[Content Note: Depression, Self-Harm, Shitty Doctors, Fat Phobia]
Enough people have written me about the depression posts that I felt it was necessary to have a follow-up post on depression in general. So let's talk about depression.
Diagnosing depression is not an easy thing to do. In my life, I believe I have experienced depression twice, by which I mean I have had two periods of sustained depression over a period of two months or more. Note that I say "believe" there for good reason: depression isn't always easy to diagnose, it frequently isn't easy to track over time ("When did I start being depressed?"), and it often isn't easy to remember after the fact ("What was my depression like?"). I may well have been depressed multiple other times and failed to recognize or mark the illness with the appropriate label. Depression tends to start slow and build up over time to something that isn't recognizable to the sufferer because it happened so slowly. Indeed, one reason why my last bout with depression was easy for me to recognize was because -- since it was medically induced -- it hit me full-force out of the blue. Most depression sufferers aren't so "lucky".
If you're reading this wondering if you are depressed, I would tend to encourage you to err on the safe side, assume you are, and seek what treatment is available to you. Depression is ridiculously under-diagnosed, in my opinion, and it would not surprise me if the real numbers were that 9 out of 10 people suffer depression at least some point in their lifetime. I have had people write me and say they think they are depressed -- at which point they will frequently insert numerous very big red flags for depression -- but they worry that they are being "dramatic" or "overly sensitive" or even appropriative of the illness. I say: if you think you might be depressed, now is not the time to be worrying about appropriation. Now is the time to seek help in whatever way you can, whether that be with a doctor, a nurse, through a book, through online resources, through friends who have also been through depression.
There are tests online -- many of them; here is one and here is another -- that help to diagnose depression, but these tests are far from perfect. One major problem with diagnosing depression is that most symptoms of depression have alternate causes. For example, in my first bout with depression, yes, I did dramatically lose weight. However, that weight loss was caused because I had acquired an eating disorder as a means of dealing with the situation that was ultimately causing my depression. I didn't tell my doctors about my eating disorder because I was afraid; instead, they (correctly) diagnosed me as depressed and treated my depression. When my depression went away, the eating disorder went with it, but it's important to note here that my weight loss was not without a "reason". Similarly, my second bout with depression had fatigue and sadness and losing interest in shiny things... after a major surgery! It would have been easy for me to say, "Oh, well, I only feel this way Because Surgery, so I'm not really depressed." That would have also been wrong.
Being "depressed" does not mean "sad all the time"; many people who suffer from depression are happy from time to time. (Additionally, when you are depressed, it can be very hard to gauge "happy" and "sad", in the same way that a long-term eating disorder can make it hard to gauge "hungry" and "full", or in the way that life with chronic pain can make it very hard to answer the "how much pain are you in right now" question.) Depression doesn't mean that the myriad of indicative symptoms have no other plausible cause. Depression is not a diagnosis that we only reach for after all other possible causes have been exhaustively excluded. If we did that, probably no one would ever be treated for depression, because there's almost always other factors going on in a sufferer's personal life and physical body.
So if you think you might be depressed, my personal opinion is to assume that is true and seek help for it under that assumption. That "help" doesn't necessarily have to be Big or Drastic or Medical; it could mean looking up self-treatment online and seeing if anything clicks with you. But! If your "maybe depression" includes self-harm, thoughts of self-harm, and/or persistent thoughts of suicide or that the world would be better off without you, please do seek medical help because that is pretty serious.
So let's say that you've decided that, yeah, you're depressed. Now what?
Now you probably get to deal with too many cooks in your kitchen. Well-meaning family members may dismiss your depression, saying that you "just" need to alter your behavior (get out of the house more, meet a nice romantic partner, finish that degree, find a better job, move to Pluto, etc.). Doctors who can't find their butt from a hole in the ground (and they do exist, believe me) may try to insist that you actually have something other than depression, or they may try to put you on medication that doesn't work well with your system. (One of my anti-depressant medications basically turned me into one of those fainting goats. Not fun.) Romantic partners may fail to be as supportive as you need them to be. And so forth.
There is no one "right" way to treat depression. Some people respond well to medication; others (myself included) do not. Some people (like myself) respond well to situational changes; other people will remain depressed no matter what the situation. Some people respond well to individual therapy, others to group therapy, and others to individual self-therapy like journaling. And all this can vary even for an individual person: journaling may work great for the first two months, only to tail off in effectiveness for no apparent reason and then the medications have to be gotten. Or any number of combinations. Depression is fun like that!
