Recognition and diagnosis of depression

Some people had had only one episode of depression, others multiple episodes. For many it had taken years for their depression to be recognised. It was common for people to say the diagnosis was made when they were an adult, yet they believed they had depression as early as childhood. People commonly felt different from other children in ways they could not easily name (e.g., loneliness, feeling an outsider, anger, sadness, mood swings, anxiety, fear), but which they later linked to depression. Such early symptoms of depression were not readily apparent to adults, although one man did say that a teacher realised there was a problem, and suggested he should see a school counsellor.

It took until she was 19 to be diagnosed with depression. Yet she has come to the conclusion that…

Age at interview 59

Gender Female

Age at diagnosis 19

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I wanted to begin by asking you, was there a time before depression that you remember?

Not really, because whilst I always believed that my depression started in my teens, I’ve more recently come to the understanding that in fact, it started around the age of 7. And even as a young child 7, 8, 9, I would sit with other people, other children, and it was as if I was on the edge.

And I wasn’t part of it, and there wasn’t a lot of joy or happiness. I had friends, but even that, it never seemed to be enough. So… life was very difficult, right through until I suppose I had a diagnosis at the age of about 19, and that was because I was having difficulties at work, and my employer said, “I think you ought to see somebody”, and I was referred to a teaching hospital in London where I saw an eminent psychiatrist who diagnosed chronic depression of several years standing.

That was really based on what I was able to tell… tell him then, and he recommended psychotherapy, which I had for nearly two years.

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Believes that people make assumptions about children’s mental health, and are not necessarily…

Age at interview 40

Gender Female

Age at diagnosis 37

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If you were to look at a child you could probably think of any reason why they may be unhappy at that point. Exams, marital break up, whatever. But there will always be a child like me, where that isn’t the case, where there is something more deep, and I think theres a lot of assumption about why children are unhappy.

I think with the, new child and adolescent mental health teams hopefully there is more recognition there, that children do have mental problems. But I think when I was a kid it just wasn’t the case. I mean not even educational psychologists, there just was nobody. I was perfectly average at school. I didn’t get noticed for being bad or good, which suited me fine, but nobody ever looked beyond that.

I guess the system doesn’t look for anything that appears to be going right. I think I probably could have benefited greatly, from some help.

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One difficulty in the recognition and diagnosis of depression is that people often find it hard to articulate their feelings. Several people described this feeling as if they were ‘locked in’. One woman described this locked in experience as ‘terrifying because I could not get across to people how I was feeling’. Additionally, unlike a broken leg, outsiders cannot directly see depression. This makes depression hard to spot unless a health professional is specifically looking for it.

Finds it difficult to describe how he felt before his depression was diagnosed.

Age at interview 35

Gender Male

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I left school age sixteen, which was in 19 [coughs] excuse me, which was in 1984.
And after that I really felt quite, I don’t know… really, it’s hard to describe looking back at it now. But I felt quite sort of, sort of unwell and as if I couldn’t really… I didn’t have much confidence in doing anything, or in going on to do anything.
And I did go to a college, in [name] at the time, the September of that year. But, I felt it was all a bit sort of large and a bit, kind of, it made me feel rather panicky and you know, sort of nervous. And after that I then went into a sort of a kind of a I suppose, what I can only really call a long kind of… sort of there were quite a few years of feeling off.
And what really later became sort of anxiety, depression, feeling tense and nervous, stress, feeling bothered by people [laughs]. And I did, after a few years, in about 1987, see a psychiatrist, a coloured fellow, an Indian sort of gentleman, called Dr [name], and I saw him at home for about a year or so.

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People frequently tried to appear as if they were coping when depressed. And even when people did try to explain how they felt, friends and family often suggested that it was a temporary response to stress, or due to being physically run down. Although some said they were desperate for someone else to notice how bad things were, others very much wanted to believe their friends and family were right. To get a diagnosis people usually had to ‘make the first move’ and visit their doctor. People often reported physical ailments associated with their depression (e.g., gastric upsets, backaches, extreme tiredness), which could make it even harder to diagnose depression.

