Depression: The Pain That Never Goes Away

'It takes an incredible amount of strength to move through the darkness'

Posted By Doug Edgar

It was Churchill's black dog. "Bob" calls it the dark place. "Jane" thinks of it as the black hole.

They are all references to depression - a condition Statistics Canada has pegged as the fastest-growing diagnosis in the country and one that some local mental health officials believe most sufferers still try to deal with on their own - and society as a whole often doesn't recognize as a potentially debilitating illness.

Bob - a local man who spoke on the understanding he would not be identified - has been diagnosed with bipolar disorder, a condition that involves mood swings from highs to lows. Jane, also not her real name, is a middle-aged woman who said her depression has been a chronic condition since she was a teen.

"For me, it's just a pervading darkness," Bob said of his depressive episodes. "I don't want to do anything. I don't want to see anyone . . . all the things I usually like to do, I don't want to do."

Just getting out of a chair can be a chore and "decisions can be completely paralyzing," he said.

For Jane, depression was more about feelings of helplessness, feelings that led to thoughts of suicide because "that was something I could control."

Both have learned that while they may share many experiences with others as they deal with depression, there are also differences, from triggers to treatments, that make each case unique.

But when does feeling down become a mental illness? It's a question even Bob has trouble with at times when he examines why he might choose not to do something.

"Sometimes I'll catch myself asking: Is this illness or personality?" he said.

Most cases are less severe than Bob's.

"When we're talking about clinical depression, we're talking about depression that persists for more than two weeks," said Claude Anderson, executive director of the Grey Bruce branch of the Canadian Mental Health Association. "We know that (when) things like work and socialization start to become affected, that's when someone would normally need to seek some help and treatment."

Symptoms include sadness, loss of interest in usual activities, changes in appetite, changes in sleep, changes in sexual desire, difficulties in concentration, a decrease in activities or social withdrawal, increased self criticism and thoughts of suicide. Depressive illness can change the way a person thinks and behaves and also how his or her body functions.

Temporary depression can persist and become a more significant mental health problem for between 15 and 20 per cent of men and 15 to 25 per cent of women, according to the Centre for Addiciton and Mental Health.

"It's a fairly substantial part of the population. At any given time in a workplace, for example, approximately one in 20 employees will be experiencing clinical depression, so it's fairly significant," Anderson said.

While people often recover from depression without treatment, getting help will likely cut the time involved and the impact it has of the person's life.

"The average for a mild episode would be about 16 weeks. Then there is some severe depression that may require up to two years to recover, and then there is approximately 10 to 20 per cent of people who don't recover, who have persistent clinical depression," Anderson said.

"Fifteen per cent of people with serious depression commit suicide," he said. "That's a staggering statistic."

A depressed person may have trouble realizing he or she has a problem, then have difficulty seeking help, since he or she may not want to do anything.

"It takes an incredible amount of strength to move through the darkness," Bob said.

There's also a stigma attached to many mental ilnesses, including depression. Such attitudes can prevent people from seeking help and make recovery more difficult.

"This is something that no-one need be embarrassed about," said Anderson. "It's an illness, not a weakness . . . people think it's a weakness, or that you're somehow responsible or bring it on yourself and if you just pull up your socks you'll be fine. When you have that cloud hanging over your head - that somehow you're to blame for this - its very hard to disclose it to family and friends."

That attitude often holds true for people suffering from depression too, at least at first, according to Bob.

"People with mental illness are a part of society too," he pointed out.

He had to accept his illness before he could improve his life.

"You come to the realization that you have this, let's move on."

According to Statistics Canada figures, however, only a third of people who suffer from depression ever seek proper help. Anderson is sure many people successfully mask depression for years. They may cope, but they also suffer in silence. "I think that's where coworkers, family, friends need to be educated on the signs and symptoms of depression and if they know someone who they feel may be depressed, they should encourage them to seek medical attention," said Anderson.

There are many ways to start getting help, said Shane Barker, director of community network programs with the Grey Bruce Community Health Corporation. It could begin with a trip to the doctor, help through a program at work, or through groups such as the CMHA, the community health corporation, or one of five mental health teams in Grey-Bruce. For others, the first step could be speaking with a clergy member or a call to a help line, such as the Mental Health Crisis Line of Grey & Bruce.

"As long as they ask one of those key people, they will be able to get help," Barker said.

