I’VE SURVIVED THREE CLINICAL DEPRESSIONS. HERE’S HOW.

“In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come- not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying- or from discomfort to relative comfort, or from boredom to activity- but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience- one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devastation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.”

― William Styron, Darkness Visible: A Memoir of Madness

I have had three major depressive episodes in my life, and several mild to moderate episodes.  Perhaps I’m writing this for me, but I hope that now, while I’m in remission, I’m writing this for you or someone you love.

First, the darker side.  When many hear the term depression, they may think about a person who is in grief, who suffers a chronic illness, someone who may be sad over a loss.  And indeed, some of those people will, under those circumstances, understandably,  be depressed or enter into an episode of major depression.

But what I have is different. It’s an illness. This is  a depression not only in the mind, but a depression that lives in the delicate chemistry that makes up our complicated human bodies. It’s real, it’s not imagined, and it’s serious. It kills approximately 45,000 of us per year, and I think that figure is low.

It can recede and remit, but there is no cure, only treatment. When treatment works, I’ve been able to go years between episodes. But it must be treated.

There are many theories as to how depression occurs. One interpretation is that neurotransmitters in the brain are out of balance, and this results in feelings of worthlessness and despair. Magnetic resonance imaging shows that brains of people who have depression look different than the brains of people not exhibiting signs of depression.

First, here’s just a wiki version of what this is:

A major depressive episode is a period characterized by the symptoms of  Major Depressive Disorder: primarily depressed mood for 2 weeks or more, and a loss of interest or pleasure in everyday activities, accompanied by other symptoms such as feelings of emptiness, hopelessness, anxiety, worthlessness, guilt and/or irritability, changes in appetite, problems concentrating, remembering details or making decisions, and thoughts of or attempts at suicide. Insomnia or hypersomnia, aches, pains, or digestive problems that are resistant to treatment may also be present.

Here are some things that have helped me over the years. And remember, some things help for mild to moderate depression. If your depression is severe, you need medical treatment.

–Psychotherapy. It helps along with other treatments. For me, it’s an add on.

–Some nutritional supplements can help. Talk to your doctor or read up on supplements that show actual research on which supplements can help.

–Yoga and meditation have been helpful for me in lifting me out of the crippling anxiety that can come with depression. As I have an anxiety disorder as well as major depression, I continue to do this at least twice a week.

–Anti depressants, although this can take time and many get trapped into what we call “Medication roulette” My doctor did a test that matches your body chemistry to a drug that show which drugs you may metabolize better than others. It does not however, show efficacy. But it helped me understand why SSRI anti depressants didn’t work for me.

–A severe episode may require more. For me, twice, it required more. In more serious cases, hospitalization or intensive outpatient treatment may be required. My first two major episodes were assisted by the right medication and in one case, a treatment facility in Arizona.

–My third severe episode required another method. I did Ketamine in Los Angeles in 2016. It worked quickly, and though not without complications, it was amazing. However, it was short lived for me and I returned to California a month later for more and that worked brilliantly. Ketamine treatments are becoming more widely available now. Do some research on this.

–My moderate depression was helped tremendously by Transcranial Magnetic Stimulation. It’s a longer term process, but it did help. And TMS treatment centers are showing up across the country. I needed a special machine called the Nexstim, so I had to travel, but for most, other machines work well.

–Read up on everything, when you can concentrate, and that may be hard.  If not, have family members or friends research anything that may be of benefit.

–If you are feeling suicidal, you need immediate help.  Don’t keep that to yourself.  Reach out. I’m very fortunate to have not been suicidal, but I’ve met many who were at a treatment facility in Arizona I went to in 2009. I had no judgement of those who had attempted suicide. I understood them. The suicide prevention hotline is 800-273-8255

–While you are in the difficult process of waiting for the fog to lift, you may choose a number of options to get through it.  Some people literally try to sleep through it. I get that. I walk through it the best I can, while knowing that life as usual has altered.

–If you can, move your body. I swam every day during my 2016 episode. There were days when I’ve forced myself, but research shows that exercise can alter your brain chemistry and in a good way. It didn’t lift me out, but it can help a mild to moderate case.

–Spend time in nature and get natural sunlight every day, when and where possible.

–Talk to friends, family, and a therapist.  It can help to just express yourself and have someone telling you they love you and know you’ll get well.  Try to not isolate totally, keep talking to people who understand and will listen to you.

–For those friends who feel a party or large social event or travel might help a severe depression, set them straight.  At least for me, during those three horrific episodes, my time was best spent one on one with trusted family or friends or with people who understand depression.

– Throwing a severely depressed person in with a group who are not depressed and don’t get depression or what it is, and are just having a great time, can be harmful. That’s just my own experience, but many depressed people have told me they feel the same way.

–Even three to four people together can be stressful for me, and may be for you. Again, it’s different for everyone, but for me , the only large groups I could handle were people who were in a group therapy setting, who were experiencing what I did, and understood.

–When you find family or friends who don’t understand what you are feeling, perhaps share the opening quote above. It’s the darkest, toughest, but best quote I’ve ever read on depression by acclaimed author William Styron.You won’t always feel this way, the pain will end, but until you dig out, that’s how it can look.

–Try to do the smallest things that seem normal. Just a trip to the grocery store, doing a few simple emails, cleaning the house.  For some, it’s impossible or seems impossible. But give something a try daily.

–Avoid drinking.  I enjoy a glass of wine or so while I’m cooking or when out to dinner.  When the 2016 episode hit, I did what I’ve done the other two times I’ve experienced this.  I just don’t do it. If you choose, and things are stable, and you do it very moderately, there could be time for that when recovery happens and when stability comes back into your life. That depends on each person, their illness, and their history.

–Try something creative.  You may enjoy a bit of art, making a new garden space, re arranging a room.  I try to keep busy. It makes the days go by quicker, and believe me, when you are in this, you want the day to fly by.  If you can’t though, don’t beat yourself up.  You didn’t create this illness.

–Nutrition.  As I’ve experienced before and many do, the appetite can be gone.  I stopped cooking. I love to cook normally and I’m a “live to eat” kind of person.  First, eat what you can get down, even if it’s forcing yourself.  Later, do some reading on healthy foods that can help lift the mood.

–Have a complete blood test done, including vitamin levels. You may be insufficient in some areas and a course correction may help.

–Know that your gut bacteria can be related to mood. 

-If you can’t find the right treatment close to home, go elsewhere if at all possible.

–Remember, it’s hard to describe this to someone who has never had it.  The strongest quote I ever found on the depths of this is above, from author William Styron. It’s dark but brilliant. Have others read that so they just might get a glimpse of how the darkest parts can look to the person suffering.

–Know that it WILL lift.  There are treatment resistant depressions, but there are other methods that can be used that go beyond traditional antidepressants. 

–You may notice that after a period of terrible psychic pain, you may awaken to more clarity, a better day.  Take that as a sign that you are getting better, even if the days go a bit up and down.

You aren’t alone.  At one time, in any day, in this country, approximately 20% of us can be experiencing a mental illness. The term brain illness is a better one.

 You aren’t a bad person, you didn’t make this happen to you, and that fact that you’re alive and still moving forward is a testament to your strength.

For times of recovery, I choose to look at brighter themes, more clear cut, not perfect, but hopeful like an early spring.  I return to Styron, who ended “Sophie’s Choice” this way.  He said and I end with this,  “This was not judgment day – only morning. Morning: excellent and fair.”

For you…to the morning and the light…you are a precious soul and you can survive.