Living with Depression, Part I: Recognizing Clinical Depression

Welcome to Part I of BCC’s mini-series about depression. If you haven’t already read the series overview, please do so before proceeding.

In this post, our group members introduce themselves by describing how they came to recognize depression as a problem in their life. Depression is an untidy concept, and our semantics reflect that. We use the term to describe a vast spectrum of emotional and mental states, from mild and temporary situational distress to severe and abiding pathology, and even with the help of diagnostic parameters it can be tricky to distinguish between the “normal” depression of human experience and the mood disorder called clinical depression.

“There are many grey states between full-blown depression and a mild ache unaccompanied by changes of sleep, appetite, energy, or interest,” writes Andrew Solomon. “In an era in which we are increasingly alienated from our feelings, we might be comforted by the idea that a doctor could take a blood test or a brain scan and tell us whether we had depression and what kind we had. But depression is an emotion that exists in all people, fluctuating in and out of control; depression the illness is an excess of something common, not the introduction of something exotic.”

The definition of “excess” can vary from individual to individual, and presenting symptoms for depression differ from case to case. This variation shows in our group’s responses to the question, When did you realize depression was an issue for you?


***

Beatrice: I was thirteen the first time I had suicidal thoughts, but in retrospect I think I was depressed even earlier than that.  I was not a happy child.  My parents will testify to that.  Puberty just made things worse, though.  It was probably the hormones, but I never had anything like PMS when I was younger.  All times of the month were the same (i.e. crappy).

I didn’t really think of it as depression at the time, though–as in an illness.  I thought of it as moral failings and loserdom.  Which is actually kind of how I think of it now, too, only this time I (should) know better.  I’ve found that it doesn’t help to know better, though.  I tell myself it is an illness and I need to take my pills or get new pills or do something else, and my self just says, “Shut up, you’re a loser.  Nothing’s going to help.”

On the other hand, I’m no longer 13, so at least there’s that.

Ophelia: I realized I had an issue after the birth of my third child when I simply could not pull myself together and was so over my head I could not figure out why. I never felt what I thought were the classic depressive symptoms—instead I felt angry and full of fury all the time, and would then destroy myself with guilt and shame about my anger.

My OB suggested I try an SSRI when I called him in a panic because I was so angry with my boys and my new baby. It was completely irrational, and I didn’t want to take meds. He said to try them for two weeks, and if they didn’t help, we could try something else. Within 3 days I felt normal again. Not drugged, not loopy, not high—just normal. I had patience again. Little things did not make me feel like the sky was caving in anymore.

And from there I was able to look back on my life and see patterns of pain and sorrow I hadn’t recognized before.

Rosencrantz: In my experience, a mild depression appears to be normal.  I remember reading an article about depression in my early 20s which listed 9 symptoms of depression and realizing that I was 9 for 9.  I think I became pretty adept at coping with persistent, low-level depression, but it wasn’t until later in life when events put me into a tailspin that I was forced to begin to deal with it.

The breakdown was a combination of pressures from 1.  Inability to function at my job as I had done for 20 years, 2.  Resulting lowering of income, 3.  Intense pain as a result of feeling that God had played me for a fool (with subsequent almost complete loss of testimony) and 4. pressures from church job.  Not to even mention the stress that all of the above puts on a marriage and family life.

Wow, this is hard.  The tears just start flowing as I type this.

Mistress Quickly: It’s amazing how vivid this kind of experience can be, even decades later.

I’ll never forget the time I realized I had a problem with depression. I was partway through college, and living on my own. I’d always been a melancholy person, even as a little kid–I’d say my depression started around age 10, but it was mild enough that nobody noticed, and I just thought it was normal. But when I was 20 I started having these daily episodes where I’d feel this harrowing black despair engulfing me. I’d cry for hours every evening.

At the time I’d returned to church activity after a pronounced lapse. One night I knelt down and prayed more sincerely than I’d ever prayed. I just kept saying (out loud) “I’m sad; I’m sad” and wordlessly pleading for relief, but none came. I crawled into bed feeling utterly alone and bereft. I was already in therapy and my counselor had been wanting me to try an SSRI but I’d been resisting because I was embarrassed by the thought of needing medication. But soon after this particular night, I began treatment. I realized something was happening to me that was beyond my control.

Rosencrantz: In my case, we were at a family reunion, and my brother-in-law whom I see only once or twice a year walked over to me at an outdoor dinner.  He just walked up and asked if I had talked to a therapist, because it was obvious that I needed one.  It sounds funny now, and I think I even laughed then, but I honestly thought that it was normal to feel/act that way.  I just assumed that I could limp along on my own until things got better by themselves.  I’m still in the process of realizing that that hardly every happens.

Jack Cade: The line between depression in the colloquial sense (feeling down, or frustrated or gloomy or whatever) and depression as a clinical, neurochemical disorder was difficult for me to discern.  My wife started to tell me that she thought I was probably suffering from mild-to-moderate depression (having once suffered a fairly serious but short-lived bout of PPD, for which she took medication for roughly 8 months) a few years back.  I was under a tremendous amount of stress and had recently received a bit of devastating personal/professional news which totally compounded it. I dismissed her concerns because I felt like it couldn’t be an actual neurochemical problem if there were real, external forces that could account for the symptoms.  I figured, being depressed when depressing shit happens to you is a fairly normal, even healthy response.  The professional problem was something that I knew, in time, I could fix.  I told her that I assumed that as soon as everything had formally worked itself, as soon as my external sources of serious stress were reduced, I expected my mood/disposition/frustration/sadness to work itself out as well.

Well, the working-out came and went — I successfully took care of the problem and got back on track and everything was mind.  But no change.  My symptoms — all the horrible mood stuff plus more introverted behaviors, ranging from mindless time in front of the computer to the occasional flirtation with porn and all the self-loathing it induces — were still there.  I even tried to do things to manipulate my mood, but always seemed to return to the same dull and dreary baseline.  After about a week of introspection and self-analysis, I concluded that the prolonged period under the weight of stress had in fact altered my neurochemical baseline.  It seemed to me like I was past feeling — like I was experiencing emotions or at least aware of them but not really feeling them, a weird kind of numbness.

I phoned a woman in a neighboring ward — a licensed social worker whose research has focused on depression in families with conservative religious backgrounds — and began treatment.  So the long and short is, I realized I had depression when I came to an awareness that my persistently shitty mood was not, in fact, a mere reaction to shitty externalities.

Portia: I’m pretty sure I was depressed by the time I was 8 or 9, and I knew I was by the time I was 11 or 12, though I don’t think I had a name for it.  I wrote in my journal when I was 11 1/2 “It’s spring, and I know I should be happy about the flowers and the warm air and the sun, but I’m not happy at all.  I’m not anything.”

As it turns out, Spring has often been a trigger for me–that feeling that I should be happy, should feel something at least. That my heart remains frozen long past the time of daffodils is often a crushing grief.  That sense of being somehow beyond or outside of the realm of human feeling is the most difficult thing.  “Triggers” or external crises that generate something like sadness are a relief.  Depression is more absence than real pain for me; it’s the disconnect between life and feeling.  I vividly remember walking home from a college class one day in April or so.  It was just getting warm enough to shed coats, and everything was muddy and fecund-smelling.  I had just gotten a paper back, with glowing comments from the professor (who was a scarily eminent scholar in his field, from whom anyone (well, anyone except me, probably) would have been ecstatic to get a B, and I’d gotten an A with copious praise).  It was like I was watching myself, and thinking “look at that girl–young, smart, privileged, full of potential” and I just couldn’t feel my way into that life at all.

There have definitely been times when some external trigger has set off hideous bouts of pain–but the “when you know you are crazy” moments are the ones where I’m just dead to my own experience.

Falstaff: It’s hard for me to know when depression started. I don’t think I had the vocabulary to recognize it when I was growing up. I felt sorry for myself often and had imaginary friends that understood and liked me. The Sioux have a prayer that begs for pity from the heavens. Part of their seeking the pity was to cut off a finger to make the God’s feel sorry for them, and this was me as a child. I wanted God to feel sorry for me. To an extent I suppose I felt emotionally a wreck and wanted that to be recognized by someone somewhere. I did not, or could not couch this as depression, but maybe it was. Memory is a strange thing, and I really don’t know.

The first time I ever had recognizable depression was at a time I had fairly recently become active in the church and in so doing had lost my old friends. I was made the young adult rep and there was a list of 50+ inactive young men and I was running around trying to contact them all, mostly on an Army base, no one wanted the Church. I felt endlessly guilty, as if this were my fault somehow  that I was not successful. In December, when I was alone for Christmas I fell into a deep depression. I was shocked at the numbness and emptiness and I could look at myself from some rational part of my mind and see it. There was nothing to be done that I knew of. This was not something you would bring up with a doctor–these feelings were part of a moral weakness and inability to shake it off. It never even occurred to me that there might be medicines to help. As I saw it, the Church taught that we were responsible for our moods. Feelings of worthlessness where just the whisperings of Satan to be thrown off by strength of will and focus. In becoming active the church, I had lost friends and habits and I missed them. I missed the culture I had been a part of and missed the sense of belonging. Interestingly, there was an upcoming Young Adult Conference and it required enormous work to arrange going. Somehow in finding a focus and something to work for I came out of it. But that was the beginning and this was going to reappear again and again over the next few years.

Desdemona: I hesitated to join this conversation because I’ve never been professionally officially diagnosed with depression, and I’ve never been on medication. So I feel like a second-rate “me too” participant. But I thought that if I didn’t respond to Kathy’s call, I would be just continuing to deny that I have a problem.

Like others have said, I was a melancholy kid. I was deeply bothered by cosmic questions, injustices big and little, and daily problems. My high school years are a blur, but in retrospect I was badly depressed for much of the time. I did consider suicide in high school, but always ruled it out because of my theological belief that it wouldn’t end the misery. I had a sense of wanting to hurt myself physically–pinching or whatever, to distract from the emotional pain or because it seemed more tractable than emotional pain. Luckily it never progressed to cutting or anything that leaves a mark. It never occurred to me that I had a medical problem, because I thought that was just my personality, or that I was rightfully feeling bad about things I had done. It took a very kind bishop telling me that my guilt was way out of proportion and I needed to forgive myself to help me drag myself out of one episode. I think another reason I didn’t recognize it was that during depressed times I would hang around other depressed kids so it seemed normal. In retrospect, I had two sets of friends, one for depressed times and one for happy times.

