Tag Archives: depression

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Domhnall MacAuleyDomhnall_Mac is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.

 

Dear Linda,

I have just read your book - or, should I say, it completely captivated me. I couldn’t put it down. What a compelling life story. When you lectured about depression at those Masterclass lectures I chaired years ago I was so impressed with your grasp of the topic, your understanding of the difficulties facing family doctors, and your overall approach to managing the condition. You had such a clear understanding and appreciation of depression and the difficulties of treating it in practice. And, you were so assured, confident, on top of your subject. I had chaired many similar sessions but yours were outstanding. There wasn’t even the slightest hint that your understanding extended so far into your personal experience. ...continue reading

Laura SchepLaura Schep
Dalhousie University
Class of 2017

“I don’t want these anymore,” I say, avoiding my doctor’s gaze as I reach into my purse and retrieve the pill bottle, half empty. Or half full, depending on how you look at it. I place it on her desk. She looks from the bottle to me, her expression curious, no doubt wondering where to go from here. She expected to do my Pap test today, perhaps give me a flu shot, but did not anticipate this: a discussion about my antidepressants.

She asks me to explain. She asks whether the meds have helped with my mood. “Oh yes, ...continue reading

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sarahCSarah Currie is a medical copy editor at CMAJ

 

I was 16 years old when Sadness and Joy first went AWOL in my brain for a protracted period. I was an angry, scared, self-loathing teenager. Typical, many might say, but the anger and fear ran deeper and longer than my teenaged psyche could endure. I started taking anti-depressants when I was in university, and I have alternated between diagnoses of anxiety and depression for much of my adult life. I am fighting hard to keep the black dogs at bay. Finally, at the age of 36, I feel like I am making some head way.

Inside Out brings to life five of the small voices in our heads, each of which represents a universal emotion: Happiness, Sadness, Fear, Disgust and Anger. (Surprise is absent.) We learn how these five emotions interact with each other in 11-year-old Riley’s head to keep her safe, drive her passions, connect with others and form her personality. ...continue reading

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Photo credit: Heather Pollock

Photo credit: Heather Pollock

Amelia Curran is a Juno Award winning singer-songwriter from St. John's, Newfoundland. Amelia has toured extensively throughout North America, the UK, Europe and Australia. She releases her seventh album "They Promised You Mercy" in November, 2014

I used to think suicide was cowardly. I was angry with my friends who committed such an act. I avoided those who had tried to end their lives but lived. Then in 2004, with the death of my friend and roommate RM, I obediently cut her obituary out of the paper to put with the rest and discovered some were missing and that I had lost count of my dead friends.

I had lost count. I was twenty-six at the time and I had lost count. I was living through a plague that was taking people from me and I had not bothered to notice. ...continue reading

sarahC

Sarah Currie is a medical copy editor on CMAJ

The opposite of play is not work. It’s depression. — Brian Sutton-Smith

A little nonsense now and then is cherished by the wisest men.― Roald Dahl, Charlie & the Great Glass Elevator

Recess Rules

What happens when we play? What changes do we notice in our bodies? When we play a game with others, how do we experience those players? What physical or physiological responses to the actions or emotions involved do we notice? What is play? According to Jill  Vialet, author of the book 'Recess Rules', play is like pornography: you know it when you see it. The dictionary definition includes words like “aimless” and “frivolous.” Bernard Suits described playing a game as a voluntary attempt to overcome unnecessary obstacles. But we shouldn’t be so dismissive of play and its benefits and rewards.

People who play are more trusting; they are better self-regulators and can resolve conflict more effectively. Groups who play together have healthier interactions ...continue reading

declanfoxDeclan Fox is a Family Doctor in Tignish PEI (that's Prince Edward Island, Canada, for international readers)

 

How did I get here?

With apologies to Talking Heads, I wonder sometimes, myself. How DID I get here? Resurrecting this family medicine practice in Tignish, PEI, is what I'll be doing for the next few years. At the ripe old age of 59 I'm taking on something I wouldn't even have attempted 25 years ago. And I'm doing it 2500 miles away from home in a health service that is very different from the UK NHS I once loved with a mighty passion.

So what's so great about moving to Tignish? A little history might help. 17 years ago this month I was mooching around home, three months after a suicidal breakdown due to my second bout of major depression. ...continue reading

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Domhnall_pic_resizeby Domhnall MacAuley, CMAJ Associate editor

In her inaugural professorial lecture Professor Siobhan O’Neill of Ulster University had some fascinating insights into the psychological manifestations of the patients we see in practice and the long term influence of the Northern Ireland troubles on people’s psyche.

Women get anxious; men get angry. A generalization, of course. But, it does explain consultation behavior. Women tend to internalize their feelings becoming anxious and moody- they over think. And, come to the doctor. Men, on the other hand, externalize their feelings becoming more impulsive, aggressive and self-medicate through alcohol or substance abuse. Family doctors know that if a middle aged man actually consults with depression, it’s serious. Middle aged men and those with relationship problems are high risk. So, how can we identify depressed men? They are more likely to turn up to the police, lawyers or in seeking child access. The feminisation of the mental health services has not helped. According to Siobhan “We don’t need any more nice pink counseling buildings, smelling of pot pourri and staffed by kind listening women”- we need to actively seek out troubled men.

Qualitative research gets to areas that other research methods just cannot reach - providing insights beyond the quantitative work with which most of us are familiar. But terms like “interpretative phenomenological analysis” tend to make even an editor’s eye glaze over. Yet it is just about taking meaning from your experiences. Everyone suffers some trauma in their lives but not all of us become depressed or suicidal- it’s the meaning that leads to the disorder not the experience itself. So with Post Traumatic Stress Disorder, patients may tell us about the flashbacks and how they relive the experience and the nightmares. But they don’t appreciate how they subconsciously adopt safety behaviors to prevent it happening. They avoid trigger situations and develop a protective numbness in response. They make no plans in life and see only a foreshortened future. No wonder their lives begin to feel so meaningless.

What proportion of PTSD in Northern Ireland is conflict related? Interestingly, and some might think it relatively low, 26% was conflict related. But PTSD in Northern Ireland is more severe and more enduring. Siobhan also asked a fascinating question- could conflict be protective? My personal impression of working in a troubled area was that, while there were many difficult problems, there seemed to be less depressive illness during the conflict. Her theoretical background supports this view- there was a certain common goal and focus, the conflict increased connectedness and connectedness tends to be protective against low mood. Post conflict, however, connectedness reduces but there are still victims. While the troubles are over, many have lost loved ones or limbs and are in danger of being forgotten. Understanding the importance of connectedness has wide ranging relevance for the many victims in society. We must create a culture of connectedness. Reach out. Show that seeking help is a sign of strength. Although suicide is associated with mental disorder, many people have mental disorders but relatively few commit suicide. So what makes a difference to rates of suicide? Acceptability of behavior is a factor. Public perception is important. Cognitive therapy access and the means to address problems. Media guidelines also help so as not to increase risk of suicide contagion.

Siobhan left us with a quote attributed to James Addison.  "Three grand essentials of happiness in this life are something to do, someone to love, and something to hope for."

I thought it a superb lecture, but it is possible that I am biased. Siobhan was my first PhD student!