DEPRESSION MAY CO-EXIST WITH, OR BE SECONDARY TO, ANOTHER PSYCHIATRIC CONDITION

Sometimes one type of psychiatric condition can mimic another. For example, an accountant in his mid-forties was referred to me for treatment of his low mood. He was very discouraged about his work, where he was constantly in trouble for procrastinating.

He was very intelligent and had no difficulty understanding the complexities of his clients’ finances but somehow he had insurmountable problems with deadlines. He would leave things until the last minute, stay up all night working crazily and would almost always succeed in getting the work done on time. But these last-minute all-nighters were becoming tiresome not only to my patient but to his associates as well. As a consequence he was under pressure to work in a more steady and even manner and he was depressed at his difficulties in doing so.

Careful questioning revealed that he had suffered from atten-tional difficulties since childhood, had never performed up to his potential and had always relied upon the intense pressure of deadlines and the prospects of failure to motivate himself to get anything done. In lectures and classes he would lose track of what the lecturer or teacher was saying. He was extremely distractable and often left tasks – particularly boring and unpleasant ones such as paperwork – half completed as his attention shifted to something which at that moment he found more interesting. I diagnosed him as suffering from attention deficit disorder (ADD), prescribed Ritalin, a stimulant, and recommended certain behavioural changes in the way he approached his work. He responded immediately and favourably and his mood improved as well. He turned out to be someone whose depressed mood was the result of another problem which responded to treatments that were specifically helpful for that condition. An anti-depressant alone would have been unlikely to correct his fundamental problem, namely his attentional difficulties.

Even if a person is indeed depressed, it is worth going to see a doctor to determine whether some other treatable condition may be present in addition to the depression. Shakespeare noted that ‘when sorrows come, they come not as single spies but in battalions.’ And so it is that depression is often accompanied by some other condition, such as a drug or alcohol problem, attention deficit disorder or an eating disorder. If these conditions are present they deserve to be treated in their own right with the appropriate treatment. People with more than one condition often require more than one type of treatment to get the best results.

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