Depression isn't "just feeling a bit rubbish." Depression isn't "suicidal thoughts and extreme emotional pain."
Depression will be different for everyone, but it's also different as individuals progress through it.
Because depression is something you progress through. It won't always be the way it starts out, and I feel that's an important thing to discuss as mental health is increasingly centred in Western society, and conversations become more open, and more commonplace.
I have depression. For me, if we were to use a mental health version of the pain scale, which might look something like:
1. Everything's great! I'm really positive and motivated, with plenty of energy! I'm actively enjoying existing hobbies, and exploring new ones. I'm focused on how good things are going to be in the future, and I have pleasant memories of the past.
2. I'm feeling positive and motivated, and enjoying my current hobbies. I have things I'm looking forward to, and plenty of happy memories.
3. I'm feeling happy, and have things I enjoy. Some things in the future worry me, and I have some memories I'd rather forget, but, equally, I have things I'm looking forward to, and some good memories.
4. I feel mostly okay, but often get caught up in worrying about the future, or feeling upset about the past.
5. I'm not feeling great, and I worry a lot about the future, and feel significant regret when I think about the past. I'm not really drawn to my hobbies anymore, and there doesn't seem to be any point in exploring new pursuits.
6. I don't have any motivation or energy, and regulating my emotions is very challenging. I feel overwhelmed by bad memories of the past, and I can't think of anything to look forward to in the future.
7. I'm beginning to feel that things would be better if I wasn't here, that people don't actually like me or want me around.
Depression will be different for everyone, but it's also different as individuals progress through it.
Because depression is something you progress through. It won't always be the way it starts out, and I feel that's an important thing to discuss as mental health is increasingly centred in Western society, and conversations become more open, and more commonplace.
I have depression. For me, if we were to use a mental health version of the pain scale, which might look something like:
1. Everything's great! I'm really positive and motivated, with plenty of energy! I'm actively enjoying existing hobbies, and exploring new ones. I'm focused on how good things are going to be in the future, and I have pleasant memories of the past.
2. I'm feeling positive and motivated, and enjoying my current hobbies. I have things I'm looking forward to, and plenty of happy memories.
3. I'm feeling happy, and have things I enjoy. Some things in the future worry me, and I have some memories I'd rather forget, but, equally, I have things I'm looking forward to, and some good memories.
4. I feel mostly okay, but often get caught up in worrying about the future, or feeling upset about the past.
5. I'm not feeling great, and I worry a lot about the future, and feel significant regret when I think about the past. I'm not really drawn to my hobbies anymore, and there doesn't seem to be any point in exploring new pursuits.
6. I don't have any motivation or energy, and regulating my emotions is very challenging. I feel overwhelmed by bad memories of the past, and I can't think of anything to look forward to in the future.
7. I'm beginning to feel that things would be better if I wasn't here, that people don't actually like me or want me around.
8. I don't want to do anything, I feel overwhelmed by both the past and the future, and I don't feel I can trust people. I'm starting to feel physically run down, and am struggling with frightening and uncontrollable emotions.
9. I'm actively considering self-harm and/or suicide. This doesn't cause any emotional spikes - my emotions are painful, but 'flat'. Ending my life just feels like a logical decision. I can't even hold coherent thoughts about interests and hobbies, and am overwhelmed by painful memories and extremely anxiety-inducing thoughts of the future.
10. I am at immediate risk of self-harm and/or suicide. I am completely shut down, and experiencing frequent dissociation, de-realisation, and de-personalisation
9. I'm actively considering self-harm and/or suicide. This doesn't cause any emotional spikes - my emotions are painful, but 'flat'. Ending my life just feels like a logical decision. I can't even hold coherent thoughts about interests and hobbies, and am overwhelmed by painful memories and extremely anxiety-inducing thoughts of the future.
10. I am at immediate risk of self-harm and/or suicide. I am completely shut down, and experiencing frequent dissociation, de-realisation, and de-personalisation
then my usual mental state would be somewhere between points 4-5 on a daily basis. Today (Tuesday October 1st) I'm at a 4, for example.
My depression does 'flare' - rapidly and suddenly escalating to extreme levels, often with no obvious cause. In the most recent flare, as I didn't have to go into shut down in order to focus on an employed job role, I was actually able to pay attention to the entire journey along the street named depresssion.