He had trouble expressing how he felt and he and others tended to explain his depression in other…

Age at interview 37

Gender Male

Age at diagnosis 22

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I suppose sort of from returning from the holiday, although I’d felt sort of tired and run-down. It was always a… always a tendency, certainly initially, for people to put it as something else, you know, rather than accepting, you know, you were diagnosed as a depression.

You think, oh, I’m run-down, it’s physical. And I think, you know, in some ways I still do that now. But I had felt quite sort of locked in and difficult too expressing very well. And I know I wouldn’t…. I went through a phase when I didn’t speak very much at all. But the psychiatrist came out and he put me on Amitriptyline.

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Not only was it difficult for people to understand that their symptoms meant depression, but doctors sometimes seemed reluctant to make the diagnosis. It was felt that GPs could easily mistake the symptoms of depression for other conditions such as post-exam stress or just trouble sleeping. When the seriousness of their depression was not recognised, people could suffer in silence. Such people were often angry about remaining unheard. They felt that an earlier diagnosis and/or recognition of the severity of their condition could have made a real difference to their lives. One woman who did get a diagnosis felt that the seriousness of her condition was not adequately acknowledged. Some people with a diagnosis of depression felt they also suffered from hypomania or mania which their doctors did not recognise.

As a teenager she did not understand she had depression, and felt her doctor should have found…

Age at interview 27

Gender Female

Age at diagnosis 16

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In terms of like doctors and that kind of thing, I mean I’m not sure if this was exactly the first time but this was some time between the age of 13 and 16, I remember going to, because I didn’t know, it’s taken me years to find out what the sort of official symptoms are of depression. And now if I go to the doctor’s I know what they’re asking me, and I know what they’re expecting me to say, and I know what it’s all about.

Of course I didn’t know that then, I was only 13, 14. They,… I’d had… , basically I would go to bed early, I would go to bed late, I tried everything but I always felt tired, the whole time. I still have that and I don’t know if it’s like.You know it can be a symptom of depression, of just feeling you know tired or just not sleeping very well.

And I think, like I went to the doctor and I said, ‘I can’t, I sleep but I always feel tired. I’ve tried going to bed early, I’ve tried going to bed late, I’ve tried everything that I can think of. And he just said, ‘Try getting more sleep. [laughing] I was like, yes, I could have thought of that, I’ve tried that, it didn’t work.

So I went, ‘Okay, thanks. I think, I can’t have been that old because I think my Mum came with me but you know, my feeling is that really he should have asked a few questions and could possibly have diagnosed that I was depressed.

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Says that had the seriousness of her depression been recognised earlier, and she had had support,…

Age at interview 60

Gender Female

Age at diagnosis 27

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When I was first diagnosed and had that experience having been chucked out of hospital after 5 days’ If I’d had had the support then that I’ve had since the 1980’s things might have been a lot different. I might not have had to have gone through all that. If it had been recognised, it was, it was just not recognised that I was ill enough. Or as I say, it was decided for some reason I was to go. You know, perhaps, I was taking up a bed or something.

They actually were quite cruel, they really were quite cruel. But I’m sure if I’d had the same treatment then as I had in the ’80’s, I mean I don’t think depression goes away, but there must be something that you know, you get on and off over the years. But with modern medication, theres going to be other progress isn’t there. You know, so don’t despair. No, if, if they’d at least have acknowledged how ill I was then it would have made a difference.

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Resisting the diagnosis of depression was partly about the stigma attached to depression, but also about trying to avoid the implications. One woman who eventually got a diagnosis saw it as a double-edged sword’ she was concerned that her medical records now ‘said ‘psychiatrist’ all over it,’ but she was also grateful she was finally being taken seriously.

One young woman did not want a diagnosis of depression because her father had depression and she saw it as stigmatising, and spent her childhood ‘trying to be completely different to him’. Sometimes, the experience of depression was considered so horrible that people preferred to deny they were depressed. One man explained he did not want to know that he had descended into depression, and so denied the possibility to his doctor when he initially went to see him about sexual problems.

It took him about 6 months to accept that he had depression and to be able to tell his GP about it.

