Nick Johnstone: Blue notes

The past four years of my life are a blur. When I try to place certain things that happened to me, it's a real struggle to get the days, weeks, months to fall into place. It's rather like hearing a song I used to love blaring from a passing car and being unable to remember who it's by. That is what it feels like to come out of a major depressive episode. At the moment, settled at 75mg of Efexor XL, I've come to a clearing in my life where I can stand still and breathe a sigh of relief. The worst of this recent depression is finally behind me.

It started in mid-1999. Soon afterwards, I went to the doctor begging for antidepressants, having nearly chucked myself off a bridge into the Thames. Almost five years later, with spring around the corner, I am ready to shed a skin. I'm at a point where it feels emotionally safe to look back. When you are going through the worst of depression, you daren't look back, not even to yesterday. Everything is too raw, too painful, too volatile. But eventually, you reach this clearing in the woods and it feels OK to sit on a fallen tree and say to yourself, thank God that's over.

The first serious depressive episode of my life descended when I was 18 and lifted when I was 22. The second struck when I was 24 and cleared off when I was 26. With three blackouts to reflect back on, I accept that it will happen again. And again. And again. But for now, I'm in sync with the seasons, readying myself to come out of a long, cold winter, excited about pushing a new me out of the soil, lots of blue-sky days ahead.

I attribute all three recoveries to a mix of medication, therapy and exercise. Too many people struggling with depression think that it's enough to take antidepressants. Then, as soon as they come off the medication, they go right back to the bottom again. Depression is a powerful illness that requires powerful treatment. Pills only treat the symptoms. They might play an invaluable, stabilising role in putting an end to suicidal impulses, obsessive thoughts, insomnia, episodes of self-harm, diminished appetite, crying, low energy, aching limbs, but they don't operate on any deeper level.

That is where therapy and counselling come in. Depression is usually two things going on at once: an accumulation of stressful life events and a malfunction of brain chemistry leading to a deficit of serotonin. One needs medication, the other a form of "talk" therapy. The two in tandem get the job done. Add exercise - ideally something soothing like yoga or swimming - and the whole torturous inertia that is depression taking over your life will be given a run for its money.

A lot of people are frightened of therapy and counselling because they think it will be violating, intrusive. This is understandable: when you are depressed, you are ultra-sensitive to everything and the thought of sitting with a stranger and sharing your secrets sounds terrifying. People also forgo therapy for financial reasons. Over the years, countless GPs have offered me six "free" counselling sessions - a useless standardised NHS policy. I tried once and by the sixth session we were still talking about symptoms. You can't solve self-harm or panic attacks in six one-hour counselling sessions. To do it properly, you need to see a counsellor or therapist for at least six months, ideally for several years and at anything from £25-£75 a session, it soon adds up.

The first time I was depressed, I saw a counsellor for 18 months; the second, a hypnotherapist for six months; this recent time a psychotherapist for two years. I have acquired invaluable skills from therapy. First, I learned self-understanding. Then I learned about depression and anxiety. Next, I learned how to cope with them. More recently, I learned - and am still learning - self-acceptance. Friends who keep having identical Groundhog Day depressive episodes are the ones who reject therapy, who swear a quick fix of antidepressants does the trick.

Today, done with therapy, slowly weaning off antidepressants, shedding all the weight gain from the medication and feel-good over-eating, exercising five times a week, my ship is steady. It seems like only yesterday that I was thinking about not being around anymore. And now, I couldn't be more here if I tried. Therein lies the bittersweet paradox of this dance with depression. As it says in the Bhagavad Gita: "Good is the intellect which comprehends the coming forth and going back of life."

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