As I’ve mentioned in response to excellent posts on a couple of other sites, I struggle with depression. Although I don’t usually talk about personal topics here, nor am I as entertaining and eloquent as Dooce on the subject, I do want to collect and share my thoughts in this forum.
I have battled depression since adolescence, probably since I was 14 or 15. I didn’t know what it was back then, and wasn’t diagnosed until my mid-20s, but it seriously impacted me. I was quite a handful, my moods must have given my parents and college roommates whiplash.
There is a difference between situational depression (my dog died so I’m down in the dumps) and clinical depression (which is ongoing, intractable, not responsive to the ups and downs of life). The variables are usually duration and severity – but please, if this at all applies to you, visit a trained mental health professional to help with that evaluation!
When I first started getting counseling, and later was prescribed medication, it helped. A lot. After that particular depressive phase was over, I went off my medication. Just a few months later, I crashed again. And the next year, again. My doctor gently suggested that I had “chronic, major depression”. To maintain any kind of mood management, I needed to look at taking long-term, consistent antidepressant medication, as well as develop a long term, as-needed relationship with a counselor.
That was a bitter pill to swallow. What the hell was wrong with me that I couldn’t bootstrap my way out of this? Why was I not strong enough, resourceful enough, to manage my moods independently? Was I flawed, defective, less than fully capable? If I couldn’t keep my thoughts & feelings under control, was I a failure? It’s taken a very long time to make peace with those questions.
Depression, at clinical levels, is a mix of biochemical and behavioral factors. The predisposition can be genetic, but environment is significant. All the women in my family struggle with the mood disorder to one degree or another. Is it because of our genes, or because of our family and cultural programming, or all of the above?
Untreated depression is different for everyone. In my case, I constantly felt hopeless, unable to face the requirements and obligations of everyday life. I held it together and was able to function at work, marginally, but nowhere else. I couldn’t sleep when I needed to, but was exhausted & groggy when I was supposed to be awake. I felt constantly fatigued and had little initiative. I was excessively irritable, very withdrawn, unable to laugh or enjoy any facet of life. I was faintly paranoid, carrying around an anxious feeling like I was in trouble about something, even though I was not. My well of creativity and problem solving ability was bone dry. I just plain hurt, it felt like I was walking around with a lead blanket over my head and broken glass in my heart.
Part of the solution for me was medication. The antidepressant I take does not numb me nor cost me my ‘edge’. At different times, I’ve been on Paxil, Zoloft, and Wellbutrin, but the last seems to work best for me.
Because I’m a geek, I’ve graphed it, mapping mood swings from a low of 1 to a high of 10.
Depression treatment doesn’t quite improve my moods to the range that a non-depressed person might experience. Anti-depressants also smooth the extreme mood swings a small amount, so that I no longer am likely to spend as much time in the highest highs and lowest lows.
Medication, though, is far from being a magic bullet. It simply lifts the dark cloud far enough that I have less pain and more space, initiative and clarity to address the absolutely essential attitude and behavior issues. The classic mood-management suggestions for depression include:
- Manage stress effectively
- Get physical exercise regularly
- Learn to set boundaries appropriately – work on assertiveness, saying yes all the time is not healthy, but neither is saying no
- Learn to express emotions appropriately – don’t clamp down anger and sadness
- Develop some outlet for emotions – writing, art, physical activity, therapy
- Maintain a network of supportive friends and family
- Participate in activities that you find pleasurable and rewarding
- Be of service to others in your community – helping others dramatically improves perspective
Can you see the inherent flaws here? If you’re exhausted, hopeless and withdrawn, you’re sure not likely to head to the gym or call a friend. Self-starting any of these very beneficial suggestions is always a challenge; medication helps.
Cognitive therapy is a school of behavioral science that suggests that the way we talk to ourselves helps determine how we feel and how we see the world. It’s not a falsely positive approach, rather, a realistic approach. For example poor self-talk says:
My tax bill just came, and it’s a disaster. I’ll never be able to pay all that. Dammit, I’m such an idiot for not planning better. What a disaster – the IRS will take everything!
Instead, I could say:
My tax bill just came, and it’s huge. That really stinks and I wasn’t prepared for it. I am pretty determined, though, and I can make myself sit down, go through my money and figure out how I can either pay it or get help if I can’t. I’ll also work on a way to prevent this nasty surprise next year.
To some degree, beyond choosing how to respond, attitude management is about developing some core beliefs: I am a strong survivor-type who can handle anything; Life’s not fair but I’ll get over it; and that current circumstances may suck but I can choose to respond constructively.
What I achieve, what stuff I accumulate, and what people think of me matter very little; what’s truly important is how well I love, give, create and make a difference in this world.
I have a long way to go on some of those, but my current frame of mind is cautiously positive. I’m thankful for the love and support of my family. They’ve been inordinately patient and infinitely supportive, and I couldn’t have kept going without them. I am blessed.