Several times over the last 10+ years I’ve managed to get up enough courage to take an online self-quiz/screening for depression. I always score 100%, but I always find some excuse to ignore the suggestion to make an appointment. I thought everybody felt that way, that it was normal, and the test was just erring on the side of sending everyone in for an appointment. Plus it’s not depression if the guilt is due to me actually screwing up my life, right?

About 5-6 years ago I finally got the courage to act on the pleas of the survey results page to make an appt. The intake form at the office had a question, “Have you had thoughts of suicide?” and I remember that I left it blank. It’s not “thoughts of suicide” if I had ruled out the option, right? (because I believe in an afterlife where I’d be just as miserable) That doesn’t count. The counselor asked why I had left it blank, and all I could say was “I don’t know” over and over.

At that time I was experiencing a hormonal cycle-linked thing. Basically I was “normal” (probably mildly depressed) most of the time, but for 3 days a month the whole world would collapse. I couldn’t leave the house because I couldn’t think–that feeling of going into a room and forgetting what you were there to get/do, but so constant that I couldn’t drive or do anything. When I say whole world collapsing, I often felt like that was physically happening to everything in my surroundings, or that at any moment a great crack would open up in the ground and swallow me. Or that unseen somethings were following me. Then right when I’d be to the point of wanting to end it all, poof! back to normal without a trace of those feelings. It was all like a bad dream that lasts for 3 days. Luckily, I only endured that for a 3-6 months before I got pregnant, which ended the cyclical crazy.

I’m sure I also had post-partum depression but that first year is such a blur that it is hard to describe it.

Viola: I was a sad kid too and I kind of liked it. In books, movies, stories whatever. I liked sad things. I’ve often wondered if this is innate, my basic, long-time world view, or the way of validating all the sadness I saw around me–I decided to like it.

And depression was all around me. My dad had significant mental illness problems, my mom had a major depressive episode when I was about seven and our family really struggled under the weight of two depressed parents. One of my siblings manifested signs of severe depression pretty early on, too.  All this to say, I felt intimately involved with depression but I never identified it in myself. I was the keeper of the depressed, but not the actual depressed person. With a few episodes under my belt, I think my first episode was as a late teenager. Or maybe once a month since I was 12 during PMS, I’m not sure which.

But the first time I knew it was my disease was when I was 24 at BYU. Teaching at the MTC, I had a panic attack as I was headed in to teach one of my districts, and though things had been rough for a while, it was from from then on that things went downhill. I couldn’t feel anything, I couldn’t wake up, I couldn’t care, I couldn’t taste, I couldn’t like what I normally loved, I couldn’t even feel guilty. I stopped going to work, stopped school, stopped eating (VERY unlike me), made a suicide plan, and wished that I would at least cry over my life stopping. It was a few months into the non-life living that I realized I was in an episode and that it was my problem, not my dad’s or my mom’s or my sibling’s or my grandpa’s. I got started on SSRIs (Celexa and then Celexa and Welbutrin also Xanax for the anxiety) and I started to pull out of it after a few months and felt back to mostly normal (which is still a sad normal) about a year later.

I still held out a lot hope that it would be an isolated episode. That it would be the major breakdown of my life. But then I had another one a few years later and maybe that’s when I really really knew that this thing was mine and here to stay.

***

Stay tuned for Part II of our conversation, which will focus on how depression affects daily life and family relationships. In the meantime, we welcome readers to share their insights about recognizing clinical depression.

Next in the series: Part II: Impact on Daily Life and Family Relationships

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Comments

  1. wished that I would at least cry over my life stopping.

    That made me both laugh and cry, because that’s how I remember feeling, I just have never been able to put it that well. Only it lasted years, and despite trying several SSRIs.

    Funny thing is, I’m almost naively optimistic most of the time. Then the two major episodes of clinical depression, each lasting years altogether, first descending into, then coming out, made me a pessimist where there was no future as I could see. Both episodes got started by the whole world basically collapsing on me in form of bankruptcy of my own company or losing my job, and getting weird physical symptoms, too. And I have those physical illnesses, the didn’t go away. This last time, to make it perfect, my sister, father and mother died within a couple of years (only my mother was expected).

    It’s weird to lose the ability to really feel anything at all.

    BTW, the SSRIs and SNRIs may be good for some, but I went through a lot of them, and as far as I could tell, they did nothing for me — well, I did have some side effects.

  2. I have felt similar things to all the group members here. I knew that it was time for me to get help when I was continuously tempted to purposely get into a car accident just so I could feel physical pain instead of the emotional pain that was driving me insane. I remember one night literally trying to pull my hair out.

    I ended up at LDS Family Services (which I thought was for adoptions) where a very good therapist helped me work through the worst of it.

  3. I have to say “depression” is one of the most unfortunate names for a medical condition ever established. It is all symptom, no cause.

    Patient: “I feel depressed”
    Doctor: “Let me do the diagnosis”

  4. But depression is an emotion that exists in all people, fluctuating in and out of control; depression the illness is an excess of something common, not the introduction of something exotic

    This is exactly what I mean. Here he does not make a distinction between symptom and cause. I call it the psychological fallacy.

  5. Kathryn Lynard Soper says:

    Psychological fallacy, Mark D?

  6. MikeInWeHo says:

    Mark D,
    There is no medical conditioned named simply “depression.” What most people are describing here would likely be diagnosed as Major Depressive Disorder. There are other common diagnoses such as Adjustment Disorder with Depressed Mood and Bipolar Disorder, Most Recent Episode Depressed (and a bunch more).

    Any competent mental health clinician most certainly is making a distinction between symptom and cause.

  7. Anon for now says:

    Thanks for this post, guys.

    SSRIs do take the edge off for me, and I am grateful I finally went to see a doctor after about a year and a half of planning my own death at least once a week. I think I know what the source of my depression is (apart from genetic predisposition), and it’s not something that’s going to go away, so I expect that, like the poor, Celexa will be with me always. When it started to kick in, it was actually a scary experience––I had had no idea how bad things were. I remember thinking, Whoa, I didn’t think I was that depressed.

  8. #3, #4 Mark D:

    We live life on a continuum, so I would be careful about calling depression a “fallacy”. We all obviously have good and bad days. When depression gets in the way of a functioning life, however, it is a problem.

    Depression does have some stigma associated with it, as your comments so perfectly pointed out (and likely inadvertently). To make it a more concrete example for you, I see people with knee pain. All people, from the time they are young, start wearing out, even you. Sometimes it’s just an ache here and there, and people manage by ignoring it or taking an ibuprofen when they need it. That may be all they do their entire life.

    Sometimes, though, it’s bad enough that they have to start giving up employment, activities, life… If someone invites you to dinner and you don’t go because of knee pain, that’s bad and not how you want to live your life. So at that point, we might treat it by replacing your knee.

    So, just because something is on a continuum and is a facet of life, does NOT mean it’s a “fallacy” or that it doesn’t need to be treated.

  9. This is amazing! Thank you, thank you, thank you, for lending your blogging efforts and insights to this topic. I just linked to you all. I’ve been doing my own sporadic blogging on this topic for a year and a half now and I have quite a few dedicated readers who will appreciate what you are saying. It’s very difficult to write about depression while living with it but I’m going to answer your question on my blog and encourage my readers to do the same on theirs and link to you.

  10. Jack Cade writes:

    I concluded that the prolonged period under the weight of stress had in fact altered my neurochemical baseline.

    This is interesting, and I’ve wondered about this possibility. Is there any research or clinical data that has shown this to happen? Can a prolonged stress alter the neuro-chemical components and/or responses?

  11. Kathryn Lynard Soper says:

    Thanks, Mike S. Here’s a great quote from _Noonday Demon_ that echoes your metaphor:

    Mild depression is a gradual and sometimes permanent thing that undermines people the way rust weakens iron. . . . Large depression is the stuff of breakdowns. If one imagines a soul of iron that weathers with grief and rusts with mild depression, then major depression is the startling collapse of the whole structure.

    And while it’s currently popular to liken depression to diseases like diabetes, it’s much more complex to diagnose and treat. Another quote:

    Influenza is straightforward: one day you do not have the responsible virus in your system, and another day you do. HIV passes from one person to another in a definable isolated split second. Depression? It’s like trying to come up with clinical parameters for hunger, which affects us all several times a day, but which in its extreme version is a tragedy that kills its victims.

  12. Hopeful Dad says:

    My son, who has been struggling with depression for years, only began to talk to us about it a couple of years ago. He’s been on and off meds, in and out of counseling, a short stint with alcohol abuse that thankfully appears to be over, but he is still depressed. Occasionally the anxiety is debilitating, but what is scary to me is that he has determined that this is just part of who he is, and figures that he is just going to be like this forever. At present, he is off meds, not going to counseling, and avoiding going to church and associating with his close friends.

    It was disheartening to learn that he struggled with this for several years before it kind of blew up in our faces, and he finally admitted he was depressed. Had we been better equipped to consider and recognize this, we wonder if earlier intervention might have helped keep him from hitting bottom. Our biggest concerns are what it has done to him spiritually and to his relationships with friends and family. For those of you who struggle with this, I’m most interested in what family and friends can do that is helpful. Part of the problem is that depression is just so far out of my normal routine as a permanent optimist, that I really don’t understand it. I know enough to avoid saying stupid things like “just get up and do something” all the time, but I’m sure I still say things like that too often. What can I do to help someone who really is not sure who he is without depression?

  13. @#10:

    There are, in fact, some results supporting the idea that just concentrating for a half hour on “happy thoughts” or things that make one feel happy and peaceful makes a measurable difference in one’s neurotransmitter balance. I don’t know what we can make of those studies, but there you are.

  14. HopefulDad:

    If I had a nickel for every time someone has told me to “just get up and get a grip” or something…

    Anyhow, what is, I believe, ultimately most important is to tell and show a depressed family member you love him/her. Regardless of how exasperated one might feel with a depressed person, who perhaps doesn’t seem to want to believe it.

  15. Kathryn Lynard Soper says:

    Can a prolonged stress alter the neuro-chemical components and/or responses?

    Absolutely–and vice-versa. Reactions to external events transform the chemistry of the brain, which in turn influences reactions to external events.

