I started to get extremely depressed at 19. I was a sophomore in college and doing well in school and socially but I had this weird existential angst and sadness and apathy that eventually morphed into clinical depression and a full-blown eating disorder. That turned out to be the beginning of what would be a life long struggle with mental illness. At 22 I was put on anti-depressants. I’ve been on them all: Zoloft, Paxil, Wellbutrin, Celexa, Prozac, Trazadone, Lexapro, Effexor, Cymbalta. You name it. Later, over the years, would come the addition of Lithium, Abilify, Seroquel, Topamax, Risperidone, Zyprexa, Geodon, Adderall, Provigil…I had a full-blown nervous breakdown at 24, a second at 35 and then a third at 42 while going through my divorce. I’ve been on anywhere from a single anti-depressant to a cocktail of 6 different medications at one time. Here’s the thing: anti-depressants and other psych drugs don’t make you happy. They make you, if you’re lucky, undepressed and in my experience, usually not for very long. And yes of course I was in therapy, every type you can imagine: everything from NLP to CBT and analysis but also Rolfing, Reiki, shamans and I kid you not, an exorcism. (And I’m Jewish!)
When my depression would hit, I would take to my bed for days on end. Showering was too much effort. Eating wasn’t a big priority. I wouldn’t answer phone calls. Suicidal ideations abounded and eventually I attempted 3 different and obviously unsuccessful times. That plus my drinking and drug use got me 5150’d on four different occasions.
I wondered if I was just lazy or sad or a drama queen. I really didn’t have anything to be depressed about. People would tell me to “snap out of it” or “go take a walk” or “make a gratitude list”. But my depression was a demon that siphoned up all my energy and will, filling my veins with lead and my head with a type of pessimism and self-hatred and dread that only other depressives can truly understand.
In my 30’s I finally learned about my “family history”. My great grandmother was diagnosed with a “nervous breakdown” and hospitalized. My grandfather received Miltown, the very first anti-depressant as well as electro-shock therapy.
My father hid behind alcohol and the cynical veneer of the writer. And that was just the paternal side of the family. The genetic legacy on my mother’s side was equally rich: my grandmother and uncle were both schizophrenic. My grandmother had a breakdown and was hospitalized when my mother was just in her teens. My great aunt was hospitalized her entire life in Camarillo state with schizophrenia and also given electro-shock treatment. My other great aunt starved herself to death in her early twenties over an obstructed love affair.
When I heard about the genetics of my family tree, I felt two very different and conflicting emotions. On the one hand there was relief. It WASN’T in my head. I didn’t just have a “bad attitude”. I had inherited something very real and very debilitating. But on the other hand, it felt like a death sentence. I was fucked. It wasn’t just a stage. I wasn’t going to grow out of it. This was a chronic illness that I would have to live with and manage my whole life.
Addictionologist, psychiatrist, author and former Chief Medical Officer of Townsend Treatment Centers, Dr. Howard Wetsman (Twitter: @addictiondocMD) had this to say: “You have to know if you have Depression or depression. I don’t mean to be cute about it, but ever since Oprah started talking about it on her show, no one knows what the word means anymore. So first the symptoms: can’t sleep, no energy, can’t enjoy anything, overeating or no appetite, irritable with everyone, etc. These can all be symptoms that people with low midbrain dopamine tone say they have. If you just list these it looks like Major Depression, but is quite common in untreated addiction.”
Okay but I have 5 years clean and have had years of sobriety before where I was still bolted to my bed for days at a time, taking breaks to Google noose knots, anti-freeze cocktails or Samurai swords to fall on.
Dr. Wetsman continues: “In Major Depression, there is a response to chronic stress that includes a hormone in the brain that usually keeps the brain growing interconnections. That hormone, or growth factor, called Brain Derived Neurotrophic Factor, stops being excreted and the neurons stop making new connections. We’re constantly losing connections in a remodeling process of pruning and regrowing them so if growth stops we have a net loss. There are fewer interconnections and you actually get white matter loss and the brain is smaller. All the anti-depressants that work, work by interrupting the stress response and stopping the loss of BDNF so that you don’t get this loss of interconnections. But this takes a long time. The med has to work, then it has to get the stress response to be blocked, then BDNF has to turn back on, and then BDNF has to go to the nucleus and turn on other genes, those genes have to make a product to tell the neuron to grow interconnections. That has to go all the way down the axon to the end of the nerve cell and then that nerve cell can start making more connections. That’s why it takes 6-8 weeks for these things to work.”
“Having a chronic illness whether it’s depression, addiction or diabetes has a kind of soul sucking quality to it that people just get tired of,” Dr. Wetsman says. “Can’t I just for one day forget I have this fucking thing and pretend I’m normal?”
So now in my…ahem…late 40’s, I’ve found some things that help but nothing that cure these frightening bouts of mental darkness. These include meditation, exercise, creativity or just getting out of the house even when you’d rather pull out all your teeth with pliers. I can always feel the depressive episode coming on…like seeing a storm far off in the distance. And instead of trying to fix it or escape it anymore, I just buckle down now and weather it out. If that means sleeping as my psychological storm shelter, I’m okay with that. And despite my surviving many a season of this disabling illness, I’m still convinced when the depression hits that this is it. This is going to be the one that takes me down. It will never lift. But it always, eventually, does.
So please don’t ask a personal with Clinical Depression “WHY” they’re depressed. The answer is we don’t know. It’s just what our brain does.