Still-Depression.

cracked_depression_pt_2_by_dankex-d63q1xcSo here’s the thing about coming out about experiencing depression. Or rather, about being in the throes of an ‘episode’. (Such an innocuous word, episode. It should at least be dark and black and infused with the imagery of the lived experience of an episode). The shift in perceptions of depression as a medical illness has generally been a great improvement on widely held views that depression is a weakness, a made-up all-in-your-head-pull-yourself-together flaw. A choice, if you will. I have seen palpable relief in friends and patients who are fighting against their ‘weakness’ when I’ve suggested that depression is much like diabetes (for example) – a chronic condition that needs treatment to be managed. While this doesn’t absolve a person of the responsibility of getting help and doing everything they can to help themselves, it does remove the sense that this is somehow their fault and, if they just tried harder, they’d stop feeling so mad/bad/sad.

But, through this latest episode of mine, I’ve realised that the depression-as-medical-illness perspective can hold its own dangers.

First, we tend to think of illness as acute, not chronic. Like a bad case of flu or gastro, there seems to be the perception that you take your depression to the doctor, get a prescription and in 10-14 days, give or take, you’re well again. Notwithstanding the unlikelihood of stumbling upon the right medication first time around, depression typically doesn’t resolve itself in a few weeks. This is difficult: not knowing when (let alone if) you are going to start feeling like your Self again. More difficult: the expectation from well meaning people in your life that you should be Better now. It’s been a month, right? 6 weeks, right? Two months? You’re doing Better, right? If it’s tiresome to keep getting the “I’m not okay” response to your “How are you?” question, please try to imagine how it feels to live that not-okay, every day, for a month, two, three… Most difficult: the suggestion, implicit in that question, that you are obviously not trying hard enough to Get Better. Depression is hard to deal with. So is a depressed person. It’s easier, sometimes, to pretend it’s not happening (anymore). If you happen to be the depressed person, you don’t get that luxury.

As useful as the depression-as-chronic-illness can be, it somehow doesn’t quite portray the transition from physical to mental suffering. Depression is (largely) unseen. Its blackness unfolds inside you, makes the unreal real, the irrational rational. The very part of you that can rally your physical and emotional resources is the part that is broken. No matter how I’ve tried, I’ve yet to adequately articulate the experience of living with and through this illness. How do you explain an illness so tortured that, instead of fighting to live, you fight to die? In my experience, at least, this is difficult – impossible in some cases – for people who care about you to come to terms with. Confessing such an awful truth is pretty much taboo. And so you live with the thoughts and feelings in silence, alone. You get out of bed, you get dressed, you might make it into work. You look normal. Your chest is clear; your leg’s not broken. But this illness is still there, unrelenting. What would depression look like, I wonder, if it was no longer invisible? If we could see the torment reflected on a person’s skin? Would it evoke more empathy, or more fear?

I have a close friend who broke her leg last month, and was booked off work for 6 weeks (and counting). The experience has been a difficult one for her – a fiercely independent, vivacious person, highly invested in work and relationships, now housebound and ‘out of action’ because of a broken bone, a cast and crutches. I’m sure I’ve never fully appreciated how physically incapacitating a broken limb could be and certainly not what an emotional blow it delivers. I was struck, though, by even my own perception of how legitimate her injury was. Of course you should get booked off work for 6 weeks (and counting) because you cannot walk. Of course you can’t go to the shops to buy milk because you cannot drive. Of course it’s okay if you can’t make it to my supper party because it’s too difficult to move around. Insert “depression” for “broken leg”, however, and perceptions shift (mine included). The difference, for me anyway, is that it is my whole self that is (hopefully temporarily) broken. But it’s not quite so acceptable to not be able to work or go out and buy bread. And it’s definitely not okay if you keep turning down invitations, or don’t have the emotional energy to “keep in touch”.

I am not okay. Not right now, anyway. I’d very much like to be okay again. I’m doing what I can. I get out of bed (most days). I eat. I try to maintain some form of connection to the world out there. On really good days, the 8 long hours spent in front of my computer result in something productive. And I try, with the support of some extraordinary people, to push back against this illness. I’m trying, hard, to Get Better. Part of that, for me, means trying to talk about the experience, no matter how scary or shameful it feels. Perhaps – perhaps – it will make depression a little more visible.

