I turned up to the GP, the other week. New GP, same old spiel; history of depression, not feeling great, suicidal ideation. Yes, there’s something of a family history. Tend to respond well to citalopram. Can I have some?
Of course, the GP says, and has me fill in a PHQ-9 while he taps a prescription out.
(The ‘Patient Health Questionnaire – Section 9’ is the standard test they give to – I think – anyone turning up to a GP’s office with suspected depression. It’s somewhat similar to something called the Beck Depression Inventory, which is used in research. It’s ten questions about your mood and thoughts over the past week, each scored 1 – 5, which map roughly onto the DSM-IV and ICD-10 definitions of major depressive disorder. I’ve filled in more PHQ-9s than I’ve had hot dinners)
Problematically, I don’t look depressed.
I know, I know – those twee fucking jpegs that do the Facebook and Twitter rounds, ‘Spot the depressed person OMG THEY LOOK JUST LIKE NORMAL PEOPLE’, as if those experiencing depression are some kind of alien stealth attack force. But by the time I make it to a doctor’s office, I am usually in a bad way. For weeks I will have been failing to claw my way out of this hole even as the ground crumbles beneath my feet; I’ll have gone from unremarkable, to tired-looking, to vacant and miserable; unshaven, matted hair, somehow smaller. I finally get into the doctor’s office, away from the eyes of the world, and I sink into whispering, eyes bobbing like dead fish in water. Mouth closed, open. Closed. In those moments I do not look just like anyone else. I look like one profoundly depressed bastard.
When you turn up looking like that, sounding as I do when I’m bad – slow, quiet, halting – then GPs are happy to fire anything at you. When you turn up obviously, profoundly depressed, and say you’ve been here before and say you’ve been helped by drugs before, doctors have no problem in handing you a script and also – in my experience – will ask what dose you’ve previously been on.
So, I don’t look depressed; I’m sat straight, speaking and gesticulating easy, eye’s maintaining contact; bright. Because I’ve been sensible, and this time I’ve gone to get drugs before I get really, really, really bad.
And this is problematic, because I get to the pharmacy and see I’ve been prescribed half my effective dose. This isn’t a huge issue in the moment, since I can simply double dose. This becomes an issue later on, when I finish the script early and have not arranged a further appointment to sort it out because – hey, depression, mind scramble, strobe light impulsivity.
It becomes an issue now, when I’ve run out.