Someone rings me to ask me to ask to see his friend, who is very depressed and needs help immediately. I am closed to new referrals, I say, but something in the friend’s voice changes my mind. If someone has a friend who cares so much for him, somehow that makes me care more too. I become involved, recruited to be a member of the team and help the friend out of his depression. Two months later the friend is completely well (on Lustral, incidentally, not St John’s Wort. It was too acute and serious to warrant my trying the herbal anti-depressant, though, in future, as we learn more about the herb it may become a first-line treatment even for more serious depression). Serious depression can cost a person his or her life. It can wreak havoc with relationships and jobs. It is a medical emergency – and it is treatable. So it is clearly a reason to seek out medical help without delay. And if you have a friend or loved one who is severely depressed, do go the extra mile or two to connect him or her with a good doctor. It is really worth the trouble and effort to do so.

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* low self-esteem or lack of confidence

* pessimism, hopelessness, or despair

* lack of interest in ordinary pleasures and activities

* withdrawal from social activities

* guilt or ruminating about the past

* irritability or excessive anger

* lessened productivity

* difficulty concentrating or making decisions.

Because the symptoms of dysthymia are less severe than those of major depression, dysthymia is not always recognized and is sometimes misdiagnosed as a personality disorder. The importance of the diagnosis cannot be underestimated because diagnosis determines treatment. Yet in psychiatry, diagnosis can be imprecise. Psychotic hallucinations, for instance, can be a symptom of schizophrenia, which is notoriously difficult to treat, or of severe manic depression, which can be controlled with lithium. Unhappiness and feelings of emptiness can be characteristic of borderline personality disorder or of dysthymia. The difference is major. If the diagnosis is dysthymia, medications such as Prozac may help. We have treatments. If the diagnosis is a personality disorder, the treatment involves many years of therapy, and the prognosis is guarded. Thus, if a patient is diagnosed as having a disease which he or she does not have, or for which there is no cure, then nothing will be done to help the patient. In this sense, whether you get well or not is determined by the diagnosis. The importance of finding an experienced doctor is critical because the diagnosis—along with the doctor’s knowledge of which drug to choose and in what dosage—can determine the person’s fate.

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