suffering at all (!!) and yet again because a withdrawal rather than intoxication is involved we're in the "it doesn't count" territory) and also having constant mood swings on nothing, but they really were mild. but matched something called cyclothymia where you swing from dysthymia to hyperthymia which means mild depression to mild hyper. bear in mind if the hyper is the same and the depression bad enough to count as "clinical" it's automatically type ii bipolar... all highly technical involved (actually not really at all if you're a mental health professional which makes me want to smack one considering what is happening to me now)
i did answer you at mine as well... gist being: in depression you always will look back and see your entire existence as depressed and that meds are an empty con. not that it's wallowing more a kind of hopelessness (and there may be a degree of wallowing it depends on person and circumstance, I spose, being contrary, I always tried to do the exact opposite which made me look in need of no help when I desperately needed it)...
... where is the point here? yeah your friend, if he's not open to the idea of mental illness, needs to be in a normal mood again to really see the pattern
also he's a man. i know one in particular who isn't severely depressed but i did notice that when he is down there's nothing wrong with him; the world is irritating. how you'd get through i don't know.

sorry i can't be more helpful

hokgardner said...

I just wrote about my depression on my blog. I've been struggling for months and have finally taken the step of getting help.

The hardest part was admitting to myself that I wasn't doing well. And then I had two of my closest friends, within days of each other, tell me that I needed to see someone. Their words were what tipped me over the edge to making the call.

Best wishes to your friend. It's a hard road.

Kate Hanley said...

Depression is such an unknown for me. I have felt down a lot lately - no interest in doing anything but that doesn't mean I don't do it, it just take more energy. But I do know people who swear by their anti-depressants "better living through chemistry" and still others who seem to glory in their depression but whom I think aren't really depressed but who need a diagnosis to make them feel better about themselves. Anyway, I hope your friend gets the help he/she needs whatever it may be.

Brian Miller said...

i am pretty sure i hit some depression through my recent issues...i will say that what changed was someone being empathetic, that had been there...the ones that tried to fix me without hearing me and made assumptions just pissed me off to no end...guilt sucks too...just saying

She Writes said...

I have dearly loved some people who have struggled with depression. I don't know how to get people to get help. I have no answers, but I know love that keeps reaching out and doesn't give up can go along way in anyone's life.

Jill said...

This is what I do for a living and it is a sad situation every, single time.

Sometimes folks get to the point where they just cannot "see" how depressed they are OR worse, do not CARE how depressed they are. There MUST be someone who loves them enough to INSIST they get help. If there is no one who cares for them, the end is often very tragic.

Tom said...

you struck a chord with this post. I'm sure everyone has had a brush with depression--but how to deal with it? You're a good friend Helen, and that is very helpful. Stick with it...and thanks.

Carolina said...

You are a good friend

Janice said...

Once upon a time, I took myself to therapy; I knew I needed help but that is not always the case. All I know for sure at this point is that mental issues are complicated, but it is appropriate that you are concerned. Too bad you don't live closer but you are never too far away to let your friend know that you care and offer support in ways that you are able.

I always enjoy your comments on my blog and, regarding the doggie sweaters, no...they are not really needed here in my part of CA but it does get pretty cold at night since I turn the heat off. The old dog (Winnie, age 11) shivers if she is without her sweater. Plus, it's fun to dress them up!

PattiKen said...

There is a lot of good advice in these responses.

I have been through depression (which lasted years)and treatment (which also lasted years). I also have family members who suffered from it. I agree with the comments saying that an adult needs to want to get better. If they don't, there's not much anyone can do to help.

Ian said...


Being depressive since I was a kid, the stuff sounds familiar. I now rationalize it by saying that if there are no troughs, then there can be no peaks.

It usually passes.

Robyn said...

Interesting post!
Depression is one word to describe a myriad of things.... just like the word cancer.
There are a multitude of solutions.

For some it is a lifestyle and for others an inconvenience.

I haveno answers for you except to say... good luck with it all and be prepared to let go if need be.

x Robyn

Kath Lockett said...

I'd add two words to that list:
Despair and Exhaustion.

Having had the Black Dog visit me more times than I'd like over the past five years, it is those two moods/situations/shrouds that are the constants.

