Monday, 29 June 2020

Neuroplasticity

Neuroplasticity is the process whereby the brain changes its neural pathways and synapses over time.


Surprisingly the brain doesn't stop changing when we are young but continues to adapt itself into old age. It is true that the brain grows fastest when we are young - but it's ability to transform itself continues all through our lives. Basically the brain is not set in stone. Just like the hard drive of a computer  - it fills up or empties depending upon what is saved or deleted. The brain works out what is most relevent and can delete irrelevant pathways/information. The brain can respond to injury and illness by creating new pathways and learning new tricks.

Neuroplasticity is particularly important for depression sufferers because it means that the negative effects of depression on the brain can be reversed. In some ways the brain is just like a stomach in that it digests/absorbs what it experiences: thoughts, happenings and attitudes. If you feed it negative thoughts then it will become negative. If you feed it postive thoughts then it can become postive. (So maybe good old-fashioned positive thinking may work after all.) The brain can also respond positively to exercise.

One classic study looked at the brains of London taxi drivers who were doing the 'knowledge'. The study concluded that the hippocampus increased in size while they studied and was largest in those who had been driving for the longest. So, using our brains is crucial. Use it or lose it.

The bottom line about neuroplasticity is that we aren't necesarily stuck with our old broken mind but can build a new one. So that brain-fogged, forgetful, indecisive old organ between our ears can be retuned and rewired to turn it into a cognitive powerhouse. All we have to do is feed it the right food. 

Sunday, 28 June 2020

Medication

If you have major depressive disorder - then sooner or later you'll be recommended medication. Medication is not a panacea and doesn't work for all people. It is reckoned that only 50% of people respond to antidepressants. Medication can also be accompanied by a myriad of side-effects. Furthermore, critics argue that medication does nothing to address the underlying causes of depression.



However, medication can open a window for you. It can buy you time. When your brain is on fire - it can be impossible to concentrate on any other therapies or strategies. All you are doing is trying to get through the next minute.

I went through a lot of medication. I was on antidepressants, anti-psychotics, anti-anxieties and anti-inflammatories. Nothing seemed to work for me. I went through endless dosage increases and seemingly endless switches from one type of medication to another. Then after about five years and on the third time of trying I found that Aripiprazole was actually starting to work for me. Without it my days were a blood-bath of negative thoughts. (Ever tried living inside a  hurricane?) With it there was a chance to breathe - a chance to grab a modicum of mindfulness. I'm not saying it was Nirvana, because it wasn't. But it bought me time. It allowed my head to clear somewhat. It enabled me to concentrate more on what I was supposed to be doing - like work or being with my family. I could remember what day of the week it was. It also rekindled the vestiges of my sense of humour.

If, like Matt Haig, you can get by without medication - then great. But if you can't - don't be ashamed to use it. If you were diabetic you would take insulin.

Furthermore, depression doesn't like medication - so that may be another good reason to take it.

Saturday, 27 June 2020

Brain Training

One of the other classic ways that depression has of wrong-footing you is through brain-fog.

Use it or lose it!

When I was ill, I found that the fog of depression quite literally entered my brain. What had previously been a perfectly adequate (and in some ways high-functioning) organ suddenly became indistinct, muddled and befuddled. I suddenly became confused by the simplest thing - like how to open a car door with an electronic key or how to tie my shoe laces. I also became chronically indecisive. If somebody in a shop asked me if I wanted a receipt - I would be glued to the spot in an agony of choice.  Furthermore, I didn't always know what day of the week it was and I couldn't remember the birthdays of my nearest and dearest. As for the geography of Norfolk - that had all become a blur.

Many people simply don't understand how much impact clinical depression can have on cognitive ability. At one stage I was so worried I went to my GP who peformed an Alzheimer's test on me. I managed to pass but struggled. I only knew the date because it was on my appoitment card. I was OK on the current Prime Minister and telling the time on a clock face but I couldn't remember the three names that were given to me at the start of the test. I passed but I was far from being an A grade student. 

But brain-fog is another of depression's little tricks - so don't panic. The brain fog just makes you feel even more desperate and plunges you further into the depression.

So, what I tried to do in the early days was to try and use the brain for brain-type things. I couldn't solve my depression but I could try to recite the alphabet backwards. I learnt our car registration numbers (and still know them); I tried to remember Led Zeppelin albums; I tried to remember churches I had visited in Norfolk. At work I tried to remember plant names. Gradually the fog began to clear. I was still struggling with depression but the purely admin function of the brain started to come back.

Friday, 26 June 2020

Acceptance

One of  depression's biggest fears is that you will learn to accept it. By accepting it you intrinsically weaken it. Acceptance is a way of embracing and transforming depression. It is not easy to do and in many ways it feels counter-intuitive. Why would you want to accept this malevolent intruder? Well the truth is that by accepting it you stop fighting with it. And by stopping fighting with it you diminish its power to hurt you. 

