Pull Yourself Together!

By | 9 May, 2011
Slough of Despond

The Slough of Despond; shortly after consuming yet another diabetic.

ShootUp’s resident Type 2 Terry gives a personal insight into the complication of diabetes we often forget…depression. 

How often has that been said to you?  Maybe not very often, because people have learned to avoid using this somewhat patronising phrase when people are suffering from depression.  There, I’ve said it, the big ’D’ word; depression.

So what does depression have to do with diabetes?  That’s probably a stupid question; I would be very surprised if everyone that lurks around on ShootUp hasn’t suffered from depression at some time or another.  If you’re a T1 who’s been unfortunate enough to be diabetic from childhood, I’d be willing to bet that your teenage years were punctuated by bouts of it.  Periods when you rejected your treatment regime and tried to believe diabetes did not exist.  I still get them even now.

If, like me, you are a T2 who was diagnosed in middle age, the crunch didn’t really come until the words, “We’ll have to put you on insulin,” were uttered.  I’m not trying to elicit any sympathy here, just explaining where I was in my life when depression first hit me.

I was particularly unlucky, a long term relationship had just ended in the October of 2005, I was put on insulin in January 2006, and my mother died in the February, not a great concatenation (Damn!  I love that word!) of events, and depression welcomed me with open arms.  The night my mother died I started smoking again after fourteen months nicotine free.

I’ve just re-read that last sentence and realise I’ve imbued depression with anthropomorphic attributes.  (Try saying that after a Shoot Up Night Out!)  Wasn’t it Winston Churchill who called depression his ‘Black Dog’?  Maybe this monster really does seem as if it’s alive in its malevolence, though Chaucer’s inanimate Slough of Despond works well too, now there was a man before his time!  However you visualise it though, depression is an evil thing.

It’s the side effect of diabetes that’s never mentioned, everyone talks about neuropathy, macular degeneration, and nephritis, but nobody mentions depression.  Just the symptoms are depressing, so instead of trying to remember all that I felt, here’s a list of symptoms as provided on the BUPA website:

“If you have depression, you may have a number of different symptoms including:

  • a continuous low mood, which may be worse in the mornings
  • feeling irritable
  • crying a lot
  • a loss of interest in your social life
  • a loss of self-confidence
  • a lack of energy
  • tiredness and poor concentration
  • difficulty in making decisions
  • feeling helpless, worthless or hopeless
  • feeling guilty
  • thoughts about death and suicide
  • anxiety
  • a loss of sex drive (libido)
  • trouble sleeping – possibly taking one or two hours to go to sleep or waking up earlier than usual
  • disturbed eating patterns – either loss of appetite or eating too much
  • unexplained or worsening aches and pains
  • physical slowness.”

I have to say that sadly, I recognise quite a number of those symptoms, maybe you do too.

If you do recognise any of those symptoms, but you’ve done nothing about them there are two things you need to do.  The first is to believe that you really do suffer from depression.  The second is to talk to someone about it!  When you’re depressed (we’re talking real clinical depression here, not just feeling sad for some reason) one of the first hurdles is actually admitting to yourself that you have a problem.  The second, and often the most difficult, is talking about it.

So, once you’ve admitted to yourself you have a problem, who are you going to talk to?  If you look on any of the websites they’ll always tell you to talk to your GP, but my (very unprofessional) suggestion is to talk to the one you love, the one who is nearest and dearest to you, and has been suffering the fallout from your problem.  If they tell you that you aren’t depressed, and to “Pull yourself together!” then maybe you should be looking for someone else.  In reality, they’ll sympathise with you, and tell you how worried they’ve been.

It’s not easy, I know, and unfortunately I didn’t really have anyone close enough to make a difference, one of the downsides to living alone.  I did talk to my GP though, and got a lot of help, my DSN at that time was a rock, and I could always talk to her, at one time I was seeing her every week.  Some of that help was chemical in the form of Fluoxitine capsules, (if you look it up it’s a generic form of Prozac)

There are indications that Fluoxitine shouldn’t be used if a patient has diabetes, but there are other drugs that can be prescribed, and anyway, the contra-indications may not be for you, your doctor will know.  If you do go onto medication, there may be a period in the initial few weeks where your doctor wants to see you every week anyway (I saw my DSN by choice, but the doctor saw me regularly too).  The immediate effects of anti-depressants can be a slight worsening of the situation.  Your doctor may recommend counselling as an alternative to drug therapy.  Personally I think counselling is widely overrated, but it may work well for some people, I only know, that having done the first year of a counselling course, I’m not one of them.

