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When acute depression takes you unawares, it's tempting to reach for the drugs

I'm back.

Perhaps you never noticed that I was gone? Perhaps you had an inkling that the editor had finally got rid of me? Sorry, you're out of luck.

I have been writing for Pharmaceutical Marketing for six years and I've never missed a chance to have my say; but last month I was missing.

I told the editor a lie. I said that I was travelling and couldn't hit the publication deadline. It was nearly true. I was on a journey - to hell.

The truth is, I couldn't write. I couldn't lift a pen or tap a keyboard. I was bereft of inspiration. No idea what to say. In fact, I had no idea who I was.

Something had happened. One day, unexpectedly, without any warning at all, without even the polite notice one might afford a stranger, I was left with empty coat hangers. My world imploded. I didn't recognise where I was, who I was or what I did. I couldn't write. I was dysfunctional.

I'm never ill. I get the occasional bout of man-flu, but other than that I'm lucky. However, this time I was ill with a collection of symptoms that defied a layman's interpretation.

The doctor diagnosed acute depression. I had unwittingly joined the select club of over 100 million people worldwide - who, incidentally, result in 75 per cent of all psychiatric admissions.

Why am I writing about this? Is it 'too much information'? I am doing it because I can. People who have had what the NHS laughingly calls a 'mental health' problem almost never talk about it. There are few advocates. It is a mystery made obscure by embarrassment, social expectation and ignorance.

It shouldn't be. In the world of mental health, a bout of acute depression is like getting the flu. Trivial, debilitating and revealing. It's not about me. It's about an illness that reduces strong men and women to jelly. For the record, the medical books say: 'Depression is a treatable illness involving an imbalance of brain chemicals called neurotransmitters. It is not a character flaw or a sign of personal weakness. You can't make yourself well by trying to snap out of it. The direct causes of the illness are unclear, however it is known that body chemistry can bring on a depressive disorder, due to experiencing a traumatic event, hormonal changes, altered health habits, the presence of another illness or substance abuse.'

Here's my definition: Depression is shit.

The physical symptoms are unbelievable.

Sickness, loss of appetite, uncontrollable shaking, coldness, temporary amnesia. I forgot how to do what babes in arms can do on trains, the bus and in a supermarket queue - sleep. I went for night after agonising night listening, as the clock ticked down to the time when the water-colour wash of dawn appeared upon the bedroom window.

I lurched through guilt, worthlessness, indecisiveness, unexplained aches and pains, indifference and pessimism. I developed a stammer. My thoughts were entirely occupied with suicide, death and ending it all. Worse, I was irritable and angry with the very people who remained in my life, ready and willing to help.

I had no idea of (and nothing could have prepared me for) the damage that the manifestation of mental anguish could do to my body.

Standing up was actually painful, followed by the greater pain and black comedy of not being able to remember why I stood up in the first place!

Middle class help
Is there a point to all this? Yes. For me, normal service is resumed. It took four excruciating weeks, but I'm OK.

For me it was easy - as easy goes. If you get depression, you need a circle of good friends that will be honest with you. You need friends that care enough and are flexible enough to drop what they are doing and come and stay at your house, empty the medicine cabinet of anything you might take a handful of, and make you eat something.

I had that.

You need a gym membership and time, so that you can train twice a day. Exercise somehow gee's-up neurotransmitters to produce good stuff called serotonin.

I did that.

You need a doctor who says I could prescribe for you Roy, but I'm not going to. We will get through this without pills if we possibly can. Note the 'we'.

I have that doctor.

Let me tell you of the need for huge support to say 'no' to the blessed respite pills might offer. Friends made me read the possible side effects: dry mouth, nausea, nervousness, insomnia, headache and sexual problems, plus the inability to sit still, and constant tiredness. Oh, and runny stools and diarrhoea. If that sounds like depression, believe me, it is!

I had the support to say 'no'.

You need someone who will, patiently, help you re-learn the knack of sleeping.

I had that someone.

I had all that because I am middle class, articulate, have good family and friendship networks and the resources to do it.

What if I were working class? Living on a council estate with two kids, a pitiful income and no prospects? What if I were old, lonely and could see nothing in the future that I wanted? What if I lived in a community and the primary employer collapsed and swept away my income, prospects and family security? A life of dependency on pills beckons.

Suppose I was a child? The Harvard School of Public Health says that kids from low socio-economic backgrounds are more at risk of depression, even if they triumph over their parents professionally.

Go to http://www.personalityresearch.org/papers/beattie.html and speed-learn about depression. The causes are nearly all avoidable; if we wanted to, we could easily design depression out of our lives.

Me? Well, I've learned: life is full of surprises; friends are priceless; you can cope with depression if you are middle class, but probably not if you are not - and that can't be right, can it?

Oh, and I've learned lessons about love, life and lying to editors. Sorry.

The author
Roy Lilley is a healthcare author and broadcaster

2nd September 2008

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