[OOC] A handy guide to depression (and mania)

[sweetporcelain]

As you may or (more probably) may not know, when I’m not being Kurt’s mun, I am a psychologist who spends my days working on a clinical trial comparing treatments for adolescent depression. The vast majority of my working week is spent with kids suffering from depression and other mental health problems.

In light of Ryan Murphy’s tweet the other day, suggesting that Blaine may well be a sufferer of depression himself, I thought Blaine muns may find some insight from someone who (hopefully) knows what she’s talking about helpful.

There are a lot of fics out there that focus on depressed!Blaine, and the key thing that I notice throughout them is the extreme focus on self harm/suicidal behaviours. An important thing to note is that this is only one symptom of 9, of which a teenager would only need 5 to get a diagnosis. So, in other words, it’s quite possible for someone to be severely depressed and not at all suicidal. And, also, suicidality alone is not enough to get a diagnosis. It can be a marker of many different mental health disorders, so whether or not you go down that route in fics/RP, you need enough other symptoms to be “realistically” depressed.

I’ve written a very brief run down of the symptoms below. One important note: depression is diagnosed based on how things have been going during the 2 weeks prior to diagnosis. So things need to have been going on for at last 2 weeks without a lull.

1.       Depressed mood and/or irritability. “Depressed mood” is a low/sad/empty feeling that is present more than it is absent. In teenagers, this can also come across as being very irritable at things that don’t deserve the reaction. In other words, getting irritated with your annoying brother is understandable. Getting annoyed to the same extent by the weather, or a crease in a t-shirt, is not. Teenagers can have both low mood and irritability, but that’s still 1 symptom.

2.       Loss of interest/pleasure. No longer feeling like doing things that they used to enjoy, or not enjoying these things when they’re doing them. This can be things like going out with friends, Glee club, watching TV... anything that they’ve lost interest in/enjoyment for.

In order to have a diagnosis of depression, the teenager MUST have at least one of those first 2 symptoms, no matter how many of the following symptoms they get.

3.       Suicidal behaviour (and/or self harm, though this alone tends not to be a symptom unless very severe).

4.       Sleep problems. This can be:

a.       problems getting to sleep (2hrs+ to get to sleep)

b.      problems staying asleep (waking up throughout the night and not being able to get back to sleep for 30mins+)

c.       waking up much earlier than needs be in the morning

d.      a shift in sleep pattern (i.e. staying up very late and then sleeping into the afternoon)

e.      not feeling rested in the morning – struggling to get out of bed and taking a long time to really feel “awake” in the mornings

f.        sleeping a lot more that used to be normal

                 Any of these, or any combination of them, count as “sleep problems”

5.       Tiredness – feeling tired all the time, regardless of amount of sleep, and having to spend a lot of time resting with no energy for usual activities.

6.       Concentration problems – so difficult to concentrate that school work is being adversely affected. Being very forgetful/scatterbrained – unable to remember things that other people have no problems with (e.g. what happened yesterday, what the teacher set for homework, what this week’s Glee assignment is). And/or inability to make decisions, to the point where other people have to decide on their behalf – this is probably rather irritating for the others involved!

7.       Appetite problems – this can either be a notably decreased or increased appetite compared to usual. Substantial weight loss/gain also counts.

8.       Unable to sit still/being really fidgety/agitated (more so than before the depression started) and/or being very slowed down, unable to speak or move as fast as before.

9.       V. low self esteem – feeling like a failure, unable to come up with any good qualities about themselves. And/or feeling very guilty about things that they haven’t done or aren’t their fault (e.g. bad traffic, friends falling out with each other).

So, any combination of 5 of those symptoms would be enough to diagnose depression (so long as at least 1 of the symptoms were nos. 1 or 2). The only other thing to note is that the symptoms don’t count for anything if they’re not affecting daily life. How much daily life is affected is used to determine how severe the depression. For example, mild depression would be if social life has taken a hit, but family life and school work’s going okay. If social and school’s gone downhill, but family’s okay – that’s probably moderate depression. And if all three are going downhill, then that’s probably severe depression.

***

A conversation with one Blaine mun lead us to think that, if anything, he’s more likely to be bipolar the unipolar depressed. Bipolar’s a really complicated disorder to describe, and can come in many different varieties, but the most basic description is extreme mood swings. So, having clinical depression (as discussed above), but also broken up with extreme highs.

Manic highs are a lot more than just “going back to normal”. They’re extreme highs, often mistaken for being high on drugs, appearing as weird or scary to other people. In these highs, people tend to feel absolutely invincible, all-powerful, like there’s nothing they can’t do. They may well become very active in a lot of different things very quickly (e.g. clubs, hobbies, activities).  They tend to be very flighty, jumping from one thing to the next, unable to settle (eg. activities, sexual partners).  In the manic phase of bipolar, it’s common for the sufferer to do things that show poor judgement (e.g. cheating, dangerous behaviours like running across the road without looking, spending more than they can afford). This in turn heightens the depression when the mood change comes, as patients then tend to be mortified by what they have done, and have to deal with the consequences.

***


I really hope that helps someone. Feel free to share this about if you think others might also find it useful, within fandom or without. It may not be useful at all, but hopefully someone will get some use out of this.

One final note – I tend to work using the DSM-IV, which is one of the major manuals for diagnosing mental health disorders. It is, however, not the only manual out there, so there may be contradictory ways of diagnosing depression to the way I do it on a daily basis. So, please, don’t take this as gospel!

Comments

[blainewanderson.livejournal.com]

I think... I think he has issues stemming from fear of rejection and abandonment and a rather crushing fear of loneliness, so it's probably partly from his family's indifference to his pain, partly from being separated from Kurt that it's more evident now than when they are together and happy. I like to think it becomes less up and down as he gets older, and he can find an even keel to settle into once they are married and start a family. Though I'm sure triggers like the first time Christopher gets hurt, or Kurt is late coming home without notice could start a burgeoning panic attack that could turn into an episode.

[prancysmurf.livejournal.com]

Poor Blaine :( I'm sure there will be triggers for him, throughout his life, but hopefully the more times that happens and he has Kurt - and later on his children - to cuddle him and love him, the easier things will get for him. Kurt would never abandon him, or treat him like the Andersons did. Hopefully he'll learn to believe that, in time.

[blainewanderson.livejournal.com]

I think being a Hummel, and them being Anderson-Hummels, a whole brand new family will do wonders for Blaine's feelings of self worth, I think just not being in an environment where you are made to feel 'less than' all the time should be positive for mental health, or at least getting in the direction of better. Even if it ultimately is a chemical imbalance as much as emotional connections. Though those are the opinions of a lay person.

[prancysmurf.livejournal.com]

I'd imagine that Blaine would still have occasional periods where the depression comes back, but they'd be far shorter and far less severe. It would be so much easier for him to fight when he's surrounded by people who love him and make him happy, as opposed to his family who just push him even further down.

[blainewanderson.livejournal.com]

I agree. And if there are times when Blaine is unmanageable, he would take some time away from the family for a bit, a teaching conference or something, he would be loathe to expose his children to something that would put confusion or fear on their faces. Or of course in the world that they have now, he could go to his sister.

[prancysmurf.livejournal.com]

Oh, Kurt would be so torn :( He'd not want the kids to see that side of their Daddy either, but he'd also want to be there to help Blaine through. Just as I'm sure Blaine would want to be there in the future when Kurt has days where his weight obsessions come back (not that Kurt would ever let the kids see their Papa having a calorie panic).