- Tony Frais
- afrais{at}tiscali.co.uk
Waking in the middle of a dream, I felt a palpable click in my brain. Suddenly I felt very unwell. It was the same uncomfortable feeling you get when you are on the downhill part of a roller coaster. I got out of bed very scared of what was happening to me. I decided to book an appointment with my GP. My expectation was that I would be prescribed a pill and that would be the end of my discomfort. It never crossed my mind that any of this would be related to my mental health. I had no symptoms or concerns before this.
My GP referred me to a psychiatrist. It was an evening appointment, and I turned up feeling quite cheerful. Unknown to me at that time, I was experiencing a feature of severe depression known as diurnal variation. I felt unwell for most of the day, and then magically the symptoms disappeared in the evening, before returning the next day.
Treatment with a positive thought
I was prescribed medication to help my mood and sleep, but it didn’t make me feel any better. I then tried another medication that didn’t help. Nothing seemed to be working. My hope for recovery was fading fast. This led to thoughts of suicide. In desperation, and believing there was nothing to lose, I started looking on the internet for other treatment options. I discovered electroconvulsive therapy and asked to try it. I had a full course of treatment.
After a few weeks I walked outside and remarked to myself, “What a lovely sunny day.” The symptoms had disappeared. It felt as though my brain had recognised that I had not had a positive thought like that for 10 months. The depression went as quickly as it came.
Finding the right support
My focus now is on preventing relapses. I recognise that psychotherapy is crucial to this. Finding a psychotherapist who tailored the treatment to my needs and was on the same wavelength as me was challenging. Not getting anywhere with my first psychotherapist, I started to think that this kind of treatment might be a waste of time. But I tried two other psychotherapists before I eventually found the right person, and they were extremely helpful and effective in supporting me to recognise possible relapses. I wish I had been told at the beginning of my journey that I might need to try a few different therapists before finding the right one.
Alongside my psychotherapy I have remained on medication for the past 20 years. I have no serious side effects and would worry about another relapse if I were to come off it. I was not aware that the dysregulation in my brain caused by the depression meant there would be the ever-present potential of relapse. I wish someone had told me that recovery from depression is fragile, that there may be relapses, and that I would need to manage them. Knowing this would have helped me to recognise the importance of continuing treatment and leaning on the support I need to help me avoid the drop of a roller coaster again.
What you need to know
Severe depression can appear from nowhere with no previous symptoms, leaving patients confused, frightened, and lost
When discussing a diagnosis of severe depression, help the person to understand that treatment may be complex and that it might take time to find the right approach
Having an open conversation about the potential for relapse can help patients understand the importance of continuing treatment
Education in practice
How could you ensure that a person with severe depression feels supported to navigate different treatment options?
When might you have a conversation about relapse and the importance of continuing treatment?
Footnotes
Competing interests: none.