Hanging On In Quiet Desperation

"Hanging on in quiet desperation is the English way"
Pink Floyd

Early Warning Signs for Depression

A research study investigated the effect of teaching people with bipolar disorder to recognize their early warning signs (prodromes) for both mania and depression and to take appropriate action. It was found to be very effective for mania but not for depression: "The experimental treatment was effective in reducing manic but not depressive relapses because manic prodromes are more distinct and longer than depressive prodromes and acute mania can be treated more quickly and effectively than acute depression."

Perry, A, Tarrier, N, Morriss, R et al: "Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment." British Medical Journal 318:149-153, 1999. Full copy of paper.


The onset of an episode of depression is unlike that of mania. There is no problem recognizing it for exactly what it is. The problem with depression is that antidepressants take longer to work than drugs for mania. There is not so much point to an emergency pill drill for depression.

The first cold breeze of autumn, after a lazy hot summer, brings with it memories of autumns past, of the new term at school, of leaving for college. So depression can make itself felt initially as a kind of twinge, a hint of half-remembered depressive thought patterns. During periods of health it is hard to remember the details of depressive thought patterns but they are unmistakable when they recur.

Several times my approach to such twinges of depression was to appeal to the Almighty and to just hang on in quiet desperation until it passed. I just pretended that things were normal and kept doing what I normally did—no medication, no visit to the doctor, just hanging on. I don't recommend this approach, but several times the cloud passed after a week or so and I escaped.

With a good relationship with your doctor, a better approach is to make an emergency visit and start a course of treatment. Once again we come back to the need for a good relationship with the doctor. You are asking that she treat you without the symptoms having yet fully manifested themselves. Unless she can trust your insight she is unlikely to treat you until she can observe what is wrong.

Just hanging on has not always succeeded. Sometimes the symptoms do not go away. One can slide slowly, and inexorably, into the Pit, fully aware of what is happening, fully aware that there is nothing you can do to stop it.

I'm sorry, you can't go home until you're better.