Pip Mulgrue: A Warning From History.

Depression seems to be a hot topic at the moment, and look, I’m jumping on the bandwagon. This is despite me going on and on about my bloody Depression. I can say with utter certainty that nobody reading this will have the reaction ‘huh, I didn’t know she was Depressed!’

Actually, to be fair, it's that time of year again when I'm coming up to getting a year older, coupled with Christmas, which basically makes me think over and over about Claudia getting ill, and for the past three years, I’ve spent much of this particular week of the year in tears. This year has not been an exception.

In addition, I can’t help but feel we still need to have the conversation. There have been a couple of high-profile cases of late, and once again, there has been the brilliant outpouring of ‘we need to be open about depression! We need to start understanding this!’ but there has been another outpouring of ‘I just don’t get it’, and more worryingly ‘at least that will never happen to me!’

There’s also a lot of suffering at this particular time. The light, the weather, the stress of Christmas looming, the financial situation that the world is in, the stress and panic about what’s to come… These things build up and after a time they start knocking you down. In the last two weeks, of the people I know personally or on line, six of them have independently mentioned to me that they’re really going through a rough patch at the moment.

I think that there probably is a lot more of this about, so in this space today, I’m going to write my whole Depression story. I’m going to follow this with a list of hints, tips, thoughts, feeling, and in honour of Hugh Grant, some of the myths I have heard about Depression.

So you might like to get yourself a cup of tea before reading on.

I’ve been chronically, clinically Depressed since I was 21, possibly longer, but that’s when I was first diagnosed. During that time I’ve had a two year period where I was very ill, a fairly long time of being mildly ill or having depressive episodes but shaking it off without too much intervention, followed by a three year period of being very ill indeed.

It’s that second, most recent period that I’m going to focus on (the first is painful, but a hazy memory now).

I moved to London. I had fun. I met my husband, we had a child. I did not experience post-natal or any other kind of Depression at that time. I started getting ill when Tom was about a year and a half. In that time we moved house, I had two miscarriages, I moved jobs, we were burgled. There were a series of quite serious stresses going on, and so, when I finally became pregnant with Claudia, I was already Depressed. Because I was pregnant, I stupidly decided not to get treatment.

I was Depressed when Claudia was born. To say I felt absolutely nothing for her when she was handed to me for the first time is a lie, I felt disappointed with and ashamed of her. Not an auspicious start to our relationship.

What happened next was breastfeeding. It hurt, it hurt a lot. With time and research, I now know that the broken and misshaped nipples were because her mouth was very small, and I was being crushed against her hard pallet. I can also recognise that I was having a weird and thankfully rare reaction to the milk let-down hormones. (These are hormones that stimulate a ‘let down’ of milk when the baby his hungry. This happens once every minute or two when the baby is feeding). I'd experienced a similar reaction with Tom, but because my physical and mental health was so much poorer to start off with with Claudia, feeding her was nightmarish. It was painful, I'd feel nauseous and dizzy, have feelings of despair, and I’d have really strong feelings of violence that I'd have to fight against every time she was on the breast. And, on account of being a tiny newborn, she wanted to be on the breast a lot.

I demand fed in the early days, and quite quickly I learned to associate the sound of her crying with the feelings of pain and depression.

At about two weeks, I switched to expressing breastmilk and feeding it to her from a bottle. As luck would have it, I could express a feed in about 15 minutes, so though I'd still have those unpleasant feelings, at least Claudia was safely in the pram or being rocked in her bouncy chair while it was happening, and then I was able to cuddle and feed her without having to fight the urge to push her from my lap or pick her up and shake her.

It wasn't a perfect result, and there would still be occasions where she'd cry, and I wouldn't have a bottle ready, and she'd go back on the breast.

What seems to have happened then is that my body started to respond to her cries with panic. My back would tense up, my heart would race, my mouth would go dry, I'd want to vomit or run away. Being a baby, she cried a lot.

After eight weeks, I switched to formula, which resolved the let-down hormonal problem, but it didn't stop me feeling the stress of her crying, which was now pretty much ingrained into me. I remember wailing 'she cries all the time!', which I now know wasn't true. I think that she cried at the high end of the normal spectrum.

