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Depression

Limiting and controlling episodes of depression

Many of the people we interviewed who had had depression wanted to limit the impact of further episodes. They did this at a number of points:

(1) in between episodes when feeling well
(2) at the point where the person notices that an episode of depression or mania may be starting (i.e. noticing the forerunners)
(3) during the depression (i.e. noticing the pattern).


The trouble is that it can be difficult for people to know when they are going into a depression. Also, people's experiences differ so much that it is not possible to identify the common warning signs for everyone. Nevertheless, people had identified their own signs that they might be going into a depression. Some took lack of sleep and tiredness as a warning of looming depression. These people attempted to get extra rest and sleep to prevent depression.

 

He takes tiredness as a warning sign that his brain needs a rest, so he ensures that he gets more...

He takes tiredness as a warning sign that his brain needs a rest, so he ensures that he gets more...

Age at interview: 68
Sex: Male
Age at diagnosis: 57
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I have to say its not often now that I get...it's not often now do I get an experience which indicates to me that I'm going to lapse back into it. I'd no history of depression before this came along. If I find myself getting very tired, I take that as a warning'Well I think you see, if your brain has had a battering, it needs time and rest to recover you know. If you're awake you're not resting it, and I think that's what happened, I think you know this detachment, the brain was saying, 'I've got too much overload I want to chill out', as it were, "I want, I want 'out' of this", you know.

One woman realised that her warning signs were intolerance of noise, wanting to isolate herself, having a feeling that things were not right, and wanting to 'lose' herself. A man who was vividly aware of his signs of going into a depression could take it as a warning to get to a doctor. Another man in his late thirties found it so difficult to judge a looming depression that he resorted to using the Beck Depression Inventory at regular intervals to monitor himself. Those who also experienced mania could notice the forerunners of getting high (or ask their friends to watch them) in order to prevent mania and subsequent depression. For instance, one man made conscious decisions to try to stick to routines, particularly sleep, when at risk of mania.

 

Her warnings signs for depression include intolerance of noise, isolation, a sense of something...

Her warnings signs for depression include intolerance of noise, isolation, a sense of something...

Age at interview: 33
Sex: Female
Age at diagnosis: 24
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You were saying before that you know the warning signs. What are the warning signs for you?

The warning signs for me are I don't listen, I can't listen to music or television. I can't bear noise. I'm very intolerant of any noise. Any kind of noise at all, and I take to my bed. Or I isolate myself. I stop answering the phone, before that something must happen before that. Just generally feeling things aren't right. Something is wrong somewhere. Intuition. Something's wrong. Something's not right.

I don't feel at ease with myself. I don't really want to be with myself. If I could get drunk. I haven't turned to drink. I have drugs, I have used my medication to get myself off my head sometimes, sleeping tablets. I've taken four or five sometimes to just release myself.

And it's the same thing as getting drunk. You kind of need to lose yourself because you can't bear to be with yourself anymore. I'm not really sure what that's about but.

 

Has accepted that he will have depression again, he knows the signs of a looming depression,...

Has accepted that he will have depression again, he knows the signs of a looming depression,...

Age at interview: 31
Sex: Male
Age at diagnosis: 17
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The signs (of depression) are panic, yeah you just think "I'm panicking." And that's physical, you know your heart rate goes up, the old classics of waking up early in the morning, that happens, the fear of being on your own, that you recognise. And just the sheer onslaught of negative thoughts that you just can't push out. And then you know, you know when it's coming, you know this is a bit different from just feeling shit.  

You know I have crap days, you can come home from work, and you think, "Oh shit, that was awful, I feel crap.'"And you know, maybe you've got some kind of material problem in your life, we all have them you know that's different, there's a very different' Quality, a panicky quality, a dark kind of' it's a very different texture that kind of anxiety from'. and depression from the kind of stuff that we deal with every day, or you know sometimes you have a couple of days of feeling, 'God, I didn't feel that great last week.'  

But you know it's very different from what'.. yeah that, when you see it coming I think, I remember saying to myself, "Oh no, not again." Really you know, I know, I've got over this once, surely, I thought I was over it and it's back. Now if it happened to me again, which I dare say it will, I'll never think, "Oh God, I thought I was out of that", because I think I've kind of accepted that  it is something that's there now. And people will say oh how sad that is, and I don't think it is really, without saying yeah it's something that's there, but I know the signs, and I know what to do, and I know you get better.