  16. Alright, this may constitute a threadjack, and if so, I am sorry. I think this is a great idea of a series and look forward to reading it – as one who would probably not self-identify as depressed (other than a year long stint of unemployment not too long ago) and would like to understand it better.
    Now the threadjack: I read a fascinating blog a couple months ago (really, the first time the bloggernacle called to me) about beer and the word of wisdom. Here is an excerpt:
    Are there other ways besides beer to cope with the stresses of life? I suppose. Antidepressant drugs are prescribed in Utah more often than in any other state, and at twice the national average. I would guess one reason is because, unlike the rest of the world, we refuse to recognize and use a natural substance God gave us to cope with stress, even when our own scriptures provide for it.

    If we are to believe the statistics, Mormon women are the country’s unhappiest creatures. Wouldn’t it make more sense if, instead of ingesting a dangerous drug twice a day, you simply followed the counsel of the Lord and sipped at a bottle of beer while reading to the kids? You could help them learn what the Word of Wisdom really says, while at the same time affirming to them Ben Franklin’s adage regarding the proof of God’s love.

    And here is the whole Post: Pure Mormonism – Too Bad I Don’t Like Beer

    I would be curious to see the responses of Mormons self-proclaimed and diagnosed with depression as to the possibility/likelyhood of truth in the connection between not drinking beer – and high occurance of depression among the saints.

  17. re: 15
    Yes, but the actual mechanisms involved are not well understood yet. If I have more time later I’ll try and look up some of the research on this.

  18. Like many of the posters, I’ve always struggled with depression (its an anxious personality thing combined with some strong genetic pre-disposition). I always thought, however, that I could control it – get through it on my own with help from God. Ha.

    Looking back, I had major depressive episodes throughout my adolescence. The one that I can definitively point to and made me realize that I might have a bigger problem than most. The week before HS grad, I couldn’t get out of bed. Everything was pretty much done except for a graduation speech to be fine tuned (I was valadictorian) – and I couldn’t find any reason to do anything, couldn’t get out of bed, nothing. I barely made it to the graduation ceremony with significant prompting from my mom. It lasted about 2 weeks, slowly disappearing as summer plans required my attention. Amazingly, nobody thought to send me to a therapist or anything. I think depression is so normal yet stigmatized in my family of origin that everyone just acknowledged that I was having a hard time and left it at that.

    These types of things happened to me several times a year for many years. Some were situational. Others just were. As a young adult I helped keep under control with ballet class – and then as my body gave out, yoga. I prayed, I became a scriptorion, I set goals, I accomplished. It kept me busy and going. But it was always lurking.

    Fast forward to 8 months after my first child. I wasn’t functioning – unable to keep self care much less care of my infant under control. I found myself saying “I want to throw him out of the window” several times a day. I was anxious about everything. I was also losing memories plus handfuls of hair at a time (for the second time in the past 8 months). There were some situational things going on, but even as they cleared up, I felt worse. I finally got the strength to call my midwife’s practice. They said it sounded like the baby blues. I said I wanted my thyroid checked first (the hair + genetic predisposition). Turns out, my thyroid had completely shut down. (WOMEN, ALWAYS CHECK THAT THYROID WITH SUDDEN ONSET OF DEPRESSION LIKE SYMPTOMS)

    But while the thyroid replacement therapy immediately helped the brain fog, lessened the anxiety, and got my sleep a bit more under control, I still wasn’t functioning and was still always in tears. The doctor said to give the thyroid two months. I talked myself into a month more, promising myself I’d take care of it.

    And then I realized it wasn’t going away. My list making, yoga practicing coping mechanisms had been stripped from me as a mama of a twelve month old. And in that place was a tired, anxious mama with no patience who would burst into tears about totally normal things.

    So, I took myself into yet another doctor (insurance change) and said I thought it was time for an SSRI, but I still wasn’t convinced I was depressed enough to warrant it. I think my doctor just thought I was a type A personality who needed to relax, but to his credit, wrote the script while telling me I should exercise more. Within two weeks of Celexa, I could feel the change emotionally and, surprisingly, physically. My body wasn’t as achy or weighty – something that had been the case for the past 6 months!

    It has been over a year since first trying the SSRI. My normal self coping mechanisms are (slightly) more obtainable with a two year old and I’ve learned some new ones (formal meditation) along the way. At this point, I’m toying with the idea of leaving Celexa behind. But, I know it will never be left behind forever. Because I (and my husband) look back and realize that there were at least a dozen times where I (we! as a family!) needed it badly. Now that I know what I can have with a little bit of chemical help, I hope I will be quicker to take that help a little sooner next time.

  19. Kathryn Lynard Soper says:

    HopefulDad, I’m glad your son has a caring and sensitive father. My guess is he probably can’t be himself without some degree of depression. Of course, that doesn’t mean that it has to ruin his life. But it might help to approach it as an inherent condition to be managed rather than an alien entity that’s swallowed your “real” son.

    Depression has the insidious quality of preventing its victims from seeking, accepting, and continuing treatment. In a future post we’ll discuss in greater detail how friends and family can be supportive.

  20. 152, alcoholism runs in my family, and I suspect that what that really means is that depression runs in my family (which it definitely does) and past generations have been using alcohol to self-medicate. I hardly think that alcohol self-medication is a healthy approach. It seems much more likely to exacerbate problems, lead to alcoholism and attendant destruction of family relationships, DUI, etc, than treatment with anti-depressants. In the worst case, anti-depressant drugs simply don’t work. They tend not to actively cause their own problems. “…instead of ingesting a dangerous drug twice a day…”–isn’t alcohol a dangerous drug? (Have you ever seen a liver failure case?)

    I absolutely understand that many, many people are able to responsibly consume alcohol. I also think that people prone to depression and other mental illnesses are among the least likely to be in that category.

  21. Nicole, thank you for sharing. It sounds like we have a lot in common.

  22. Kathryn Lynard Soper says:

    #17, true–the dynamics of depression are shrouded in mystery. But there’s no question that the mental and emotional affect the physiological, and vice versa. It’s a chicken-and-egg thing.

    Currently, pop psychology circulates the misleading theory that depression is caused by a deficiency of one or more neurotransmitters in the brain. But it’s not that simple.

    Solomon again:

    There’s a lot going on in a depressive episode. There are changes in neurotransmitter function; changes in synaptic function; increased or decreased excitability between neurons; alterations of gene expression; hypometabolism in the frontal cortex (usually) or hypermetabolism in the same area; raised levels of thyroid releasing hormone; disruption of function in the amygdala and possibly the hypothalamus; altered levels of melatonin; increased prolactin; flattening of 24-hour body temperature; distortion of cortisol secretion; disruption of the circuit that links the thalamus, basal ganglia, and frontal lobes; increased blood flow to the frontal lobe of the dominant hemisphere; decreased blood flow to the occipital lobe; lowering of gastric secretions.

    Which are causes of depression; which are symptoms; which are merely coincidental?

  23. I am not sure that I was depressed, you know diagnosis, etc. I do know that I stole a bottle of potassium cyanide from the chemistry lab when I was a freshman and it sat on my desk top. I even mixed up a glass full. Maybe it was juvenile existential nausea. You know, the whole diagnosis problem.

    I threw the cyanide out of the window in the wintertime. When spring came the grass under the window was so green because of the nice fertilizer…. There was a message in the grass.

    I determined at some point that being depressed was like getting sick. Some times a cold, some times pneumonia. Most often you did not die from it and if you recognized that recovery was almost inevitable, the whole burden got lighter. A good book, hot cocoa, and a few days is good enough for most minor episodes. It has been many decades since one of them has become pneumonia.

    In the latest Atlantic there is an article about SSRI’s. The article is, according to my expert, inaccurate because it ignores certain data sets, but the author maintains that antidepressants are not substantially better than placebos. All together the antidepressants or the placebos are quite effective in treating depression. According to the article the antidepressants are effective mostly in the most severe cases.

    Andrew Weil wrote a book about harnessing the placebo effect. FDA approved drugs only have a marginally better effectiveness than placebo. Even chemotherapy can have a substantial placebo effect. Even surgery…

    How can we enlist the placebo effect on a conscious level? Difficult but not impossible to a Yoga master.

  24. 20 – by your response I can assume that you did not read the post that I linked to, if you had alcoholism probably wouldn’t have entered the discussion.

  25. #16: 152

    I do actually agree with your thoughts. I actually think having a glass of wine with dinner to relax or a beer would work for the majority of people. I also think it would not only NOT be as harmful as many of the antidepressants, but many recent studies show it would actually be beneficial for our hearts, towards cancer, etc. besides mild depression. This obviously doesn’t mean to get “drunk” to “hide” from your problems, and for people with an alcoholic tendency who couldn’t stop with a drink or two, they might need to stay away from alcohol all together.

    In fact, in the times we have recorded with Joseph Smith drank wine or beer (neither of which were the “strong drinks” actually prohibited by the Word of Wisdom), he specifically states in most of them that it was done to “lift our spirits”, or for a similar matter that you are describing.

    Unfortunately, the Word of Wisdom has been reinterpreted since Joseph Smith gave it to the “not a drop” philosophy talked about today. For the majority of Church members, they would currently be made to feel even more down and depressed than they are if they did have the same glass of wine that Joseph Smith had (or even Christ for that matter).

  26. Kathryn Lynard Soper says:

    152, there’s sound logic in the supposition that populations who don’t self-medicate with other substances might be more likely to use to prescription antidepressants. I think that’s all we need to say in this regard.

  27. 25, that makes sense. Two questions: Are the reinterpretations inspired, and if not, what would the likelyhood be of de-interpretation?

  28. 26, fair enough I’ll leave it at that.

  29. Wow.

    I would only add the following:

    1. Clinical Depression can present very differently in men and women. Men and the women who love them ought to know what to look for since pop psychology tends to focus on the stereotypical female presentation.

    2. I am convinced that my oldest child’s emotional challenges are at least partially due to the struggles with depression my spouse and I had during the child’s first year. Get help early.