I don't say this to make you think "oh, crap, I'm doomed, might as well not even try". Please do not think that. Instead, I say this so that you will not think you are doomed if a treatment isn't helpful to you. If a treatment is not helping, it is not that you are broken or bad; the problem is that the treatment isn't a good match for you. Plain and simple. And while it may be hard to do so, there is absolutely nothing wrong with standing your ground to Doctors, Family Members, and Partners and saying, "I am depressed, and this treatment isn't working and I need to try something else, and you need to support me in this." I fully and 100% support you in saying that in as firm a voice as you can.
And if you're not getting support and understanding and the treatment you need from your medical professionals, see if you can't find new ones. Doctors aren't infallible, and you don't need the added stress of someone telling you that you're not "really" depressed when you are, any more than I need some fool telling me that I don't "really" have a bad back, I'm just Fattie McPorkygirl. (X-rays be damned! Weight Watchers, that is what is needed to fix a spinal curvature!)
Living Under Depression
One of the hardest things about depression is that the knowledge that you are depressed often doesn't actually help all that much. It can be nice, sure, to know that there's a reason for why you feel a certain way and there's hope that you'll get better, but most of the time you just want to be better. You don't want to feel like you're wasting your life struggling with this crappy illness. I get that. Boy howdy do I get that.
If it helps at all, I don't think you're wasting your time. In my experience, on the other side of depression you can look back and remember good things and often forget the painful things. I don't clearly remember the soul-crushing depression I experienced after my surgery nearly so much as I remember watching shiny television shows (my most effective treatment of choice) and the good support I received from my mother and husband. (The times of bad non-support -- and there were some -- I have mostly buried and forgotten.) I gained experience in a disease, and that experience helps me to interact compassionately with others who struggle with it. And though I was deeply depressed at the time, I've come on the other side for the most part and, against all expectations, I have some good memories to pluck out from that time. Hopefully, your experiences will be similar.
But I know that isn't great comfort in the here and now. Depression is one of the worst things to suffer from, and I personally far prefer physical pain to mental anguish. I want to reiterate that: depressive pain was, for me, infinitely worse than living my life with chronic back pain. I hope you'll remember that the next time you worry that you're being "overly dramatic" or "too needy" or "weak" for not being healed up and all better yet. Depression is serious, even if the people around you don't take it seriously.
As much as you can, try to take depression a day at a time. Try not to worry about the future or not being healed yet or if you will ever get better. Definitely try not to make any major life-altering decisions, and particularly try to avoid thoughts and situations that lead to self-harm. Try to make small, doable goals for the day. Treatment is the most important thing, and it's important to work out at least something that will make you feel a little goodness. For me, it was as silly as watching episodes of "Friends"; having something light-hearted and fluffy to focus on helped to jar me out of my depressive mental patterns for a short time. Everything else has to be pared down to necessity: does X help keep you alive and/or help treat your depression? If the answer is "no", then X may need to fall to the wayside, or you may need to ask someone you can trust to accomplish X for you.
If you do have supportive people in your life, then please utilize them. If someone is saying "how can I help?", now is not the time to feel guilty for impinging on them. "Can you pick up my groceries for me?" or "Would you mind doing this household chore?" gives them something concrete for them to do in order to help the person they love, and may well mean all the difference in the world in terms of whether you have time for your treatment. If you feel safe doing so, share with them your treatment and how it works; telling them why "Friends" makes you happy or how journaling helps can help them to understand what you're going through and may help them find ways to ensure that you have time to do these things. If your loved ones are a drain on you -- and this can happen and it's not necessarily your or their fault -- try to tell them so tactfully; "it's just really hard for me to be around people right now" can clarify that it's not them, it's just the illness, and can (hopefully) forestall hurt feelings and drama that you don't need to deal with right now.
Above all else, try not to give up. Living with depression is terrible, but you're not alone and it can get better. Sometimes it gets better slowly, with a step back for every two steps forward; sometimes it gets better rapidly when the right treatment comes along. There are people who love and care about you, even if the depression makes it hard sometimes to understand why they do. Try not to listen to the depression. Try to take it a day at a time. Try to enjoy the things that bring you enjoyment, and try not to stress about not being better yet. Try to believe that "better" may come when you least expect it. Try not to expect so much of yourself. Try to remember that you have a serious illness and that just getting out of bed can be something to be proud of. Try to hang in there, at least for one more day.
And try to remember that you're not alone.