What was happening quite quickly was that I was obsessing about her crying. I was tense between times, waiting for the next cry, my world was occupied pretty exclusively of trying to find ways of occupying her and calming her without touching her because my body had learned that it didn't want to do that. I remember calling my husband and sobbing because the batteries in the mobile had run out (the sort that hangs over the cot - not a phone), and that was the one, sure fire way of me getting ten minutes break from the crying.

I dabbled half-heartedly in some Depression remedies over that six month period. Notably SSRIs which was pretty damned silly because I know I don't react well to them. I was facing that common triple whammy of symptoms; denial, fear and shame. Several people during that time suggested all was not well with me and it made me hugely angry. I'd stomp around my room like a teenager stropping; 'They don't understand! They think I'm weak! I'll show them! I'll never ever talk to them again, ever!'

I'd legitimise all the bad feelings I had about her; 'nobody would like a person who cries and pulls their hair and screams at them, so it's normal for me not to like her!' and 'I can't like everybody! We'll just have to be one of those mother/daughter combos where we don't love or like each other. As long as I continue to mechanically care for her, it doesn't matter; what difference does it make?'

Over the course of the pregnancy and early months of Claudia’s life, my relationship with Tom became spectacularly unhealthy. I suddenly became preoccupied with him just being good! I remember when I was pregnant, I took him to a friend’s wedding and I spent the occasion in a huge panic because he just wouldn’t sit still and behave. I knew one of the brides and her family well and I know for absolute certainty that nobody in that room cared that my two year old was acting like a two year old, apart from me. Several people laughed and played with him. Meanwhile, I’d be looking at him thinking ‘Oh my God!!! He’s looking at the piano!!! That will lead to touching the piano!!!’ and I’d be reacting as if this would surely mean the end of the whole world.

I spent most of my time with him exhausted and just screaming and shouting when he stepped out of line. He didn’t stop stepping out of line. This was probably because he was two. The only difference it made was that he stopped being the laid-back, affable little boy he had been, and he started reacting to my approaching him with a look of fear and panic. There were several occasions when I was changing his nappy, and he started kicking his legs (being two, that sometimes happened) and my instant reaction was to grit my teeth and raise my hand. I didn’t hit him. I can honestly say that if I had have hit him when I was that out of control, it would have left a bruise and it would have been completely and utterly unacceptable.

I screamed in his face once. I leant in over him when he was strapped in his pushchair and screamed right in the child’s face. Imagine how terrifying a sight that was to a child of two. I refuse to forget that moment, or to brush it under the carpet, or to pretend that it didn’t matter.

Now I’m not saying this because I want a response of ‘oh but you’re a brilliant mother! He’s fine! He’s perfect!’ because part of the point of this post is to recognise the fact that I was very, very ill. I was quickly out of control, and the effects of that illness were felt by a far greater audience than just me.

Plus… Tom had a mother he loved and trusted, who quite suddenly changed into a mother who was scary and erratic. That is a simple truth, and it would be foolish and irresponsible for me to deny responsibility for that. Our relationship broke slightly, and it was absolutely not his fault.

Tom and I have worked pretty damned hard at both of us staying calm and acting sensibly when he makes a mistake or does something naughty, but I still see a look in his eye of panic about how I’m going to act. It’s usually gone in a second, but it makes me sad (but not depressed) when I see it. We've spent a lot of time getting to know each other again. At some point when he’s more mature, I will sit him down, I’ll talk about that time, and I’ll give him the explanation he deserves about what happened, and I will apologise.

So that’s the person I was when Claudia was six months old. A lot of people, including me, have sort of stepped to the conclusion that my Depression was caused in a large part by the shock of Claudia getting desperately ill. What I’m trying to explain here is that I was already pretty damned sick, but I was determinedly refusing to be treated.

I don't think I can imagine a parent more eager to send their child to nursery. I pretty much threw her through the doors and waved and ran.

When I got the first phone call from nursery to tell me she needed picking up because she was ill, I resented her so much! I'd just arranged this place where her crying was no longer anything to do with me, and they wanted me to take her back! How dare they? This is what I'm paying them for!

So to be honest, when she got very, very ill, I had absolutely nothing left. I was pretty much done. Alongside the shock of seeing her fighting for her life, was the sudden recognition that it was my fault, for having wished her away so often. Alongside the panic I felt whenever she was with me, I felt another sort of panic every time we were apart.

I have tried, over time, to give names to the various ‘Depressions’ that I was by now experiencing. Pre-natal depression, post-natal depression, hormonal-related depression, post-traumatic stress disorder… It really doesn’t matter. There was probably a bit of all of them in me at that time. I was pretty committed to ignoring all of them until the last one hit.

