Disability: Depression Diaries and Hanging In There

[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

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.

Treating Depression

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.


Lily said...

Does anyone mind if I vent for a sec?

Content note: depression/anxiety, family issues, people with disabilities and romance, religious terror

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.

God, I beat myself up for that all the time. I'm 23 years old, have spastic diplega cerebral palsy and sometimes I do not FEEL like looking nice, Mom, because there is no one I particularly want to impress by looking nice. "You look homeless," is something that is thrown at me at least once a week. In my mother's mind, the fact that I am medicated (20 milligrams of generic Prozac) cancels out my depression. I also have bowel issues and my parents' criticism has kept my self-esteem pretty low. Living in a conservative home just makes it worse because of my death phobia; I've had to compulsively pray out of sheer terror just to be able to fall asleep. I'm very anxious and I think the anxiety leads to depression and slight obsessive compulsive disorder. . (Example of the crazy that runs through my head on a daily basis: "God doesn't like me. I'm a bad person. I might be gay even though there's no evidence for it & I really don't want to be gay because that's not my thing.")

I honestly think my sexuality issues come from wanting the same kind of relationships that able-bodied people have and getting laughed at for it, so now that I've met an absolutely wonderful guy I feel like I don't deserve it somehow. (Yeah, I know I actually do deserve it, but this is how my mind works.)

...I'm stuck with my extended family for Thanksgiving and I think it shows.


Tigerpetals said...

I'm fine with your venting.

I haven't been diagnosed or medicated for depression and don't have those physical problems, but I empathize with your feelings on family and how they affect you. Today I am going to do the same thing I always do on Thanksgiving, which is isolate myself as much as possible when at my grandmothers' houses and hope there will be a minimum of them attempting to approach me for any reason. And bring books and the iPod.

And you're right: you do deserve to be with a wonderful guy regardless of what anyone thinks.

At least it's only for Thanksgiving.

Trynn said...

See, I keep getting my friends telling me that I just need Jesus. They're not really AGAINST me getting professional help, like, if I mention it they don't tell me I shouldn't. But when I ask them point blank, "do you think psychological help is necessary?" They tell me I just need Jesus.

Which is dumb, because when you have a physical illness, you do not just pray and hope it goes away (well, you might for small things, like a common cold, but the minute it becomes serious is the minute that mindset becomes dangerous). No, you pray AND you go to a doctor. You pray that the doctor finds out what's wrong with you (a prayer I've still been trying to get God to answer, ftr) and that he can help you. (this, of course, is if you are a praying person, which not everyone is, but these people are so I have to say it like that.)

It's the same way with mental illness. Yes you should pray if you want to, and then you use the thinking, rational brain that God gave you to reason that maybe you should get thee to a professional. If one believes in God, the logic should be that God gave the professionals wisdom (you hope) to help you.

Even after this explanation, some people still do not get it. Others think it is a very valid perspective, but, at least in my tiny little circle of friends, not a lot do....

It's just been very hard on me because I've been too scared to talk to someone about getting help. So I reach out to my friends, and then I get.... this. And I don't know what to do.... am I even sick?

hidden_urchin said...

This post was very well timed for me. I've been struggling with mood changes, but predominantly deep depression, for the past year now after believing that I'd finally managed to kick it. The psychologist I am seeing isn't really helping so I figured I'd see a psychiatrist as well. She's tentatively diagnosed me with bipolar disorder. It's hard to say, though, because, while I have the depression down pat, the mania is far more subtle. That part doen't negatively affect my life and, in fact, improves it greatly. So it could be that I have some form of bipolar disorder with stronger depressive states than manic states or it could be that I have depression/anxiety and my elevated mood comes from those instances in which the depression/anxiety eases. Also, my mood doesn't shift predictably or on a regular time scale. Sometimes I can go for weeks or months in one state or another and sometimes I can switch in minutes or hours.

It doesn't help that this is the third pyschiatrist I have seen in the past five years and the third different diagnosis.

Anyway, that's not my point. My point is that I'm frakking terrified.