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Un-Depression.

meiroun-frame-3This is a post about depression. You’ll notice how I highlight this upfront, in the title. This is deliberate; a sort of disclaimer, if you will. It tells you right away that the content of the story that follows is not going to be pretty. It warns off anyone coming here for a nice cup of tea and pictures of daisies. But, if the title has done its job, you’ll realise that this is also not really a post about depression. It’s about the price you pay to live a Life Un-depressed.

There are a lot of really great personal accounts and metaphors about depression out there. I particularly like how Allie Brosh, Andrew Solomon and Matthew Johnstone have managed to capture the experience of it in ways that, hopefully, both depressed and un-depressed people can relate to. What I think many of these narratives don’t quite capture, though, is how impossibly part of your Self depression is. Like a virus, it infiltrates your cells, blackens them and reflects the worst parts of yourself back at you. It becomes impossible to tell the difference between what is real and what is depression. It’s all sorts of awful.

All sorts of awful is where I’ve been these past few months.

The thing about recovering from depression is that there is no one-size-fits-all. Some people have spontaneous remission without treatment. Some go onto a course of medication and / or psychotherapy and get through the ‘episode’, which might be the only one they’ll ever be unlucky enough to have experienced. Some, like me, will cycle in and out, from one episode to the next, emerging eventually with the knowledge that theirs is a chronic condition for which, much like diabetes, they will need to be on medication for the rest of their lives. If, like me, you’re one of the lucky ones, you’ll find an anti-depressant (likely after many hit-and-miss attempts) that takes the depression away. I stumbled upon my particular brand of drug – selective serotonin reputake inhibitors or SSRIs – a decade ago. I got Better. I stayed Better, for over ten years. Until I decided, last year, to come off SSRIs. 

Every anti-depressant affects every person differently. SSRIs, in their defense, have a fairly good reputation for being effective for many people. They also have a reputation for a rather significant set of side effects (more on this later). It was because of these side effects that I tried to come off them (resulting in a pretty trippy few months), and was put onto a different class of drugs. Evidently, this new drug did not work. My neurotransmitters wanted their SSRI back. Faced with a severely depressed patient, my doctor put me back onto my trusty SSRI. I protested against this, but at the time I was not in a position to put up much of a fight.

And here, finally, is the point of this story. I am lucky to have found a drug that works for my depression. I am less lucky to be one of the people who is particularly affected by the drug’s side-effects. And so I wonder: when you take anti-depressant medication, does it make you become more of yourself, or less?

A lot of medications have side effects. Headaches, nausea, dry mouth, insomnia, somnolence… an endless list, really. But mine are not physical side effects. Physical side effects, quite frankly, I could live with. There are a number of delightful terms given to this particular melody of effects: emotional blunting, SSRI-induced indifference, frontal lobe syndrome. The offshoots include detachment, apathy, numbness, indifference, boredom, anhedonia, and lack of interest in anything and everything. Unsurprisingly, these are not among the endless physical ‘contraindications’ listed in the box insert. They are seldom spoken about in doctors’ offices. The idea seems to be that if the SSRI makes you un-depressed, the rest you can live with. As if living like that is really living.

Please don’t misunderstand me. Being depressed is intolerable. No one would choose not to get better. But living a robotic, colourless, emotionally void life is, I think, a very high price to pay. I’m willing to bet this is true for a great deal of people. What astonishes me, though perhaps it shouldn’t, is how little has been published about this price. On the web, anecdotal evidence abounds. Message board upon message board has pages of posts and comments about the experience of becoming less alive on SSRIs. But scientific, empirical research (the kind that is taken seriously by the medical community) documenting these effects? A virtual void. If you’re fortunate, you’ll get a doctor who has seen enough of this in his or her patients to pay attention to these complaints. Although, so far, none have been able to tell me exactly why or how these drugs have this effect. I’m guessing this has something to do with the fact that medical science, for all its astounding advances, still can’t quite say exactly how or why anti-depressants work at all – or why one person’s miracle drug is another person’s nightmare. There are theories, of course. But I’ve yet to hear or see conclusive evidence.

How does one make a choice like this? A reverse Sophie’s Choice, if you will, where neither option is desirable. I of course have the option of trying one of the anti-depressants from the vast range of non-SSRI alternatives, and I am now working my way back to being off SSRIs. Trying, once again, something new – a drug that works on different neurotransmitters all together. But because my depression seems to be serotonin-based, there is the risk that this new drug will not work. Then, once again, I will have to choose between depression and the life-altering effects of SSRIs.

It’s an impossible choice. But the risk is worth taking: I want to see how much more of my Self I can become.