Age at interview 45

Gender Male

Age at diagnosis 45

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So January 2003 I kind of came out a bit of this downhill process, and I decided to go to the doctor and talk about the problem of losing interest in sex, and I was quite embarrassed about going to a doctor and saying, ‘Well, you know. And funnily enough he asked me, ‘Is this anything to do with. he didn’t say depression, I don’t remember what he said, but he asked me if this was related to stress.

And I said, ‘No’, almost as if I didn’t want to accept the fact that you know’ So I said, ‘No, no, no. I said, ‘it’s actually very embarrassing. And he said, ‘Don’t [feel embarrassed] because I see it every week, men with this problem, and he said, I’ll give you Viagra.

And then I was, ‘Okay’, so he gave me Viagra and it took me a long time to try, and then once I did try and then, it does work or it did work. But I realised that I felt horrible because in fact it was not even the fact of performing sex, or not, it is not even wanting to have sex at all.

So when I look back now, it started in November 2002. And so it was like 6 months, almost for myself to accept that I was’ or something was utterly wrong with me, to go to the doctor and ask for help, you know. Because in previous depressions I had managed not to go to the GP. I never took medication for depression before.

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It was striking how some people managed to struggle on with depression even with severe symptoms. Sometimes only a crisis (e.g., a suicide attempt, inability to work) made them take notice. For instance, several people were alarmed enough about their attempts at suicide that they finally saw a doctor.

As a 14 year old her suicide attempt frightened her enough to visit her GP, who diagnosed…

Age at interview 24

Gender Female

Age at diagnosis 14

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When I was about fourteen I had my first suicide thought. And attempted to commit suicide after a relationship break-up.

And, I tried to jump out of a three storey building window. At which point I was caught and sort of taken down by somebody in the house, and it was then that I realised that I really should not be feeling like this, and I had no support from the family environment. No-one was picking up on how severe things had got for me, I knew it wasn’t the norm to be doing things like that. So I took it upon myself to go and see my GP, and speak to her.

So you went by yourself?

Aha, yeah.

That’s unusual for a teenager?

Yeah, but I think when you’re actually faced with, “Oh my God I would have jumped if someone hadn’t come in”. That just absolutely petrifies you because you know that you’re young, you shouldn’t be feeling like that, it’s not right, theres got to be something wrong. Can somebody take me out of this environment? Is it my environment? Is it me? Is it’you want someone to sort of answer those questions for you.

So, sort of, I suppose clever enough to sort of work out that I needed to go and see someone to get some sort of help, and so then went to see my GP and she diagnosed it, straight away.

Right.

You know, she said, “Yeah, you’ve been, you’ve been suffering from depression for a long time, we had thought it. And knew a lot about my family history. My parents history. My father had suffered with severe depression throughout all of my childhood, so obviously that has impacts on you.

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Believes she has had depression for many years but was able to normalise it, and only considered…

Age at interview 44

Gender Female

Age at diagnosis 41

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I want to begin by asking you if you remember a time before the depression, what life was like?

I actually find it quite difficult to remember a time (before depression) because whenever I look back now I wonder if it wasn’t sort of… that I’ve been chronically almost depressed for a number of years. Prior to being diagnosed, I had periods where I felt really, really low that, for what seems very little reason I would suddenly plummet to, great depths. And I had real difficulty keeping going on, on a day to day basis.

And eventually I would just sort of keep my head down, keep on working, feeling really miserable inside, but eventually emerge at the other side. And then to counterbalance that, there were times that I felt it was almost euphoric. So I had the huge sort of waves and dips, emotionally and mentally, for a number of years. So I look back now, and I think it was probably in my late teens, early twenties that I can remember a phase where perhaps I wasn’t affected to that degree. But it became much more prevalent probably in the last 7 or 8 years.

I was very aware that, at times, things were really difficult, but it still never struck me. I just thought that…. blamed it on hormones, blamed it on life events etc. But I went through a period where in one of my very low periods, that I began to contemplate suicide, contemplate, actually just that life wasn’t worth going on.

There was no point wading through this shit, I suppose any longer, it was just becoming more and more difficult. And it was at that point that… that I realised that if I was going to get through this’that I had to seek some help. And that’s when I went to see my GP.

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