I've looked at the data on the medication the psychiatrist wants to put me on and a.) there aren't a lot of studies for it because it was only recently approved by the FDA for treating bipolar depression and b.) the studies that exist are split as to whether or not it is effective. Furthermore, the more rigorous the study design is, the less likely this drug performs better than placebo. So I doubt that it will work and I really can't afford to waste the time to do the guess and check method which is pretty much the only way to do psychiatric treatment. This semester has tanked and my GPA is so low I'm worried I'll be kicked out of my program. If that happens then I'll lose both my sense of purpose, small as it is, and my health insurance. It’s not that I’m incapable of learning the material. It’s just that I need help and I don’t even know what’s wrong to begin figuring out what accommodations to ask for. It’s that there’s no way for me to rest and recover so I have to try and manage my mental illness and accomplish everything the university expects its healthy students to do simultaneously.

On top of that, I could really use the support of my family but they aren't known for sensitivity. (The reason I'm in grad school despite not being really ready for it is because my mother made it clear that I could either get a job or go to grad school but I couldn't stay at home anymore. I couldn't get a job in my field and the thought of going back into the service industry was giving me panic attacks so I went to grad school despite not having a community or real drive to succeed. Then, when I pointed out it was a bad fit for me, one relative said, "I think the real reason you're unhappy is because you thought it would be easy and it's turned that you need to work harder." When I tried to explain to my mother how horrible my emotional state was she actually mocked me. I told her I had, for the first time last fall, seriously considered suicide and she got all high pitched and started waving her arms around and said "“What do you want me to do? Run over to you and give you a big hug? Tell you it’s going to be OK? If this were really a big deal then why am I just hearing about it now?”

So now I've got to put on my happy face and pretend to be normal when I'm breaking apart.

So, yeah. It helps to have other people saying that it's OK to do what you have to in order to manage what is a illness because it can sure be easy to forget that. Even if it's just a virtual space, it means a lot to me to have somewhere where I can feel like I can rest for a bit.

Sven said...

I want to add: The above is very much NOT meant to say "See, this can be fixed!"---I just wanted to provide some information that I wish I had had when I had to deal with a similar situation early in grad school. I just want you to know that there may be options other than keeping your head down and trying to perform like a non-depressed person. But of course the latter is a valid choice, and it is your choice to make.

MaryKaye said...

One reason why I think that depression sufferers are often stigmatized as "lazy":

A person with normal brain chemistry can take pleasure in the idea that a good thing will happen later. For example, you can be having a bad day today, but thinking about what you'll do this weekend can make you feel better.

When I am depressed (and I've seen this in other depressed people as well) the horizon within which upcoming good things make me feel better gets shorter and shorter. When the depression is severe, a happy thing *right now* can still make me feel better, but a happy thing tomorrow means absolutely nothing. I can know intellectually that it will happen but it might as well be a hundred years away for all the difference it makes to my mood.

This makes it very hard to delay gratification. I think of this with a financial analogy. A neurotypical person who is having a bad week can borrow against the fun they expect this weekend, and get a bit of anticipatory fun to tide them over. A depressed person often cannot borrow ahead more than a short period (for me, often the horizon is same-day). So they go broke today, where a neurotypical person could manage by borrowing. Or they make short-term decisions which look like laziness or inability to defer gratification, but which are really a logical attempt to deal with their inability to borrow ahead.

Once you know what is going on with this, it's a bit easier to handle, and you can sometimes explain to the people around you.

Joolya said...

"You don't want to feel like you're wasting your life struggling with this crappy illness."

For me this is the shittiest thing. I feel like I've wasted (am wasting?) so much of my life being miserable. I have these periods of being okay, but then there are periods - inevitable ones, like when the nights get long in winter - of being in the abyss. The fact that I've been this way most of my life, and that it responds to chemical intervention, means I have to resign myself to the possibility of having depressive episodes. The void is always yawning, but I walk closer to it than maybe most people do (from what I gather), so the pull of it, the danger of falling, is greater.

It's a difficult thing to learn to manage, and manage for the foreseeable rest of my life, without getting hopeless sometimes.

But then I think, so is any other kind of chronic condition. Like back pain. Maybe we have to work a little harder at self care, be a bit more aware of our spoon stock and triggers and therapeutics.

It's so important that mental ... I don't want to say "illness" necessarily, but "conditions"

BaseDeltaZero said...

