Depression: Why sometimes it’s normal to feel sad
Readers talk back
Sue's in her mid-20s, well-educated with a full-time job in the city that she enjoys very much.
She's been my patient for a few years now but I have only seen her intermittently for routine checks and the odd cold or two.
However a couple of weeks back Sue presented asking about treatment for depression. It seems work has been particularly stressful over the last few weeks, her grandmother died three weeks ago and one of her best friends in the office left to go overseas. Sue just feels tired and miserable and doesn't feel like going to work.
Apparently Sue's mother takes medication for depression so, not unreasonably Sue wondered whether she needed treatment.
Now don't get me wrong – I think it's wonderful that people are so much more open these days to the possibility that they might need treatment for a mental illness. And it might well be the case that Sue does have a predisposition to getting depression based on her family history.
But in this scenario it's absolutely normal to feel down. As I said to Sue it would be more abnormal not to be affected by these recent events. It's the same in situations when someone dies. So often, there's a well-meaning relative or friend who insists the grieving partner needs to see a doctor for a script of anti-depressants to help them cope.
It's understandable to want to do something if you see someone in pain, but the reality is these are treatments for a disease and the reaction people feel to stress or loss, while unpleasant is not necessarily a disease.
With depression it's particularly confusing as we have the same name for the symptom as we do for the clinical condition.
Some specialists are trying to have the terminology changed, referring to the sensation of feeling depressed as melancholia. I'm not sure how that will take given that it sounds like a chapter in a Jane Austen novel but the principle of separating the terms certainly would be worthwhile.
Another challenge with depression (the condition) is that it may develop following a trigger such as a death or a particularly stressful period. What's more, the point at which a 'normal reaction' clicks over to a 'clinical condition' is very tricky to pick.
There are all sorts of factors including time, a person's ability to function, their ability to enjoy different things...So I can't say to Sue she definitely doesn't have depression. However for every one person whose depression starts this way there are hundreds who will feel better with a bit of time and without any medical intervention at all.
No one enjoys feeling miserable but it's part of life, and in situations such as this it's to be expected. Medication is not the answer. Instead it is better just to be patient. Exercise, talk about the problem, eat well and avoid alcohol - that will all help, but overall it's time that is needed.
Sue's not unwell, she's upset, and she needs to look after herself the same way she'd look after an upset friend. I'm seeing her again in a couple of weeks, sooner if she needs it but I suspect she won't. The only good thing about bad times such as these is that they do pass.This story first appeared on It'sMyHealth