Depression

Since my late 30s I had occasional bursts over a few days at a time of a sort of nervous exhaustion, which in my mid 40s became more chronic and by the end of my 40s had been diagnosed by my GP as a combination of low level anxiety and depression which was by then chronic — meaning that it never went away — and I began to receive a prescription for a small dose of a medication for that which continued for almost 18 years. The origins of this were assumed to be genetic: it is one of a number of forms of mild depression that tend to run in families; and it can be thought of as a hereditary inability of the brain to keep some of the brain chemical messengers that affect mood at quite the right level for normal happy temperament.

We are told by the literature that a considerable proportion of the population suffer from some form of depressive illness at some time in their lives. Also, there are a number of forms, some of them more severe than others, and typically some of the mild forms never get any worse but also never go away, whereas typically some of the less mild forms do at least recede and go away after treatement (though bouts may last perhaps a year or two even with treatement before they do reccede, and they may come back again, though possibly only many years later).

So, I accepted this diagnosis from my then GP, who looked after me from when I moved to my home in Headley Down, East Hampshire, in 1983 until he retired in 2015. I took the amitriptyline he prescribed daily for all those years, and seemed to be all right.

As I turned 60, I had reached an equilibrium. I had retired, and that was important because the chief thing that could set me off on a descent into a spell of lower spirits would be stress. This could be from work, if I had a time when it was not going well, or perhaps more often some detail connected with work such as commuting to a workplace. As a contractor in the IT business I used to be offered contracts involving working at client premises and when those were any great distance away the daily journeys there and back could, as the years went by, become trying and so stressful. Once I retired from that kind of work, the business of joining the rush hour every morning could stop for ever, and I generally managed to avoid anything I find stressful.

Historically, I found I could look back to certain times and believe that I had had a spell of the anxiety-depression in the years before I had the diagnosis or was put on the medication, and nowadays, I avoid stress in order to avoid triggering any new low. The chief possible source of stress now is probably boredom, and nowadays I would give in, perhaps rather too easily by some people’s standards, to boredom: therefore I try to avoid spending any length of time on activitiee I find boring, or tedious. This means that, for example, I am not very thorough with housework, and in my home the little lumps of fluff collect and roll across the mahogany herringbone-pattern wood block floor like tumbleweed across the desert or the only street of desert towns in areas like rural Arizona (or at least, that is how I imagine it).

I also avoid much travelling. I don’t mind a long car drive if I have plenty of time, and if it is important enough to set out in the first place, and if should there be some real catastrophe along the way it will not be another disaster if I get there a little late. I have not done any other travelling except local shopping and visits for several years. I last went away either abroad or on holiday when I visited family in Australia for a few weeks in 2005-6. I don’t do holidays; I can’t be bothered: there is no point in travelling away on what people call a holiday if the journey, and enduring the facilities (or lack of) and the activities (or lack of) while one is there are more stressful than simply staying at home. So I simply don’t take holidays; I probably never will again unless it is to visit family or friends in another country again, let us say one more time before I die, somewhere, some day. Apart from that I cannot imagine myself having the slightest wish to bother ever again. I gues the one exception might be the following: suppose that someone I know were to win tens of millions of pounds on the lottery and then die leaving it to me. Were that extremely improbable thing to happen, so that I suddenly became immensely rich wth no effort, I might consider travelling to a few nice places. I would have chauffeured cars everywhere, stay in 4 or 5 star hotels, only ever go to western Europe, Australia, NZ, the USA, or Canada. I would still never wish ever to go to any other countries in the world under any circumstances. That is certain. And even then I would only really be interesed in bothering if I had friends to visit in a place. Otherwise I am happiest staying at home.

However in 2015 the man who had been my GP since 1983 retired. On 1st July 2015 I had a telephone call at 10:00 from the receptionist at the surgery asking me if I could come in to see my new GP, a lady and my first female regular NHS GP. She had an appointment free at 11:00 if I could come in, for the annual review of my medications which was apparently about due before a new prescription for another 8 weeks was issued. So I went in and saw this new doctor. She measured my blood pressure and found it was very high although I had taken my atenolol for that already that morning. She wrote me a new prescription for a second medication to reduce blood pressure and I asked her whether it was known why I had high blood pressure, because my previous GP had never done anything to identify the reason.

No, my file did not say anything about why I might have such hypertension. I told her thatI had been waking up some days shivering as though I was cold although I was perfectly warm. I said: this appears to suggest too much adrenaline. Consulting websites, one finds mentioned the thing called phaeochromocytoma!

Now, phaeochromocytoma is a scary condition: it is one or more tumours in the adrenal glands, causing them to produce way too much adrenaline. The lady GP said that we should indeed test for adrenaline levels, and said she would launch that process which involves a 72 hour urine collection which is then sent off for pathology lab tests. This happened; they got me three 5 litre bottles, each to be used to collect everything from 24 hours. That was sent off and when I saw the GP 10 days later she said the results were that my adrenaline product output was three and a half times the maximum end of the normal range, and that she was sending me to see a consultant endocrinologist.

Well by now, if you are still with me, you may be wondering what this has to do with depression; but stick with the story. The pathology was done in July 2015 but my first appointment with the consultant endocrinologist at Frimley Park Hospital was in October 2015. She asked me a few questions and then sent me for their scan for phaeochromocytomas. Note that symptoms of these include elevated blood pressure and anxiety, which can look like depression. I was given a date for this scan in November 2015 and that happened; I saw the consultant again in January 2016 who told me no tumours had been found, which meant that the high adrenaline product figures were unexplained. She told me that I had to stop taking the antidepressant I was taking for two weeks and then repeat the pathology. That was done in February 2016 and the results were still high, and this time the endocrinologist told my GP and me by letter that I had to stop taking the antidepressant I was taking for EIGHT weeks and then repeat the pathology. Well, that happened in March and April and when I took in the three 5-litre collection bottles that third time, to the Frimley Park Hospital pathology lab handing-in counter, I wondered what the results would be. When I got to see an endocrinology consultant (a locum this time) the result was that there was no sign of raised aderenaline.

So what was going on? I still do not know. Nobody would say whether the instruction to stop taking the amitriptyline was because it caused wrong results in that particular pathology measurement, or because it caused production of adrenaline which made my level of it sky high and was making me tense and shaky, the way adrenaline is supposed to do. After all, it exists as the body's way to make antelope and zebra on the plains in Africa ready to run from lions when they have seen see them. Or, to fight them (which can be what wildebeest do if they encounter lions). It is the “fight or flight” hormone.

When I went to see my new lady GP again after all that, it was 30 June 2016, so 364 days after I had seen her for the first time ever. I told her that after stopping taking the amitriptyline antidepressant for 8 weeks, after stopping it already for 2 weeks, I never started taking it again. And I had never felt depressed. She said: fine, do not start taking it again.

So in spring 2017 I reached a year of not taking that mediation after takingit for about 18 years supposedly on the grounds that I would suffer from depression if I did not. As I had never gone to my original GP in my village complaining of feeling depressed, I am forced to conclude that in fact I was never suffering from depression at all; the apparent illness that I had gone to see him about was not that, whatever it was. That is also a mystery still, 20 years later.