In this episode:
Venessa: Depression is often described through symptoms and checklists, but that rarely captures the reality. For many people, it's less about sadness and more about heaviness, disconnection, and just getting through the day. Lucy, thinking back to when you were diagnosed, what did depression actually feel like for you day to day?
Lucy: So when I was originally diagnosed with depression, it was actually physical symptoms that emerged first.
I spent a few months where I was actually very physically ill. I lost a stone in weight in about a month, and I was already very thin, so that was quite extreme. I could not sleep, or I was sleeping at really inconvenient hours for a long time. I had no focus, no motivation. I just could not eat. I did not want to eat. Or if I did eat, I binged. I just felt generally rubbish, and I didn't like myself very much, and all I wanted to do was sleep on the sofa or lie there mindlessly watching films.
So my mum became quite worried, decided to take me to the doctor. They did loads of physical tests while I was there, and everything came back normal, so they didn't really have a clue what was wrong. So they hesitantly suggested it might be depression and gave me some mild antidepressants to take.
A week later, I returned to university, and we were preparing for going out in the evening with my friends, and I just started crying, and I couldn't stop, and it went on for hours.
And earlier that day, I had gone into the bathroom to clean it because it was my turn on the rotor, and I literally ripped that bathroom to pieces in an effort to clean it. It felt dirty. I felt dirty. I just was consumed by this amazing energy that meant I had to clean this bathroom to within an inch of its life.
And then later on, the crying started and just went on, and obviously, my housemates were quite worried, so they phoned my parents.
My parents came and scooped me up and took me home, arranged for a doctor's appointment a few days later. I went to the doctor, and the doctor said, "Right. I'm going to write down a list of symptoms for you, and I want you to tell me which you have."
And they included crying all the time, suicidal thoughts, self-hatred, lack of motivation, lack of focus, not eating, not sleeping, and I basically said, "I've got all of those. I've got every single symptom."
And he said, "I think you're depressed."
And I said, "Okay."
Hadn't really heard about depression, was quite shocked.
But I was put on some antidepressants and referred to a psychiatrist, and that's how my mental health journey began.
Venessa: So Lucy, you mentioned the list that the doctor gave you when you went to see them. So Zing, could you tell us a bit more about this list?
Zing: Yeah. It's known as the PHQ-9, which is essentially a screening tool that doctors, psychiatrists, and psychologists will use in order to diagnose clinical depression.
The main criteria include a loss of interest in your usual activities, which impacts functioning, things such as not sleeping or oversleeping, weight loss or weight gain, depressed mood for most of the day or all of the day, suicidal thoughts, and a sense of worthlessness and guilt.
Venessa: What if someone just doesn't meet those criteria, or they don't have all of those?
Zing: I think you can still go to your GP and discuss how you're feeling.
It's just a framework, and we all understand, as psychologists, that everyone is unique, and different people will have different criteria and different symptoms.
Venessa: So how would you describe depression to someone who has only heard the stereotypes?
Lucy: Okay. It's quite complicated to describe because it's kind of different for everyone, but my personal experience is I feel like I'm drowning.
I'm drowning in the deepest, darkest sea, and the waves are coming, and they're tossing me around, and I have no control. I have no control of my body. I have no control of my emotions. I just don't know what's going on. I'm desperately trying to reach the surface, and I'm desperately trying to reach shore because I know that at the end, there's light and there's joy there, but I can't find it.
I just am consumed by self-hatred, consumed by negativity. There is no joy. There is no light, and it's just horrible.
Venessa: So Zing, where do you most often see a mismatch between clinical signs and a person's internal experiences?
Zing: Well, that's a really interesting question, Venessa, because we ask questions around suicidality and whether or not the person wants to end their life. That's a key question, particularly for risk, and it's a question we must always ask.
But I find that many of the people I speak to don't necessarily want to end their lives. It's the sense of wanting to escape, the sense of not wanting to be here.
And so sometimes when I ask that question, people may become confused and wonder why the question's being asked, because actually, their experience of depression is incredibly real, they just don't necessarily want to end their lives.
And then you get others who absolutely are planning active suicide.
So I think some of the screening tools could be slightly more nuanced in that respect.
Venessa: Do you relate to any of that, Lucy?
Lucy: Yeah. So definitely when Zing said the thought of everything wanting to stop, I think I used to describe it as a feeling of really wanting the world to stop and to get off, that eventually I did take overdoses.
But when I was in the early stages of depression, I had suicidal thoughts, but I had no plans.
But it was a thought of just wanting everything to stop or just wanting to go to sleep and just sleep and then wake up and everything to be better.
Venessa: Zing, so you've mentioned suicidal thoughts with that, and Lucy, you've referenced that in your experience as well, and you say it's something that you have to screen for. Why is that?
Zing: It's mainly for risk. As psychologists, we're there to protect life, essentially. So we need to be careful if people are suicidal. We want to take the correct action for safeguarding purposes.
Venessa: So, Lucy, from the outside, people often assume you're coping. How different is that from what's going on internally?
Lucy: Okay. So I was diagnosed in the '90s, so I've had quite a long time to get used to my depression. As a result of that, I've become very good at masking. So that basically means that you present an exterior to the outside world.
And as you can see, I dress nicely. I wear nice makeup. I have showered. I've got up. I generally look put together, but it can be that I'm falling apart inside.
So on Monday of this week, I had a team meeting, and as we were having the team meeting, I could feel myself getting panicky, and I could feel my depression coming to the surface.
And afterwards, I just cried for an hour on the phone to my husband, and I would say that was a really bad day, but none of my work colleagues would've known that that was something that was coming to the surface or that was something that happened, because that is not really the way I present to the world.
Venessa: Zing, is that a common experience that you've come across? Or any comments on that?
Zing: Yeah. I think regarding depression, it's absolutely a mask, and I think that in today's society in particular, we are conditioned to sort of, as they say, keep calm and carry on. I do believe that there is a place for that. I think we need to be far more compassionate to ourselves.
We need to be far more honest with ourselves when we're struggling, which Lucy obviously clearly is, but it takes a long time to get there.
Venessa: So, Lucy, what helped you feel more able to show up honestly with yourself and with others?
Lucy: When I was originally diagnosed, I lost quite a lot of friends as a result of it. They didn't know how to cope with the diagnosis. They didn't really understand what it meant to have a mental health problem and for me to have a mental health problem. They didn't really understand how to be around me, and I didn't really know how to be around them. So I did lose quite a lot of friends.
So I sort of went through a period where I just didn't talk about my depression to people, and I was very ashamed of it.
And then as I got older and became less ashamed of my mental health problems, I realised that actually talking about them was a very healing process, and it was actually something that I started to do to prevent myself from getting emotionally involved and hurt by people.
I thought that if I told them about my depression quite quickly in the relationship, that if they couldn't cope and they backed off, I was okay with that because I hadn't formed any emotional attachments.
But if I'd waited for a long time and then told them, and then they went, "Well, I can't deal with this," it would hurt me in so many ways and really affect my depression.
So I learned that a brilliant coping mechanism was just to be really upfront with people because it is a part of who I am, and I can't disguise the fact that I have good days and bad days, and if you want to be my friend and if you want to be my genuine friend, then you need to know that about me.
