Questions about depression?

Is clinical depression the same as intense misery? Yes and no. In
practice the terms are synonymous however the clinical definition is
more complex. It seeks to identify a biological syndrome that can
present without the symptom of low mood. Low mood is only 1 of the 8 or
9 symptoms of which 5 are needed for 2 weeks to get a research-quality
diagnosis. The criteria for clinical depression doesn't include every
person who reports they felt mentally unwell for a 2 week period. To me
this is quite complex and where the psychiatric theory is far different
from the lay perception. As more and more symptoms are required for a
diagnosis fewer and fewer people who report feeling mentally unwell for
two weeks also show clinical symptoms of depression. A study in America
compared these rates and the rate for men getting a diagnosis of
depression decreased quicker than the rate for women, though this result
wasn't what the paper was about.

Can it be left untreated? Yes and no. Studies show that 85% of people
recover from a bout of depression in one year without treatment. As
someone who's recently been through the experience of untreated
depression I think it's a hard choice to make. Untreated depression is
really hard going. However other studies about depression have shown
that many people have cyclical depressive periods in their lifetime and
modern treatment is making the frequency of the cycle shorter. The
modern mental healthcare system may not fully understand depression or
has a too simplistic view in this respect.

Can it be treated without SSRIs? Yes. There are herbal alternatives.
There are dietary supplements and foods that can help. Exercise. Sex.
There are many types of depression and not all respond to medication or
physical cures. Social contact. Fun. Love. Intimacy. Positive life
events. Resolution of the psychological cause. These can all affect a
person in small and large ways. There are many alternatives to
medication for the treatment of misery. However SSRIs are effective in
some people just as St John's Wort is also effective but has milder side
effects; the evidence seems to be SJW is better for milder depression
(and has some pleasant, positive side effects) whereas SSRIs may be
better for more severe depression. SNRIs are a newer type of
antidepressant used for treatment resistant depression and they
definitely work but after prolonged use the effect diminishes greatly.

What if nothing works? A mean thing to say but something that might be
true is perhaps the depression serves a purpose and it may be worth
trying to understand it while tolerating the suffering. There are many
ways to alleviate the soul pain of depression. Sometimes it can just
involve gainfully filling time till spontaneous recovery happens.
Sometimes something out of the blue changes everything. It can be a
person or an event. It can be anything. Waiting for it can be hard but
the change comes. There are many, many solutions to depression that
doctors may not think of. If you reach the stage where nothing works
then try things you woudln't try. Speak to people who have lived with
depression for years. Each person will have a different solution. It
takes a dogged attitude to keep going and trying things when it feels
like nothing works. In my mind the image of Rocky in the penultimate
round resonates with the feeling. And as Rocky did, it's worth sticking
it out till the end. You'll win eventually. (win meaning getting get
what you want. For some that's the simple victory of waking up not
feeling like shit.).

What happens if I've been feeling really unwell for ages but the doctor
doesn't recognise it? This can be one of the most awful situations to be
in. That small minrity of people who feel mentally unwell but their
unwellness isn't recognised by mental health professionals. It can be be
hard for lots of people to admit they need a bit of help in the first
place. Overcoming the barrier then being told that there's no help
because the doctor either doesn't believe the patient or the paitent's
externalisation doesn't fit the diagnostic criteria or the doctor is not
properly trained to recognise the complex manifestations of misery and
mental illness is going to make anyone feel worse. It canbeen seen as a
blessing. It means find your own path. Seek the solution for you. If you
start reading the research you'll quickly realise that mental health is
a pretty poor science. The most important part - a high level of
knowledge of the individual, their cycle, their triggers and their
personality - is not know by doctors so they can't truly assess the
change in a person, whether what they're going through is normal for
them, what the cause is and how to treat it correctly first time round.
Becoming an expert patient capable of self-managing is a hard journey
but it's a worthwhile one. The evidence shows that most medications and
psychological treatments for depression don't work very well for most
people. So if you've been refused help then it may not be too bad.
There's a lot of information in the internet. There are mental health
information lines and NHS Direct where you can get advice. There are
support groups and online forums. There are lots of places where you can
learn to become an expert patient.