by Dr Faheem Naqvi, Psychiatrist, Manchester, UK
Many cultures lack a substitute term quite as clinical as ‘depression’. In England we use it unashamedly often. A consequence of this is that it is extremely common to see patients in outpatient clinics with a presenting complaint of feeling depressed. But it is clear that a quick glance at ICD-10, coupled with a prescription of antidepressants and a diagnosis of clinical depression, however helpful, may not correspond to the whole picture in all cases and can sometimes be damaging.
As a psychiatrist practising in England, it is important to decipher with great care what is meant when a patient uses this emotive and culturally common term. Depression in the English context can relate to both pervasive and non-pervasive low mood. The latter, I would say, is more commonly seen in England and can be as debilitating and risk-prone as pervasive depression. Pervasive and non-pervasive disorders of mood and emotions both need psychological interventions, but the psychological interventions need to be uniquely tailored to the individual.
The first National Health Service (NHS) hospital opened in Manchester, England in 1948. The NHS is the pride of England and employs a staggering 5% of the working population. Unfortunately, a side effect of economic uncertainty, political austerity and mismanagement, coupled with reductions in social care across the board, has seen the NHS stretched to unprecedented levels. As a result patients can struggle to get the appropriate individually tailored psychological therapies that they deserve, which is frankly frustrating.
I started by saying depression is a common English term, but there remains much misunderstanding and stigma despite definite positive strives being taken. Depression is often invisible to the onlooker and so only too often as psychiatrists we hear patients tell us about unsympathetic employers and patients being told to ‘snap out of it’ or that ‘they have everything going for them’ by friends and family. Finally, depression can affect anyone and does not discriminate. From my own personal experience, many friends and colleagues that I found the most containing and resilient later went on to suffer from severe depression themselves. Keep fighting!
999 and 112 are the national emergency numbers in the United Kingdom
111, Option 2, is the National Health Services’ First Response Service for mental health crises and support. This is not available in all areas of the country yet.
Samaritans (http://www.samaritans.org/) is a registered charity aimed at providing emotional support to anyone in distress or at risk of suicide throughout the United Kingdom. They provide a 24/7, toll-free crisis line, as well as local branches. Samaritans Helpline can be reached at 116 123.
Campaign Against Living Miserably (https://www.thecalmzone.net/) is a registered charity based in England. It was launched in March 2006 as a campaign aimed at bringing the suicide rate down among men aged 15–35. It has a limited-hour phone and webchat options. CALM (Nationwide) can be reached at 0800 58 58 58 (available every day from 5PM to midnight).CALM (London) can be reached at 0808 802 58 58 (available every day from 5PM to midnight). CALM webchat can be found at https://www.thecalmzone.net/help/get-help/ (available every day from 5PM to midnight).
Shout (https://www.giveusashout.org/) is the UK’s first free 24/7 text service for anyone in crisis anytime, anywhere. It is a place to go for those struggling to cope and in need of immediate help. To get help, text 85258.
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