Down, Down, Down?

Courtesy of the new operating system, Windows Vista, I have newsfeeds on my desktop; as they are generally from US news stations, I don't tend to read them, unless something catches my eye. Today, though, there was a comment from MNSBC news, that over the last five years, there has been a 20% increase in visits to doctors and hospitals in the US, and the most commonly prescribed item is antidepressants. Apparently, in the area where I live, I have heard that this last is also true. There are a lot of us out there taking antidepressants.

Now, this isn't a rant about whether or not to take medication; I take mine religiously every day, and am profoundly grateful for the difference it makes in my life. Rather, I'd like to understand something that has puzzled me for several years now. I have two chronic illnesses, asthma and depression. My asthma is under complete control, and has been for many years, yet the surgery insists that every year, I attend a clinic, so that one of the nurses can check that that is indeed the case (as if I'd lie about it...). It takes about ten minutes maximum, usually less. My depression, though, is not under anybody's control, really, or no more than intermittently, and hasn't been for many years. Yet there is no annual clinic, no check to see that things are progressing as they should. Nobody mentions it, ever, unless I bring it up as an issue. It's as if it wasn't there.

I've been treated for depression, on and off, for most of my adult life. It seems wrong to me that the only time anyone is interested in the progression of the illness is when I'm in crisis. And as soon as the crisis is resolved, I'm deemed able to manage it on my own. Which I can, if I'm relatively well. But depression is an illness that clouds your judgement; it can be difficult for me to say if I'm ill or not. I live with a certain level of 'negative noise' in my head, for example. Most people do, I think, it's just that mine is a tad more extreme, and more persistent. I don't want to make a big deal of it, particularly, but I do find it useful when those working with me on my health actually acknowledge to me that I live with this illness, that it doesn't go away, and that it affects the whole of my life. So why isn't there an annual clinic for people like me, those whose depression is chronic, whose lives are lived around the illness, or despite it, perhaps? If it did nothing but acknowledge that the illness is there, and is real, and is nothing to be ashamed about, if it simply encouraged the person who lives with it, that it is worth persevering, then that would be a gain.

But I don't believe that that would be the only gain. Crisis management is expensive. If I have a crisis, it has the potential to involve not just my GP and the practice based local psychiatric nurse, but also a psychiatrist, plus a psychiatric consultant, plus possibly at least one member of a crisis team, usually a psychiatric nurse. That's a lot of people, and a lot of time, and a lot of cost. If a potential crisis could be recognised, and averted, by a short screening meeting, or by action taken after such a meeting, surely it would be significantly more cost-effective than waiting until the crisis breaks? Throwing money at a problem isn't usually the best way of solving it. Prevention is always better than cure, they say. I'm sure they're right. I'd just like to have the chance to prove it. Sadly, I doubt I ever will, and the illness will go on being ignored. As will I.