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Memoirs detailing struggles with depression are important to reduce the continued stigma associated with the condition
Depression is now the leading cause of ill health and disability worldwide, according to the World Health Organisation (WHO). More than 300 million people around the world are currently living with depression, an increase of over 18 per cent between 2005 and 2015. Each year, almost 800,000 people die due to suicide and for every suicide there are many more people who attempt suicide. Despite positive statistical trends in recent years, suicide is still the second leading cause of death among 15 to 29-year-olds globally.
It is impossible to over-estimate the suffering caused by depression. Mary Cregan, in her recent memoir, The Scar: A Personal History of Depression and Recovery (Lilliput, 2019), writes that “serious depression causes useless, prolonged suffering, and – given how common it is – a wasting of human potential on an enormous scale”.
The symptoms of depression can vary between individuals depending on the person’s character, their life situation, any stresses triggering their depression, and various other factors. Sometimes, the clinical picture is very confusing and can initially appear to make no sense at all.
Over time, however, certain patterns emerge in many people with depression, eventually pointing to the correct diagnosis. The WHO outlines a range of symptoms that are especially common features of the condition. These include low mood, loss of interest and enjoyment, reduced energy, marked tiredness after slight effort, reduced concentration and attention, diminished self-confidence and self-esteem, and ideas of unworthiness and guilt. There can also be pessimistic views of the future, hopelessness and helplessness, disturbed sleep and appetite, and ideas or acts of self-harm or suicide.
Patients often say that it is impossible to understand fully what depression feels like unless you have experienced it yourself. This is undoubtedly true, but there are still insights to be gleaned from other people’s accounts of their depressive illnesses, both from patients in surgeries and clinics and from people with depression who share their stories in the published literature. Cregan’s book, The Scar, is an especially affecting account of the condition, dealing openly with loss, suicidality, depression and various forms of treatment including electro-convulsive therapy (which she found very beneficial).
Cregan writes with particular grace and candour about antidepressant medication, which has also helped in her recovery.
Despite uncertainties about how the brain works when a person is well, let alone depressed, and despite our lack of knowledge about the mechanism of action of antidepressants, there is compelling evidence that a majority of people with depression benefit from them. Indeed, treatment with an antidepressant is more effective in reducing relapse of depression (relative risk reduction: 58 per cent) than aspirin is in reducing serious cardiovascular events (19 per cent).
Of course, medications have side effects as well as benefits. Some people do not benefit from antidepressants and others experience only adverse effects. Plainly, when the benefits of any medication outweigh the adverse effects, it should be continued for the course of treatment. When the adverse effects outweigh the benefits, other strategies or medications can be considered. With treatment, 80 per cent of people with depression recover fully and 20 per cent have problems requiring ongoing treatment and care.
Psychological therapy, such as cognitive-behaviour therapy, can be just as useful as antidepressants in mild and moderate depression, if the therapy is available in a timely fashion. General psychological support is also vital. Cregan, again, highlights this in her book.
Tolerance is vital. There are evidence bases to support the full range of treatment options (psychotherapy, medication, ECT, social prescribing) in various different situations. Because each person is unique, a number of different treatments might be tried before finding one that works.
Despite these very useful approaches to treating depression, there remain very real challenges in the field and much work to be done. Suicide rates need to continue to fall over the coming years: Even one suicide is one too many. We need better staffing of community mental health teams, more ways for families to become involved in care, expansion of services for children and adolescents, and continued implementation of A Vision for Change, the national mental health policy devised in 2006.
Most of all, we need to continually address the stigma wrongly associated with mental illness across all sectors of society. After all, one-in-four people will experience mental illness at some point in life.
Memoirs such as Cregan’s help greatly with the reduction of the stigma. Described as “searing and riveting” by novelist Colm Tóibín, the book tells a relatable, real-life story that is as moving as it is engrossing.
Most valuably, perhaps, The Scar helps focus attention on the reality of life lived with the challenge of depression. As Cregan writes: “Perhaps living with this challenge has in the long run made me stronger and taught me greater patience and resilience. But I would have given – and would still give – almost anything to be free of it.”