Monday, 7 April 2014

Symptoms I have known

I think that people underestimate the range of symptoms thrown up by depressive illnesses, not just the usual diagnostic criteria but the strange symptoms and behaviours that can afflict one on the dark path.  I mention behaviours in this as, unlike some people, I actually consider some of my odd behaviours not as separate things or indications of other mental health problems but as symptoms that I would not have if not for my depressive illness.  I don’t deny that I have been recently diagnosed with a personality disorder but some of my behaviours are definitely related solely with my depression.

So, very much in the same vein as my previous article on side effects of my medications, I have decided to write about the symptoms I suffer from in the hopes that it might make someone suffering the same symptoms feel less alone in their pain.

I suppose we should start with the regular stuff first, the most common symptoms or the ones you’ll find in most books on the subject:

  • Persistent low mood (for at least two weeks) plus
  • At least five of the following:

1.    Poor appetite or weight loss/increased appetite or weight gain
2.    Sleep difficulty or sleeping too much
3.    Loss of energy, fatigue or tiredness
4.    Body slowed down or agitated
5.    Loss of interest or pleasure in usual activities
6.    Feelings of self-reproach, excessive or inappropriate guilt
7.    Complaints or evidence of diminished ability to think or concentrate (slowed thinking or indecisiveness)
8.    Recurrent thoughts of death or suicide or any suicidal behaviour

The above symptoms are self-explanatory and aren’t really worth discussing in too much detail, however, I do have a problem with the persistent low mood one because it could be said to be entirely subjective.  In my case, I have had persistent low mood for 35 years yet my consultant psychiatrist has been of the opinion that I don’t actually suffer with a diagnosable depression even in the presence of at least five of the other symptoms.  It’s hard enough living with depression as it is without being told that your persistent low mood isn’t technically low enough to count as depression.  But a sufferer knows how low they are feeling and how long for, by what right can a psychiatrist, who knows nothing about your usual level of happiness, dictate what is or is not low mood for an individual?  A bit of a side issue, but I think something the profession needs to think about before writing someone off as not depressed.

The trouble with this list is that some of the symptoms can be made worse by the medications you take.  Items 1, 2, 3, 5 and 7 on the list are common side effects of anti-depressants so once you’re on medication for depression, you may not know if the symptoms are genuinely hanging around or if they are, in fact, side effects of the meds.  The only real way to find out is to ‘take a holiday’ from your meds (under supervision of a mental health professional) and see what symptoms remain.

Now we need to look at the other symptoms, the weird and wonderful problems that can crop up with depressive illnesses.  To do this I will take myself as an example.

Anxiety is quite a common co-morbid problem with depressive illnesses but mine comes with sometimes quite severe feelings of paranoia, the feeling that people are looking at you in a strange accusatory way whether they know you or not.  In some ways, my paranoia can be traced to life events but there are also times when paranoia just hits with no provocation.  There are many times that I have questioned people’s motives simply because my paranoia has kicked in.

My depression has also made me quite susceptible to obsessions and compulsions.  One of my over-riding obsessions is the need to find the perfect (or nearest to perfect as possible) instance of any item I purchase.  I take a terribly long time to buy magazines because I have to make sure that there are no imperfections in or on the paper – no dog-ears on the pages, no bends on the spine, no bad printing – and it doesn’t matter how small the imperfection is because once I’ve seen it, I can’t forget it’s there.  In fact, any imperfections tend to draw my eye like a magnet.

I’m also compelled to collect things – partworks, magazines, series of books, anything collectable.  I suppose I should count myself lucky in that I limit my compulsion for collecting things to only things that actually interest me.  I don’t collect, for instance, every copy of a particular newspaper or every piece of junk mail that comes through my door but if there’s a set of books and I have the money I will attempt to buy the entire collection.  For a while, I was compelled to buy the “Very Short Introduction” series of books until I no longer had the money to buy them.  I started out by buying one that I liked the look of and suddenly my compulsion hit and I ended up buying about 55 of them.  I managed to keep myself in check by prioritising the books with subjects that really interested me but I would pick up one even if it didn’t interest me to make up the numbers because, I may be obsessive and compelled to buy the books, but I would only get them on a deal for financial reasons.  Most of the books and magazines I have collected have remained unread because, although I may be interested in the subject matter, I tend to lose interest in actually reading them when I’ve got them home.

This kind of leads me onto the other aspect of my collecting – the need to buy things to feel ‘normal’.  It’s an offshoot of the obsessions and compulsions I suffer from but also has a ‘feel’ of its own.  The more unwell I feel, the more I will seek out things to buy because for the brief time it takes to look for and purchase an item, I feel calm and just like any other person because buying stuff is a ‘normal’ thing to do and I need that normality.  Unfortunately, almost immediately after I leave the store, I am hit by a wave of self-hatred.