I've found that finding something, however small, to look forward to helps. A phone call, a cup of coffee all the way to a pay cheque or weekend away. It's not so much wishing your life away as seeing the purpose and eventually the grey bits in between become fewer or less important or develop bright spots of their own.

That and exercise. Nothing makes you feel better about yourself than knowing you pushed your body to work hard and you didn't give up.

Hugs help too and if medication is what you need and they work: TAKE THEM.

Vicky said...

We lost a friend to depression 2 years ago January. He left a wife and three kids and no one had any idea that he suffered from depression. We think we didn't notice it as he had always been like it in the 20 plus years we had known him.

Anonymous said...

There is unfortunately still a stigma associated with depression, so I'm leaving my experience anonymously.

I've had the down feeling for over 20 years. It comes and goes. I really do feel that without the lows you don't notice the highs so much.

Where it becomes a problem is when you can't actually do anything: not just an inability to get out of bed - but can't stop crying for hours at a time. Complete feelings of desperation and lack of self worth. I could go on. This is so debilitating that it's frightening - not just for self but for the husband/wife/other who finds and has to deal with this.

The weird thing is the opposing thought processes: its like there is the normal you and the down you. Both are always there, but the down you is normally supressed. Occasionally he/she leaps up to the fore and screams and shouts and takes over. Normal you is putting the thoughts in your head: ignore that crap. And down you manages to chime in with "yes but" and pushes the normal you aside. The internal conflict is no fun, and very strange.

The only way that anybody in the end deals with this is they have to want to, and they have to go see a doctor. The modern treatments work, and are astonishingly effective.

A bit like the writers, and so on, I don't feel as creative when doped up. But when really really down there is no function at all. Its a pretty stark choice.

kj said...

hells, about depression: there is often a feeling of helplessness and hopelessness that may or may not have to do with current circumstances. i've always felt the the two week 'criteria' to diagnose depression is too brief though. myself, in my work, i look for a longer period. ususally a combination of insight oriented psychotherapy and anti-depressant medication can and will greatly improve depression within 6 months.

as for a bipolar disorder, this is when a person cycles into a really manic stage where he or she may stay up all night, be incredibly creative etc, and then falls into a deep depression. it's a popular often overused diagnosis, not often manifest until young adulthood. the good news is it and its manic and depressive cycles are very treatable with medication but the bad news is that people often stop taking their meds when the are cycling upward because they hate the side effects of the meds.

the stigma around seeking mental health treatment continues to be real and is so unfortunate. i work as a psychotherapist and i know for sure how incredibly helpful a good therapist and/or a thoughtful prescription of the right medication can be. some people have been depressed most of their lives--a low grade depression where there is not much joy--and they don't know they can and deserve to feel better. it's like looking through a window that has never been cleaned: once it is, the fog is gone and you are able to see and appreciate the colors the glazed over window kept gray...

btw, the criteria for hospitalization varies: in my experience a person does not have to be 'suicidal' to enter an inpatient treatment program. being a danger to self or others can involve a lot of factors. sometimes a higher level of care is needed because the treatment provided is not working and the person's functioning has deteriorated.

great post honey hells. i love all the comments.

love love always

everyone deserves your friendship, hells. i know i am grateful for it! i hope your friend is willing to accept the help you desire for him.

Baino said...

Thank you all for your blatent honesty and comments. I have a truly wonderful bunch of readers who aren't afraid to say what they think. Rare but rather beautiful.

Megan said...

So can we all go have a drink now?


Jay said...

Oh fuck. I'm in deep shit .. and I thought it was merely a mix of fibro and laziness! ROFL

Let's see.. 2, 3, 4, 5, 6, 8, 10. Yep, they all fit and have done for over a year.

Shall I book myself into the nearest rehab centre?

The flaw in this list is that often, one feeds into another. Lack of sleep leads to fatigue, diminished ability to think or concentrate, lack of interest in activities, weight gain (through sitting around with reduced psychomotor activity all day and the lack of interest in doing stuff). Weight gain and sitting around all day doing nothing can lead to feelings of guilt.

I guess my point is (unless I am completely depressed and haven't realised it) you shouldn't self-diagnose from a list. If you or your family seriously think you're depressed, go and see a professional.

Mmm said...

My ex was b-polar and still has some issues there. It distorts reality but sadly they think they see tings clearly and can be pretty opinionated.