I don’t know if any of my fellow ‘Shoot Uppers’ are old enough to remember, but there used to be an advertisement on TV for a headache remedy, I think it may have been Anadin, but I could be wrong.  The tag line for the advert was, “Leave me alone, I’ll be all right soon…”  Sadly, many people with depression say the same thing, hoping it will go away.  Depression though is much more insidious than a headache, and it won’t just go away; in really bad cases it may even need psychiatric help, so don’t dismiss it out of hand.

Don’t feel as though it’s something to be ashamed of either!  Part of the depression is to feel as though one is less than a person for admitting it, don’t be fooled!  If you can relate to any of the symptoms mentioned above, you need help, it’s not ‘being silly’, it’s not ‘wasting the doctor’s time’, you have a real illness that needs real treatment, believe me.

Me?  Well, I’m much happier now; I’m off the drugs and have been for a couple of years now.  I still get problems with sleeping, but that’s often more to do with the neuropathy than depression.  I never really have got back into the swing of doing housework, so I have to ask the spiders if I’m allowed open a window.  Overall though, my life is good, but I keep my eye open, looking over my shoulder for Churchill’s ‘Black Dog’!

Terry Ozbourne

22 thoughts on “Pull Yourself Together!

  1. Alison

    Great post Terry, and thanks for being so honest about something that many people won’t talk about. I think the brain is one of the most important tools for good diabetes care, if your head isn’t in the right place, it’s a real struggle, yet mental health is so often glossed over with a quick “You’re not depressed are you?” at an annual review and that’s your lot.

    I’ve seen counselling work really well for a few people – especially cognitive behavioural therapy for people with diabetes – from what I’ve read and speaking to people, there was a real focus on changing how you react to things, to make it all more rational eg not feeling like a failure everytime you’re high or low, keeping it all in perspective and looking at the positives. It sounds really simple stuff, but for the people I spoke to, it just broke the downward spiral they were stuck in and helped them look at things in a different way.

  2. Tim

    Can I go off-topic here? The “Slough of Despond” isn’t Chaucer, it’s Bunyan – from Pilgrim’s Progress; thought to be English literature’s most boring book.

    As you were.

  3. Tim

    Back on topic – thanks Terry, another great article. I couldn’t agree more, the NHS is great at patching up the body but pretty bloody awful at patching up the mind.

    When I was first diagnosed I found the thought that I would have a life-changing chronic condition until the day died quite a jolt. I didn’t find it depressing more stressful – but perhaps we’re splitting hairs here. For some reason I found reading about the discovery of insulin and what happened to people prior to 1922 (a slow lingering death) actually helped a lot by putting it all into context.

    Since then I go through up and downs with my diabetes. Even when things are going right most of the time I can get down about the whole thing. After all, it’s an insane drag to have to think about your chronic condition all the time; it’s very hard work being responsible for your health all the time; it’s also hard work just organising silly little things, like repeat prescriptions and medical check ups. It’s all a real ball-ache!

    Anyway, I have a copy of Psyching Out Diabetes: A Positive Approach to Your Negative Emotions (http://goo.gl/KBNyk) which is quite a good book about this sort of stuff. On the whole it’s a collection of common sense, but – as always – objectively reading common sense stuff is good compared to subjective worrying about stuff.

  4. Rohan

    Huh, a fair bit of that list sounds a lot like me until I moved. Though actually some of it’s still there, but hidden under the super HAPPY I have got from moving to Bristol. I know from previous experience though that all I need to do is get out doing stuff – get to gigs, out on my bike, get friends to visit, etc.

