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Depression
Anxiety, Depression, and Other “Gifts” You May Have
Don’t blame your mother. It’s not her fault, or yours.
Posted January 14, 2018
“I’m Superman, as long as I take my crazy pills”
I have been working for almost 20 years with a man who struggles with depression and anxiety. When he is experiencing an exacerbation of symptoms, he can become extremely irritable and angry. When he’s on his medications, his episodes are significantly less frequent, less intense, and last for shorter periods of time. Although the addition of medication may not completely eliminate episodes, they allow him to incorporate strategies he has mastered. How we respond is the result of a complex interaction of our genetics and environment. It’s not so much about self-control, the experiences of your childhood, or even your parents. It’s the interaction of all of this—and who you are.
Once our brain takes in anxiety-provoking information from our surroundings, whether it is something someone has said or an experience, the brain deals with it in two ways: the relatively automatic, immediate or "fight-or-flight” response; and thoughtful analysis, drawing on higher levels of cognitive functioning.
Input from the environment is synthesized by a part of our brain called the amygdala. The amygdala sends that information to the Hypothalamic-Pituitary-Adrenal axis, another area of the brain—and the sensitivity of these two systems is due to the complicated interaction of both genetic and environmental factors. Someone prone to depression or anxiety will usually have a response that is more extreme than would be indicated. The automatic response area of the brain overwhelms the higher level of functioning or analytic response. The function of medications is to bring the systems’ response back into the appropriate range so that the higher functioning response can work. This is one reason why the combination of medication and psychotherapy is so effective.
Learning about ourselves requires that we not only understand our interactions, interpretations, and responses to the world, but that we also understand the sensitivity of our own inner biological system. The intensity of how we experience anything is on a spectrum, and the cascade of actions that happen in our body as a result of an experience leads to physical and emotional symptoms. Each of us has a unique spectrum of how we process experiences. For some people, their processing can lead to physically and emotionally damaging outcomes that require the assistance of medication to help bring their system to a tolerable and healthy place.
With my patient, he would struggle every few years with wanting to stop his medication, and we came to an agreement that he would talk with me so that I can guide him in coming off medications with the least discomfort. He was unhappy about the side effects, in his case the most significant ones being sexual dysfunction, weight gain, and poor sleep—and this contributed to his desire to stop them. He also simply didn’t like the idea that he needed medication to be happy. “Why couldn’t he control his depression?” he thought.
Six months after stopping his medications, he contacted me to set up an appointment. Initially, he felt okay and was relieved that the side effects went away. He noticed, however, that increasingly he had been arguing with his wife. Things that he was previously able to shrug off were leading to irritable and hostile remarks that led to arguments and tension between them.
He was normally an easy-going guy, but this day he presented as angry and irritable. When I asked him how he was, he snapped, “Not good. Everything sucks. Didn’t you get that from what I just told you?”
“Everything?” I asked.
“I get angry at the slightest thing, not only with my wife but also at work. I feel like I am ready to leave my job even though I liked it until a month ago. Last week I thought I would be happy if I didn’t wake up in the morning. And I already know what you’re going to say—'You need to go back on the medication'—so just prescribe them so I can get back to work.”
He was right; I did advise him to go back on his medication.
When we met for our next appointment he was in a much better place, although still not back to himself. He was distressed that the side effects returned but was relieved to not be feeling so depressed. During this session, he started to talk more about his depression and how it returns after stopping his medication.
“I wish I could get off of these medications, mostly because of the side effects but I also hate having to take medication to be happy. I’ve been in therapy on and off for most of my adult life and I can really appreciate what I have and who I am. I have so many great things and have gotten past so much but whenever I stop the medication, I go right back to that place that I hate. The only reason I went back on them this time was because it was the first time I really thought about suicide. Just the idea of going on living felt empty and meaningless, like I was killing time being miserable until I died—so why not do it now. The only thing that stopped me was remembering how devastating it was for my family when my mother killed herself.”
He was having a hard time accepting that his depression is not under his control, that he shouldn’t feel that he is a failure because he became depressed. “Genetics make a significant contribution and it doesn’t matter how strong your willpower or self-control is,” I explained. “Since your mother struggled with bipolar disorder, you too are at greater risk of developing depression.”
“Just one more thing she gave me,” he retorted.
“When I first started the medication, I felt a kind of relief. It’s hard to describe but I was not as angry. When I was a kid, starting when I was about three years old, my mother would get so angry it terrified me. I can remember her screaming at me. She scared everyone around her. When I realized all the adults around her were also scared, it made me anxious and fearful. Sometimes, even when she was in a good mood and there was nothing to worry about, raising her voice would make me flinch. Even if she was just laughing. I couldn’t even control it and then she would get mad at me for flinching.”
As a young child the response of jumping or flinching when his mother raised her voice was automatic, and likely a fight-or-flight response. That’s built into our brains. If she was going to physically harm him, the automatic response served as an attempt to remove him from the possible danger.
The response to his mother raising her voice when laughing is an example of both an automatic and more considered, analytical response. The initial flinch is the fight-or-flight response, but once he realized she was in a good mood and raised her voice because she was laughing, he was able to calm himself.
When we met for the next appointment, about six months after he restarted his medication, he was back to himself.
“You seem to be back to yourself,” I commented.
“Yeah, I’m Superman, as long as I take my crazy pills.”
“How about the side effects?”
“They’re all back. I figured I would deal with it by not going to the gym and start eating more, so I gain a lot of weight and my wife will be relieved when I can’t have sex with her. We’ll have a great relationship.”
“I would recommend a different strategy: Go to the gym, monitor your diet, and try Viagra. I think this is a much better solution to a happy marriage.”
