Saturday, April 24, 2010

The Black Dog

Sir Winston Churchill, former British Prime Minister who led Britain through the dark years of the Second World War, suffered with depression.  His adult life was punctuated with mental health crises.  Although he's probably not the first to use the term, he famously referred to depression as "the black dog".

The black dog lives with me, too, and has since junior high school.

By now, most people understand that depression is different than "the blues" or a bad mood.  I've been taught that long-term clinical depression can take a couple of forms.  Some folks experience it as something that lurks in the background at a low level most of the time.  Others experience it as a series of troughs, but feel fine in the sometimes extended period between troughs.  I experience both forms.

Depression is like wearing unremovable glasses that radically distort one's view of the world.  One can become aware of the distortion, and to some extent adjust for it. But the distortion is still there.

Many people with diabetes experience depression. For many PWDs, depression occurs (at least in part) due to the daily burden of diabetes management. For me, I've been a diabetic for about two years and a depressive for about thirty-five.  It's possible, though, that causality goes the other way: I've seen that there's some clinical evidence that depression can be one of the cluster of things involved in the development of Type II.

The implications of depression for diabetes management could not be more profound.  When I'm depressed, it's hard to feel that even basic self-care is worth the effort, so such activities as dieting, exercise, blood testing, and even medications can become sporadic.  Depression brings perpetual low energy, so the impulse to "carb up" for at least temporary energy is very strong.  Planning and decision-making become very difficult, so I'm always eating out of impulse.  For me, I sleep less when I'm depressed, so that both affects BGs directly and also feeds negatively into the energy cycle.

The treatment of depression has become controversial.  I've never been hospitalized, though there was one point when maybe I should have been.  I am under the care of a psychiatrist, and take a couple of different medications.  The medications I take provide no kind of "high" or artificial happiness: I find that they provide a "bottom" to my mood swings so that I feel good enough to cope successfully with my life.  I would never advise somebody else to take medication for depression: it's a very personal decision.  I've very grateful, though, that I have the opportunity.

One thing I've learned that helps is that it's important to remember that depression lies. And one of the biggest lies depression tells me is that the pain I experience during an episode is forever, that it will never get any better, that I will never experience any peace, joy, or satisfaction.  So, I try to treat a depressive episode like a nasty head cold: sure it's really unpleasant right now, but it'll be better in a few days.

I also find that it helps to think of depression as something outside myself, as something that happens to me.  Yes, there are behavioral and cognitive components to depression.  But allowing depression to become one more thing to feel guilty about just isn't helpful.

If you "enjoy" the companionship of the "black dog", you're not alone.  If you're not receiving any treatment for it, you might consider discussing it with your doctor.


  1. Bob,

    You are definitely not alone in this, I am there with you. Glad I can number you among my friends

  2. This is more common than you realize. I also am on a medication. I am very thankful that it does level the lows at a higher level. At first I did not want it, but my heart doctor was ready for me and answered all my questions and said he would not oppose me to get off it, but asked if I would give it a year. I am very thankful he answered my questions and challenged me.

  3. I so hesitate to talk about depression on my blog because a) My friends and family have started reading it due to my publicity via facebook, which is AWESOME, but somehow when people I Know are reading it it makes me have more discretion than when just internet friends are reading - i know - weird, and 2) I don't want people who i don't want to know that i suffer from this disease to know - acquaintances, prospective employers, etc - googleing my name will already let them know i have diabetes - why let them know about the other things wrong with me too? But it's something I always want to write about - i sometimes do and I usually call it "the other D"...

    ANYWAY the point of this personal, rambling comment is to say thanks - I appreciate someone brave enough to come right out and say it - because as the previous commenters have stated - you are not alone in this, and it is more common than any of us think - especially in people with diabetes - they are linked, no doubt. - At any rate - great post - very relateable - you rock.

  4. This, Bob, is a fantastic post. I too deal with depression, and take meds for it.

    I thought your description was spot on, and very well said.

  5. Thank you for posting about this. I've experienced depression since junior high as well - and anxiety issues even before that. I am sure that it had some impact on the development of T2, too.

    It's so easy to talk diet, to talk exercise, but what some people don't understand is that neither matter when you're not well mentally.

  6. Your post is SO much better than mine.

    You hit so many great points. So many.
    When I am depressed, I don't care. I test because I fear lows otherwise, thinking about Anything is just too overwhelming.

    It truly impacts how we manage ourselves, chronic illness or not. More Docs Need to recognize this.

    Sometimes we just need a nudge or a little help. Talking to someone and/or meds to help but the rest is up to us. The latter is the hardest part for me when the one thing that depresses me the most is being lonely.

    Vicious cycle at times.

    Thanks for reposting this link on Twitter!!!!


Creative Commons License
T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.