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.