Removing the mask on depression
“Wearing the mask and trying to appear normal is so exhausting and one day you just can’t put it on anymore.”
That is how David Renwick describes his life in the months leading up to February 2015.
It was the second episode of major depression David experienced and it took close to a four-week inpatient stay at London Health Sciences Centre to get back on the track to wellness.
David’s first episode began as anxiety in the early autumn of 2013 and then progressed into depression. He couldn’t sleep, he couldn’t eat, he couldn’t concentrate.
“I went to our family physician and talked about how I was feeling and where I thought the stressors were coming from. That was the beginning of the deep slide into depression,” says David.
David took time off work. The antidepressants he was prescribed by his family physician took quite a while to become effective but a few months later he began to feel better.
“I felt well enough to go back to work. The medication worked but I hadn’t learned anything, any of the coping skills or being able to recognize when depression began creeping back in.”
It crept back in the late fall of 2014 and for a while David tried to handle it through work and the busy Christmas and New Year season before it all came crashing down.
“In February I was back to sleepless nights, not eating. It was a downward spiral I got into and I just couldn’t catch it. Medication didn’t help. I was curled up on the floor in the family room when my wife Jane came downstairs one morning. I couldn’t get up. Jane and my kids took me to the hospital.”
Home to hospital
David spent more than three weeks as an inpatient on the mental health unit at Victoria Hospital, LHSC.
Life on the mental health unit is built around routines. Meal times are generally at 8 a.m., noon, and 5 p.m. and there are a variety of morning and afternoon group and individual sessions for patients to choose from.
“We encourage patients to have a busy and scheduled day -- get up, shower, to go to the dining room for breakfast and socialize, not stay in bed -- as the illness would otherwise have a patient withdraw into their room,” says Dr. Richard Owen, who was David’s psychiatrist while in hospital.
Daily programs for patients include sessions on addictions, dealing with depression, mindfulness and medication management. Establishing a daily schedule allows the patient to gain a sense of control and accomplishment at the end of the day.
One of the best tools David learned was using Cognitive Behavioural Therapy (CBT). CBT teaches patients how to respond versus react to a wide range of feelings, circumstances and stressors. “It really helped slow down the mind, think about the situation and then respond,” he says.
“My favorite program was the Cognitive Skills Group, which involved working with my hands and concentrating on instructions to build something concrete like a birdhouse. I could focus on a task where you see you are making progress, visually. That was the best part of my day.”
By the end of his first week David was able to sleep through the night, something he hadn’t been able to do for four months. After two weeks he had gained some weight back, and by his third week in hospital, he was able to learn and practice his newly acquired skills.
“While you are in hospital you are just concentrating on getting well. You don’t need to worry about anything else, you have no other responsibilities. It’s why it is so important to work hard with your health care team while you are in this ‘bubble like’ environment to develop a range of coping skills,” says David.
“My new skills gave me a sense of what to do when depression comes back around again, and it will come around again.”
With this understanding, the transition to home takes on a great importance.
The Track to Wellness outpatient program supports the transition period and provides the patient with the social and psychological tools to get well.
The discharged patient comes to hospital twice a week for two hours over an eight-week period. There is homework assigned after every session. The focus of the program is reinforcing what the patient learned while in hospital. One of the key tasks was to build and follow a daily schedule.
“I continue to use what I learned in CBT, it is a life skill. I also continue to maintain a daily gratitude journal. Every night, I write down three to four things that I was grateful for that happened during the day. This has and will continue to be a very powerful tool for me,” says David.
“Mental unhealth is a silent killer. People just don’t talk about it, we’re embarrassed, and we worry what people will think. That’s why we try and keep the mask on. My advice is if you think something is not right, go and talk to your doctor. This is not a dirty little secret.”