Recently I received a book on ‘healing’ for those suffering from fear, anger or depression, which spurns the ideas of both antidepressants and cognitive behavioural therapy. It suggests that these treatments are just sticking plaster for symptoms and do not treat the root cause of a person’s problems. The book was written by a relative of mine who is not a health professional and has a very caring but alternative approach to the treatment of what he calls ‘fear’ (perhaps GPs would call it anxiety). He suggests that most, if not all, symptoms of this type originate in earlier life experiences. Among the healing processes he mentions are crying, sweating and shaking.

There has always been a tension between the so-called biological/biochemical view of psychological illness and the psychological/psychotherapeutic model. When proponents of different management approaches are polarised into the genetic/biochemical and the alternative and psychotherapeutic wings, there is little common ground. Patients and GPs may feel caught in no-man’s land, dodging bullets from either side and becoming snagged in the barbed wire in between.

One patient was dragged into the consulting room, almost literally, by a very worried husband. A young mother with two small children who was used to living a high energy lifestyle, juggling home and career, but now almost unable to get out of bed with fatigue and depression. She could identify no external causes for her low mood and her childhood had been happy and carefree. She had lost a stone in weight, could barely sleep a few hours each night and was constantly anxious and frightened. Through cascades of tears and much wringing of her hands, she confided that she would prefer to be dead but would not ‘do it’ because of the children. Insomnia, poor attention span, low mood, anhedonia, non-existent libido, appetite loss and poor motivation...she had a full hand of the classical symptoms of depression. 

Depression in patients presenting to the practice for the first time or calling again with chronic low mood is always a challenge, but a successful outcome is a joy sometimes experienced by both patient and doctor. When I started in practice I frequently felt overwhelmed by the enormity of the negativity and suffering expressed by patients with depression. I was helped by the fact that I had spent some time working in St Patrick’s Hospital with a consultant who specialised in mood disorders. Having to ‘lead’ group sessions with patients was a fantastic (and humbling) learning experience; their stories of the highs and lows of depression and elation were extraordinary and salutary narratives of suffering and courage. Successful healing among these men and women was very individual and each patient was healed in a very unique way. 

Some conditions were very responsive to medication and others were refractory; some patients thrived on psychotherapy and most responded to a combination of drugs and talk. A few sufferers of deep depression seemed unresponsive to all modes of treatment and only emerged from their total psychological and physical imprisonment following the extraordinary last (but usually successful) resort of ECT.

So how did the young mother fare? She was reluctant to start antidepressants, having a suspicion of psychoactive medication and a fear of dependence and altered mental state. However, she did agree to give medication a cautious try; both she and I were reassured by strong family support from her husband and mother. She responded very well and after a few weeks rediscovered her mental energy and lost the overwhelming anxiety, which had accompanied her low mood. Remission was achieved after two months and was reinforced by counselling. To my knowledge she is now well, has discontinued all medication and is back at work. 

A separated father of one child has not managed so positively and for several years has fought against depression despite high doses of antidepressants, as well as counselling, psychological treatment and a huge amount of insight into the origins of his low self esteem. In his case, desperately low mood and self loathing are rooted in institutional child abuse and appalling rejection by his parents. But even he acknowledges increments of improvement and though there is no easy answer for him in either the formulary or the psychotherapeutic repertoire, he and I both feel the better for a good consultation.

While not as easy as reducing the HbA1c in a type 2 diabetes patient or curing deafness in a stuffed ear with wax, depression is often more rewarding to deal with, especially if a therapeutic relationship is created and a long view is taken by both patient and GP.