So uh... I got 'Very High' for Bipolar on the first test, and 65 on the Goldberg test... that's probably a bad sign.

I guess Bipolar makes a bit of sense, since I'll have brief periods where I'm hyper-excited followed by periods of being unable to do much of anything... but the cycles are entirely too fast... like minutes or hours, not months. Getting a score that breaks the scale, though... it might have just been a bad day, and I tend to exaggerate on such quizzes anyways.

chris the cynic said...

[Yeah, I've told this story before, I only have a limited number of stories.]

And then it suddenly clicked for me: I should treat myself as other people are treating someone with a broken leg (in a better world, other people would treat me like that, too, and some do, but most people do not).

Once upon a time I sprained my ankle badly enough to need crutches. It was barely a hindrance. The only thing that it really made difficult was moving slowly, standing still or moving at a good clip were easy as can be. My hands were occupied but that's what a backpack is for. It really wasn't much of a problem at all.

Everyone was willing to be as accommodating as could be then.

Before and after, and during as well I suppose, no one gave a damn about the depression which was a hell of a problem and did much worse to me than a sprained ankle ever could.

If people can't see your problems then, for the most part, your problems are things they feel completely comfortable ignoring.


The non-depressed non-doctor person I've met who does the best job of treating people with problems like depression with respect explained her perspective to me one day. She just makes sure to think of a mental problem like a physical problem. "Would I act this way if someone were having trouble because their cancer was holding them back?"

Of course there are some people out there who probably demand to see proof of cancer patients' diagnosis before they take that seriously, because it can be quite invisible as well.

Sven said...

"It's important to give myself permission to do the bare minimum sometimes."

This is very important. Learning of Spoon Theory did not only give me a great tool to explain to people what depression can be like, it actually also helped me to think of my illness in a helpful way. As in: There is a limited resource that you need to Do Stuff, and `healthy' folks have so much of it that they don't realize it is limited (or even something you need). Depression means (can mean) you don't. Sometimes you wake up and realize you don't have any spoons. And that's okay. It's not your fault. And some days, it will cost all your spoons to get up and go to the corner store to pick up something, anything that can give you sustenance. Those days, if you manage to do this one thing that your spoons allow you to do, however little it is, you have done a lot. Relatively speaking, you have done more than a `healthy' person who had a productive day. And if you did not do that other thing that you wanted to do that day, that thing that you thought you HAD to get done that day, then that is because you did not have the spoons to do it. It is not because you where to lazy/weak/undisciplined to make yourself do it. It is because you could not, because you have an illness that made it so that you could not.

And: Treatment costs spoons. Which does not mean you should skip the treatment that helps you in order to do other things, it means that if the only thing you managed to do today is doing something that makes you feel better (or makes you feel not-worse, or even only possibly makes you feel not-worse tomorrow), like watching an episode of a TV show you like, or sleep 16 hours, or whatever, then you have done all you could. You did not waste the day. You were not lazy. You were not irresponsible for spending your meager amount of spoons on something that made you feel better.

It took me a long time to think of my depression as an Actual Illness, even after I had been consciously dealing with it for a long time (and having realized that I had been depressed a long time before I first got help). I may have called it an illness, but I later realized that I did not really emphasize with myself accordingly. Until at one point, as I was dealing with a depressive episode, someone where I work broke their leg. Everyone tried their best to accommodate this person. No-one criticized for not doing the tasks they could not do because of the broken leg. No-one among the subgroup of co-workers that also are friends criticized this person for putting their social life on hold while the leg healed. No-one called this person lazy for not keeping up with their running regimen. And then it suddenly clicked for me: I should treat myself as other people are treating someone with a broken leg (in a better world, other people would treat me like that, too, and some do, but most people do not).

One thing that can be treacherous in dealing with depression long-term is that you will notice that you sometimes can prevent the worst if you realize in time that you are sliding into a depressive episode (up whatever treatment works for you, reduce exposure to people or other stressors that you know make your depression worse, etc.). Knowing these things is good. It empowers you. But it does not mean that if you don't catch the warning signs in time, or if you do and the measures you take do not prevent your episode, that means it is your fault. It is not your fault.

sterling said...

