Not that gripping today...

Well, what to do, what to do...

A lot been going on.

One thing, there isn't that good a correlation between blog posts and author moods. I tend to be more open in my blog than in my normal life, and I tend to write about (and thus think about) things that upset me, and so the average emotional content of the blogs is certainly more extreme than my normal life.

Having said that, moods have been down for a while, and I don't know that the valproate or the reboxetine are working well enough. Nor is the boxing or the writing or stuff. I wake early, I feel bad, I panic, I've got the whole "intrusive thinking about death" thing... all that. Next step I have to go up to the dose of valproatte that makes me both nauseous and hungry, or the dose of reboxetine that maketh me not as a mighty tower, tall and strong.

Nauseous, fat and impotent. That ought to cheer me up.

Thing is, depression is a complex beast. I've never been fully comfortable saying "depression is a disease like any other disease". That's true in one sense. I tell clinically depressed people that they have a disease, not a character flaw or a moral failing, and that like any disease, there are treatments. And that's true - people who get appropriate psychotherapy and appropriate medications do get better.

But depression is also a response to a situation. I tell people about the differences between, say, reboxetine and street amphetamines, and the most important one is if you feel miserable and you take reboxetine it does you no good at all. It doesnt' make you happy then and there, it only works in a few weeks, and it doesn't really work against misery, grief, sorrow or guilt. It works against the mental illness depression, which resembles some of those, but is different in that the feelings are inappropriate - you feel miserable when you should be happy. You feel horribly, crushingly guilty when you should feel good. You cry and you feel something like sorrow, or you feel nothing at all, when you can't find a need or an explanation for the sorrow.

But there are a couple of things wrong with that last paragraph. The one that worries me is the temptation to try to medicate away something that is not a medical problem, but at least partially a response to a situation. A woman in her thirties comes to me. She says she loves her highly paid, prestigious job, that her husband is a saint, that her life has been remarkably good... but in the last six ro so months, she's started feeling sad. She doesn't sleep, she worries instead. She's started putting on weight, she eats crap food then feels bad about it. She feels guilty, and she's started to avoid seeing her friends. Lately she's begun to wish that maybe there was some way out of all of this.

I could have her out of there in minutes. Does she have the symptoms? Check. Have the symptoms been there for long enough? Check. Are the symptoms not able to be better explained as bereavement, etc. ... well, that's what the crazy person says, isn't it? Check.

Is she depressed? Quite probably.

But is there something else going on? Is her job all that she wanted, all that she was told? What if she's got to where she wanted to go and she's not where she wanted to be? And what if she can't say so, because, for God's sake, she's got the good job, the good husband, the good life, the whole gold star on the colouring in and the elephant stamp on the sheet of sums? What if there is something going on, what if it doesn't mean much to her because it doesn't mean much? What if the part of her that realises she's got a job and a relationship and a life that she should love but doesn't.. what if that's the part of her brain that won't let her sleep? What if it's making her fat because it can't stand him finding her attractive and she wants out? What if the guilt is the unarticulated but obvious response to not feeling and wanting and taking pleasure in what should satisfy you?

Will she get better on the drugs? The evidence suggests she will. And they're good drugs, they've made a lot of people better, they save lives. I've seen it. And with the anti-psychotics and the mood stabilisers I do not have this concern. And I believe that the drugs can treat the pathological side of things, so they can get you well enough to solve your problems, and if that solution includes leaving your A-list spouse and living as a goat on the mountainside, you're more likely to be able to do it medicated and thinking calmly than not. Because depression, while it may be a response to a situation, is not an intrinsically adaptive one. Beaten wives, all that kind of thing.

I don't know. One day someone will come up with a new antidepressant - Stepfordamine. It'll be more powerful than the others, the side effects will be relatively acceptable, and it'll home straight in on those parts of the brain that in happy content people fire more often than the rest of us. Husbands will give it to their wives and they will love them like they did in the beginning. Anyone who reckons something like that wouldn't fly off the shelves, go to the back of the class. Save some seats for those who reckon stepfordamine is not coming in their lifetime.

We shall all be saved.

Sigh. Anyway.

Speaks to self: If you've got to where you wanted to get and you're not where you wanted to be, it's not like you're a fucking cripple. Get up and do something about it. I took today off, I'd done overtime Tuesday and Wednesday and Friday I start nights. That's a start. Tonight I see Sarah. I will write today.

Thanks for listening. Hopefully tonight I can post the truly Sherlockian "Strange Tale of the Depressed Intern", and what was said at the registrars meeting (much more exciting than it sounds) and try and work out what to do for this Friday night, when I may be in charge.