This is the fourth in my series of articles on depression — my depression. They are written from a very personal perspective; they are my views of how I see things working and what it feels like on the inside. Your views and experiences may be vastly different. My views and experiences are not necessarily backed by scientific evidence or current medical opinion. These articles are not medical advice or treatment pathways. If you think you have a problem then you should talk to your primary care physician.

Questions & Answer
What causes your depression?
As I’ve tried to say in previous articles in this series, the cause of my depression is certainly multifactorial. I know I have a tendency to Seasonal Affective Disorder (SAD) and I am certainly worse during the winter months. I also know that I may have a genetic predisposition to depression. My father was depressive, although I think never treated for it. And by all accounts my father’s father also suffered from depression. In my grandfather’s case this was put down to Trench Fever from WWI and the depression shouldn’t be surprising given his experiences in WWI and that he was a struggling back-street corner grocer in the Depression. Clearly none of this would have helped my grandfather but I suspect, from the little I knew him in old age, that he would have suffered from depression regardless. But then all the men in my family (and I include myself) are dysfunctional.
Perhaps, to me, the most obvious cause of my depression is stress, change and far too much to do; so much that I can never hope to catch up. Yes, I know I take things on (although I am getting better at picking and choosing what I do) and I’m involved in various voluntary projects. But I can’t sit and do nothing! As I said in an earlier post, an acquaintance commented to me recently about his situation: “if I sat at home all day I’d go senile”.
Other things that add to the depression, although may not be direct causes, are financial security (will I run out of money in a few years time); lack of achievement (past and present); a lack of attention (although I’m a loner I do still need people); dieting, having to watch what I eat and drink; being ill. All of those make things worse.
What are the physical effects of your depression?
It’s sometimes hard to separate the physical from the mental, the depression is so pervasive. Basically I feel incapable of doing anything. Nothing is fun or enjoyable. Everything is too much effort; I don’t even want to get out of my chair and make a cup of tea; and it’s this lack of ability to get up and do which stops me doing all the things, like exercise, which I know I should do. It’s like someone has taken all the elastic out of the joints and brain. I’m usually headachy and irritable. I often feel weepy — which is usually a part of a mild panic attack about being able to do something. I’m not interested in anything; I don’t want to do anything — even hobbies; and I can’t concentrate. I frequently sleep badly, although I’m dead to the world in the mornings and can sleep fine all morning. In the last few years I’ve had a very low libido; something I never used to have a problem with. It is all too easy to eat too much (which I know I do) and drink too much alcohol (which I am able to control — I am nowhere near being an alcoholic but I know I could go that way).
You’re on antidepressants. Do they have any side effects?
Mercifully I seem to tolerate most drugs fairly well; I’m not someone who gets allergic reactions, nausea or many of the more regular side-effects of most drugs. I’m currently on a moderate dose of my antidepressant. In the past I have been on the maximum dose, but managed to reduce this a couple of years back. And I don’t want to go back on the maximum dose because then I do get some side effects. The two most noticeable things are due to the anticholinergic effect of antidepressants: they decrease gut motility, so one tends towards constipation; and they are extremely good at preventing (not just delay; prevent) orgasm (which is why I don’t want to go back on the higher dose).
The other thing about the antidepressant I’m currently on is that it is one of the worst for getting off. Over the years I’ve had several attempts at reducing them with the intention of changing drugs, but every time I’ve ended up with withdrawal symptoms. I’m currently trying again and I’m more hopeful this time.
What is the depression like on the inside?
At the moment I have half a cold. Apart from the slight sore throat and tickly cough this is how I feel almost permanently. At least some part of a headache. Stiff neck, which is probably the cause of the headache. Physically drained, as if someone has taken all the elastic bands out of my joints, and slightly achy. I just want to close my eyes, and maybe sleep. I feel as if I have a head full of cotton wool and it’s been used as a football. I cannot cope with thinking about doing anything; let alone actually doing anything and certainly nothing I have to concentrate on. Thinking is fuzzy because I can’t concentrate. Everything is an effort. All I really want to do is curl up under the duvet until it goes away.
This is very much like you feel after a bad bout of ‘flu; when you’re beginning to recover but can’t yet do anything. You’re totally debilitated and incapable. And everything is too much effort — mentally and physically. But with ‘flu this goes away after a day or two. With depression it doesn’t; it stays; day after day after day after day …
Sometimes I have to curl up under the duvet; and sometimes some part of it does go away. For a while.
Are you typical?
I’m not sure there is a typical depression or reaction to it; we’re all different, although as I’ve maybe shown there is a set of common themes.
I got another view recently from Charlie at Sex blog (of sorts) who wrote about her depression.