Just want to let you know:
Reading this blog helped me to identify myself as depressed, and to do something about it. You'd think I'd have figured it out on my own (master's degree in counseling) but living with it is different than helping other people, perspective-wise. It also became worse very slowly and insidiously.
Medication is now helping me. I also have realized for how very long I'd been experiencing symptoms of both anxiety and depression while thinking that I was just lazy.
So thanks-I came here for the Twilight deconstructions and got way more than I was expecting. Thanks to everyone who's posted about their experiences here.

thing said...

I mean something that doesn't depend on accessing someone else, aside from strangers on the internet. If I thought I could rely on someone I wouldn't have written that comment at all. I just never find strategies that aren't 'go to x person,' aside from stuff like hobbies. They also assume one is independent.

Silver Adept said...

@Divya Jagadeesan -

I'll echo Ana above about anxiety, but also note that the two go together quite well, as Smilodon pointed out. Also, you get a solidarity fist-bump from a similar sufferer.

Something I found useful is trying to pinpoint whether the feelings are triggered by certain things. For example, at work, I can handle all sorts of mean and nasty without being fazed. At home, if something breaks, though, Instant Rage. (often resulting in the breaking thing getting Good and Broken.) Plus, I always felt unhappy and depressive after handling bills and paying statements.

The two are connected - because my primary anxiety at this stage of life is financial security. Broken things cost money to replace. If I don't feel like there is money to replace the broken thing, I get mad, because now I have to spend money I don't have. Same thing with paying the bills - they tell me just how much money I don't have and how nothing seems to be working in getting the expenses under control (which is more difficult when you're not the only person spending household money). So, it's a bit of a yo-yo between depression (no money) and anger (no money).

I haven't been able to figure out how not to swing back and forth between the two extremes, but I can at least identify the trigger and hope for the days when there will be enough security to not be bothered by the small stuff. Assuming the depression isn't interfering and telling me I'll be homeless and bankrupt by that point.

So, from one sufferer to another, hang in there. We understand.

Joolya said...

(Oops, silly phone)

... It's important that we as a society recognise mental conditions as real, as treatable and treatment-worthy, and as not stigmatised. I try to be open now about my depression - my partner had a bad episode a few years ago and is now an evangelist for "coming out" about depression, so that people can deal with it without that shame. His coworker had a depressive episode last year, and my guy talking about his own experience was so helpful to this guy. I for a long time did my best to cover up my struggles. But now I am trying to take a different view. For example a good friend and colleague of mine was diagnosed with MS when we worked together. I think if she'd tried to hide it from us, instead of letting us help her when she had a flare-up, would have made her episodes that much worse. And we wouldn't have known why she was acting funny. So last time I had problems that were interfering with my work I came out to my boss and a few coworkers, and was surprised, touched, and grateful for their support. I know not every place is as good as mine turned out to be ... But I think raising awareness of depression as a Real Medical Thing (not a sign of weakness or "craziness") is the way forward.

Thank you to Ana and everyone here for sharing.

Long-time lurker Joolya

MaryKaye said...

bearonacarpet writes:

"...not least of all I've friends who've had severe depression who would poopoo the idea that I have anything like what they suffer..."

Two things worth considering:

(a) There's a real chance that this fear is the depression speaking and your friends would be sympathetic and willing to help.

(b) If they really do say that, that's not friendly. Poo-pooing your friend's pain is not a good thing to do. A friend should be sympathetic, within their means, when you are hurting. Particularly when you are depressed, you can't afford "friends" like this, and you may need to focus your social time on people who genuinely care about you.

In any case, please don't let this fear get in the way of seeking a diagnosis and possible treatment. If it helps, consider that you *don't have to tell them*. You can keep it between you and your doctor/therapist/counsellor. Or you can identify the people in your social circle who could be genuinely supportive, and not tell anyone else. It's up to you.

Smilodon said...

It's taken years and years, and concerted efforts by me and another person, but we finally convinced someone we both love to take a first step to getting help.

I don't have any brilliant methods that work to get someone to the point of accepting help. If I did, it wouldn't have taken years. The two biggest things I can think of that seemed to make progress - firstly, normalizing the idea of depression, and of help. We both talked to them a lot about our own problems, how we got help, what medication/therapies were like and did for us (good and bad wise). The other person sent them blog posts about depression (which were totally different from Ana's ones, but at the same time similar) and I think sent them some of the tests for depression (similar to the ones Ana mentioned).

