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His episodes “sneak in the back door,” he says, and when they strike, a battle begins -- against himself.

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For half of people, one episode is all they’ll experience. But after three or more, these episodes are 90% more likely to become recurrent. This was the case for Knights.

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Knights grew up in the coastal town of Leiston in the Suffolk countryside. With a population of only 5,500, it’s a small community.

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Knights was in for a major readjustment, which experts believe can significantly affect mental health.

“The bigger the change, the more stressful, and that’s more likely to provoke mental health problems,” said Allan Young, professor of mood disorders at Kings College London. “If you go from very rural environment to a city, that’s going to be a huge adjustment, and for people with vulnerabilities, that’s going to lead to problems.”

Drug and alcohol abuse are very common with depression and at university, Young said, adding that this further increases a person’s vulnerability to mental health conditions. “[Its] use just makes things worse,” he said.

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Knights lived with six flatmates whom he considered good friends. They tried to get him help, but for months, he ignored their attempts and continued drinking alone, night after night, waking up alone, unable to move.

Despite attempts to change attitudes around mental health globally, stigma remains, leaving people unable to open up.

Knights now recalls a sense of masculinity and pride that would stop him from seeking help, pushing him deeper into a cloud of hopelessness and desperation.

Knights had tried to explain what he was going through to his friends -- but became unaware of where he was or what he was saying. Before he realized it, security had been called, and the police were there to take him away. They detained him under a section of the UK’s Mental Health Act.

Knights says he felt relieved because he knew that something would change. “This was enough for me to feel relief when they arrived.”

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Knights would first speak to someone three days later, when a psychiatric assessment board would descend upon his room to identify the best means of treatment.

Four people in four chairs in his otherwise empty room would determine his future and help him get better.

Knights consented to going into a rehabilitation hospital, a priory, where over many months he would receive therapy and medication.

He soon learned where he had gone wrong in his reactions to his depression, becoming equipped to learn more about himself and to explore his mind. “Depression is a lifelong condition,” he noted.

He still experiences at least two depressive episodes a year, but these now last a few weeks at a time instead of several months, because he now knows how to deal with it.

If you’re experiencing symptoms of depression theAnxiety and Depression Association of Americais an international nonprofit organization providing current treatment, support and resource information. The UK charityMindalso provide advice and support to empower anyone experiencing a mental health problem.