I should point out that acceptance is not the same thing as giving up or surrendering. It is not about capitulating to depression but about actively coming to terms with the enemy within. It is about learning to live with the malevolent intruder - about seeing through all of its tricks. In some cases it is even about being grateful for it. I know this might sound bizarre when you are engaged in a life and death struggle - but try it.



Some people believe that depression happens for a reason and that it comes to us in order to teach us a lesson about ourselves and life. It is true that depression can bring about change. However, as an agent for change it is certainly a peculiar one - as it simultaneously strips us of the normal tools that we need to bring about change  - such as energy and perseverance and resilience.

But depression does change people's lives. It certainly changed mine. It got me out of a job that I should have left years earlier. It didn't do it in a congenial or professional way; in fact, it very nearly killed me. But it did it. It made it literally impossible for me to continue. As a result I now have a new job that I enjoy. I have no more stressful meetings, virtually no staff development, no formal sit-down appraisals and no corporate bull-shit. Instead I have plants to move and water, deliveries to take in and palettes to forklift. I get up in the morning and go in and I work and I come home feeling tired - but tired in a good way. I listen to the birds singing in the trees while I'm there and I talk to customers about bamboo and hydrangeas and runner beans.

Many people ultimately find that depression brings something new into their lives (assuming they can get through the horrors.). Depression is a brutal teacher and forces us to re-evaluate our lives. In some cases this re-evaluation is literally a matter of life and death. If you don't change then you get sucked down into the black hole.  But after the darkness subsides - and it does subside - there can be new adaptations. Many people say that after depression they talk to everyone they meet - whereas before they kept themselves to themselves. For others it might mean more exercise or more time spent in nature or more connection with family and friends. Or more love.

For some the acceptance is that depression will always be there - but maybe in a quieter less adversarial kind of way. For others, acceptance can be the final stage before complete recovery.

Thursday, 25 June 2020

Exercise and Nature

Exercise is one of the best ways to beat depression. The poet Alfred Tennyson used to take daily walks on the Downs near his home at Freshwater on the Isle of Wight. Alastair Campbell and Matt Haig are runners and Winston Churchill used to lay bricks. Exercise makes you feel fitter and more alive and also releases feel-good endorphins into your system. 

Depression Hates Exercise

Predictably depression doesn't like exercise. In fact, depression will do whatever it can to prevent you from exercising. To start with depression makes you feel tired and weary - so that you will feel less inclined to want to exercise. Doing anything when you have depression can feel like hard work - very hard work. If you have leaden paralysis (which is the feeling that your arms and legs are very heavy) then even going up the stairs in your home can feel like Mount Everest.

To start with you may need to re-calibrate your perception of exercise. You may have to start very modestly. However, it is very important that you congratulate yourself for whatever you manage to do - no matter how small. Remember that the negative voice of depression will try to undermine anything that you do. After you've finished your exercise is often the time when the voice kicks in. If you've been for a short run, for instance, it might say:

'How far did you run? A mile? Is that all?'

'You used to be able to run that route so much faster before.'

'Why do you feel so tired when you're only managed a mile?'

 Remember that to exercise with depression is doubly difficult. It's like carrying another person round with you.

But you need to be aware that depression can also play other tricks on you. It can make you agoraphobic or, in my case, dizzy. It can also make you feel anxious about joining a gym or self conscious about wearing Lycra, or make you worry unnecessarily that your bike will break down.

One of the other benefits of exercise is that it can get you out into nature. Research has shown that being in the countryside can create serotonin and dopamine in our brains and/or reduce cortisol. Hence nature is very good for mental health. All natural places can boost our sense of well-being: woods, hills, moors, marshes, beaches, fields and lakes. In particular, it has been shown that being near water is good for mental health. It slows our heart beat and calms us down. In his book Bird Therapy Joe Harkness details how a love of bird watching and nature helped him recover after a nervous breakdown. He started a blog about his bird watching experiences and then secured crowd funding to publish his book in 2019. it has since gone on to become a bestseller - thanks to endorsements from the likes of Chris Packham.

I have to admit that since becoming ill five years ago I have failed to establish a regular exercise regime. I used to be a keen walker/hill-walker and a proficient mountain bike. However, clinical depression clobbered me with both dizziness and leaden paralysis. Since then I have managed to climb a few mountains: Great Gable, Blencathra and Haystacks in the Lake District and Cadair Idris in Wales - but on every occasion my body felt like concrete. It was as though gravity had increased ten fold or that I was hauling a rucksack full of bricks. The dizziness also made every step disorientating - as though all the horizons were out of sync.



Wednesday, 24 June 2020

It's Good to Talk

Depression doesn't like being talked about. It doesn't like it because it dispels some of the secrecy and mystery surrounding it. Every time someone talks about depression then depression can become a little less powerful. 

As I've said before depression thrives on secrecy and invisibility. If you suddenly develop depression and have no knowledge of the illness - then it is likely to hit you harder than necessary. Men are particularly prone to suicide - more than three times more likely than women and so it is particularly important for men to talk about depression.