  30. Thanks so much for this post. Unfortunately, so much of it resonated with me. The pain, the numbness, the not realizing how bad it was, until you are starting to do better. The growing up with depression being your mother’s/sister’s/father’s thing, not your own. Until you realize that, just like your older brother told you would happen when you were 11, that you have grown up to be “crazy”, just like your older sisters.
    I have a bottle of zoloft in my medicine cupboard. It expired 3 years ago. I have nursed that one bottle, since the birth of my 5th child, 4 years ago. My body is so sensitive, that I respond well to 1/2 pill. At even a very low beginning dose, the side effects are unbearable. I would like to go get more. Maybe even take them more regularly, instead of just when I’m hitting bottom, every 6-12 months. But I don’t know if I can find a doctor who will believe me about how low of a dose I find to work.
    Anyway, Desdemona, #20….while I am in complete agreement with you about alcohol not being a very good choice for self-medication, I have to disagree with you about the worse case scenario for an anti-depressant simply being that it doesn’t work. The side effects can be devastating. I have experienced this. The end of the end of my first marriage can be directly traced to my response to paxil. It was bad enough that rather than try another SSRI, I just dealt with the depression for the 8 years following. There have been reports of young people’s suicide risk going up when taking certain meds. The reality is, these are mind altering drugs. It’s rather frightening to take that little pill, and not know what it’s going to do to your personality as you know it. I am not saying that SSRIs and the like aren’t helpful/good/whatever. Just that, having experienced them, I would never, ever, just cavalierly pop one down.

  31. Back to the topic of this post – Recognizing Clinical Depression

    As mentioned, 100% of people on this earth have good days and bad days. There are days we feel depressed. It’s just how it is. That’s not what (I assume) this post is about, so any attempts to add that just confuse the issue.

    If you look at various scales to determine “clinical” depression, many of them are focused on the effects. Are you missing work? Are you missing out on life? Are you considering suicide? Etc. So while there may be some relation to “feeling bad”, this is a MUCH bigger problem than having a bummer day.

    If someone is clinically depressed to the point where it is taking over their life, that is when help is needed. That is the difference that I think this series is trying to address.

  32. StillConfused says:

    I used to think I had depression and was even diagnosed with it and put on medicine. It was only when I met up with an amazing shrink that we were able to determine that I did not have depression, I have severe hypoglycemia. When the blood sugar is very low, you feel all of the classic depression symptoms… moodiness, lethargy, confusion etc. Now that I am careful to keep my protein levels high, I don’t have any of those symptoms anymore. In this day and age of processed foods and lots of carbs and sugars, I wonder if any formal studies have been done on the relation between sugars and depression.

    As far as the post above about beer, I recall as a youth in Virginia that there was a lady in our branch who had what I must assume was depression or anxiety or something. I can remember her drinking beer and being shocked. My mother, a nurse, said that it was for medicinal purposes and was cheaper than drugs. I think the risk with alcohol is that it is too easy to self-medicate without proper physician oversight.

  33. Kathryn Lynard Soper says:

    #29, yes. We’ve got a post coming on gender and depression.

    #30, you’re right that antidepressant medications can cause highly problematic side effects. I think what Desdemona meant is that if the med isn’t working for you for whatever reason (side effects or just no effect), you’re free to discontinue it, while alcohol as medication can become addictive and destructive. I’m sorry you had such a terrible experience with Paxil–your doctor should’ve given you other options, as there are many, and each of them affect different people in different ways.

    #31, it’s wise to seek help BEFORE depression takes over your life. That doesn’t mean we should all start taking Prozac just because we’ve been feeling down lately. But waiting too long to seek treatment can seriously backfire. Better to err on the side of caution.

  34. Kathryn Lynard Soper says:

    #32, that’s why it’s a smart idea to have a complete physical, including blood work, before starting any medication for depression.

    Diet can certainly have an effect on mood. If you’re feeling lousy and you’re not taking good care of yourself, obviously it makes sense to start there if you can. However, depression can actually keep you from doing the things that help all people feel good. Other treatment may be needed just to get to the point where you’re able to exercise and devote time and energy to managing your diet.

  35. After lots of time growing up in Idaho and even living on the Wasatch Front, I get the impression that members of the Church tend to figure that if you’re depressed, it’s your own darn fault.

    Ezra Taft Benson, “Do Not Despair”, Oct 86.

    “First, repentance. In the Book of Mormon we read that “despair cometh because of iniquity.” (Moro. 10:22.) “When I do good I feel good,” said Abraham Lincoln, “and when I do bad I feel bad.” Sin pulls a man down into despondency and despair. While a man may take some temporary pleasure in sin, the end result is unhappiness. “Wickedness never was happiness.” (Alma 41:10.) Sin creates disharmony with God and is depressing to the spirit. Therefore, a man would do well to examine himself to see that he is in harmony with all of God’s laws. Every law kept brings a particular blessing. Every law broken brings a particular blight. Those who are heavy-laden with despair should come unto the Lord, for his yoke is easy and his burden is light. (See Matt. 11:28–30.)”

    I’ve sat there as sisters stood in testimony meeting and announced “I learned that when I took Prozac, I was serving Satan.” We’re under tremendous pressure to be thin, shiny, happy people, beacons of light to the world abounding in good works. If you’re depressed, it’s simply because you’ve got unconfessed sins in your past, you didn’t get your home/visiting teaching done, and family prayers have become a rare thing. My mission president tried to tell us that if we felt depressed, it was because we weren’t tracting enough. LDS doctors have told my wife, “I don’t go for those mood pills.” Depression is a personal failure at worst, or a matter for the bishop.

    Anybody ever hear how some Mormons are genetically pre-disposed to some forms of colon cancer? A gene has been traced to a man who came to the United States around 1630. Much later, about 1850, a female descendant of his married and took a boat around the southern tip of South America and moved to Utah. Two large families ended up with that gene – one that stayed in New York, and one that went to Utah. Lots of kids, lots of weddings, more kids, more weddings, and eventually you get a segment of the population that has some genuine identifiable genetic risks.

    Think the same thing might happen with depression? That perhaps there’s no more shame in seeing a doctor for it than there is in having cancer? Would we tolerate somebody getting up in church and claiming “I was diagnosed with cancer, but I didn’t want to become dependent on the chemotherapy.” Would we tell our friends, “Well, it’s too bad she got breast cancer, but it’s probably because she dressed immodestly as a teenager.”

    In short, get the help. If the doctor won’t help, find another doctor. Don’t think that you don’t deserve any better than the life you have.

  36. I think it would be helpful to discuss the symptoms of depression. Is it “feeling lousy”? What does this mean, really? What if you rarely have anything positive to add to a conversation, choose to watch hours of mindless entertainment, and aren’t particularly interested in interacting with friends and family, then are you depressed or is this just your natural self? Is depression manifested by objective behavioral activities (crying, watching hours of mindless entertainment instead of interacting with friends) or a subjective inventory of one’s own emotional well being? Or what?

  37. Isaac, here ya go, from the DSM:

    A person who develops severe depression may appear so confused, frightened, and unbalanced that observers speak of a “nervous breakdown.” However it begins, depression causes serious changes in a person’s feelings and outlook. A person with major depression feels sad nearly every day and may cry often. People, work and activities that used to bring them pleasure no longer do.

    Symptoms of depression can vary by age. In younger children, depression may include physical complaints, such as stomachaches and headaches, as well as irritability, “moping around,” social withdrawal, and changes in eating habits. They may feel unenthusiastic about school and other activities. In adolescents, common symptoms include sad mood, sleep disturbances, and lack of energy. Elderly people with depression usually complain of physical rather than emotional problems, which sometimes leads doctors to misdiagnose the illness.

    Symptoms of depression can also vary by culture. In some cultures, depressed people may not experience sadness or guilt but may complain of physical problems. In Mediterranean cultures, for example, depressed people may complain of headaches or nerves. In Asian cultures they may complain of weakness, fatigue or imbalance.

    If left untreated, an episode of major depression typically lasts eight or nine months. About 85 percent of people who experience one bout of depression will experience future episodes.
    Depression usually alters a person’s appetite, sometimes increasing it, but usually reducing it. Sleep habits often change as well. People with depression may oversleep or, more commonly, sleep for fewer hours. A depressed person might go to sleep at midnight, sleep restlessly, then wake up at 5 am feeling tired and blue. For many depressed people, early morning is the saddest time of the day.

    Depression also changes one’s energy level. Some depressed people may be restless and agitated, engaging in fidgety movements and pacing. Others may feel sluggish and inactive, experiencing great fatigue, lack of energy, and a feeling of being worn out or carrying a heavy burden. Depressed people may also have difficulty thinking, poor concentration, and problems with memory.

    People with depression often experience feelings of worthlessness, helplessness, guilt, and self-blame. They may interpret a minor failing on their part as a sign of incompetence or interpret minor criticism as condemnation. Some depressed people complain of being spiritually or morally dead. Their mirror seems to reflect someone ugly and repulsive. Even a competent and decent person may feel deficient, cruel, stupid, phony, or guilty of having deceived others. People with major depression may experience such extreme emotional pain that they consider or attempt suicide. At least 15 percent of seriously depressed people commit suicide, and many more attempt it.

    In some cases, people with depression may experience psychotic symptoms, such as delusions (false beliefs) and hallucinations (false sensory perceptions). Psychotic symptoms indicate an especially severe illness. Compared to other depressed people, those with psychotic symptoms have longer hospital stays, and after leaving, they are more likely to be moody and unhappy. They are also more likely to commit suicide.

  38. Cynthia L. says:

    Would we tell our friends, “Well, it’s too bad she got breast cancer, but it’s probably because she dressed immodestly as a teenager.”

    In short, get the help. If the doctor won’t help, find another doctor. Don’t think that you don’t deserve any better than the life you have.

    Preach it, Michael!

  39. Anon for now says:

    Isaac, I think that depression manifests differently for different people. There are some common threads though: sleep problems (insomnia or chronic fatigue), major shifts in appetite, suicidal ideation, withdrawal from previously valued relationships, emotional numbness, etc. Having one or more of these symptoms doesn’t mean that you are having a depressive episode, necessarily, but several of them together can suggest just that.

    Looking back, I can see crazy warning signs that I wasn’t aware of at the time: I stopped making any plans (apart from suicide), I couldn’t bear to talk to people I used to enjoy conversing with, I abused sleeping meds so I wouldn’t have to spend as much time conscious, my emotional responses to various situations were completely off kilter (successes didn’t please me, tiny setbacks felt like monstrous disasters), etc. Given that, when stressed or upset, I used to be able to sit down and think a problem through logically and so reach a decent perspective on the subject, the latter symptom was especially telling. I could still be logical, but my emotional reactions were way out of proportion, and recognizing that changed nothing. I told myself that my reactions were crazy, but I couldn’t moderate them.

    A week or so like that, even a month, I might have believed that I could just convince myself to snap out of it––but after more than a year of it, I knew if I didn’t do something I would soon try to introduce my tonsils to the barrel of a handgun.

