Welcome. I continue the series “What Is Depression?” by sharing a fact situation from which elements will be drawn to form a diagnosis. All of the facts I present are mine. They give you a taste of what I went through. The diagnosis was taken from the report of my first interview. I give you John.
Who Is John?
John is a 50+-year-old male, separated, overweight, unattached, and unemployed.
He presented as alert and eager to cooperate, was appropriately dressed for the weather, and was clean and neat in appearance. He had good posture and was attentive to all inquiries. During his interview, he exhibited strong eye contact. He seemed to be forthright. However, it was apparent that this required effort. As the interview progressed, signs of fatigue were evident. Answers wandered and comprehension diminished. Shoulders stooped.
John’s Suicide Attempt
When asked why he was here, John revealed that several weeks earlier he’d attempted suicide. He confirmed that he’d prepared a suicide note apologizing for his actions. The note also asked that his son be taken care of. He believed he wouldn’t be missed and that his son would be better off without him. John made it clear that he’d had thoughts of suicide for some time prior to his attempt. He planned to die and made it clear that he wanted to die. It was clear that these facts continued to cause distress.
He states that prior to his suicide attempt, he was in a “bad place” mentally. In addition, he said that for some days before his attempt he hadn’t eaten because he didn’t have any food in his home. Despite his lack of food, John found himself unable to leave his apartment. When he did have food he tended to overeat, what he described as “binge-eating” that coincided with when he had money.
Seemingly, motivation was lacking. He couldn’t motivate himself to bathe or get dressed. In fact, he couldn’t motivate himself to do anything. John explained that he was constantly tired, yet he was unable to rest. He said that his body felt heavy and what he called “leaden”. He complained about his thinking being slow and said he had problems with his memory and comprehension. To compensate he used notepads and kept notes.
When asked he agreed that he’d been feeling this way for years. Apparently, the feeling had grown worse before the suicide attempt. Tellingly, he mentioned that once his decision had been made, he felt calm.
John agreed that he was still in a low mood, but that it wasn’t as severe. He attributed the difference to the medication prescribed by his family doctor and the unexpected support of his parents.
Isolation and Appearance
He explained that he’d isolated himself from everyone. He’d had no contact with friends for some years and expressed that he didn’t know how to contact them, or even if he should. John believed that any approach would be unwelcome. Similarly, he’d isolated himself from his family. Access visits with his son had slowed dramatically. John confirmed that he had a strained relationship with his spouse, from whom he is separated.
John admitted that his appearance has improved since he started treatment. Previously, personal and residence hygiene was non-existent. He described his apartment as being cluttered and very unkempt (his word).
John’s Medical History
More facts were elicited. When asked about his medical history, John said that he believed that he suffers from depression and that he has since his teenage years. He described incidents in his past, what he called “The Black” when he would isolate himself until the mood passed.
John denied any alcohol abuse but admitted to the occasional use of it and marijuana. He also denied having had any other episodes of self-harm but admitted that he sees himself as unworthy of life. Finally, he denied having experienced any manic episodes or any delusions or hallucinations. He did exhibit some elements of paranoia in his thinking.
Loss of Pleasure
John mentioned that nothing gave him pleasure. He described incidents where he would watch comedies and feel tears running down his face. Apparently, he used to read but gave it up because he was unable to remember the plot or understand the story. He admitted to being frustrated at this. He also admitted to being frustrated at being unable to overcome his low mood. John didn’t see any cause for it and grew increasingly annoyed at his lack of motivation and inability to “snap out of it”. He said that he was ashamed of his inability to be a good father or provider for his son.
John and Major Depressive Disorder
These anecdotes, these facts, together with his presenting affects lead me to conclude that John has experienced and is still experiencing Major Depressive Disorder. He:
- has had depressed mood for a period longer than two weeks;
- gains no pleasure from formerly pleasurable activities;
- has weight fluctuations due to “binge-eating”;
- suffers from poor sleep;
- has impaired motor ability (as the interview progressed his movements noticeably slowed);
- feelings of worthlessness;
- diminished thinking ability; and,
- suicidal ideation with and without a specific plan (criterion 9).
His isolation is clear evidence of impairment. Since there is no evidence of alcohol or substance abuse, or delusions, hallucinations or any episodes of mania or hypomania, there does not seem to be any presence of another mood disorder.
I remind you that I’m not a mental health professional. I live with Major Depressive Disorder and, from time to time, I experience depressive episodes. My most severe depressive episode resulted in a suicide attempt. This prompted my reaching out for help. My own research, the guidance and lessons shared by fellow sufferers, the compassion of therapists, and so much more, have all inspired me to share what I’ve learned with you. It’s information, not a diagnosis.
If you believe that you’re in need of help, I urge you to speak to your family doctor. IF YOU ARE THINKING OF SUICIDE PLEASE CALL 911 OR VISIT YOUR LOCAL HOSPITAL EMERGENCY ROOM.
Image by Gerd Altmann from Pixabay