Stressed or depressed?
The reason so many functioning depressives don't realise they are depressed is that they (and those that love them) find it hard to distinguish the fine line between depression and the 'stressy', overwhelmed state that is the norm for many of us living the 21st century version of a happy, successful life.
Renee O'Neill, 40, a mother of two, and formerly a high-powered television executive had negotiated a four-day week and really did appear to 'have it all'. But the reality was that her work days had reduced but her work load hadn't. "Looking back I was definitely feeling down for a period of about two years," she says. "My answer was 'to get a grip'".
Renee thought that more exercise would get the famed endorphins pumping and blow away her blues; while she was on an early morning run she was crippled by sharp pain in her chest and the terrifying sensation that she couldn't breathe. I was sure I was having a heart attack and went straight to my GP. To my amazement told me my 'heart attack' was a panic attack and that she wanted me to take six weeks off work starting immediately.
Of course, when I found it wasn't physical I said there was no way I could take time off. Her response was "You are completely burned out and severely depressed. I see lots of people like you and I think if you take my advice and have a complete break, there's a chance that you'll feel better in six weeks. But if you don't, there's every chance you'll have a breakdown and be off work for months'".
Her doctor's evident concern shocked Renee into following her advice. "I phoned in sick and thought that after a few days sleep I'd be back at my desk inside a week."
The 'week' eventually became five months. "When I finally stopped and admitted everything wasn't fine, it was as if I'd been kicked in the stomach. I was overwhelmed with grief and cried for about two weeks straight," she recalls. She started taking Prozac "which did help although I don't take it now," she says.
Complete rest, resigning from her job, medication and therapy eventually helped her. Her depression lifted but has left a legacy. "I feel fragile – it's always out there the thought that I could slip slowly again into depression," she says.
"I take far better care of myself now, for instance, I left my job and started working for a friend in a more junior role." She is still amazed at how bad she had got without realising how ill she was. "Sure, I was stressed out – but I don't know anyone who isn't in my profession. But thank God my doctor was thorough and took vague symptoms that I disregarded, seriously."
These symptoms added up to a picture of clinical depression. "I wasn't sleeping, I would cry at the drop of the hat – once I burst into tears because a light changed to red as I was approaching it."
This attitude of 'getting a grip', working harder, becoming ever more perfect is far more prevalent than the popular idea of us demanding Prozac at the first sign of an obstacle, says Dr Brener.
Renee's response to her depression is typical of functioning depressives (Katherine Ward routinely worked until 11pm and every weekend.) "All sorts of distractions are used by depressives to change how they feel," says Dr Brener. "They work harder, exercise more or drink or take drugs more than usual."
This will work for a while, sometimes many years, but eventually the feelings of alienation will become overwhelming, culminating in a crisis. Renee O'Neill was lucky that her GP realised what was happening, but often the functioning depressives headlong spiral into ill health goes unrecognised until there is either a physical or mental breakdown.
'Siren sounding'
The Samaritans take this so seriously that they are training managers to recognise the 'siren sounding' but for the most part, whether or not someone challenges a depressive at the right moment, is mainly luck.
"A practical stranger gave me the impetus to get help," says Penny Gatt, 38, an academic. "I was in the pub one night when a friend's boyfriend, whom I hardly knew, turned and quietly said to me 'You really need to talk to someone. Here's the number of the woman who is helping me' and he gave me his therapist's number on the back of a beer mat."
Strangely, she wasn't offended, but relieved, although she still doesn't know how this man knew. "Perhaps it takes one to know one. That particular night I was feeling like hell, although no one saw it but him. He was very cynical and probably like me, felt that life was ultimately futile and recognised a similar outlook in me.
"I'd always felt like this, but when I was doing my PhD it got much worse. In public, I was the life and soul of the party, but the depression would get so bad that I'd spend four or five days at once lying in bed with the duvet over my head."
None of Penny's friends appeared to notice her disappearances or suspect her deep anger. "I was sweetness and light with them," she says. "The only person who felt my anger was my sister. Normal bickering had turned into me being totally vile to her."
Dr Neil Brener says that this pillorying of the people close to them is a pattern frequently followed by functioning depressives. Siblings are often the scapegoats, partly because of their loyalty but also perhaps because they are our most obvious peer group and serve to remind us of what we haven't got in life.
Friends of Katherine Ward have wondered if her own career success failed to compensate for the happy family life which her beloved and brilliant sister had managed to combine with a highflying job.
Penny admits now that she resented her own sister's self assurance. "She has always been quieter than me, but more self confident," says Penny, "and I resented this. I was the brilliant, flamboyant one, but she was steady, content with the long-term partner and I resented her that security.
"One of the things I came to admit in therapy was how lonely I am, that many of my so-called brilliant friendships were false. And a big move forward was when I started being more honest with friends about the things that weren't working in my life."
Sharing emotions
Sharing emotions is key. "If you are irritable, angry, sad, despairing - tell someone," says Mike Cobb, of the Samaritans. "Research shows that it works. Most people choose to talk to friends and family and that's fine. But lots of people find it even more helpful to talk to a complete stranger and that's where Samaritans and therapy comes in. The important thing is to talk to someone."
Recovery is possible. "We hear back from people saying 'thank God, I called you. My life's turned around in the last year'," says Mike Cobb. Dr Brener echoes this: "Another myth about depression is that it is incurable. In fact, I'd estimate that with the help of medication and some forms of counselling which change outlook such as cognitive behavioural therapy, around 70 per cent of people recover fully and most of the rest receive some benefit."
Further help - British Association for Counselling and Psychotherapy: 0870 4435252
Samaritans: 08457 909090 or jo@samaritans.org
Mind Information Line: 0845 766 0163
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