The southwest Local Health Integration Network, which funds and co-ordinates medical services for much of southwestern Ontario, recently announced $100,000 for education sessions to help physicians better understand and treat mild to moderate mental illnesses, including depression. The LHIN identified services for people with such mental illnesses as an area that could be improved, said Kelly Gillis, senior director of planning, integration and community engagement with the network.

"Traditionally, the health-care system has not focussed particularly on individuals with more mild and moderate mental illness and so we see gaps across the system," she said.

What the training will include and when it will start remain to be worked out, she said, but the money has been set aside and LHIN officials hope training for doctors will be available by late March. Funding has been approved in principle for the project in the following fiscal year as well.

Anderson and Barker agreed more training for family doctors is a good idea.

"I think more and more now physicians are being asked to diagnose and monitor people with mental illness, which was traditionally the role of the psychiatrist," Anderson said "In our community, for example, we're down to two psychiatrists, when we should have nine or so," he said. "We're so underserviced in that area that it puts an incredible pressure on family physicians to be able to assess and treat mental illness, including depression."

Anderson suspects depression may be more common in Grey-Bruce than elsewhere, based on higher rates of conditions and behaviours that can be tied to it.

"We do know that in our area we have higher occurrences of things like heart disease, diabetes, substance abuse, obesity. Those would be indicators that depression would likely be higher too."

Substance abuse can be both a contributor to depression and a coping mechanism, he noted. Similarly, obesity could be tied to poor eating and sleeping habits that often accompany depression.

Many people in Grey-Bruce get help through one of the Community Mental Health Teams. They are based in Hanover (Central Grey Bruce Team), Markdale (South Grey Team), Owen Sound (North Grey Team), Wiarton (North Bruce Team) and Southampton (Bruce Shoreline Team).

"People come into our service from a variety of avenues," said Jeff Franks, manager of the north Grey team, which is based at the Owen Sound hospital. Some come on their own, others are referred by family doctors or others in the medical system, while others might be referred through work.

Most people would come in for counselling with team members - social workers, psycholgists or nurses trained to provide therapy for people with moderate mental ilnesses, including depression.

The process starts with an assessment, often over the phone. After that, a series of therapy sessions - usually eight to 12 - follows. Team members don't prescribe medication, but quite often the therapy is accompanied by drugs prescribed by a doctor.

The person getting the counselling may not be entirely better when the sessions are over, but there is some flexibility in the system, Franks said.

"There's obviously a certain pressure on the system and if we start seeing people for an extremely long period of time it means there is less space for other people," he noted.

"My own personal feeling about therapy is you learn something, you make some changes. It may not be enough to get the illness completely in remission forever, but hopefully you can go out into your life and make some changes and if the illness comes back, you're welcome to come back."

Cognitive behavioural therapy, with or without medication, is the most common treatment, Anderson said. The person examines events in his or her life and tries to change negative ways of thinking about them.

"Often people who have a depressive illness start to put a whole bunch or negative events together like they belong together when they don't," he said. "The therapist can help pull those things apart."

Help also is available through the Grey Bruce Community Health Corporation's Consumer/Survivor Development Project, which operates information and support groups for people with mood disorders in Hanover and Owen Sound and people coping with mental illness in Wiarton and Kincardine.

There is a "community of understanding" in such groups, said Jim Lonie, co-ordinator of the consumer/survivor group. Participants can also share practical personal knowledge about things like treatments..

"It can be inspiring for people to see that others have got through this," he said.

Since depression has different causes, treatments can vary. Someone who has become depressed after a specific event such as a divorce might benefit most from therapy, while someone who is more chronically depressed due a biochemical imbalance may require medication.

Medication plays an important role in Bob's case, and he doesn't try to second-guess his psychiatrist. He's also careful about his general health - getting enough sleep, exercising., eating right - and hasn't been hospitalized for about five years.

Jane, on the other hand, can't take many medications due to another medical condition. She has found creative endeavours very helpful, especially writing and music.

"I did a lot of journal writing," she said. "It's a release."

Art therapy is a common way of dealing with depression.

"I believe the underlying aspect is that it gives you a physical example of your worth," she said.

Therapy didn't help her much until she realized she had to take a bigger role in it.

"It took me a long time to realize the counsellor wasn't going to fix me."

Both Bob and Jane said they have discovered things about themsleves and others through their depression.

"My depressive experience has created a lot of humility for me," said Jane.

"You learn some different things about who you are," said Bob. "There are lessons to be learned in the darkness." Article ID# 865339

Reproduced from http://www.owensoundsuntimes.com/ArticleDisplay.aspx?e=865339&auth=Doug+Edgar.

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