The flare started when I woke in a state of extreme anxiety and agitation. Throughout the day, my mood became darker and more aggressive (anger and aggression are part of my heightened arousal states, and I have to work on directing that in unharmful ways.) At that point, I was probably at point 8 on the scale given above. As the first week progressed, my mental state deteriorated to point 10 on the scale - I managed not to harm myself, or end my life, but it was an extreme effort to move past those desires, and left me with no energy for other things. My emotional arousal had dropped from anger and aggression to tearfulness, with anger flashpoints.
In the second week, my mental state shifted to point 9 on the scale above, and my emotional responses were essentially flatlined in "dismissive, frustrated exhaustion."
That state lasted for a further week-10 days, holding at a solid 9 on the mental health scale. Then, slowly, my mental health began to improve, rapidly rising from 9 to 5 over the course of a further 10 days.
Surviving the "point 10" on the scale took everything I had - but the improvement, which took place over the 10 days to the end of last month, was a rapid transition, with the occasional "roadbump", where I would 'relapse' to prior, higher points on the mental health scale.
It is relevant to make it clear that, for me, my flare states will very literally see me waking up at a much higher point than usual on the mental health scale, with no preceding events which would justify that state, and no ability to prevent the decline.
The only medication I used during this time was valerian, to help me sleep during the times I was between points 8-10, as depression triggers nocturnal insomnia, and daytime sleepiness, for me, and I have domestic responsibilities which mean I can't "just sleep during the day." (I'm also completely night blind, so there's very little I can get on with during the night.)
I didn't drink any alcohol during this time, and I don't use recreational drugs.
For me, depression results in significantly decreased appetite, and much lower energy levels.
Mental health deteriorations are not the same for everyone - and that's why the way the UK government funds "treatment" for mental health challenges, presenting "one size fits all" options, is not cost-effective. People don't all experience the same course of mental illness, even when they are experiencing "the same" mental illness as someone else.
In many cases, the freely-available, government-funded, non-medicalised interventions are only really suitable for individuals who are at points 4-7 on the mental health scale I've presented here. Anyone at points 8-10 is typically told they're "too severe to be helped by this programme", and referred to medicalised treatment - which means NHS waiting lists, often over 12 weeks - which doesn't seem too bad when you're feeling okay, but can feel like an eternity when things are falling apart, and is certainly far too long for most employers to maintain patience with staff who are experiencing mental health challenges. Once people reach the top of these waiting lists, there is a huge amount of variability in the quality of treatment that people receive - generally, clinicians with lived experience of mental health conditions leave the healthcare profession, so that intuitive understanding isn't routinely and reliably present in clinicians who are treating people experiencing mental health challenges. Pressures such as staff shortages, cost targets, and availability of suitable treatment facilities can cause a poor treatment experience, as, unfortunately, can attitudes and prejudices of healthcare staff, whose reactions to their own stress and pressures can result in accusations that people experiencing mental health challenges are "just entitled and self-absorbed", with these attitudes escalating if the people seeking treatment are out of work because of their mental health situation, which tends to result in aggressive hostility centred around the idea that these individuals are "just skivers who'll use any excuse not to work!" In many cases, what's underlying all of this is poor mental health on the part of the healthcare professionals themselves, and a feeling that they "can't" take time off, or get support themselves, because of the pressures of work they're facing.
My depression does 'flare' - rapidly and suddenly escalating to extreme levels, often with no obvious cause. In the most recent flare, as I didn't have to go into shut down in order to focus on an employed job role, I was actually able to pay attention to the entire journey along the street named depresssion.
The flare started when I woke in a state of extreme anxiety and agitation. Throughout the day, my mood became darker and more aggressive (anger and aggression are part of my heightened arousal states, and I have to work on directing that in unharmful ways.) At that point, I was probably at point 8 on the scale given above. As the first week progressed, my mental state deteriorated to point 10 on the scale - I managed not to harm myself, or end my life, but it was an extreme effort to move past those desires, and left me with no energy for other things. My emotional arousal had dropped from anger and aggression to tearfulness, with anger flashpoints.
In the second week, my mental state shifted to point 9 on the scale above, and my emotional responses were essentially flatlined in "dismissive, frustrated exhaustion."
That state lasted for a further week-10 days, holding at a solid 9 on the mental health scale. Then, slowly, my mental health began to improve, rapidly rising from 9 to 5 over the course of a further 10 days.
Surviving the "point 10" on the scale took everything I had - but the improvement, which took place over the 10 days to the end of last month, was a rapid transition, with the occasional "roadbump", where I would 'relapse' to prior, higher points on the mental health scale.