    Thanks for the post, and I feel you on the subject of not having someone close nearby. While I wasn’t single when diagnosed, it was long distance, and someone saying ‘aww, have a hug’ on a phone really isn’t the same. And when trying to dig yourself out of a hole, having someone you really connect with around makes a world of difference.

  5. Hairy Gnome Post author

    @Tim – Sorry about mixing up Chaucer and Bunyan, I sit corrected! 😆 Mind you, the Slough of Despond was my second choice simply because I couldn’t find a picture of a vicious black dog! Churchill’s analogy has always had a ring of truth to me, I can imagine depression as an evil beast waiting to pounce. It saddens me though, to think how many good people have been dragged into oblivion by the beast, and if my little missive can save one person from that I shall be eternally grateful.

  6. Cecile

    Thanks to diabetes, I’ll propably be wiped off the face of the earth much sooner: in the light of overpopulation, that is reason for celebration 😈

  7. lizz

    Hmmm, well my OH would say I am irrepressibly cheerful, although I do recognise a lot of these symptoms (and despite being told in your post, to admit it!) I really don’t think I do get depressed, my moods are too transient. Some are present more long term, tiredness, but I can definitely think of other reasons for a lot of the problems, ie irritability is a side-effect of long term sugar swings.

    My OH did suffer from it, both his sister and brother have manic depression, both are on long-term drugs, his brother is severely affected. We found the answer for OH, a complete surprise, was my low carb, very high veg and salad diet, which worked like magic and he hasn’t had a bout since – before it was every coupe of months.

    The problem with telling your Dr you have depression is insurance – he couldn’t get life insurance even though he only went once, was given one course of pills, of which he only took one (it sent him high as a kite) and has never been back.

  8. lizz

    Should also say, Bristol residents are the happiest city dwellers in England, so Rohan’s post doesn’t surprise me! i think it’s something to do with the laid back people, the green open spaces, the water and ships, and the general beauty of the city.

  9. Tim

    @lizz – as an ex-Bristolian who lived right next to the Downs I would agree! Bristol is second only to Edinburgh in my view 🙂

  10. Dave

    Good article Terry and whilst not knowingly being depressed I do agree that it is a wholeheartedly avoided subject. I have never being asked in a consultation how I felt. Plenty of “how is your control?” and “what can you do to improve that (you failure)?” but no touchy-feely typey questions.

    I now feel disadvantaged at never having a Bristol connection as most of the SUOPUers seem to. Maybe that’s why I’m never fully content with life?

  11. Annette A

    I have no connection with Bristol, nor do I wish to have. My yearnings are for the wilds of Yorkshire (where I grew up). I’m happiest when up a hill, or getting lost in a forest (I’m good at getting lost…). Gentle rolling fields just dont do it for me…
    But back on topic. I was once asked at a Drs clinic how my mental state was, and I said I was having some problems, which lead to a course of CBT (my GP had a therapist who did weekly clinics) which did help with my particular problem, but not so much with life in general. But I’ve always had a propensity towards depression – my younger sister has clinical depression, is under the care of a psychiatrist etc etc. I know when its coming on and can sometimes stave it off by doing something. Not letting my mind have space to wander off, I call it. Sometimes, I cant. It just happens, and there is nothing I can do to stop it. My OH cant really cope with it, so I deal with it myself (and down the phone to my middle sister, who also gets depressed at times – it must run in the family). Luckily, I dont get it bad, not real bad, and I always know it will end – that I think is often a problem for people who are depressed – they can’t see where it will end.

  12. Rohan

    I’m sort of with you on preferred locations, @annette! Though my preference is for North Devon, it’s for similar reasons. Sadly there’s no awesome cities down that far, so Bristol will have to make do – it’s within easy reach of Wales!

    Also, “Not letting my mind have space to wander off”, I think that’s exactly what I do. Sort of, any way – I find it’s fine to let my mind wander if I’m out for a nice walk or long cycle ride, as long as I’m active and doing stuff. It’s when I get stuck at home clicking ‘stumble’ over again I have issues 😛 And you’re right about needing to see an end – the closest I’ve come to going to a doctor about it was when I was struggling to see how I could sort myself out. I’m glad I was told I could move to Bristol when I was, tbh!