Anxiety is so much worse than depression, right? Depression is just, well, sadness. And I can handle sadness … Sadness can be fixed with chocolate and wine and hot baths and long walks and time alone. Sadness is like a prompt to take better care of yourself: to eat properly, to get some fresh air, some more sleep.

Yeah, right! Charlie is being somewhat tongue in cheek here. This isn’t full on clinical depression. It’s more like what I’ve termed Dynamic Depression. But then she goes on:

I sit and I feel this crashing sense of despair that things will always be this shit, so what’s the point? What’s the point of anti-depressants or therapy, when life isn’t going to improve? Why won’t everything just stop? Why can’t I just go to bed and stay there?
… … …
People don’t understand why depression is tiring … It’s tiring not only because everything seems so pointless, but also because I’m in constant battle with myself. I’m not this person who doesn’t have any determination to achieve stuff: I have a good degree, a good job, some fucking self-respect, for god’s sake … my ability to give a fuck about any of that stuff has totally gone. Except it hasn’t. I still do give a fuck about it and so I beat myself up: I’m doing a shit job at work, I’m not socialising enough, I’m a lazy cunt. And the more I think and act on those feelings the closer I circle to burn out.

That’s better. That’s pretty much how I feel a lot of the time.
How do you get out of that?
That’s the point. I don’t have a flying clue. If I did you wouldn’t be reading this.

This series may, or may not, be continued at a later date.

This is the third in my series of articles on depression — my depression. They are written from a very personal perspective; they are my views of how I see things working and what it feels like on the inside. Your views and experiences may be vastly different. My views and experiences are not necessarily backed by scientific evidence or current medical opinion. These articles are not medical advice or treatment pathways. If you think you have a problem then you should talk to your primary care physician.

The medical profession generally characterise different types of depression by their causes and effects, and they may range from mild, through moderate to severe. (See, for instance, www.mentalhealth.org.uk/help-information/mental-health-a-z/D/depression/.)
However pragmatically, over the years, I’ve come to realise that there seem to be two types of depression, which I have never heard voiced by a clinician. I’ll call them Dynamic Depression and Static Depression on the basis of what appears to help alleviate them. I’m not in a position to work out if the symptoms and/or causes are different although I suspect Dynamic Depression is at the milder end of the spectrum.
Dynamic Depression
This is the type of depression which everyone thinks you have, and which is the subject of every self-help book (and a lot of counselling) that I’ve encountered. The “cure” (which is how I characterise these two types) goes along the lines of “put on some brass band music, have a cold shower, think how blessed you are with everything you have going for you, and just get on with life”. Yeah, right. That may work for some people; probably those with low-grade depression who have a short-term problem. This is out of the book of “tell it like I want it to be and it’ll be that way” management. It is a fallacy which does nothing but con the brain — though that may of itself be valuable for some. It doesn’t work for me; it never has; and it may be why I’ve never succeeded with talking therapies.
Static Depression
Many years ago I read an article by a couple of medics who had looked at a small number of patients hospitalised with depression. Unfortunately I didn’t keep the article and I cannot now trace it, but this was the gist … They found that if these patients were given the standard treatment of drugs and compulsory occupational therapy they didn’t get better and sometimes got worse. Further they observed that all the patients wanted to do was to sit in the corner. So the medics allowed them to sit in the corner. And they found that as long as the occupational therapy was there, and visible to the patients, then allowing the patients to sit and vegetate meant they eventually started to get better; they eventually came out and joined in the occupational therapy and started to recover. The medics’ hypothesis was that this was because these patients were suffering from too much stress and change in their lives and they needed a prolonged period of stability, on their own terms, to recover.
This is what my depression is like. It is (at least in part) triggered by stress, lots of expectation and a high level of change. Which, I suspect, is why the “dynamic” approach doesn’t work on me.
Fortunately it is now recognised that change, especially, is a major contributor to depression. And change is why our society has increasing rates of depression — society is always chasing after “faster, better, cheaper”; there is no stability and no respite. It is becoming a major mental health problem, and the solution is not to keep popping happy pills.

To be continued …