Monday, 26 May 2008

Z is not depressed - but has friends who are

I have a friend who is strong, capable, a successful business-woman who, in partnership with her husband, runs a stressful business which, by its nature, means that one or other of them is on call at all times. Whatever the occasion, they might have to leave or make a phone call to ensure that someone deals with a situation that has arisen. On top of this, she has an elderly, frail and demanding mother, to whom she is devoted, but who can infuriate her. She also does voluntary work that involves her in heavy responsibilities, both for people and for finance.

What annoyed me last Sunday was when she told me that she just can't kick the heavy dose of anti-depressants that her doctor put her on last autumn.

I know too many people in this situation. What they should be told is that they are wonderful. Fabulous. They have coped with pressure that many people would find unendurable. They may have had traumas in their past that many of us cannot imagine having to deal with. They reach the end of their tether and this is not only understandable, but inevitable. The mind and body are not supposed to be able to endure the unendurable; sometimes we crack but, because of the nature of the pressures we are under today, this cannot be admitted. So they go to the doctor, say that they can't sleep, they cry, they lose their temper, they are losing (or gaining) weight, they have a constant headache, irritable bowels, aches and pains, stiff jaws through constant teeth-grinding, and what are they told? They are depressed and the way to deal with this is with anti-depressants.

These can help, in the short term. But they deal with the symptoms, not the problems. And, a few months later, they say that the sleepless nights and all the other problems are still there, the pills don't really help any more, but they can't do without them. If they try, in less tense times, to cut down, the anxieties kick in again.

My friend has taken steps to lessen her and her husband's work-loads, although the effects of this will not really come through for a few more months - and they acted more because of the physical effect on his health than the mental ones on hers - but in the meantime, she thinks she is a failure because she still feels that she can't cope and now she's hooked on powerful mind-altering drugs to boot.

I met a friend in town a while ago and we went for coffee. She moved house last year and she told me how much she is enjoying life in her retirement with her daughters nearby and with her grandchildren in close contact. "Still on the happy pills, mind you," she said. "One day I'll manage to get off them." Now, I know when she started taking them. It was years ago, when her last marriage broke up. Since then, she has put her life together and done it very well. But she can't kick the pills, even though she is happy and has a tranquil life now.

I know any number of people in this situation, and some of those are you, whose blogs I read, and whom I admire hugely. And I don't blame you if you need help, and I truly sympathise if you suffer from depression or mental illness, and I know that sometimes there is too much to bear and you can't offload work, anxiety and grief, and that drugs, properly prescribed for good reasons, can help.

But.
1 - I believe that doctors are still too ready to prescribe them. Some people need to be told, in the first instance, that their health should come first and that they need to cut down and slow down. They are not depressed because they are ill, but they are ill and depressed because they are overworked and overstressed. They might need some medicinal help in the short term, but it is more important to treat the cause than the symptoms.
2 - I become very upset when these people, however hard they try to cope with the shit that hits them at every point, bewail their inability to do so. Of course they can't. They are not meant to. They are not inadequate, they are normal. What sort of fool sleeps calmly through their bankruptcy, or their parent's terminal illness or impossible demands on their capabilities and emotions? When you are going through an awful time, your body reacts, however hard your brain tries to compensate.
3 - We expect and are expected to 'get over it' far too quickly. I think part of the blame lies with the soaps and similar fiction. A few weeks at most after a traumatic death or disaster, the community "comes to terms" with the losses, because the pressures of the storyline dictates that it can't keep harking back. And so we think we should be the same. We're not allowed to mourn, we're given a few weeks and then expected to snap back to normal. Life isn't like that. I remember a friend of mine, whose husband died at the age of 48, telling me that the second year was worse than the first and that she only started to cautiously regain her equilibrium towards the end of the third year. I know that it took me (in retrospect) three years and three months to recover from the strain of looking after my mother, her death and a very difficult situation in one of my voluntary jobs that I had dealt with very capably at the time. And I had a supportive family, enough money and fundamental security, which many people don't have.

I'm not saying that depression is not real - it is. And I'm not saying that no one should need medical assistance if it's caused by 'events' rather than a mental ailment. Actually, I've lost track of a conclusion and I don't think I know enough to come to one - just that doctors should look for causes, not just symptoms, and that we should all look at ourselves without judgment and with kindness. And I'm not criticising anyone who can't cope or who takes pills, just saying that one shouldn't look to them to make things better if they aren't.

16 comments:

Dash said...

I completely agree with you, Z. In my experience, too many doctors are happy to just prescribe anti-depressants without taking any steps to help their patients deal with the underlying problems.

Anti-depressants have their place but they are never a solution on their own.

Dave said...

You could be describing my situation; certainly my GP is very happy to give me said pills. I, on the other hand, am refusing to take them. I want to be in control of my own mind, thank you, even if it is a sad and pathetic one.

It's bad enough having the light-headedness and nausea and other side-effects from the painkillers, which I only take when the pain is really bad; a little background pain is worth it, to feel that my mind is mine.

Clarissa said...

