My stay in the hospital was important for structuring my day
James, 57 years old
"I sometimes felt like the living dead – emotionally numb. I was like a zombie who could hardly get out of bed in the morning and then walked around in a daze all day."
I only realized that I had been showing signs of depression afterwards. About 20 years ago I was on vacation with my family. Everything was great: the weather, the accommodation, the scenery. But I felt mentally absent and was unhappy. I complained about everything and treated my children unfairly. I spoiled the vacation for everyone. I thought everything was awful, although I couldn't say exactly why.
I was constantly at the doctor’s
Two years later I got really sick. That year I was constantly at the doctor’s. I just felt miserable. I didn’t know why. All the symptoms were so vague, and I couldn’t really describe them.
I'm self-employed, and my worries about my company started getting to me more and more. But that was already due to my depression – looking back, I can now see that I took the problems too seriously. I felt incapacitated and down, and developed all kinds of problems like back ache, sleeplessness, loss of appetite, and strange sensations in my body.
I described all of this to my doctor, but he didn't really know what to make of it so he advised me to relax and take things a little easier. But it got worse and worse, and at one point I started to believe I was seriously ill, like that I had leukemia or another kind of cancer. My doctor then put me down as a hypochondriac. He played it all down a bit, and took me less and less seriously. I still think he’s a really good doctor who has always taken good care of my family. He just didn't quite understand what was going on in my particular case.
The diagnosis came as a relief
Once, when he was on vacation, things were pretty bad and I went to see another doctor. After talking to her she said that it sounded like depression to her. That was a relief at first because I finally had a name for my condition. I had felt all along that something was not right. I was finally able to read up about it and stop worrying about having a serious physical disease.
Back then I hoped that things would get better after a few visits to a psychiatrist. But that wasn't the case at all. Things kept getting worse and worse.
I eventually had a breakdown
It got to the point where I couldn't go to work anymore. I felt absolutely terrified and was no longer able to do my job. I was afraid of making serious mistakes and thought that I wasn’t at all capable of doing that kind of job, and always did everything wrong anyway. But a few days later I was able to return to work again. Things went on like that for about six or eight weeks, and then I broke down completely. I was hardly able to sleep at all anymore, and was constantly in a state of panic. I no longer dared to leave the house and my family was very worried. We didn't know what to do. We didn't have the information we needed. It was also very difficult to find a psychiatrist who could help us soon enough.
The waiting lists for most psychiatrists were at least four weeks. But then I happened to get an appointment with a psychiatrist nearby. That wasn’t a particularly good experience. He did a kind of basic neurological check-up and told me that everything was fine. I couldn’t believe my ears. He then took some medication out of a drawer and told me it was great, and that I should take it for two weeks. I then had severe side effects and found out that the medication wasn’t even officially approved for the German market. I stopped taking it and never went back to that doctor. Friends then advised me to go to a hospital.
Things couldn’t carry on that way
The situation at home had escalated by that point. I have two children. One was six years old at the time, the other twelve. By the time I had made it out of bed at around 11 or 12 in the morning, my wife had already got back from work and was often pretty angry. I would then start crying uncontrollably – I simply couldn’t stop myself. My daughter would start crying too, and my son would get embarrassed and poke at his food. It was then that I realized that something had to change. My business partner also wanted to know what was happening and when I was expecting to come back. I thought it’d be best if I committed myself to a mental hospital. That would help make it clear that I was ill and unable to work. I needed that safety zone.
The clinic was a safe environment
I stayed in the hospital for 13 weeks in total. The people there advised me to take medication. But I thought depression was a personal issue and I didn’t want to treat it with medication. After that, the doctors treated me with sleep deprivation. That worked really well at first, and I felt pretty good for a few days. But it didn’t make my depression go away.
My stay in the hospital was also an important step for me because it got me back to a structured daily routine. I remember making a helicopter and other things out of wood as part of my therapy. That now seems pretty absurd to me because that’s not usually my thing. I don’t usually go in for arts and crafts. But back then it gave me the feeling that I was still capable of achieving something. Before that I had convinced myself that I had lost every single one of my skills. I was totally sure of it.