    So, I saw a doctor. Thank God.

  40. Just a comment to the Word of Wisdom/beer thing started by handle 152. I tried self-medication with alcohol with almost disastrous results. Very few depressed people can avoid becoming worse depressed with alcohol.

    I talk weekly with a group of men, whose only choice for medication for a long time has been alcohol; what they wish someone had told them earlier is that it can cause clinical depression, even in patients who don’t have it previously.

  41. Depression is one of the few diseases that causes the person with it to totally deny having it.

    My dad is mildly Bipolar, my mom has clinical depression, One of my sisters also suffers with Clinical depression and I’m not sure what I have but I know I have it. My description of my own depression is that is it triggered by something (like someone shoving you into a hole) and then I have a very very very hard time getting out. Once I’m out, though, I’m okay until the next shove comes.

    I knew I struggled with depression when I was in high school. I remember telling my mom “I don’t want to do this anymore, I just want to sleep until it all goes away… can’t I just go into a coma for a couple of years?” She was an awesome mom and recognized the symptoms (probably due to my sister at one point trying to commit suicide) her response was “Do you want to talk to somebody about it?” To which I said “ya”. She call the psychiatrist that same day.

    I have to say, of all the genetic ailments to have, I think mental ones are the worst, simply because they can’t be seen, and they usually push the people you love away from you.

  42. Velska,
    I think that 152 is talking not about alcohol as an appropriate medication for already depressed people, but about moderate imbibing (a mild barley drink in the evening, which even President Grant enjoyed most of his life) as a lifestyle pattern that could be helpful in preventing the onset of serious depression.

  43. icanrelate says:

    Thank you all for being so brave to share your experiences.

    This quote from Portia really hit home: “As it turns out, Spring has often been a trigger for me–that feeling that I should be happy, should feel something at least. That my heart remains frozen long past the time of daffodils is often a crushing grief.”

    I really look forward to the rest of this series and knowing that I am not alone in my melancholy.

  44. If anyone wonders about the criteria, to my recollection there was a depression symptoms site linked to.

    Depression has many faces, really. One depressed person may be kept barely sane and functioning by having a responsibility, while for someone else, any responsible becomes this big black monster that eats up all pleasure (not to mention sleep) from your life.

    But If you’re planning to take your life, walk under the bus, something like that … get help.

    I remember standing at a busy intersection, waiting for a pedestrian light to turn green. I’d look at the oncoming trucks and think “just one step, and I won’t feel this pain any more.” Except that I didn’t really believe it, and I have an idea, how devastating it would have been to my family. I just couldn’t do it to them. As for myself, I believed I was just totally unlovable and basically between redemption anyway (my self-medication had led me to behaviors I abhorred).

    These kinds of symptomatic episodes should open your eyes to seek help.

  45. Any competent mental health clinician most certainly is making a distinction between symptom and cause.

    I have never seen the slightest evidence that any practicing mental health professional has any ability to distinguish between the two, or rather, because the causes are unknown and undetectable by any means readily available to a practicing doctor or psychiatrist, most are reduced to idle speculation whenever the topic of causes comes up.

    It is the same thing with medications – an alarmingly large number of medicines used in the treatment of depressive disorders have no known mechanism. In other words, the developer / scientists have no idea what exactly it is that they are treating, or what the underlying problem really is, just that the treatment appears to work.

    So if the wizards at the NIH cannot tell you what causes serious depressive disorders, it is a bit much to expect a local psychiatrist to come up with anything more profound than “poor thinking habits mumble mumble perhaps genetics in some cases”.

    What I call the psychological fallacy is the universal predilection for mental health professionals to conclude that the symptom is the cause. If someone is prone to negative thoughts, no doubt that is caused by negative thoughts.

  46. As going to another page can so often be a threshold, here is a site that explains depressive symptoms (And there’s a quiz somewhere there).

  47. Kathryn Lynard Soper says:

    Mark, there’s plenty of speculation, to be sure. But there’s also plenty of solid information, even if it doesn’t offer one-size-fits-all answers to complex questions.

    Solomon describes in detail studies of how cortisol (the stress hormone) relates to depression, and how an experimental cortisol-regulating medication is producing very good results in depressed individuals who aren’t helped by tweaks to the serotonin system. Apparently, the brain’s capacity to absorb and process stress begins to break down after a significant high-stress episode. “The first episode of major depression is usually closely tied to life events; the second, somewhat less; and by the fourth and fifth episodes life events seem to play no part at all.”

  48. #45: Mark D

    Many things in medicine have “no known mechanism”, and not just with regards to psychiatry. Since you seem to hate psychiatry and its vagueness, I’ll give several examples from a more concrete area of medicine. In our joints, our cartilage is like brake pads – as life goes by, it wears out. Someone comes to me in pain, because a normal thing is getting worse. What are options?

    – Chondroitin / glucosamine: I talk to a number of patients about these. They help 70% of patients with arthritis. Interestingly, in the same studies over 50% of people with placebo also feel better. We also don’t have any idea why or how they work. 2 ways of looking at that: 1) they have a minimal effect so are a waste of time, or 2) The majority of people get some relief from “no known mechanism”

    – Knee arthroscopy: There are many things we can do arthroscopically that are minimally invasive. Someone thought that if we could “clean out” a worn out knee with a scope, people would at least get some relief. And it worked. Over 30% of people felt better and avoided getting a knee replacement as an alternative surgery.

    Interestingly, someone did a study (approved and agreed to by patients). 1/3 of patients got the above treatment. 1/3 of patients just had the scope put in but nothing else done to see if it was just washing out the knee that helped. 1/3 didn’t have anything done. They had 3 cuts in the skin made, and then sewn up in the OR. All 3 groups did the same, and over 30% felt better in all the groups.

    So, according to your criteria, much of what we do in ANY medicine is a fallacy. Symptoms are treated every single day. Very rarely does a pediatrician know the exact organism in an ear infection, they just treat “something”. Very rarely does an internist know exactly what is causing a pneumonia, they just treat “something”. There are a number of drugs that we don’t really know how they work. There are a number of medical conditions that we don’t really know what we’re doing.

    But guess what, we do it anyway. At the end of the day, people get better. Through trial and error, people have found things that work. Though it might not be as scientific as you seem to want to cling to, it is what it is.

    I’m sorry that you think depression is a “fallacy”. But people’s lives are destroyed by it. Perhaps you’ve never known anyone in that category, so count yourself fortunate. Maybe someday someone will point to the exact cause of depression to satisfy your criteria, and then they’d be able to attack that point directly. But for now, we work away with our blunt instruments doing what we can to help people and improve their lives. What’s wrong with that?

  49. Mark,

    First of all, loved Mission Impossible 3, glad to see an improvement over the first sequel. I’ll get around to seeing Valkyrie when I get a chance.
    I’ve been thinking of getting auditing done to check my thetin levels, do you recommend a good location?

    Dude, you can have your opinions, come to your own conclusions, etc. But don’t try to claim something is a hoax (fallacy) when many people – some suicidal – depend on that thing to get through life. Its not your place to judge for other people.

  50. Kathryn Lynard Soper says:

    Mike S, your comments have been wonderful. Thank you.

    Mark D, I’m not sure where you’re coming from. You seem to be a believer in major depressive disorder, but some of your other comments read as if you’re a naysayer. You defend antidepressant therapy as well as criticize it. Where are you coming from in this discussion?

  51. Latter-day Guy says:

    Perhaps Mark has dissociative identity disorder? If so, maybe he could label his comments as Mark1, Mark2, … Markn… That might clarify things.

  52. Thank you for posting this series. I firmly believe that a lot of the stigmas regarding depression vs. feeling down can be alleviated by the education of the masses. My husband has both Major Depressive Disorder and Schizophrenia and the day-to-day life we lead would surprise many people. I can’t wait to read the “friends and family” posts coming up!

  53. It seems to me that Mark D is being misread here. He doesn’t appear to be arguing against the reality of major depressive disorders, just that their diagnosis and treatment are particularly vulnerable to what he describes as a logical fallacy that confuses symptom with cause. My understanding is that MDD is, by its nature, in a certain sense defined by this fallacy/paradox—that the individual neurobiological and chemical correlates of the disorder are extremely difficult to catalog as either causes or symptoms. I may not share what appears to be Mark’s suspicion toward medical treatments of symptoms, but I don’t think he’s characterizing clinical depression as a fallacy.

  54. As with almost anything medical the intuition of the medical provider is used.

    I don’t see any distinction between using intuition to provide an anti-depressant or using intuition to suggest the best option for trying to rid a body of cancer. The perscriber uses their best idea on what they think would work. Period. In almost every medical case. Granted a good physician will have done their homework on studies etc, but it still doesn’t take intuition out of the equation.

  55. Cynthia L. says:

    Brad, I suspect you’re right, but Mark D, your tone could use a little chillaxing.

    Really, people, can we leave the axe grinders and hobby horses at home? A thread where people have made (in post and comments) some difficult personal revelations seems to be more an occasion for support, encouragement and sharing of perspectives, rather than soapboxing. A lot of that is tone, approach and framing, and a little is content.

  56. Not to redirect from Depression, something I have seen too much of. But my problem was/is Anxiety. Not the same thing (for me). At work, I was seen as an asset_a work horse. But I was a runaway train of compulsions. By night, I could not even get my key into the key hold. I finally burned out.
    But help was also available for me. I take Xanax. It is cheap, and works in about ten minutes. Another illness not to be ashamed to seek help for.

  57. amelia bedelia says:

    I think this is an amazing discussion. The fact that we are even talking about this subject on the internet with such openness and candor (anonymous or not) really speaks to how far we’ve come as a society to erase the stigmas around mental illness. Not that they are anywhere close to actually being erased, but I can definitely see the progress.

    Here are some actual situations I have been encountered in the course my depression/OCD:

    1) I was in the hospital at age 19 after overdosing on sleeping pills and having my stomach pumped. Of course, the psychiatrist told my mother that I would have to take medications to get better. She started crying – because I would have to take medications!
    2) My college roommate told me that I wouldn’t have gone to heaven if I had been successful in my overdose attempt. I’m not Mormon and I am not trying to incite a religious discussion here – but why would you say that to someone?
    3) My grandmother found out from my mom that I was suffering from terrible postpartum depression. Her response: “Well, she isn’t taking anything for it, is she?”
    4) “But you don’t have anything to be depressed about.” or “Why don’t you go shopping?” These are courtesy of my own husband!

