Dr Samuel Hall on why we should be talking about depression, often and widely.
As I write we are enjoying unseasonably good weather with temperatures on the weekend of the Brighton Marathon reaching the low 20ºs. Marvellous. I can anticipate the lifting of my mood as the trees begin to bud and the children are enjoying a well-earned Easter break. All this should mean better sleep and lower levels of depression (reference for readers with a thirst for academia: www.ncbi.nlm.nih.gov/pmc/articles/PMC4398445/).
It’s well documented that mood is highly susceptible to the circadian rhythm and that those of us who live at latitudes where there’s more darkness than light, such as we endure over the winter months, are more likely to report anxiety about lack of sleep. Seasonal Affective Disorder (SAD) is well-documented in northern climates. I really don’t think daylight saving time helps either. The arguments for extending daylight in the summer evenings and forgoing early sunrise are sound but I’d rather we just stuck to the same time all year round.
It’s not actual daylight saving time that is the problem, it’s the fact that we move back to standard time in the autumn. I’ve talked about this before – in the winter months I sometimes don’t see any daylight at all. Hospitals, where I’ve spent my entire working life, are notorious for poor access to natural light – I‘ve gone for whole weeks without seeing the sun as a result. The artificial light that one is exposed to in such settings does nothing to boost vitamin D levels or give a sense of wellbeing. All this means we should be spending as much time in the sunshine as possible (UV exposure and skin cancer risk notwithstanding), or at least near a window!
Suffice to say, however, that my lower mood in the winter months, and struggle to acclimatise to the shifting patterns of light and dark, coupled with a lifting of the spirits at this time of year, are small fry compared to the scourge that many suffer of full-blown depression for months or years on end.
I do have experience of this; 10 years ago I began to really struggle with my gender identity. I’d managed to keep a lid on my dysphoria for decades, distracting myself with a busy life of study, post-graduate training, marriage and child-rearing. Every now and again I’d crash and be unable to do anything at all, usually for a day or two, never much longer. But in my late 30s I had a crash that was sustained and prolonged. I found myself unable to do anything about it. I was irrationally tearful, erratic in my thoughts and actions, riddled with self-doubt and inertia. Apathy was always breathing down my neck and my ability to do my job/care for my kids/manage my life was severely threatened. It took me a long time (five years) to recognise that I was depressed – a chemical imbalance in the brain that I simply couldn’t ‘switch off’.
It took another wiser clinician to point out that I might benefit from antidepressants. Still I resisted. I wanted to know what this was all about. I took to spending as much time as I could alone, I stopped drinking alcohol, started running, ate less and ate more healthily, lost a lot of weight, and most importantly, finally came out as trans. I took St John’s wort, an herbal remedy known for its therapeutic effect for mild to moderate depression, which acts on the brain in much the same way as Prozac and similar drugs. At the time I wanted to manage my problems myself, and like many people, didn’t want my mental ill-health documented by professionals.
This is a really common scenario, as a clinician I know the stigma that surrounds mental ill-health all too well. It’s still a taboo subject in my profession. Many of my patients don’t like to admit to feeling depressed, and certainly amongst colleagues it raises eyebrows and alarm, especially if accompanied by the need for time off work. How are we as a profession going to address the insidious nature of this taboo, and liberate our patients to speak up boldly if we can’t even do it for ourselves? Time and time again I bring the subject up in the workplace only to encounter my own and others’ prejudice. It’s endemic.
Early on in my transition, when I was still plagued by suicidal ideation (thinking you might be better off dead and planning it), and sometimes coming painfully close to devising ways to end the agony of my reality, I remember my father pleading with me not to discuss my emotional wellbeing with my children, for fear that I’d somehow damage them, or worse, predispose them to the same (my mother suffered very severely from depression in her mid-30s).
But we have this all wrong. We should be talking about this, often and widely. Those among us who struggle to own and own up to our emotional and mental wellbeing glitches are doing the rest of the world no favours at all.
The charity of the year for the 2017 London Marathon is Heads Together, a partnership of mental health charities with a campaign spearheaded by HRHs William, Kate and Harry. This is an excellent campaign raising the profile and hopefully reducing the stigma surrounding depression and other aspects of mental ill-health. There are so many at-risk groups, single men, teenage girls, new mothers, the elderly, disabled, isolated, LGBT+ folk, the list goes on and on.
Suicidal ideation and suicide itself are robbing us of bright young things. People are crippled by mental ill-health. We know that the solutions can be ridiculously simple for many people, and yet strangely difficult to implement. Socialising in real life rather than online, avoiding drugs and alcohol, getting outside in the fresh air, exercising and eating well, finding things that foster enjoyment and a sense of community – all these and more can mitigate the weight of the black dog, but one of the best ways is to talk about it. Let it begin with me.