Different shades of darkness

IN the wake of the death of Robin Williams, I want to go back and revisit depression and the mythology around a condition which will be the second most disabling illness in the world by 2020 behind heart disease.

The reason depression is such a lethal disease is that from the outside it’s often very hard to tell that someone is suffering from a bout. Therefore it is very difficult to recognise when someone has passed the point of ­despair.

Often when I’m depressed, let’s say for a few weeks, I can appear on the outside to be very cheerful, sometimes even gregarious. This feature can be the danger point for parents, loved ones and colleagues.

Within depression there are shades of darkness and light. You can be living under the umbrella of a depressive episode which might last months — but every now and again the rain stops, the sun shines on one’s face. The umbrella goes down, we can smile up at the sky, take a deep, grateful breath, even twirl around in relief. But due to faulty brain chemistry the rain can start again under the slightest stress until levels of serotonin or dopamine are restored with medication, rest, talk-therapy or exercise.

Because depressed people tend to remove themselves from the world during the storm, and only come out during their better times, it’s illusory. No one sees what goes on behind closed doors. They forget it’s been several days or weeks since they saw that person. My therapist at the Black Dog Institute explained to me once that when the pain stops temporarily, there might be an exaggerated sense of exuberance just because of the relief.

I suspect that in the case of many high-profile people who unexpectedly committed suicide recently, the danger wasn’t evident to those around because the “up” times — sometimes artificially induced by illegal drugs and alcohol — seemed so real.

Also depression categories can differ — there are many forms of the illness: melancholia; atypical; bipolar depression; GAD (general anxiety disorder). All have differing features. Some people rapid cycle, and can come in and out of depression quickly, but it doesn’t mean the short lows aren’t very low.

So how do loved ones tell if a person is going under?

It’s hard to finish this column with the truth — there is no definitive answer.

Worse is that we sufferers often don’t know ourselves that we’ve fallen into depression until someone alerts us.

But if not an answer at least I’ve posed a question that needs to be constantly asked. Take note when things said or done by a loved one seem unduly negative or out of character. And don’t ever be fooled by a smile. Exuberance is often the calm before the storm.


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