    The individuals in situation #s 1 and 2 have re-evaluated their stance on the topic. #3 is a lost cause. #4 – spouses say dumb things to each other sometimes, and that’s all I’m going to say about that!

  58. anon for this subject says:

    This was an incredibly powerful and hard read. As someone whose wife suffers from depression and anxiety, I could relate to a lot of these stories and I wait eagerly for the next installment.

    Just as an aside, my wife is an incredibly bright and competent young professional, but has a hard time coping with regular stress because of her anxiety. Unfortunately, because of the recent economy, our insurance coverage has been next to nothing for the past few years. It was during this that we discovered her depression and anxiety. Unfortunately, we don’t have any insurance to visit a professional or to get any kind of medication and so we hobble along, doing our very best while trying to get back on our feet.

    If anyone knows of any resources to helping this problem without insurance, any information would be greatly appreciated. For the moment, unable to afford anything else we’ve been relying completely on God and prayers, which, while I’m sure delights our more conservative Mormon friends, is unfortunately not enough on some days to get through without strife.

  59. Kathryn Lynard Soper says:

    #58, I’m sorry to hear about this struggle. Situations like yours are why I pay fast offerings–has your bishop offered any resources?

  60. Anon for this subject – I’m sorry that you and your wife are having to work through this without the proper professional support. I’ve gone through periods where I was depressed and uninsured, and it is both depressing and expensive. Does your bishop know about your situation? Fast offering funds are sometimes used for this kind of thing. Your wife’s primary care physician might have additional resources. For all I know you have already pursued both of these options and come up with nothing, but that’s all I’ve got.

    Of course the cheapest no-insurance option is to check out some books on treating depression with diet and exercise. I don’t remember any of the titles I read back when I was pursuing that path, but maybe someone else can recommend something.

  61. # 58,

    Yes, please visit with your bishop or branch president. Situations like yours are exactly what fast offering funds are designed to help with. I am quite certain that there are others in your ward right now whose therapy is being paid for, at least in part, with fast offerings.

  62. Although one might wish for a less bombastic tone, I do value Mark D’s and Isaac’s comments. Treating depression is not nearly as obvious a slam-dunk as treating infections with antibiotics. There is a lot we don’t understand, and I tend to agree that it is dangerously reductive to consider depression _merely_ chemical.

    Nonetheless, it surprises me to see people who are willing to testify to the efficacy of olive oil poured on the head as curative of all manner of ailments demanding absolute clarity on the mechanism of antidepressants’ efficacy.

  63. #58:I had three trips to the ER for panic attachs (BP 240 !-a racing pluse ).
    I have insurance. My Xanax Px is $10 for 200 pills-90 days (at Kasier). I had my doctor double the MGs, so I can cut the pills in half (now I have 4 hunderd for 90 days= $10!)
    I remember seeing the doctor (I always take my wife-RN). She said: ” Isn’t that addictive?” Doctor: ” He already is addicted to Anxiety”.

  64. These discussions have a way of popping up at just the right time. It seems that when I’m right on the cusp of utter hopelessness I’m again reminded that my condition is real and not to be trifled with. Now it may sound strange, but that little reminder can bring great comfort because it enlivens the notion that other things are at work than just my “loserdom” — as one of the permabloggers mentioned above.

    Thanks all.

  65. Hopeful Dad says:

    This has been a worthwhile discussion all around. My wife and I feel like we are fairly bright, attentive and caring parents, and we were totally taken by surprise to discover our son was deeply depressed. And if there was a magic bullet, we’d have used it by now, but there aren’t any that we’ve found.

    With other folks that I know who have suffered from depression, the severity and symptoms vary widely from individual to individual. I know some who have bounced back with no signs of ongoing issues, and others like my son where it lingers, sometimes unseen but lurking, and other times where it is right in your face, and we can’t seem to get around it to where our son is.

  66. Kathryn Lynard Soper says:

    Kristine, yes, the comparison to antibiotics is limited indeed. Just trying to make the point that there’s an in-between place in the treatment of depression where medication might help quite a bit, yet isn’t necessarily required for recovery. Some people may balk at the idea of using psychotropic medication only in extreme circumstances where there’s absolutely no other recourse, but I do not.

    Jack, you made my day. Best wishes.

  67. Latter-day Guy says:

    Nonetheless, it surprises me to see people who are willing to testify to the efficacy of olive oil poured on the head as curative of all manner of ailments demanding absolute clarity on the mechanism of antidepressants’ efficacy.

    Zing!

  68. I’m a 52 male and found myself having low energy and thinking through a fog a few years back. Doc thought it was low thyroid, but my labs came back normal. When it got worse, I started to self medicate with black market desiccated thyroid pills from a body builder friend at work (adjusted dose slowly upward to feel good but then cut back to keep bp under 125/80). It fixed my problem, but I still wasn’t 100%. Last year doc started me on testosterone HRT, and now I feel like I’m twenty-something again.

    Maybe I was initially depressed? I figured it was normal aging. Would a typical MD recognize depression?

  69. This is depressing.
    Kidding aside, kudos for your openning yourselves up to juvenile comments about high depression rate being due to your lack of faith, liberalism, Mormonism, or whatever people dislike about you. It takes courage to pull the scabs off old wounds.

  70. L-d Guy, I didn’t mean to be zing-y (well, not too much). I sincerely think we of all people ought to be more willing to acknowledge that healing is often mysterious.

  71. A typical MD recognized depression in my sister. After she described her Depression (notice the capital D) I was stunned to learn that what I had felt most of my life was depression. But as someone else mentioned earlier in the thread, doctors are different and make different judgment calls. I think my sister was lucky.

    My fall back answer for my lack luster attitude and emotions as a teen was, “I’m tired.” I was later diagnosed with Chronic Clinical Depression with 3 previous Major Episodes. As comforting as it was to have someone say that I could feel better, it was frightening to hear those labels applied to me. On the other hand it was comforting to know that some of my behaviors weren’t me, but the illness (having a crying screaming fit in the middle of my high school art class). It was terribly painful to tell my loving new husband that I thought about dying.

    My depression has been at bay for many years now. I look forward to talking about what helped me when that post goes up.

    Two cents on warning signs/symptoms- My sister and I both agree that we can tell our depression is making a comeback when we don’t shower regularly. TMI?

  72. For someone who asked about free/cheap resources for depression. I don’t believe that the meds are all that expensive… most SSRI’s are available generic, etc. The problem is you really do need a medical professional to monitor you as you go on them because (1) you step up in dosage and (2) in the cases where they do go wrong, it can be very serious. That said, your GP likely feels comfortable helping… and might even be able to regularly check in for the first month via phone.

    It is too bad and a serious indictment of our medical system that medicine is that much cheaper than therapy. I’ll leave it at that.

    My depression is driven/confounded by anxiety which should respond well to exercise. Problem is (1) I HATE (2) can’t afford and (3) don’t have time for the gym. What I do have time for is a short (20 minute) home yoga practice (there are free and/or near free sites on the web) with 10 minutes of meditation a couple times a week (my favorite basic book for that is “Mindfulness in Plain English”). It clears my mind enough to lessen the anxiety and physical tension with then, in turns, helps the depression.

  73. Michael (#35) If you can tell me more about the NY family with the cancer gene, please contact me at mercermeyer@hotmail.com. I think it may be my husband’s family.

  74. I am very grateful to the contributors and commenters for your candor. I have struggled with depression most of my life. I really appreciated the comparison between depression and hunger. Connecting that to my own experience, I am always a little hungry, and at times have nearly starved to death, with various stages back and forth between the extremes. I have seen several therapists over the last 20 or so years (I am 32 now). Some definitely have a better grasp on what is helpful than others. I have only been on medication once, during my most recent “starvation” period. Although looking back, I can think of at least 3 other episodes where I think I should have been medicated. The thing that finally brought me to medication (Lexapro), was that this episode came with severe anxiety, and I could not drive or leave the house without having debilitating panic attacks. Anxiety is clearly linked to depression, yet it seems to be more concrete to diagnose, so I think it is slightly more respected by the world than just “depression.” So, because I had such severe anxiety, suddenly it was more justifiable (even from myself) to try medication. I’ve grown used to depression and developed various coping strategies through my life, but the anxiety was new and felt like a curve ball that I had no idea how to process. It’s a whole new ballgame for me now.

    My second point I wanted to share is that I’m pretty sure my 9 year old daughter is going to be facing a lifetime of depression too. I can already see the hallmarks in her (I know what to look for, having lived it myself). I feel very sad for her, knowing what is ahead. I also feel glad that I am her mother because I don’t think I will be afraid to get her the help she will likely need. And I feel scared that I won’t know when to get her the help that she will likely need.

    Thank you for this forum. This isn’t exactly Enrichment conversation.

  75. Just saw the comments about the cost of meds. My Lexapro is $81 for a 30 day supply. Painfully expensive.

  76. Great idea for a series. I am an Therapist (LCSW) that happens to be LDS but does not work in general with LDS people in my Community. It has been interesting to read through the comments and see the perspectives of people in my faith community.

    If med costs are a concern there are a number of generics that most doctors will discuss with a patient if they know finances are an issue. 4 dollar meds at Walmart are such a blessing, and lots of stores have similar programs.

    In studies the generics often have similar results and effectiveness in treatment as the more expensive ones. For example Citalopram is a generic version that Lexipro was updated from. You may want to discuss cost with your prescriber and the possibility of switching to a cheaper med. If you decide its best to stay on your current version, Medication providers may also be able to help as well as they have access to samples at times to bridge you..

  77. All my pills are generics. I tell my doctor the worst side effect (for anxiety me) is a pill with a high price.
    Usually, my worst side effects are crazy dreams.
    I sleep with a CPAC. Don’t be scared of these; it’s like getting three more hours of sleep.

  78. I am not a Walmart lover by any means, but I just checked and yes, Citaloporam (Celexa generic and precursor to Lexapro) is $10 for a 90-day supply.

    That also happens to be my co-pay, but I believe that the non copay cost is in the $60 range for a 100-day supply (this is a Kaiser pharmacy in CA). I would check, but original receipts get forwarded to a (workplace provided) supplemental insurance.

    I understand that doesn’t help with other meds. And I wish we didn’t have to choose meds based on cost. On the other hand, we shouldn’t dismiss all medication options due to cost since some are surprisingly affordable.