The second thing was doing a lot of the work for the person. The other person found the number to call for help, and (with her permission) called and got them on a list. While calling, they found out exactly what the next step would be, down to "what will the next phone call involve, what questions will be asked". Once it was time for the second phone call, there was nothing we could directly do, since the person had to do it themself, but I made sure that they actually called back - by asking the person to tell me as soon as they'd done it, and gently nagging so it wasn't something that could be forgotten.

But giving someone the reassurance they need is helping them in a very, very important way. So don't feel like you're doing nothing.

KNicoll said...

To go back to the conversational thread about treating mental health concerns as real - there's great heaps of stuff in there, and it leads, in my experience, to a whole lot of internalised bullshit.

For years I have been doing the out-about-depression-and-anxiety thing, which is something that I have dealt with all my life, and which is actively disabling for me. I talked about how people treat it as not a real problem, about how "it's all in your head" (Sure, but SO AM I) comes out, about the way mental health (among other 'invisible' disabilities) is taken as a moral issue, and so on....

.... anyway. I was totally on top of that thing, right? And then, after a long and pointless drama, I got a diagnosis of Hashimoto's - a heritable autoimmune disorder which, among other things, is a contributing causal factor to depression. I had little slips of paper with numbers on them. Magic, magic numbers. Numbers I could show to people and say "You see these numbers? These numbers are proof that my health condition is real and needs to be taken seriously." And those people might say, "Yeah, I see your point, but I don't think it's a problem worth treating" at worst (previous doctor did this for years; see also 'long and pointless drama'), but they won't say that the numbers don't actually exist. And it was such a relief, and I felt in the back of my head a little relaxation along the lines of "See? You're not a lazy shithead after all. You have numbers. Nice, comforting numbers. People believe in numbers." (Even though it's not 'depression caused by thyroid concern', it's 'depression and a thyroid concern which aggravates it'.)

Pernicious, man. And of course, being depressive, I'm really good at beating myself up, so every so often I catch myself beating myself up for putting more confidence in the numbers which I can prove by bleeding than the stuff which I would otherwise be metaphorically bleeding out as text rather than literal tubes of fluid. Because people believe in numbers, and I'm a people so I believe in numbers; I don't, however, have a good track record in believing me.

Dav said...

Hmm. Sorry, I didn't get that from your original question. So at this point, a lot depends on you and your disease, which is even harder for a stranger to make suggestions for. I guess the core is self-care: making time for yourself and being forgiving and supportive of yourself. Are there things you do that make you feel better? Are there thoughts you have that make you feel better? People to avoid (or be with)? Internet sites that make you happier?

I wouldn't underestimate the value of strangers on the internet. I don't have any experience with particular online support groups for depression, but have used one from time to time for other health issues, and generally, it's been great. And you can be essentially anonymous, and blow off steam. If you don't feel like your browser history is safe using a forum or site, there's mail lists (i.e. Yahoo groups) that may serve you better. Even reading other depressives' blogs or articles can be nice for me. Sometimes it feels like I'm the only person who feels terrible. I feel relief when I recognize myself in, say, Hyperbole and a Half's post on depression. The internet can also be a source of comfort reading.

What can you do to prioritize self-care? I'm not sure what level of independence you have - do you have access to make phone calls safely? Internet?

There is, I think, a real danger in telling people what will solve their disease, because it usually doesn't work. It really is something that's individual, and heavily based on biochemistry and circumstance and personality as to what the best approach is.

That said, things that help *for me*, sometimes:
Doing things with intent to take care of myself. That is, making my wellbeing a consideration when I make plans, and giving myself permission to change my mind, even if it'll make someone else unhappy.

Sometimes achieving a series of extremely small goals helps me get back on track. Stuff like "eat breakfast" or sometimes just "open this book you have to read". It's important to give myself permission to do the bare minimum sometimes: breakfast may be a handful of spinach and a glass of milk; maybe I never start or finish the reading I wanted to do. I often feel better when I get to check a bunch of things off, so I try to make the goals very small and frequent - sometimes I'll add a goal to the list after I've done something, so I can check something off.