    Oh and @seasiderdave – I’m afraid you may be right about that 😛 Though there are other places better, or at least equal to Bristol…

  13. Spike Jones

    Fantastic article @teloz . Thank you.

    I have been diabolic for a loonnnggg time. The “other” D has been its sporadic companion for almost as long. I have tried antidepressants & counselling repeatedly to little effect. How could they? The depressant is riding me every single day. It has taken a near breakdown, realising that I am an alcoholic & addict & starting to take care of myself & my diabolics to finally begin the climb out of the Slough of Despond. It will be a long road but I do have the rest of my life.

    What does this drivelling rant mean? How the bloody hell is it possible not to get depressed? If only occasionally. The treatment is intrusive, even if you are in denial. Let us skirt around the medical attitude that if you not controlled, it is because you are lazy & not trying hard enough. What no one ever seems to mention either, is the complete balls up diabolics makes of your blood chemistry…

    What helps is getting the right help for yourself. Be it pills, talking or taking the piss. This sanctuary has helped me no end & I thank you all from the bottom of my boots.

    Whinge over! ;-D

  14. Cecile

    @spikej: You shouldn’t trust us – we could “all” be dogs…and black, at that 🙂

    @teloz: I’m sorry, but your menacing Churchillian black dog doesn’t bosom in fear at all: the only vicious one of that kind I encountered as a nipper was a family friend’s nipping chihuahua…though that slough fills me with dread – it looks like molten Liquorish allsorts filler (abhorrent stuff…though I like a bit of zoute drop)

  15. Nig

    Phew! @teloz where do I start?

    Firstly, good article, Tel. Thanks.

    Secondly, I have to say that the annual(-ish) question from the doctor/nurse/whoever-has-drawn-the-short-straw-this-time of “are you depressed?” always winds me up! If I was depressed, how likely is it that I would answer afirmatively? So stop asking me stupid questions and lets get on with the “mechanics” (i.e. insulin dose/insulin type/insulin delivery mechanism/carb counting/exercise/alcohol consumption)!!!! So, @teloz, next time they ask me, I will definitely try not to get so wound up about it 😉 .

    Of course I get pissed-off about the whole never-endingness of the whole diabetic farrago, but I know that is nowhere near the same as depression! Its just kick the cat (not that I have one!) and get on with life after a good long five-minute sulk!

    Sorry, I have just read what I have written and realise that it might come across a bit insensitive! What I mean the above to say is that I am lucky enough not have experienced real depression but that @teloz‘s article has helped me appreciate the experiences of others. 🙂

    As another ex-Bristolian (I sense conspiracy theories developing as I type this!) I have to agree that it is a fabulous city but @tim I am baffled why you think it lags behind Edinburgh! It has to be better than Edinburgh if only because of the weather!

    @annette – if you want hills, get yourself to Bristol! If you haven’t climbed up Park Street after a heavy night out in the City Centre you haven’t explored the full majesty and intensity of the word “hill”! 🙂 It also does “wilds” but more in the “Saturday night in the Centre” sense than that which you mean! Forests are also slightly beyond, but “woods” it can do in plenty.

  16. Annette A

    @nigho – I was born in Sheffield, that (famous?) city of the seven hills. We lived at the top of one of them. My school was at the bottom of said hill. I got to eat a caramac every day to get me home from school without hypo-ing. Trust me, I _know_ city hills 🙂 But I prefer those to be found in the slightly further north wilds of Yorkshire. That require scrambling up with the occasional addition of ropes. Tough to find that in Bristol, unless you’re half way up a climbing wall like @neobrainless 😉

  17. Nig

    @annette – have you never seen the lunatics climbing up the Clifton Gorge? Having said that, I spent a fair bit of time in Sheffield in the ’80’s (not that I lived there, just visiting) and I really enjoyed it there; nice people, nice pubs! What more could you want. 😀

  18. Tim

    I used to climb in the Clifton Gorge most nights after work; it would be more tricky if we did a five pitch climb and it started getting dark when we were half way up! What larks!

  19. Tim

    @rosief – *all* our articles are important. Especially the whimsical ones that don’t make sense.


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