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Dealing With Depression

Here comes the time when many turn their backs on the person who has just snubbed them, leaving the unfortunate to "stew in their own juice." All too often, this self-centred attitude drives them even deeper into depression because they feel abandoned by the friend they thought could help. They did try to ask, but mood and circumstances caused the words to come out in a way that wasn't intended. The fact that the outburst was taken the wrong way wasn't their fault - they were confused, troubled and more than a little frightened of what seemed to be happening to them, a progressive illness that they couldn't explain, not to themselves or anyone else. In their eyes, no-one cares, not about their state of mind, nor the problems making them feel the way they do. A singular incident like this can trigger a paranoid defensive reaction targeting all and sundry. Every friend looks increasingly like an enemy, and strangers are viewed with suspicion as co-conspirators. Although irrelevant to the rest of us, they can regard isolated events occurring on the other side of the world as personal attacks. It sounds irrational. It is, but it is understandable - the original clear-thinking person who only had a few problems has graduated to become a patient in need of psychiatric treatment; all thanks to the thoughtless act of someone who didn't realise how serious the situation was soon to become.

It may be possible to coax them into visiting a doctor, especially if they are displaying clinical conditions such as dermatitis, digestive problems, migraine, or insomnia. In the main, these are ailments which can be treated to help alleviate some of the side-effects of anxiety and depression; but a few pills and creams won't fix the major problem. Assuming the doctor recognises the underlying cause, a referral to a specialist is likely to be the next step. Though probably advisable, this suggestion could actually make matters worse. For the patient, the mere mention of psychiatry can have them believing they are going insane, as they suspected they were. Now is the time when the support of those around them is essential, to allay their fears and reassure them that the expert they will be going to see is their best chance of recovery. They also need convincing that everyone will continue to be there for them, through thick and thin; and this assurance has to be more than just empty words. The last thing they need to discover is that friends and family are beginning to distance themselves.

This can happen when a patient agrees to visit a psychiatrist. For their close associates, apart from feeling uncomfortable in the presence of someone who is "not quite right in the head", there is a danger in assuming that everything will be okay now that treatment is going to be specific and customised. Some may even regard their job as done, especially those who were instrumental in steering the patient towards a mental health specialist in the first place. The reality of the situation is far from it. Anyone not admitted as an in-patient to a clinic will need even more support, in particular the continuing kind; and it won't be easy.

Drugs of various types will be trialed to control such things as anxiety, sleep patterns and other behavioural abnormalities. Ideally, administration of these should be monitored by another party, especially if the patient is believed to have a tendency towards self-harm. Even if not, it must be remembered that they are confused and can't be relied on to take what is necessary, when it must be taken. Unless advised by the specialist who prescribed them, there is no leeway. A patient may feel "better" and not really in need of their bedtime pill; the carer might agree; neither can make that decision. Medication must be taken exactly as directed by the doctors - otherwise they can't know if it is having the desired effect, or if it needs changing. Should there be an unexpected adverse reaction to a particular medication, this fact should be reported immediately to the specialist before administering it again, or discontinuing it altogether.

Psychiatrists are the target of many jokes, so too people suffering from mental illness; but this is definitely no laughing matter. Friends trying to make light of the situation in the hope that humour will lift the mood of a patient are playing with fire. This is saying: "Come on, join in the fun." Such action, albeit well-meant, is more likely to bring tears than happiness. How can sufferers of depression enjoy themselves when they can't remember how? Seeing others clowning and laughing just reinforces the distance between the dismal place they find themselves in and the cheerful one they may never visit again. In these cases, actions and words speak very loudly indeed. Any approach should be gentle and pre-considered, tone of voice normal, subjects mentioned neither invasive nor confrontational. A patient's response to these and other stimuli will be a guide to what is and is not appropriate; but it may only apply to a particular moment: a change of circumstances or exposure to fresh information can produce an unexpected, perhaps seemingly alien reaction. A photograph, a casual comment, glimpsing a TV show or news report, hearing a sound outside like squealing tyres, any of these can trigger an instant replay of a past incident which has contributed to their current state of mind. Quizzing them on a sudden bad reaction should be left to the professionals; the job of carers is to offer words and deeds that comfort and reassure. Patients need to know that the world they thought was lost forever is still there and is ready to welcome them back without obligation.

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