Sometimes self-care can look destructive from the outside: eating a bunch of ice cream, or sleeping for twelve hours, or bowing out of family gatherings I know are going to be awful.

Writing helps. I do a fair amount of meditative writing - "Writing Down the Bones" by Natalie Goldberg is kind of my go-to for writing while depressed, because it's meant to bypass internal editors and go for the guts.

Physical comfort. Heating pads at night for my feet, or wearing my comfortable-but-casual shoes instead of the chic-but-excruciating ones. Taking extra showers and baths, and "borrowing" my favorite blankets to sleep with. Petting furry things.

Antidepressants. When I can't afford prescription drugs, I've experienced a *slight* amelioration of symptoms by drinking stimulants (coffee, chocolate, tea) and endorphin-releasing foods (spicy foods, especially comfort foods like curries and enchiladas). I suspect the effect is mostly a placebo, but placebos are still helpful, so whatever.

Dav said...

That's tough - really, really tough. If you don't have family or friends as resources, can you look elsewhere for help? I'm assuming you can't afford or access a doctor/therapist at all; do you have anyone you can trust, even if they're not a friend or family member? Teacher, boss (OMG only if you *really* trust them), coworker, neighbor, spiritual leader, principal, social worker, online friend/forum? Can you *access* social services through your school/church/social services agency, or call a hotline? A hospital may be able to help refer you (or admit you, if it's that serious).

That's a ton of research, even for someone who's not depressed. If you can only do one thing, the thing that was most helpful for my friend in crisis was getting to a hospital. She was admitted, and it saved her life. If you're not in immediate crisis, I'd look to enlist an ally to help you negotiate your options.

thing said...

That first word was meant to be 'but.' And by 'family or friends that can help,' I mean 'family and friends one can go to for help.'

thing said...

ut what if you can't see a doctor and don't have family or friends that can help? Please don't tell me to rethink or that I can and do. I try to look for help online but what I find takes for granted that one has those resources.

Kristy said...

Trynn - I'm gonna tell you something that I'm guessing you already know, but might need to hear someone else say: you do NOT need your friends' consent or approval to seek professional help. If you feel like you might be depressed, even if you're not 100% sure, go and see a doctor about it. If the doctor doesn't seem to be taking you seriously, go see another one.

Believe me, I know exactly how hard it is to do that when you're depressed. I wouldn't have if my mother hadn't pushed me into it. But if your friends aren't stepping up to help you through it, you may have to do their job for them and carry yourself. It's hard and it's scary, but take it one step at a time and you can do it.

Smilodon said...

Very yes to "coming out". I think that two of the three reasons I'm on meds right now are because of people talking about mental illness. One being everyone here on this blog, which happened to come up with the depression posts just when my anxiety hit unbearable levels. The second was a work-mate who went through a period of random panic attacks, so she couldn't hide the fact that she had a problem, and was getting help, and no it did not make her less of a scientist. Just one who had to sometimes get help for her brain chemistry. After years of thinking "I can deal with this, everyone else is strong." Well, no, lots of people go through stuff, and lots of people get the help they need.

The third is unrelated, but it was my doctor saying "Of course you can manage this on your own. You've managed this your whole life. But aren't you tired of managing it?"

Laura G said...

There's one thing a lot of people haven't heard of and really should hear about: dysthymia. (I mean, even my spellcheck isn't convinced it exists!)

If you've been sort-of depressed for a long time but don't believe you're *really* depressed because things just aren't *that* bad, or if you're recovering from a bout of major depression but for some reason you're still not quote back to healthy, it might be worth looking into.

To oversimplify a *lot*, if depression puts you out of commission for two weeks, dysthymia puts you at half-power for two months. Or two years. Or, as it appears to be in my case, two decades (I was the kid who learned that frowning takes more muscles than smiling, and then asked my parents why frowning was so much easier in that case).

I'm admittedly not getting proper treatment right now, but that's a whole other rant.

Dav said...

I got a drug-induced depression, and holy shit was it awful, especially since the drug was meant to control nerve pain. I don't think I've ever felt as unaccountably, full-on, no doubt as all depressed as when I was on Gabapentin.

