What about major depression?

Today is mental health day at work. By that I mean, I’m delving into the depths of the Ministry of Health’s Mental Health section, looking for information. It’s better than yesterday, which was infant mortality day. Anyway.

I found a neat wee Q&A about the National Depression Initiative, a project which I’ll talk about more when I have more time. For this quick post, though, I saw one question with an answer that really bothered me. It reads:

3. How is depression best treated?

Different types of depression require different types of treatment, and there are effective self help strategies for mild to moderate depression, such as regular physical exercise, relaxation and problem-solving techniques and positive social activity. Information about these approaches can be found on the main National Depression Initiative website.

This is an . . . interesting answer. In a way it’s really good, in that it can encourage people that are wary of medicalising what they just see as a case of the blues, and gives them the idea that they can be treated with just some small changes to life. Learning a relaxation technique or going out and seeing people a bit more sound just fine as methods of treatment, and it can encourage many people who wouldn’t otherwise to seek help.

It ignores a couple of things. First, that the first-line treatment for most people presenting with mild to moderate depression in many GP practices is to prescribe an SSRI. That might come as a shock to people who are looking for a Green Prescription-type intervention. Even if a doc makes the call to treat with non-medical intervention, there is still a chance that medication will be required, and I think it’s a little dishonest to not even mention the possibility of it.

Bigger than these for me is the fact that major depression is simply left out of the answer altogether. Depending on which doctor you ask, I have either Major Depressive Disorder or bipolar disorder. Either way, the depressive episodes I have are catastrophic. Looking in the National Depresion Initiative and seeing that depression is addressed by simple life changes, and then trying to apply that to my screaming disaster of a depressed self, would be terribly disheartening. If I worked out that I was majorly depressed, I think it would be worse – the first-pass look at resources for depressed people simply do not include me. That’s really really bad for my depressed brain, which goes ‘see, you’re untreatable. they don’t even have anything about you here. You’re just screwed, and no-one can help’. Depressed brains are jerks like that.

I get that they’re trying to make mental health treatment less scary and more accessible to all, to relieve the burden of disease that mental illness lays on society. That doesn’t mean that they can’t be inclusive of people going through more than just moderate depression – after all, they jump right in to talking major depression and suicide a few questions later. That’s a cheery thought for a depressed brain. They can’t tell me about treatment, but they can talk about suicide risks for people like me. Insert idea into depressed brain, blend, and pour out poison.

For an initiative designed to help depressed people, there’s a bit of a lack of thinking things through here.


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