  79. My first clue that I had a problem was when I was in my early 20s, and someone said something about how weird it was that some people got suicidal. I thought being suicidal was totally normal, and we all just knew not to talk about it. I couldn’t remember ever *not* being suicidal, other than having a good week every so often.

    I did not have a major depressive episode until my early 30s because I managed to self-medicate with an addictive behavior. In my early 30s, the behavior quit working. It just didn’t numb my emotions anymore, and I crashed. I lost my job, sold my house, moved into my sister’s basement, and slept 16 hours a day. Then I got on anti-depressants. Once they kicked in, I had enough energy to set about really destroying my life. It was another addictive behavior, but since nice Mormon girls don’t have addictions, I didn’t know what I was dealing with.

    My own personal opinion is that addictions are the flipside of depression. An addiction is when you find a behavior that numbs the despair that characterizes depression.

    Anyway, I was diagnosed with clinical depression. It took several more years to find the link between my depression, and abuse. Are you going to do a post about the link between depression and abuse? I know that much depression is not connected to abuse, but I’ve learned that abuse nearly always creates addiction or abuse in its victims. In other words, a depressed person is not necessarily an abuse victim, but an abuse victim will nearly always have a problem with depression or addiction. Maybe that’s outside the scope of your series, though.

  80. “We of the craft are all crazy” – Lord Byron (although I’d bet Hemingway echoed the same sentiments)

  81. #78: You need to learn the “Drug Formularies” of those you from which you buy your medications. Some are cheaper at say Walmart than Kaiser. But I buy 2 generics from Kaiser that are not on Walmart’s Formulary.

  82. I’ve kind of come to the realization that I may have depression.

    I have been a bit frustrated with my parents on this issue. My dad, who I think struggles with depression himself, insists that everyone has their problems and depression, when it’s not life-threatening, should not be treated. He seems to think that the people who seek treatment for it are attention seeking and over-blowing the problem.

    My mom basically thinks it’s all Satan. I don’t want to criticize her, because she’s really very nice and understanding, but it’s hard when it’s your own family.

    Anyway, I just wonder how you convince people who hold either of those views to believe otherwise? And how do you know that they’re not right (granted, we’re not LDS, and I realize that beliefs may differ on the spiritual issues)?

  83. Anon is Shakespearean says:

    Thanks for posting this. You are all braver than me and it helps to hear your stories.

  84. Latter-day Guy says:

    Tough questions, 82. It’s hard to say without knowing more about your individual situation (e.g.: your age, etc.). I don’t know about convincing your parents; attitudes can be tough things to change. Evaluate how your symptoms are affecting your life, eating and sleeping habits, (I assume) schoolwork, relationships, etc. Do you trust your family doctor? Could you speak to him/her privately if necessary? Is there a school counselor you could approach? (Particularly if they’re licensed or at least have a background in psychology. The one at my school did not––strictly academic counseling.)

  85. Brad (#53) has what I said just about right, and several others unfortunately don’t seem to have paid attention. I was making a complaint about the excessive predilection most professionals in the field seem to have to attribute mental illnesses to mental causes.

    In my limited experience, people whose psychological disorders have strictly mental causes are among the luckiest people on the planet, because it means that with reasonable therapy their trial is likely to be over in months.

    For many individuals or families with severe, recurring cases of the disorder, the suggestion that the entire problem boils down to “poor thinking habits” is ludicrous. Not only that, it is a first class insult. When someone tells you (in essence) that your brain is shutting down because you have a bad attitude, something is seriously wrong.

    To me, so obviously wrong that I consider the idea that serious mental illnesses are primarily caused by thinking disorders the “psychological fallacy” – essentially (for lack of a better explanation) a confusion of symptom and cause.

    If you went to a doctor with a severe rash, it would be an unusual doctor indeed who would blame the rash on the rash. That is what mental health professionals do every day, on the basis of extremely good evidence that thinking about the “rash” does indeed make it worse.

    The problem is that in any number of cases thinking positive thoughts about the “rash” does not make it go away, and it is both insulting and frustrating to be faced (from time to time) with a litany of trained professionals who maintain just that.

  86. Kristine: Nonetheless, it surprises me to see people who are willing to testify to the efficacy of olive oil poured on the head as curative of all manner of ailments demanding absolute clarity on the mechanism of antidepressants’ efficacy.

    As a matter of fact, I don’t think olive oil per se has any curative powers whatsoever, and I would worry about the intelligence of anyone who does.

    As for the rest, it sure would be nice to know more about the causal mechanisms for such medications, because it would advance the very argument I am making here. Is it so hard to avoid jumping to the opposite conclusion?

  87. Mike S. I’m sorry that you think depression is a “fallacy”

    At the risk of sounding like a broken record, that is not what I said.

  88. Okay, Mark D. Thanks for clarifying your position. Sometimes an argument that seems clear to the writer is not clear to the reader, despite their close attention.

    I agree that this phenomenon (blaming the rash for the rash, so to speak) can be a real problem. I’m grateful for competent doctors who have counseled me wisely–I don’t think I’d still be here if they’d told me I caused my own depression via my cognitive style.

  89. Melinda, thanks for sharing your story. Really helpful perspective on how self-medication can backfire. And this one-liner is right on:

    An addiction is when you find a behavior that numbs the despair that characterizes depression.

    Thanks, also, for bringing up the link between depression and abuse. I’ll ask our group members to address this topic in an upcoming post, although we will only be able to touch on it briefly.

    #82, my heart goes out to you. Trust your own reality, and seek out an adult who can validate that reality and respond accordingly, like Ld-G advised. Best wishes to you.

  90. Mark D.,

    Indeed, a great many things will be clearer once we understand the effective mechanism of antidepressants; I just don’t think we should eschew the use of medicines that (seem to) work until we understand how they work, or that alleviating symptoms in the absence of a full understanding of their cause is a bad thing.

  91. Winston Churchill used a metaphor for his Depression:
    ” My black dog”. He said he could feel it enter the room, then enter him.
    blackdoginstitute.org
    A good site about Depression with a great logo.

  92. I just don’t think we should eschew the use of medicines that (seem to) work until we understand how they work

    Nor do I. I fall in the “anti-depressants are God’s gift to mankind category”.

    The point I was trying to make (albeit poorly) was that the paucity of evidence regarding physical causes of major depressive disorders (in most cases) seems to provide ammunition for the relatively absurd claim that even the most serious cases are strictly self inflicted. And, as a corollary, that anyone who needs to take such medication on and ongoing basis demonstrates a weakness of determination – something to be regarded with a mixture of disdain and pity.

    House is a television show of course, but Dr. House’s attitude when he discovers that Wilson is taking anti-depressants is typical. Character weakness, that’s the ticket. House’s pain is real. Wilson’s condition is self inflicted or non-existent, his medication a crutch, his prescription for it symptomatic of a deficiency in character. It is not like these things have actual physical causes of the sort that causes severe pain in the leg, right? Oh, he doesn’t have a real problem, let’s ship him off to the psych department, etc etc.

  93. J.K. Rowling had a great metaphor for her depression as well. In the Harry Potter books, she called it the Dementors, and they thrived on fear, despair, and all the worst memories a person had to offer. The best way to counteract their influence was chocolate.

    This from a woman with a top-notch education, but who had been abandoned by her husband, had a baby, and was so broke she took to writing in coffee shops because they were heated. Rejected by multiple publishers. Now she’s wealthier than the Queen of England, described and “Britain’s greatest export”, and able to fund vast charity projects with a single wave of her pen.

  94. Both depression and alcoholism have run in both sides of my family for several generations, including both of my parents. But I didn’t experience any symptoms or onset of clinical depression throughout my entire childhood and young adulthood/married life that I can remember at all. But the predisposition was there, probably: my father was a mean alcoholic who hit all of us, including my mother most of all, as we were growing up our West. I discovered in 1990 that my married-in-the-SLC-temple-with-four-young-girls husband was gay and was seeing men in several different cities. I think I was handling the many aftershocks of that discovery with at least partial sanity, but when I was diagnosed twice with HIV (remember this was way back when and there was very little medical information available) I just couldn’t handle life any more and really crashed into darkness that just didn’t lift. I talked to my bishop, who told me he would pray for me, but I knew I needed more help than that. A friend gave me the name of a clinical psychologist in our area, and I quickly sought him out and stayed in therapy for almost ten years. My family went through every dysfunctional (but “normal” in an abnormal way) reaction/pattern that you could think of since the issues and the ultimate divorce were so difficult and long-lasting. I also went through the normal round of antidepressants and antianxiety drugs and anti-whatever was new with a psychiatrist who worked in tandem with my therapist. I am still on Cymbalta to this day. I have tried several times to wean myself off of long-term meds and a family crisis rears its head every time, and I am not resilient enough any more to cope with added earthquakes and aftershocks. There is still enough LDS stigma attached to depression that I have told my good friends about this but have not broadcast it in general. I am active in my ward and stake but cope daily with the effects of clinical depression on spiritual matters. Thanks so much for opening up this dialog — there are many of us out in cyberland who bear this burden quietly while wondering when the next earthquake is going to hit.

  95. Kathryn Lynard Soper says:

    I talked to my bishop, who told me he would pray for me, but I knew I needed more help than that.

    Indeed.

    Thank you for sharing your perspective, East Coast survivor. Lessened mental and emotional resiliency is common outcome of a major depressive episode. Saith Solomon: “People who have had myocardial infarction after great physical strain are subject to relapse even while sitting in an armchair–the heart is now a bit worn-out, and sometimes it just gives up even without much strain. The same thing can happen to the mind.” It’s a medically documented matter of cortisol management in the brain.

  96. For me, depression was something hit hard and fast when I was in college. One day I was a well-adjusted, relatively happy college student, and three months later I was crying for no reason, unable to do my schoolwork, etc. I was lucky that the change was as obvious and as sudden as it was (it made it easier for me to recognize), though it did take me months to actually get help, and then it took years after that for the doctors to realize that I had bipolar disorder and that was the reason the antidepressants they were giving me were actually making things worse.

    What I struggle with now is not necessarily recognizing that I have mental illness/depression, but recognizing when it’s getting worse again. I just went through a pretty severe episode over the past three years because of life circumstances, and this past year as I emerged from the worst of it, I was left asking, “how did I let myself get that bad again?” I knew things were worse, but somehow I ended up in denial about how bad they actually were, and I’m currently trying to figure out how to work on trying to prevent this from happening in the future.