At the moment, I'm sort of at a low level of depression that isn't probably officially clinical, that I can mostly get through/fake through but leaves me lacking in the self-care department. Sort of to the point where I think I'd benefit from some anti-depressants, but actually going to the doc to get them is way too much work.

I really wish house calls were still a thing (and economically feasible), because I think a five-minute visit from an M.D. plus a prescription would be hugely helpful. (Even better: doctor comes to the lab and checks me out while I get work done.)

TempAnon said...

I struggle with anxiety and depression, and have a few thoughts to add...

Diagnosing depression is tricky. One tool that helped me was taking a test like the Goldberg test every week, and tracking my score. I actually built a spreadsheet so I could track my responses for each question week to week. The score isn't everything, but it was useful when I found myself feeling off to look and see that yes, over the last four weeks, I had been feeling worse, and it wasn't just my imagination. It let me find some victories and identify treatments that were helping, and it gave me red flags when things were getting worse.

On the value of having a diagnosis: my own reaction to undiagnosed depression was self-destructive behaviors. If you feel awful all the time, and your life is good, that creates some strong cognitive dissonance. Self-sabotage addressed that dissonance; if something was wrong in my life (relationship, job, friends) then feeling awful at least made sense. For me, having the diagnosis gave me an alternate relief for that cognitive dissonance. ("I feel awful, my life is good, I am experiencing depression and can treat that")

Ana Mardoll said...

This. People who play "Topper" with disabilities have their own issues to work out, and it's not your place to fix them. The fact that "someone else has it worse" doesn't negate pain. Another link: http://www.anamardoll.com/2012/07/health-depression-diaries-and-theory-of.html

Ana Mardoll said...

That could be a number of things; my first thought after "depression" is "anxiety", which is something I've had a lot of experience with and which is not the same thing as depression, though some of the non-medical treatments are the same.

Smilodon said...

Also, depression and anxiety also pair nicely in the brain, or at least in my brain. They feed each other, and one masks the symptoms of the other (I always assumed I didn't have anxiety, because I knew I had depression.) I started my current meds for anxiety, and apparently they're also good for depression. So some of the medical treatments are also the same.

Either way, I'd say that any persistent "not good" feeling is worth investigating, and quite possibly indicates not-good-brain-chemistry. For me, the easiest appointment to make was with a physician, who was able to prescribe me medication, and was able to get me referrals to a number of counselor-type people (the saga of finding a counselor who works for me notwithstanding, I am immensely helped by the medication.)

Divya Jagadeesan said...

Thanks for this post Ana. I am not sure if this is a symptom of depression or something else but lately I am finding myself to be angry all the time. It is always there simmering below the surface and the slightest provocation sets me off. I say and do things that I know I will regret a moment later. Its like a red haze that descends on me. I have also lost interest in things that previously made me happy, video games, books and drawing, which used to be my passion, but I don't remember the last time I even doodled something. I know this isn't right, I just don't know what to do about it.

Mathbard said...

Any advise for someone standing on the other side of the fence? My LOML has been diagnosed with depression, but he refuses to get outside help. It's so hard watching him beat himself up for making a tiny mistake, and calling himself a "horrible person who only deserves bad things". I want to help him, and I always respond to his saying that about himself that he's not horrible, and he doesn't only deserve bad things; but he doesn't believe me, and I hug him and hold him and tell him I love him. And I don't know what to do when I see him hurting so much and I can't do anything to take away the pain.

Ana Mardoll said...

If you haven't read it, this one might help: http://www.anamardoll.com/2012/07/health-depression-diaries-and.html

For me, the best thing to do is sort of embrace the "horrible person" framing (instead of contradicting it) and then show why it doesn't matter.

bearonacarpet said...

A little disturbed to find I score moderate to severe on the Goldberg test... I've always assumed the way I am is the way I am; lazy and unmotivated. The idea of declaring I might be depressed terrifies me; not least of all I've friends who've had severe depression who would poopoo the idea that I have anything like what they suffer... thankyou for this though; I shall think upon it,

AnonaMiss said...

Quick addendum: Just because you can't remember ever not feeling like this doesn't mean you're not depressed. It just means you've been living with it for too damn long.

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