Does your loved one have smiling depression?
Alexandra was. So no one realised she was ill... until it was too late
THE story is tragic yet perhaps also frighteningly familiar to many families who have lost loved ones to suicide. Cheerleader Alexandra Wilshaw was described by friends and family as vibrant, bubbly, loud and funny.
The 21-year-old straight-A student, who was in her third year studying maths at Durham University, had everything to live for.
Yet on March 18 last year she was discovered unconscious in her bedroom, having tried to hang herself. She died in hospital later that day.
‘When the police arrived to tell me, I just couldn’t believe it,’ says her mother Carole, 51. ‘ I just thought, “It isn’t her. It can’t be.” ’
The year before she died, Alexandra has been prescribed medication for anxiety, yet seemed to have turned a corner.
Her heartbroken mother, a technology audit manager, still finds herself going over their final conversations, wondering if there could have been any sign of her daughter’s turmoil.
Carole says: ‘We never knew there was anything wrong. I asked how her anxiety was every time I spoke to her and she told me it was fine. I believed her.’
Earlier this month, Alexandra’s family, still reeling from their loss, l aunched a campaign in t heir daughter’s name to help promote awareness of anxiety, depression and the risk of suicide, and better ways to cope with these issues.
Part of their message is that, as was the case with Alexandra, people with depression may not seem typically unwell.
EXPERTS now warn that up to half of patients with the common mental illness don’t suffer telltale symptoms such as insomnia, loss of appetite and lethargy. Indeed, many seem upbeat and outgoing, despite suffering periods of low mood and harbouring dark thoughts.
Private distress can continue for years without anyone realising that there is a serious problem. Sometimes, not even the sufferers themselves know they are unwell.
According to psychiatrists, the hidden symptoms of so- called atypical depression – sometimes dubbed ‘smiling depression’ – make it especially deadly.
As the illness is less likely to be picked up and treated early on in these cases, sufferers are more likely to die by suicide.
It is a story that James, a 34-yearold solicitor from Norwich, who agreed to speak anonymously, knows all too well.
He remembers being plagued by depressive thoughts and ruminating over the smallest criticisms, even as a teenager. Yet to friends and family, he seemed outgoing and happy.
‘Anyone who knew me would say, “James is either really up or really down.” And I suppose I’ve never struggled with confidence. But there was always this fog somewhere in the background.
‘When people describe depression as a dark cloud, it’s really accurate. My way of coping was to find things to distract myself. I’d go out with friends or start a new gym regime. When I felt good, everything was fine. But then something would knock me sideways. It could be an argument with a colleague, or a problem with a girlfriend.
‘If a stranger was rude, no matter how slight, it would make me lose my rag, and then I’d find myself picking over it in my mind, blaming myself and worrying.’
Astonishingly, James struggled on into his early 30s without any medical help, holding down a job at a legal firm. But in 2017 he reached breaking point.
He says: ‘A relationship ended, and I started a new job, which was tough. Suddenly, nothing that used to make me happy did any more. The fog never lifted.’
At his lowest ebb, James planned to take his own life. ‘A friend had died in the same way, and in my darkest moments I thought about him and what he would have wanted. I knew I had to get help.’
After visiting his GP, James was prescribed medication and has had weekly psychotherapy sessions ever since, which he says helps to keep him stable.
He adds: ‘Meditation and regular exercise have also been really important. These things might not work for everyone but they do for me.’
Cambridge University psychology researcher Olivia Remes says cases such as James’s are common.
‘Patients with atypical depression do suffer from low mood, but this can lift in response to good news or positive events,’ she explains.
Sufferers may tell no one about their problems – and even seem happy and well to outsiders – until an event triggers a crisis.
‘ Patients often suffer a breakdown in response to a perceived rejection or criticism – perhaps a relationship problem, or something going wrong at work,’ says Remes. ‘ It is at this point that they are most vulnerable.
‘Perhaps if more of these kinds of cases were picked up earlier and treatment was offered, then suicides could be prevented.’
Consultant psychiatrist Philip Wilkinson believes that rather than group depression into subtypes such a typical or atypical, it should be seen as a spectrum illness.
‘Depression affects people differently, and not always in ways that we expect,’ he says.
‘There are the classic signs, like feeling demotivated and unable to get out of bed. But for others, it’s an over-sensitivity to everyday events, or in older people, memory problems or confusion. These things can all go hand in hand with the sadness of depression.’
SUFFERERS of atypical depression often report sleeping for long periods – more than ten hours a night – increased appetite and weight gain. Strangely, some also suffer what is known as leaden paralysis: the sensation of heavy limbs, lasting for more than an hour a day.
Some studies suggest that the commonly prescribed antidepressant drug fluoxetine is effective only in about half of patients with atypical depression, compared to about two thirds of those with typical depression.
In atypical cases, a class of drugs called monoamine oxidase inhibitors may be particularly helpful. However, they are seldom offered by GPs due to side effects such as dizziness, nausea and blood-pressure problems.
Dr Wilkinson says: ‘These would be prescribed by a psychiatrist, following a referral by the GP after several medications have been tried out but nothing has worked.
‘Patients need to be monitored by a specialist due to risks.’
He adds: ‘Doctors need to be aware that depression can be different for every person. Not every patient fits into a neat set of criteria.’