 

While he can be very creative and productive while manic, he consciously decides to stick to...

While he can be very creative and productive while manic, he consciously decides to stick to...

Age at interview: 33
Sex: Male
Age at diagnosis: 24
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You know in the best of moments, I can do more than somebody who hasn't been brushed with the madness stick. You know, I have, sort of, my art that I do, I like writing music, I've made films, I make animations, I write software in my spare time. I can do lots of things and you know, when I go through the things that I do in my spare time, people look at me as if I'm mad. Yeah, probably am, but you know, this is madness in a positive sense in I can pull the energy that's within me to doing something positive and doing something creative.

But I do feel that every good day has to be paid for by a bad day, and yeah, sooner or later it catches up with you. And that's when you get depressed and you have to be aware of that and sometimes I have to make a conscious decision. Why get engrossed in a project and stop going to bed at bedtime? Making sure I don't miss meals, you know, make sure that I don't get up at three o'clock in the morning because I've got this crazy idea that won't go away. You know, stay in bed, get up at a sensible time and yeah, I have to look after myself like that or'. I believe when I'm on a high, I'll lose it, and I will lose my grounding in reality.

Some particularly experienced patients had arrangements with their doctors so that they could start taking (or increase) their medication to prevent or limit a possible depression. One older man had so much experience of noticing the forerunners to depression, and managing it with medication (as well as positive thinking), that his episodes of depression now felt considerably less severe.

 

Through noticing forerunners to depression, and adjusting his medication, he could manage his...

Through noticing forerunners to depression, and adjusting his medication, he could manage his...

Age at interview: 75
Sex: Male
Age at diagnosis: 35
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Yeah I could then see this cyclical pattern, it was like being on a scenic railway you know. You'd drop down into the depths and then hit the heights. The heights were very good for thinking up schemes, and some of them were a bit over the top maybe, but I got to use it if that's the right thing. It sounds as if I'm so clever, but at the time I didn't feel it. But I was able to use it to my advantage and trim it to suit the situation, and I'd quite a lot of drive and I could get people to become enthusiastic about doing certain things and it worked very well for me. And then I thought, well that's the easy part. It's the depression is the bit that's difficult, and I then began to notice sort of [pause] forerunners if that's the right expression, little things that would tell me that the depressed state was about to start. So I was then able to increase some of the anti-depressants.

After yes'. after recovering if you like'.. but there were still periods when instead of being like this in the swings [motions with his hands a roller coaster ride] it's more like that it's manageable [motions with his hands a much flatter roller coaster], and it's got to the point where the depression is a feeling of being just fed up, plus a fraction. But not the absolute withdrawal, that's'. that's ghastly. That is awful. So that's something I've experienced.

Limiting the impact of an episode of depression is still possible after depression has set in. People can adopt an 'attitude' to control the impact of their depression. One common thing that people did was to try to think of depression as self-limited. The problem is that it can be very difficult for deeply depressed people to hold onto the idea that they will recover - they tend to think this episode is the one they will not recover from. As one young woman said, 'you still really kind of believe that this is it, and it's really bad.' Nevertheless, many people have noticed the self-limited nature of depression. The same woman said 'but at the back of your mind, at least you know that it's going to get better at some point.'

The knowledge that depression will not last has helped some people to accept and endure their depression, as well as reduce the impact of depression on their lives. An older man said that noticing the pattern of depression, and accepting depression, meant that it was more manageable and did not 'hit me as hard'.

 

Experience of many bouts of depression and recovery has led him to accept his depression, and...

Experience of many bouts of depression and recovery has led him to accept his depression, and...

Age at interview: 73
Sex: Male
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Well with some sort of experience of it, when you've had about six goes, depressed for two years, okay, depressed at least by then you know I did get better. Whilst I was depressed the thought of ever getting better was the last thing on earth, desperation of just living through a day was'. it was that desperate you know at times. And that's how I bumped along, with recurring bouts about two years depression, three years okay.

It's just my life has been bouts of depression and fairly good, and then another bout of depression. And I was warned that my particular sort of depression would follow that kind of path. So you can't be for, forearmed against it, if it's down to you, you'll get it. What you've got to be able to do is accept it, and accepting it seems to be able to make it manageable.

Last reviewed September 2017.

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