But after 13 weeks in the hospital I had recovered enough and pretty much went straight on vacation with my family. That went very well. And when I got back home I felt ready to get back to work. But the symptoms started coming back after a few days. I felt like my brain was refusing to function. I was having trouble handling figures, for example. It was like I’d frozen on the inside. And feeling that way made the old symptoms return. Within a few days I was back to where I had been before going to the hospital. I just couldn’t cope anymore.
At some point I agreed to try out medication after all
I didn’t want to go back to the hospital. I then decided to try to gradually return to normal everyday life with the help of my new psychiatrist. And that worked too. I had good days and bad days, sometimes I wasn’t able to work for a few days and then I went back again.
I was very lucky to be self-employed and have such an understanding business partner. I don’t even want to imagine what it must be like for regular employees. Constantly being off work and then coming back and then leaving again is no doubt a problem for some employers.
At some point I agreed to try out medication after all. But that didn’t really help. Back then I couldn’t have told you whether I was healthy again or still ill. I no longer had any really serious symptoms, but I didn’t feel quite like my old self. For instance, I used to love being in nature, but that feeling hadn’t yet returned. I found that quite a dangerous state to be in: you’re so relieved to feel better but you aren’t quite healthy yet, so you simply start accepting that this is the way things will be from now on.
Medication and outpatient psychotherapy helped
I was incredibly lucky to have a psychiatrist who didn’t give up on me. He suggested trying out a different medication and doing psychotherapy at the same time. The new medication really worked. I couldn’t say which of the two types of treatment helped in the end. The psychotherapy helped me identify a whole load of problems with the way I see things. I realized what a perfectionist I am, that I take on too much, and have to learn to accept help if I need it.
Things then got better as time went on. But, looking back, I think I was on an emotional rollercoaster for a total of six years before feeling fully healthy again. Six years of ups and downs, and good and bad phases.
I had come back to life again
I realized that I was fully healthy again when I was able to cope normally in everyday life again. I started having more of a social life again. My friendships have actually become a lot stronger than before I got ill. I suddenly started truly enjoying a whole load of different things again. I was more active again, was able to experience and enjoy nature. I was also able to empathize with and have good chats with other people again. In a way, my depression was good for me too. It changed me for the better in some ways, and that wouldn’t have happened if I hadn’t got ill.
My depression is related to my life story too. My parents got divorced and I pretty much had to take care of myself from a very young age. I had a difficult relationship with my stepfather. That really influenced my life without me realizing it. My illness made me think about that kind of thing and helped me understand why I am the way I am.
In tough phases: Suicidal thoughts
I did consider taking my life when things were really tough. You just feel so awful and everything seems hopeless. I sometimes felt like the living dead – emotionally numb. I was like a zombie who could hardly get out of bed in the morning and then walked around in a daze all day. For instance, I couldn’t read anything for many months. When you feel that way you’d rather not be alive. I then realized that I didn’t have to put up with things forever. I had the option of putting an end to it all.
A lot of people, I guess most people, have had those thoughts at some point in their lives – because they were terribly lovesick or in a similar situation. I think it’s sort of normal in a way. But if those thoughts become overpowering, if they turn into an inner voice and you feel like there’s no point to life anymore, that you’re only a burden to your family and those around you, and if you start thinking about the best way to take your life, then you’re in serious danger. I never actually tried to take my life. I always knew deep down that my feelings and thoughts weren’t really real, that I was ill and didn’t actually want to kill myself. Those very low phases when I had suicidal thoughts never lasted long though.