Due to certain events during the teacher training course I was on, I was compelled to go to the local ‘pound’ store where everything costs £1 and I would routinely go to class with a bag with five DVDs in it that I felt compelled to buy.  Thankfully, they were all films I was interested in watching but it was still a problem.  I have, however, become quite the connoisseur of the lesser known distribution companies output and there are some great foreign films amongst them, let me tell you.

The obsessive compulsion to collect things and the compulsion to buy things stem from the feelings of emptiness I feel at the very heart of my soul which in turn causes feelings of self-hatred.  Self-hatred builds with every purchase and with every new collection I start but is also added to with every insult, every bit of unwarranted criticism, every putdown that adds to my negative self image and need to punish myself for my perceived weakness.  I know in my heart that I am actually quite an emotionally strong person and possess an equally strong will but depression weakens even the strongest person as it makes you emotionally raw like having a whole in a tooth that leads straight to the nerve.  Every negative comment, every insult, every putdown is like having a toothpick rammed into the hole in your tooth and deep into the nerve.  To have endured that for almost 36 years is proof enough that having depression may be disabling but also makes you resilient...for a time, however, there will always come a time when your resilience is so low that you succumb to darker, self-destructive urges or simply breakdown.

Depression breeds a lack of motivation and a corresponding lack of interest in one’s personal safety.  Why bother doing anything if everything always seems to turn out bad?  And why bother worrying about personal safety when all you can think about is wanting your misery to end?

I don’t know about other sufferers but I have terrible mood swings.  They aren’t bad enough to warrant a diagnosis of bipolar but they can be quite severe and the duration of each swing of the emotional pendulum can vary wildly.  I have had such severe mood swings that I have gone from happy to sad to angry to back to happy in the space of less than an hour.  And mood swings, especially the emotionally violent and rapid ones can be so emotionally draining that the following depressive phase is worse than any previous phases and self-hatred and the inability to motivate yourself to do anything become almost paralysing.

I exhibit many aspects of a persecution complex which is tied not only to my paranoia but to events in my early life that left their indelible mark on my psyche.  I tend to keep stopping still when walking anywhere and turning around to make sure that no one is coming up behind me to attack me and I am almost constantly haunted by the idea that people are looking at me, talking about me, judging me.

I suffer with a very bad memory, sometimes even forgetting things that happened only minutes beforehand.  I have always put this down to my brain’s need to block out as many bad memories as possible but losing the ability to discriminate between the good and the bad memories thus deciding to repress everything to protect me.

Depression can make you feel so worthless and emotionally drained that you start to lose interest in your personal appearance even to the point that your personal hygiene becomes less of an issue for you and you end up bathing less frequently.  There have been times during my worst depressive episodes when I have gone without bathing for a week and only bathing then because my body has become too itchy to ignore.

A depressive tends to become very needy in terms of requiring almost constant external validation from those around them if only to try to counteract the almost constant droning of the voices of self-hatred running around in one’s head – not literal voices though, just the kind of thoughts you have when left with no other distractions.  It was this need for external validation that made me send in draft after draft of my various essays for the various courses I have taken to my tutors.  I knew that the work I was producing was good but my mind rejected those thoughts until I received confirmation from my tutors; even then the depression refuses to let me believe in the good things that are told to me as they conflict with my negative self-image.

It is so hard for a depressive to believe anything good about themselves because of the deep self-hatred built up over the duration of the depression and the longer the duration spent on the dark path the harder it is to ever believe anything good about oneself.  It takes ten good things to register a good thought in a depressive’s mind and only one bad thing to wipe it out so it is no wonder that depressives end up almost entirely mired in self-loathing, denying anything good within them.

With all this going on in a depressive’s mind, it is no wonder that they resort to self-harming behaviours and there are so many to choose from – cutting oneself, taking overdoses, over-eating, starving oneself, buying stuff to fill the empty void within, isolating oneself from the rest of society, binge drinking, taking illegal drugs and engaging in hazardous activities to name just a few.

I, myself, have succumbed to suicidal acts – taking overdoses and trying to hang myself – and, as I’ve mentioned before, I tend to feel compelled to purchase things to feel normal.  I tend to comfort eat and regularly isolate myself from people both in the ‘real’ world and online.  When I was younger, I over indulged with alcohol but not to the extent of binge drinking as it is currently defined; in fact, as it was at a time when I was still undiagnosed as a depressive, it could be put down as an attempt to self-medicate with alcohol to cope with my depression.

All of the symptoms and behaviours I have mentioned above I have, to one degree or another, exhibited.  Some of the behaviours, such as taking illegal drugs, have not been part of my repertoire but have been included as further examples of behaviours exhibited by people walking the dark path.

It is my hope that by being honest about the symptoms and behaviours I have suffered from myself or that have been reported by others, sufferers of depression will be able to feel less alone in their darkness, that somewhere out there someone else is going through similar experiences and having similar thoughts and in that knowledge they may find some measure of hope.

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