It is relevant to make it clear that, for me, my flare states will very literally see me waking up at a much higher point than usual on the mental health scale, with no preceding events which would justify that state, and no ability to prevent the decline.
The only medication I used during this time was valerian, to help me sleep during the times I was between points 8-10, as depression triggers nocturnal insomnia, and daytime sleepiness, for me, and I have domestic responsibilities which mean I can't "just sleep during the day." (I'm also completely night blind, so there's very little I can get on with during the night.)
I didn't drink any alcohol during this time, and I don't use recreational drugs.
For me, depression results in significantly decreased appetite, and much lower energy levels.
Mental health deteriorations are not the same for everyone - and that's why the way the UK government funds "treatment" for mental health challenges, presenting "one size fits all" options, is not cost-effective. People don't all experience the same course of mental illness, even when they are experiencing "the same" mental illness as someone else.
In many cases, the freely-available, government-funded, non-medicalised interventions are only really suitable for individuals who are at points 4-7 on the mental health scale I've presented here. Anyone at points 8-10 is typically told they're "too severe to be helped by this programme", and referred to medicalised treatment - which means NHS waiting lists, often over 12 weeks - which doesn't seem too bad when you're feeling okay, but can feel like an eternity when things are falling apart, and is certainly far too long for most employers to maintain patience with staff who are experiencing mental health challenges. Once people reach the top of these waiting lists, there is a huge amount of variability in the quality of treatment that people receive - generally, clinicians with lived experience of mental health conditions leave the healthcare profession, so that intuitive understanding isn't routinely and reliably present in clinicians who are treating people experiencing mental health challenges. Pressures such as staff shortages, cost targets, and availability of suitable treatment facilities can cause a poor treatment experience, as, unfortunately, can attitudes and prejudices of healthcare staff, whose reactions to their own stress and pressures can result in accusations that people experiencing mental health challenges are "just entitled and self-absorbed", with these attitudes escalating if the people seeking treatment are out of work because of their mental health situation, which tends to result in aggressive hostility centred around the idea that these individuals are "just skivers who'll use any excuse not to work!" In many cases, what's underlying all of this is poor mental health on the part of the healthcare professionals themselves, and a feeling that they "can't" take time off, or get support themselves, because of the pressures of work they're facing.
For people experiencing mental health impacts, particularly around depression and anxiety, even the impression that healthcare professionals don't believe the severity of their experience, or resent them accessing treatment, can sync with the negative self-beliefs their mental illness is presenting them with, and result in them dropping out of treatment regimes, and feeling worse, because those healthcare professionals have "proved" that "there's nothing really wrong."
It is definitely possible to just let depression play itself out, and it usually does so, even if it seems terrifying at points. But, equally, if someone has to maintain a particular energy level, in order to manage work or life responsibilities, or they are in a situation where they are not allowed or able to express a range of emotionality, support in the form of medication may be necessary to help them regulate to a position where they can engage in a form of therapy which is best-suited to them.
For me, I've found that the most effective form of therapeutic intervention is journalling - my form of journalling is quite unornamented and straightforward, but it can be as elaborate or as simple as you like.
I have had CBT and DBT as treatment for schizophrenia in the past, and consider both to have effective elements, but to not be especially helpful when you're trying to deal with a wider society in which therapy of any kind is not routine for people, and, in general, find "talking therapies" to be ineffective, and anxiety inducing; I'm an introvert, and a trauma background has resulted in me feeling that I "shouldn't complain about things", and that things that happened to me where either "normal" or "not that bad, really." Even when those things were actually exceptionally bad - including assaults including weapons, attempted group sexual assault, etc. I'm very much on the "but plenty of people deal with worse than that" spectrum, and don't consider the flipside of that - that plenty of people never deal with anything even close to that bad at any point in their lifetime, and that plenty of people also feel no guilt about engaging with therapy for things significantly less obviously 'bad' than my experiences - and, when it's not about me, I actually feel that some form of therapeutic practice is something people should be engaging with "just because", before they experience mental health challenges; if nothing else, therapy gives you an impartial, outside observer to help you put things into perspective, or provide interpretations you may not have considered.
Equally, however, part of cost-effective mental health treatment should also include resilience training, providing people with the awareness that depression and anxiety can just be "journeys", and that they can be allowed to run their course without intervention, and with minimal disruption to a person's normal life.
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