If you have no knowledge of depression then you are more likely to blame yourself for it. You are more likely to internalise it and, as a result, more likely to kill yourself. I always think of the football manager Gary Speed - who after appearing on the BBC's Football Focus and after watching a Newcastle V Manchester united game with his friend Alan Shearer in 2011 - apparently in good spirits - came home and killed himself.

What needs to happen is that the world needs to start having more conversations about depression. But how do we talk about depression? There is still a large stigma surrounding the illness. Many people are ashamed of having it and even more ashamed of talking about it.

Imagine that workplace water-cooler moment where somebody asks: 'How are you?' Even if you are depressed you're very unlikely to say 'You know what, I'm depressed.' Why doesn't that conversation normally happen? Well, owning up to depression is difficult. People feel ashamed that they feel depressed - even to somebody they know quite well. We are conditioned to think that depression is somehow unacceptable - somehow a weakness - even though it is a real illness. For some reason, mental health is seen as problematic - wheres physical health is OK.

We may have concerns for the other person. What if they are not OK with people talking about depression. Maybe it will find it uncomfortable? Maybe it will make them depressed? But in an ideal world we should be able to say we are depressed and in an ideal world we should get the response: 'Sorry to hear that. Anything I can do? Do you want to talk about it?' Just that acknowledgement lets in some oxygen. It breaks the seal on the bell jar; it lets in some light. 

But we need to build the confidence for people world-wide to have these conversations. We need to live in a world where it is OK to be open about depression - where it is OK to be not OK. Not talking about depression simply plays straight into its hand. Ultimately it only increases the death toll and the suffering.  If you had heart disease or diabetes or cancer there wouldn't be any stigma about talking about it. People would (normally) be sympathetic and that's where we need there to be with depression. Mental and physical health should be treated similarly; there should be no divide. It should be just health. Full stop.

So we all need to encourage dialogue about this illness - whether it is spoken or in books, or on blogs or on social media or on TV - it doesn't matter. So when that average guy - like Gary Speed maybe - who is suddenly beset by those terrible dark thoughts - doesn't think: 'Shit what's wrong with me; I feel like ending it all'  but instead: 'Hold on, isn't this depression?' I heard about it the other day and I know that it can make you think bad things.' We need to dispel the mystery and the invisibility surrounding depression.

Some of us are lucky and can open up to friends. But for others this isn't possible. If you can't talk to friends or family then try your GP or the HR where you work, or local clergy, or community workers. If necessary, pay money to have counseling. These days many many people have counseling for a whole range of issues. CBT can be a real game-changer.

But remember that you can also read about depression too. For me - reading depression memoirs was an important way of finding out about the illness. It gave me a reference point in the darkness. When I was having a particularly bad day - I knew that I wasn't alone. I knew that William Styron, and Matt Haig and Mark Rice -Oxley had been there before. That is ultimately why I wanted to write this book - to share some information - in the hope that it might help others. When you're down in the depths, it's vital to know that other people have been there too and come out the other side. That knowledge can be life saving.

Tuesday, 23 June 2020

Know Your Enemy

 'If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.'

Sun Tzu


Depression has been around for a long time - possibly since the first cave man became disenchanted with the hunt and retired to the back of his cave. Yet, despite all the advances of modern medicine it is still with us today. Not only is it still with us today but it is on the increase. The World Health Organisation estimate that there are now a staggering 364 million sufferers world wide.



Its success as an illness (and it has been hugely succesful) is partly down to the fact that it is both mysterious and often invisible. These qualities have helped it to spread with impunity. Depression is a stealthy opponent. It has the ability to single out those who are susceptible to its propaganda. It has many tricks up its sleeve. It is malign and artful. In it's extreme form - it is also a killer. (More deadly than both cancer and heart disease to men under 50.) If we take the personification further - we could even say that it has a malevolent intelligence. Not only does it know how to survive - but it knows how to thrive. 

But whatever shape it adopts - and that can be anything from a mild inconvenience to catatonia - it has always benefited from silence and isolation. The less we know about it - the better it likes it. It doesn't like being talked about and it certainly doesn't like having books written about it.

That is essentially why I decided to write this book. I wanted to expose depression for the trickster that I think it is. Don't get me wrong - I'm not saying that depression isn't real - far from it. When you are in its grip it seems the most hideously real thing imaginable. But - depression does play tricks on the mind and on the body and it makes us believe things which are patently untrue. It is also susceptible to treatment and can be beaten. It has both weaknesses and flaws.

Ever since I was a child, I have suffered from mild-moderate depression - but in 2015 major depressive disorder caught up with me and I experienced a nervous breakdown followed by clinical depression. Since then I have literally been fighting for my life. But ever since that day in 2015 - I have also been trying to identify my enemy. I've tried to understand it and to get inside it - to work out what makes it tick. In fact, I started the first draft of this book when I was in hospital. At the time, I could barely hold a pen and my head was exploding with the perfect storm. I've been trying to write it ever since but with limited success. But then it dawned on me that the best way to undermine a stealthy opponent like depression would be to divulge its secrets. So that, then, is what this book is about. The information in it has been hard-won; I hope that it will be helpful to others.