Suddenly I had an acceptable excuse for getting treatment. At the time, I was fooling myself that I only needed treatment for that last one, but whatever. At that point, I decided to get treatment.

Hoo-fucking-ray!

Unfortunately, by that stage, I was already fucked. From that point it took eighteen months for me to feel vaguely normal. Eighteen months during which I was receiving treatment, but during which I couldn't be left alone with the children, I barely spoke to my husband, I was physically distancing myself from the world, and a lot of my new, embedded behaviours of screaming, shouting and panicking continued to happen.

When I reached ‘normality’ it was probably a further six months before I started feeling happy, and started to feel joy in situations, and to feel properly confident about being around my family in various combinations, and responding to them appropriately.

Where I am now is that I'm maxed out on sedatives, and at the last review (about six weeks ago) the doctor and I decided we are going to treat them as lifelong medication. While we both recognise that things may well change (please god, let the menopause help with some of this), we're not going schedule a drugs review again, because it makes us (well, me) preoccupied with the concept of getting better and coming off them. I'm still reacting in a problematic way to stress (so I’ve also got beta-blockers). I've had months of therapy. This is probably as 'well' as I'll ever get.

To be honest, this level of wellness is absolutely fine! I am now happy an awful lot of the time, and I've got a wide circle of people I can communicate with! I’m productive and a lot of the time I’m producing work I’m proud of! I'm doing well!

I bloody love both my children unutterably. My relationships with them are great, and I instinctively know how to behave around them! There needs to be a little more work and attention with Tom, but generally, I can make them laugh! I can sit there while they pile on top of me and enjoy it rather than feeling crushed and needing to get away! I just took Tom and a friend to a cafe to eat and I didn't raise my voice once! These are all activities that would have been completely beyond my reach just 24 months ago.

But, and this is where this becomes a bit of a cautionary time, three years of feeling like that is a frickin' long time.

Three years! Those are three years of Tom and Claudia's lives that I'm never going to get back, ever. Three years during which my relationships with a number of people were damaged or lost. Three years of pain and misery because I spectacularly fucked up and didn't get the help that I needed immediately.

So there you go. What happened happened, and it is what it is and I'm now this and that's OK! I quite like myself. But I wish that I could have those years back, and I can't.

So please, for the love of all that is good and great in the world, if you think that you are down, or just a little wobbly, don't wait until you're catastrophically ill before getting help, because well, two years recovery time and a lifetime of drugs perhaps could be avoided.

Managing Depression – hints and tips.

And as a disclaimer here; this is written from my own experience entirely. I’m not an expert in any way, other than the fact this happened to me.

1 - Keep a close eye on your mood and behaviour. I’d suggest keeping a diary and making a note of it every day, but if I did I’d be a hypocrite because I’m in no way energetic enough to do this. I have, however, kept a diary at times when I’ve thought that things haven’t felt right and I’m not sure why. I just briefly put my general mood over the course of a day, and my general behaviour, so it might read Mood: low. Behaviour: wrote angry shite on the Internet. It’s a good way of spotting patterns, and noticing when things have been going on too long.

2 - Feed yourself. This can be hard; there are times when I want to spend weeks eating nothing but chicken soup and toast. But paying attention to a balance diet, eating regularly, and generally reining in the unhealthy crap can be really beneficial.

3 - Concentrate on your sleep hygiene. If you get into a habit of playing heart-stopping computer games, or working away at something until the early hours and then fall into an unmade bed and then suddenly realise that you’re hungry, then you’re going to exhaust yourself. Especially if you’re prone to lying in bed and fretting. Go to bed with enough time to get decent amounts of sleep, have some wind-down time before you go up, try hot milk drinks if you need something to settle you, read a distracting book for maybe a half hour in bed, and at least give your body a fighting chance to get the sleep it needs.

4 - Exercise. Fifteen minutes of whatever makes you sweat and gets your heart racing every day. This to me, is probably the hardest part of the ‘staving off Depression’ routines. There have been times when I’ve forced myself to choke down some green vegetables, and go for a brisk walk around the park, and I’ve had to fight the urge to go and crawl into bed with every step. However, there have been two occasions that this have picked me up sufficiently that I’ve avoided medication.