Many years ago I went to a psychiatrist for an evaluation. (My parents were divorcing; I'd suddenly remembered having been sexually abused as a child; and I'd dabbled w/ bulimia.) I really was just going to this guy to see if he could help. Within a 1/2 an hour, he had suggested I go on pills. Fucker. I walked out.

Gordie said...

It sounds like your friend has responded in a very natural way to a real and challenging situation. I wouldn't call that depression.

I hate the way doctors treat natural human emotions as illnesses. Nobody is allowed to be sad, angry or tired any more. Well done to Dash, Dave, and Clarissa for their positive attitudes.

unpretentious said...

well said. i ve been in the field and actually know the effect of all those medicines. psychologically too a person may become addicted to it. even the names 'anti depressants', 'depressants' etc. itself i believe makes a person jittery.
on the whole wonderful article. it lifted up my spirits a bit at least)

badgerdaddy said...

Zmeister, Many GPs are now suggesting exercise rather than prescribing antidepressants. Specifically, they are suggesting people take up running, and there have been some pretty excellent results. Obviously, not everyone can do this for various reasons, but in some cases, it's perfect. At least some doctors realise this.

One problem in the NHS is that psychiatrists can prescribe drugs while psychologists, for example, can not, even if the psychologist has been working closely with a patient and the psychiatrist has only seen them in an emergency admission. All seems a bit fucked to me.

Blue Witch said...

Excellent post Z.

If you look at the number of scripts written over time, it's getting worse rather than better. Much, much worse.

IMHO many doctors prescribe medication because they need to feel they've helped someone and there is nothing elese for them to offer in a fucked up NHS where drug budgets are apparently unlimited but access to cousellors and psychologists is more limited than ever (and the price of the latter cf the former is miniscule), asnd alternative therapies are largely laughed at.

The pharmaceutical companies rule the world in most 'developed' countries.

PI said...

I agree with much of what you say but I do feel some of us are more fortunate in that we are more able to cope.
I find myself continually prepared for disaster, especially at this late age, and would be prepared to use medication - as you say - in the short term. Fingers crossed eh?

Dandelion said...

Ooh, controversial! You've inspired me to post the other side of the debate at my place.

But I would just like to say to badge, the reason why psychologists cannot prescribe medication is that they don't have a medical degree.

Personally, I think the requirement that people writing prescriptions should have actual clinical training in the indications and actions of pharmacological interventions, rather than being fucked, is actually very reassuring.

Z said...

I hope, Pat and Dandelion, that I clarified my position - that I'm not criticising someone who needs anti-depressants or doctors who decide that they are the most appropriate treatment - in my last paragraph.

I'll write another post later. Wine and dinner call me now and neither is to be ignored.

Anonymous said...

I completely agree with you Z. Two family members have been taking the happy tablets for several years now, I suspect that this has become a permanent arrangement. To be fair, their GPs have tried other avenues (eg counselling, exercise), but they still kept on prescribing the pills.

I don't actually think that the pills have even helped - both patients claim to feel better, but seem to be a lot more emotionally fragile since they started taking them than they were before.

Unfortunately it isn't just prescribing the tablets that takes less effort: taking them requires less effort than eg the exercise/counselling regime, which seemed to get abandoned very quickly by the patient in at least one of these cases.

I'm impressed by Dave and Clarissa for being determined and positive - I'm sure that is more effective than any anti-depressants in the longer term.

Kahless said...

Came from Dandelions link.
I really liked this post and I agree with your points.

badgerdaddy said...

That's a fair point Dandelion, but sadly I have once again under-explained.

Psychologists are generally not even asked for opinion or their experience of a patient by a psychiatrist, who can then prescribe medication.

Personally, I think that's fucked, but I'm really not wanting an argument about it.

The Boy said...

In defence of doctors, they can only treat maladies of the body. The only action they have against depression is a medical one. So they use it.

Our problem is as a society not really knowing how to deal with outlying emotional distress. Grief should be tidy and over with in a week. Anxiety shouldn't exist, and Depression can be treated with pills.

We just haven't societally figured out the right way to help out here. I do think medical treatment is part of the answer. Problem is its being treated as the only answer!

Gordie said...

I agree with badgerdaddy and the boy up to a point, but I read two books by a writer called Marek Kohn - Google him, he's clever.

In the nineteenth century all the scientific professions (surgeons, psychiatrists, chemists and so on) decided to petition parliament to pass laws that gave them monopolies.

As a result, a lot of folk medicine and self-reliance became 'unscientific' and illegal or immoral.

(One example Kohn gives is that people in Ely and the fens used to take opium for a variety of ailments, and in the mid 19th century this was banned.)

hey bartender said...

I'm with you, Z. A former friend of mine has many, many problems, but refuses to talk to anyone professionally, saying only that she thinks those cans of worms are closed for a reason.
Meantime, since she has insurance, her MD is happy to keep writing scrips for whatever she wants. Not requiring her to see anyone who has any background in psychology or psychiatry, but happy to take her money. Pisses me off. And ruining her child's life as well.
I know people who have been helped by brain meds in the short term, but only got better by fixing the problems in their lives.