Trigger (Un)Happy

When finding myself in the midst of particular difficult period I often get asked ‘what triggered it this time?’ This is a perfectly legitimate question, and one that a non-sufferer would be completely justified in asking. Of course there are some obvious triggers, such as big life events like bereavements or breakups, that are bound to cause a whirlwind of emotions and a downward spiral into depression. However, for the majority of the time there are no rational or tangible triggers that precipitate the relapse; instead it appears out of the blue, like a bullet train rocketing out of a tunnel. In some instances it builds up gradually before it reaching its painful crescendo, but on other occasions it hits you full pelt in the stomach, with no warning or let up.

According to this the article Top Relapse Triggers for Depression & How to Prevent Them “the risk of recurrence — ‘relapse after full remission’ — for a person who’s had one episode of depression is 50 percent. For a person with two episodes, the risk is about 70 percent. For someone with three episodes or more, the risk rises to around 90 percent”. That statistic doesn’t provide much comfort, as clearly the chances of relapse increase with each depressive episode that occurs. Putting it bluntly, things will only get worse.

The article proceeds to suggest 3 potential trigger categories, and how they can manifest into a period of depression:

Not Following Treatment

The article proposes that “The biggest issue regarding relapse has to do with children and adults not following through on their treatment plan… this includes anything from skipping therapy sessions to missing doses of your medication to ending therapy too soon”. I can certainly relate to the negative effects of ending therapy too soon, although through no fault of my own, but rather the underfunded and oversubscribed NHS. If these support structures are not strong enough, or are fragmented and disturbed, then it undeniably ensures that a relapse is increasingly likely. The article also suggests that “while your life may involve psychotherapy, medication and the need for a protective structure that keeps your illness at bay, also realize that you have passions, desires, gifts and talents that require just as much attention.” It is all to easy for these facets of life to fall by the wayside, which consequently prolongs the negative cycle.

Ruminations

“Negative self-referential ruminations play a key role in recurrence… for example, individuals with depression tend to dwell on their (supposed) flaws and failures. They also may view neutral events with a negative lens.” Ruminations are a big deal for me, allowing my mind to dwell on my insecurities, and conjure up thoughts of sadness, hopelessness and a misguided longing for a perceived better life. This trigger is particularly problematic to tackle, as the thoughts come out of the blue, and linger sometimes for days or weeks. Unfortunately the mind cannot be switched off, and the more time you spend alone, the more the thoughts penetrate deep into the brain, eating away at you, with little or no regards to the consequences. Despite being a cliché, it’s like being trapped inside a prison, with only your thoughts as the ruthless prison guards for company.

Knowing Your Personal Vulnerabilities

“Triggers may be very specific to each individual’s situation, since all of our emotional responses are unique to some extent…learn how to recognize the who, what, whys and whens of your emotional and physical life.” For example particular dates or times of the year can prove to be difficult and act as triggers for a depressive state of mind. For me personally my birthday and Christmas are particularly troublesome as they can provoke the ruminations mentioned previously, and cause them to take hold, whilst also proliferating ideas of another year having passed by and another year when I still feel trapped in a deep well of unhappiness. Regret, frustration and sadness are emotions that become second nature. The article also notes that “If you find yourself excessively fatigued, irritable, having trouble eating or sleeping, you might be in the midst of a trigger event.”

Identifying certain triggers doesn’t really provide much assistance or solace. I sometimes have anticipated an event 8 months in advance as a potential cause of anxiety or depression, and despite this warning, it plays out exactly as I had envisioned. Plus the fact that there are so many invisible and intangible triggers at play ensures that any attempt to fight the process becomes virtually impossible. The article concludes that you “don’t measure your success living with depression on whether relapse happens or not. Instead, realize that if relapse occurs, true success comes from rising after the fall…Fall down seven times, get up eight.” The difficulty comes in the fact that falling down is so easy, but getting back up again requires reserves of energy and determination that are in very short supply.

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A Silent Killer

We are currently in the midst of some important dates: yesterday was International Men’s Day, and the whole month of November is the flagship period of the Movember Foundation. What both of these events have in common is their dedication to raising awareness of men’s health, and in particular focusing upon mental health and suicide prevention. The theme for this years International Men’s Day was Stop Male Suicide, and whilst the moustache growing month of November is what is most closely associated with the Movember Foundation, it is in fact an organistion working all year round to tackle men’s health issues, including suicide prevention. The statistics on the subject are frightening. Around the world on average we lose a man to suicide every minute of every day, and three out of four suicides are men.

It’s hard to reconcile why there are such a high proportion of suicides among males. Perhaps it’s simply that men are a lot less comfortable with opening up about their feelings and emotions, and about mental health in general. There is a lot pressure within the media for men to act tough and manly, and to not show any emotion. Men may consequently feel self conscious about admitting their vulnerabilities and frailties, misguidedly believing that it depletes their levels of masculinity, and therefore makes them appear unattractive, weak and somehow inferior. It’s often been the case than men just ‘brave things out’, ‘get on with it’, and keep their emotions to themselves, because they are ‘men’, and that’s what ‘men’ do. However, the bravery comes from opening up and talking about mental health, rather than by burying it deep down under a facade of pretend happiness; a pretense which in my own personal experience results in the volcano inside consistently being at the point of eruption.