Keeping up social contacts was very difficult
Any kind of social activity was incredibly difficult for me back then. My wife likes having fun – going to parties and having a good time. That kind of thing was pure torture for me during my depression. We would arrange what time we were going to leave parties before going to them. She often couldn’t understand why and thought I just couldn’t be bothered, but I simply couldn’t handle social situations. Talking to other people was unbelievably difficult for me. If you’re feeling normal then conversations just "happen" without you having to think about what you’re going to say next. If you’re depressed it’s torture because things just don’t “flow” like that anymore. As a result, you might avoid social situations even more, and become even lonelier and feel like you’re not a likeable person, and that nobody wants to be around you.
I often found it hard to go to shopping malls too because I couldn’t handle the flood of different impressions. It made me feel dizzy and sick. I just felt like running away and getting into the fresh air.
My wife found it difficult to understand how I was feeling. It wasn’t always easy for us. But she’s a very pragmatic person, and that helped a lot. At the time we weren’t sure whether I’d ever be able to go back to work again, so she increased her hours at work and said we’d manage somehow. That took a lot of pressure off me.
Worries about the children
My children really suffered, especially my son. His music helped him cope with everything. We’ve always tried to be open about things with our children. We told them about the diagnosis and explained that it is an illness. Sometimes I read parts of the brochures I had to the children. It can be very difficult for other members of the family to understand what you’re going through.
I was constantly worried that the children might think I didn’t love them anymore. When you’re no longer capable of showing interest in the things the children are doing, going out with them, or really communicating with them, you start having these kinds of thoughts. That was really awful for me - I had a guilty conscience and really tortured myself with the thoughts. Being open about my illness helped me, especially with the children.
I also thought it was important to be honest about things with our friends, even though some of them reacted weirdly – like not wanting to have anything to do with someone like me anymore. They even said that right to my face. You can lose friends that way, but afterwards you find yourself wondering if it was really such a big loss. You find out who your true friends are when you go through something like this.
Staying on medication
I still take medication. About two years ago I decided to test whether I still needed my tablets so I stopped taking them. Things were fine at first. Nothing changed after I stopped: I didn’t feel any better or worse. But about 9 months later I was on vacation outside of Europe and I slipped right back into depression again. I suspect my jetlag might have played a role. I sat in my hotel room crying and didn’t want to leave – I felt like everything around me was threatening. I was scared of not finding my way around in unfamiliar surroundings. After that it took me about eight weeks to get back to where I was before stopping taking my medication.
Thank God my old medication kicked in again. It doesn’t always happen that way. After going through that experience I finally really understood that depression is also a physical illness. Something in my brain doesn’t work properly. Now I take my medication regularly as prescribed by my doctor. I tolerate it very well and don’t have any side effects. My doctor prescribes the tablets and my blood is tested regularly, to monitor things like my liver.
It can be very difficult to go to the doctor when you think you have depression. It sometimes helps to write down how you’re doing, what you’re feeling, what you’re worrying about, and how you’re sleeping. If it’s too difficult to explain, you can take what you’ve written with you to the doctor. It’s often hard to put how you’re feeling into words when you’re at the doctor’s, and they might get the wrong impression. I also think it’s important to talk about it with your partner or with friends, and not just try to put up with depressive moods. It can only be treated if you talk about it.
I think describing depression as a condition of “-lesses” is a nice way of putting it: being hopeless, emotionless and so on. You sometimes completely lose almost everything: the ability to enjoy things and the ability to connect with others. You live in a gray, dull world without any meaning. I’ve often heard comments like, “What’s his problem? He’s got a job and earns enough money. He has an attractive wife, two fantastic children, a house, and a car – what more does he want?” A lot of people think depression is a kind of existential crisis. That’s a strange notion, and totally wrong. Depression is also a physical condition. When you’re depressed you lose your emotions, and with them everything that makes life enjoyable.
Our real-life stories summarize interviews with people who are affected by the medical condition. Our interview partners have given us permission to publish their stories. We would like to express our sincere thanks to them.
The real-life stories give an insight into how other people cope and live with a medical condition. Their opinions and comments are not recommendations by IQWiG.
Please note: The names of our interview partners have been changed to protect their identity. The photos are of models.