Introducing Catherine & Ally

Throughout this series of booklets, to help illustrate and explain different strategies, we will follow the stories of Catherine and Ally, who both have a diagnosis of PH and who both experience depression, but are affected by it in different ways. While both Catherine and Ally are made up, the difficulties they experience are commonly reported by real people with PH. Perhaps you will recognise some of their difficulties in yourself.

Catherine is a 69-year-old female who developed depression soon after she was diagnosed with PH seven months ago. Although there have been times in her life when she has felt low, this time she feels worse. Catherine cannot stop thinking about her future and is having negative and distressing thoughts, such as “Nothing good will happen again”.

Although her doctors have reassured her that she is responding well to the medicine, Catherine cannot stop thinking about her PH. She struggles to sleep as she lies awake with repetitive negative thoughts about what she cannot do that she was able to do before developing PH. In the morning, she struggles to get out of bed because she hasn’t slept very well, but also, she doesn’t see the point in getting up.

Catherine has always loved spending time with her grandchildren but now feels guilty about not being able to run and play with them like she used to. Although she doesn’t enjoy food in the same way, she is eating more and has put on weight, which she is self-conscious about. She struggles to engage in physical activity as she is anxious about becoming breathless. Catherine has noticed she has little motivation to do anything, even things she used to enjoy.

Catherine often feels annoyed at herself if she does not do things she feels she should, such as getting up by a certain time, cleaning her house, and speaking to her friends. She tells herself to “pull herself together” and stop being so “useless”. She has always seen herself as a young person; however, now she feels as if she is grieving for her old body.

Ally is a 25-year-old male. He has lived with PH for a number of years and felt he was coping well, but just as his friends his age are gaining more independence, he is upset that he cannot do the things they are. The medication he must regularly take is almost a constant reminder of his condition. Ally gets annoyed that he cannot play sports like his friends or go out to the same places. When he does go out, he becomes self-conscious as they have inside jokes and he feels left out. He worries whether they are having a good time when he is there and whether they really want to be doing something else but can’t because of him. He also has to plan ahead whenever he goes out in case there is nowhere to sit to rest, or if there are stairs, which he struggles with due to his PH. The last time he was out he felt exhausted and had to leave after an hour. He felt embarrassed and called himself an “idiot” and said that “he should know better”. Most social interactions now feel exhausting for him. Ally tends to stay alone in his bedroom and has become good at coming up with reasons why he can’t go out.

He has noticed his social group has reduced over time, which further fuels his negative thoughts about himself.

Ally has always been close to his parents but recently he has been distancing himself from them and often lying, saying he is fine when really he can’t remember the last time he felt fine. Ally has also noticed he and his girlfriend have drifted apart. He used to enjoy physical contact with her but now he feels he does not have the energy. Ally experiences negative thoughts about himself; for example, thinking “why would people care about me” or “why do they want to spend time with me; I am boring and a failure”.

Some people with PH are aware that they are experiencing low mood or depression and may have already discussed this with a healthcare professional or their family and friends. However, many people may not feel able to talk to others about their mental health due to feelings of shame, stigma, or thoughts of hopelessness. For example, people may fear being judged negatively by themselves or by others for having such experiences. Some individuals may also be in denial about how they are feeling, such as pretending it is not a big deal or that it is not having an impact on them, when it really is. Some people may be hoping that their depression will go away on its own; however, we know that if people do not actively manage their depression, it is unlikely to improve.

If depression goes unrecognised and untreated, then it can have a negative effect on your health and wellbeing. So remember, you have taken a positive and brave step today in making the decision to help develop skills to overcome feelings of low mood and depression.