In every country in the world (bar China where its equal) the male rate of suicide is higher than that of women, and in Russia the rate of male suicides is 6 times that of women. The statistics are staggering, and its not an exaggeration to say that mental health is truly a global and silent killer. For the first 22 odd years of my life (before I first went to the doctor) I would rather have cut off my own arm than talk about what I thought was ‘my big weakness’, and the idea of recounting my experiences in a blog or to camera would have been bordering on the ridiculous. However it soon becomes apparent that the more you talk about it, the easier it does become, and with the support of those around you it can be a vital step towards changing those terrifying statistic above. I’m not saying that merely talking about mental health will solve everything, as this is far from the truth, and medication and therapy will play an important part, and there will be many bumps in the road along the way. But at least you are on the road, and haven’t felt that you have needed to leave the path as so many men and women tragically have. As a society we need put the treatment of mental health up there with cancer, and provide as much funding and study as we possibly can to make people sit up and take the illness seriously. If not, then I fear it will get a lot worse before it gets better.

Pouring money into the NHS, supporting children and young adults with mental health treatments, and funding charities like The Samaritans, Calm and Movember are undoubtedly crucial actions that need to take place. However, a simple act of asking someone how they are, or listening to them talk about how they are having a bad day, can be all that is needed to push someone into opening up, and make them realise that they are not alone. It is infinitely more difficult for someone to admit to their mental health issues when they feel that they have nobody that cares or who will listen to them. If we can make this world a place where opening up is not a challenge but merely part of life, and where the idea of depression being a stigma is a thing of the past, then we will be on the way to cultivating an environment where we can really begin to tackle this silent killer in the decades ahead. This may seem like a monumental task, and a impossible feat, but after all, a journey of a thousand miles begins with a single step.

Avoiding the Speed Bumps

It has been almost a month since my last blog post, and generally when an extended period of time like this passes it either means that I’m in a very dark place, or in a relatively good space; the theory being that I either feel too low or disinterested to write anything, or conversely, I have no negative experiences or feelings to verbalise. Thankfully on this occasion I’m leaning towards the more positive end of the spectrum.

It’s also fair to say that I’ve had little time for writing over the past few weeks due to being extremely busy at work, and also a on holiday in Florida for almost two weeks. I believe the holiday was much needed, and felt like a true escape, not just from London, but also from my recent period of low and negative thinking. It also had the effect of transporting me back to simpler, more innocent times, a consequence of visiting the Disney theme parks as a family, just as I did when I was a child. While there is a danger that this bubble of safety I found myself in could lull me into a false sense of security, and merely act as a form of avoidance, thankfully some of the positive effects of the holiday have still lingered within me. Although the pessimist inside me insists this won’t last forever, and is merely a respite rather than a recovery.

Despite this relatively settled state of mind, it’s true to say that I enter the next few months with a great deal of trepidation, and a sense of impending doom which always seems a mere hairsbreadth away. This upcoming period has been a particularly difficult time for me in the past, acting as a catalyst for downward spirals of depression, and even though I can recognise this chain of events, it does not always mean I can can prevent it from happening. Whilst I am undoubtedly a huge fan of Christmas, it has always orchestrated extremely low feelings within, and it’s not always apparent why. Perhaps as this article suggests, “Christmas appears to be a trigger to engage in excessive self-reflection and rumination about the inadequacies of life in comparison with other people who seem to have more and do more”. Christmas is a period of celebrations, festivities and catching up with friends and family, and therefore perhaps its the presence of other people basking in apparent happiness, friendship and general joviality, which in turn precipitates feelings of loneliness, envy and deep critical self-reflection. Essentially the microcosm of Christmas fixates upon and exaggerates all of the emotions and anxieties within a 6 week period, and ensures that the shackles of depression cannot easily be broken free from.

It’s also true to state that the presence of my birthday a mere 2 weeks prior to Christmas adds measurably to the melting pot of emotions. It too acts as a time to reflect upon life gone by, mistakes made, relationships not yet achieved, and as each year passes this becomes more and more pronounced. With this year being my 30th birthday, I have a constant fear that this milestone will be the hardest yet. In many ways a birthday is worse than Christmas, as its the day in which you are the sole focus, as opposed to the global celebration of Christmas. So if no one turns up to your birthday, or you feel isolated and alone, its impossible to push away thoughts such as “nobody likes me”, “why can’t I be more liked?”, “why can’t I have the life of another person?” or “why have I not achieved x, y or z by this age?”. It also pressurises you to compare yourself with other people. Why does John Smith have a wife, a child, his own house and a purpose in his life at age 30, and yet I live on my own and have nothing compared the things he has achieved? Of course the mindset of a depressed person will conveniently forget all of the things that it has that John Smith doesn’t, as well as preemptively assuming that John Smith is happy inside, when in fact there is no way of telling if this is true.

It feels a shame to start this blog with positive thoughts, and end up writing about a purely negative mindset. Unfortunately its this way of thinking that a depressed persons mind forces upon its victim, and I am also being realistic based upon my own experiences, as well as being brutally honest, something which I vowed to do when I started this blog. As always I want nothing more than to be proven wrong, and if I come out of this next few months intact then I will feel it has been a huge achievement. Inevitably it helps that I’m on a steady road at this moment in time, as that can only help me in the long run. However, it’s the speed bumps later down the road that I’m worried about, as I don’t know if I have the strength to swerve past them, and am instead destined to collide head on with them, unable to prevent the devastation that will follow.