5 - Communicate. Try to aim to have three actual encounters a day. My favourite way of doing this is to walk to the corner shop, buy a newspaper/milk/epic amounts of chocolate, and say ‘hi! Just these please!’ with a manic grin. You can experiment with commenting about the weather if you choose. Another could just be a ‘hi! How you doing?’ email. Or just offer a colleague a coffee. You don’t need to suddenly spout a soul-searching speech or to explain the nature of the universe. You just need the stimulation of that eye contact and human interaction.

6 -  Have a plan. So you’ve got your diary, you’re eating and sleeping and exercising and reaching out. What if that doesn’t work? I have, in my ‘stress diary’ occasionally written out an actual plan. Mood low, behaviour erratic. Think I’ll feel better in two weeks, when X is out of the way. IF I DON’T FEEL BETTER ON X DATE, THEN I WILL… and work out what the next step is.

7 - Get help. This is an illness. It regularly fails to go away on its own accord. It has a tendency to get harder and harder to treat. But, and this is an important but, you absolutely do not have to manage this on your own!

And yes, that does seem like an over the top regime that places far too much importance on an illness. I, along with my husband and other family, spend an awful lot of time managing my Depression, but to be honest, I think it’s necessary and worthwhile. 

Depression kills. Stress kills. I do not want to die simply because I failed to take my mental health issues seriously.

Myths about Depression.

With the same disclaimer; these are perception and experience only.

1 - ‘If I go to my doctor for depression, he’ll instantly put me on drugs/send social services round/section me!’

OK, well they might, but it’s incredibly unlikely. Even with a long history of depression and two small children in the house, drugs were not the first action my doctor and I tried, and Social Services were contacted in an FYI letter only (it was a ‘this is the situation and this is how we’re fixing it’ letter). I have, on several occasions, gone to the doctors simply because I want it registered that I’m on a ‘low’. I want to know it’s there, so that if I’m still on a low in ten days’ time, the doctors have it noted and can move onto the next stage of treatment accordingly.

It is likely that medication will be suggested as an option. You ARE allowed to refuse it, though it’s probably more sensible to say ‘can we wait for a few weeks and then see’. There are other treatments, such as talking therapies and rest and these will probably be discussed too.

2 -  ‘Antidepressants are addictive.’

Well, yeah, in the same way that insulin is addictive if you’re a diabetic. The fact that you need a medication every day is not the same as being addicted to that medication.

As a mate said to me once; ‘If my medication was addictive, I probably wouldn’t forget to take it all the time!’ (Oh, that brings me on to another tip: if you’re prone to forgetting medication, have a reminder or two dotted around, and carry a couple of extra pills in your bag.)

3 -  ‘Antidepressants are placebos.’

Ironically, often voiced by the same people who think they’re addictive. Those addictive, addictive placebos.

There are several different types of antidepressants, and two of the common groups are SSRIs (Prozac, Citalopram, Sertraline etc.) and tri-cyclic (the only one I know is the one I’m on; Dosulpin). Within each group, as you can see, are many, many variations. Some of these will work better with some people, and other people will need something else. It is possible that if the period of Depression is a long one, it might take time to find the right drug for you. You’ll probably find that your doctor wants you to come back every few weeks at first to update on how they’re going, what side effects you’re experiencing and so on. This generally isn’t because they want to be irritating, but because they can change and tweak medications until they find what’s called the ‘therapeutic dose’ for you.

4 - ‘Depressed people are weak, take loads of time off work, and make their colleagues pick up their slack.’

No. Depressed people are not ‘weak’, they are not deliberately downing tools and being lazy. It’s very similar to other long term illnesses. You can’t help getting ill, and given the right help and support, you can generally find your way back to good mental health really quickly.

I’ve had more time off work because I’ve been avoiding treatment than I’ve ever had when I’ve been receiving treatment. The untreated times lead to me being erratic, slow of concentration, likely to need to leave work every early. Kind of the way I behave when I have any other form of illness.

5 - ‘I will never be depressed. I’m just not that sort of person.’

No. Just no.

I hope and wish nobody else in the world will ever get Depressed ever, but it’s a pretty stupid and pointless wish. People will. Lots, and lots of people will, and denying it isn’t going to be doing anyone any favours.

However, with understanding, a little bit of thought and a whole lot of care, people who do get Depressed can hopefully work their way to wellness quickly and with as little permanent damage done to them as humanly possible.

Pip xxx