  97. doingbetter says:

    This is very interesting for me to read. I also struggle with depression, but it took a long time for me to admit/ realize it. I knew that I sometimes got depressed and I even saw a psychologist off and on for the past five years. He helped me a lot, and I feel like I have an arsenal of tools to use to help get myself out of the hole when I fall in. Sometimes it takes awhile, but since I could always pull myself out, I thought I certainly didn’t need meds. Last summer I finally had a doctor convince me to just try a medication. I was seeing him for other problems that I had been having (I was sure it was hormones, but everything checked out normally). I was SURE it wasn’t depression because I didn’t fit the stereoype. I didn’t have suicidal thoughts. I didn’t lay in bed all day, close the blinds, stop associating with people etc. I was a completely fully functioning mother. I thought. In retrospect, I wasn’t so functioning, but I got through the day and did all the stuff that needed to be done. But, the signal for me was that I felt like I had mud in my head. I was not able to think clearly, remember things, and sometimes struggled having a coherent conversation without stammering trying to remember what I was saying. And, tiny things overwhelmed me. My five year old asked me to tie his shoe and I couldn’t do it. My brain completely shut down – you would think he asked me to climb a mountain. And when I was completely apathetic about an upcoming event that normally would have made me excited, I decided something was not right.
    I was very upset about starting a medication – the stigma in my family is strong – only the “crazy and really messed up people” in my family are on those drugs, and I certainly didn’t want to be in that category. However, I started them. After 2-3 weeks, I could not believe how great I felt. I was shocked. I had energy. I felt more connected to my husband and kids. I was more relaxed. I didn’t get stressed out over every aspect of my day like I usually did, and I was not so irritable anymore. It was the first time that it sunk in to me that depression was not a failure on my part – it was a chemical imbalance in my head. (In talking to friends who also struggle with this, we often have the mentality if we just tried harder, did everything right, we could beat this depression thing) My doctor asked me when was the last time I felt this good for a long time- for 6 months or more – and I couldn’t tell him. I thought it was normal to get depressed on a fairly regular basis. I had no idea that, instead of falling in the hole and pulling myself out over and over and over again, that something could help build a bridge over at least some of those holes. I still have bad days. I think that is normal. And recently I had to change my dose because I fell back in the hole (a little too hard) but I feel better again, and I like it. I still believe that counseling has played a huge role in helping me deal with depression, but the combination of the two seems to be what helps the most for me.
    For anyone out there who doesn’t feel like they fit the stereotype, know that depression manifests itself differently and to different degrees in each person. And I believe the treatment varies from person to person too. Clearly, from reading these comments, everyone could tell a different story and have a different idea on what works best.
    And thank you to everyone for talking about this. I have wanted to discuss it more openly with friends and family but haven’t felt ready to do that yet.

  98. Thank you for this series. I hope it will reach and bless many lives. I have suffered from the blues or mild depression off and on for much of my adult life. Most of the time it resolves on its own. As I have gotten older I’ve realized that my despondency was an inner problem and not caused by the people around me. This realization was a blessing. This enabled me to wait it out or deal with it with on my own, without creating regular emotional wreckage in my relationships.

    These last few months however I’ve had many more bad, sad, and just plain numb days. Mostly numb and sad. I had been struggling on and off all last summer and then my father passed away. That blow was just too much. I haven’t been able to really fully function since. Sure I’ve had good days, but other than the occasional ray of light the oppressive cloud was going no where.

    After reading this post and comments I decided to stop making excuses stop waiting this out, it has been months. When I feel functional for a day or two it isn’t like victory, I just feel like I am standing on the precipice just waiting for something to bump me over the edge again.

    So in a motivated moment of clarity I thought to myself, “This is just stupid, I have good insurance, I have a good doctor, I don’t have any hangups with mental health treatment… call the doctor.” So I did. He had a cancellation so I went in yesterday. I’ve never taken anything for depression before. Don’t know if it will help but I am hopeful.

    Thank you.

  99. Kathryn Lynard Soper says:

    Bless you, Dovie, and best hopes for effective treatment. Sometimes it takes experimenting, but there are many options, and many reasons to be hopeful.

  100. So how serious is serious enough to do something about? I occasionally have anywhere from 3 days to 3 weeks (I can only think of one occasion when it lasted longer than 3 weeks) of depressed thoughts every few months. These depressed thoughts can be angry, self-loathing, just sad or numb, and sometimes thoughts about hurting myself. However, I know if I hold out long enough, I’ll come out of the funk. Should I do anything about it? It’s kind of silly of me to even ask this question, because I know I won’t do anything about it until something much worse than what I’ve already faced happens.

  101. doingbetter says:

    Rachel, you sound a lot like what I was going through. My doctor convinced me to finally take meds by saying, “what are you going to do, wait ten years and then start taking them and then say, “why didn’t I do this sooner?” For me, I realized it kept me from being the kind of person I wanted to be. I wasn’t a very connected Mom. I was just sort of floating through life feeling horrible about myself, wondering why I couldn’t be happy when nothing was really wrong with my life. Now that I have started medications, it has opened my eyes to what life can actually be like – and it is SO worth it. I resisted it for years, for the same reasons you say – I could always pull out of it. But what if you didn’t have to go there so often in the first place?

  102. Kathryn Lynard Soper says:

    Rachel, that’s entirely up to you. Treatment comes at a price of time, effort, energy, and (with medication) side effects. Some people come out ahead just muddling through their occasional, relatively mild bouts of depression. Home remedies like exercise and meditation might take the edge off, without having to deal with therapists and/or medications. Trick is, until you try treatment you don’t know how much better you might feel, so it’s hard to weigh options.

  103. Can I suggest something else that might help besides medication and exercise (though I will fully agree that those do help!) sometimes I change in diet can help too.

    One of my sisters is able to cope with her depression by exercising daily and making sure she eats right. If she even goes ONE DAY without both exercise and diet she gets to go back on meds for a time… which is a blessing in itself that they are available, but she really would rather avoid them if possible.

  104. An addiction is when you find a behavior that numbs the despair that characterizes depression.

    A good reminder, why so many people run into depression when they try to quit some destructive behavior they can’t seem to shake.

    Personally, I consider Anxiety and Depression fraternal twins — at least they have usually been sighted together in my life. I don’t even know which comes first, unless they travel together. Anxiety was what put me on anti-psychotics. I was completely paralyzed and I still take sedatives at least weekly, when I need to slow down.

    FWIW, prayer also calms me down considerably. Prayer is actually not unlike meditation: There comes a time when all I can do is sort of repeat something like “please give me peace” until I fall asleep or must do something else.

  105. This thread has been a small answer to prayer. I think I’ve been depressed on and off since childhood. Currently I am experiencing a period of numbness that has gone on for months–since the birth of my son more than a year ago. Thoughts of suicide actually come somewhat frequently. Is that really not normal? I remember having them on and off as a child and teen and I always just assumed it was normal to want to not exist. Will you be having a discussion on how to get help? I’m terrified–and kind of at a loss–to go to the doctor about this. Part of my fear is that I live in a relatively small town with only one doctor who is taking my insurance currently. He is LDS, in the adjoining ward, and I’m scared that he’ll take the “it’s all in your head, just read your scriptures more” line. I’d love advice for just bitting the bullet and making an appointment.

  106. Numb, I think most doctors are pretty familiar with postpartum depression, and those two magic words are a good place to start the conversation. When things are bad for me, I always have to have somebody else make the appointment. Once I’m there in the doctor’s office, I sort of have to say something. But telling the receptionist that that’s why I want an appointment has always been beyond me. I will say (from experience) that arriving in an ambulance is rather more embarrassing, so it’s worth it to try to get there before you’re at that point!

  107. Kathryn Lynard Soper says:

    That’s great advice, Portia. Making the appointment can be the hardest part.

    Numb, it’s not normal to consistently wish you didn’t exist. Any doctor worthy of the title will recognize that. If you don’t have someone who can make that call for you, email me and I’ll gladly do it. kathrynsoper at gmail.

  108. I just wanted to chime in that there are several antidepressants and/or anti-anxiety medications that are very inexpensive. As a physician with many depressed and anxious patients, I rarely need to prescribe the more expensive medications. For some of you who are having trouble with the cost of your medications, check with your doctor about the possibility of switching to something generic. If it turns out that you really need a drug that costs you $80 a month, but it works for you, it is worth it.

    Thanks to BCC for this wonderful series! I am looking forward to the rest of it.

  109. Numb, I know others have different experiences, but every time I’ve gone in for help, my thought afterwards has always been an *overwhelming* why oh why didn’t I do this earlier! I’ve never been on meds, and one time was only the first visit and one phone follow-up, yet still it was so, so helpful. To just have a little grounding, a little reassurance, a reinforcement that what I was feeling *was* real.

    Wherever you end up finding it, I hope you find the help you need (and deserve!!).

  110. anon for this subject says:

    I know this is late but I wanted to thank those who gave the great advice. We haven’t met with the bishop yet because of a combination of shame and fear that we’ll be marginalized by the ward or bishop. Being on the receiving end of mercy can be an incredibly terrifying process.

  111. Kathryn Lynard Soper says:

    Being on the receiving end of mercy can be an incredibly terrifying process.

    Yes. I never understood that until I was in a similar situation.

    And yes, the shame surrounding mental illness can be great.

    Wishing you the very best as you move forward, anon. Keep us posted, if you’re willing.

  112. I’ll third or fourth the notion that even if it seems like you are muddling through, there is a good chance that going in and seeing someone (and perhaps starting meds or making a plan with the provider as to how you will do it without meds) will be one of those “why didn’t I do this sooner” moments.

    The first time is hard. Damn hard. Having someone make the appointment for you is a good idea. (It is also a good idea to have your partner have the name/number of your doctor even for the second, third, whatever time. My husband is under strict orders to feel free to force me into see a health care professional if he feels I’m significantly off because I do have a hard time differentiating between a bad few days and me being extraordinarily and consistently irritable/depressed in the midst of it)

    Also, taking one of these depression scales that have been linked, printing them off, and taking it into the healthcare professional can be really helpful. It helps start the conversation. My health care provider actually had me do one in the waiting room before we even started to talk.

    Numb – Identifying it as happening postpartum can also help make it more real and less stigmatized to a lot of people including health care providers. It also helped me realize that it wasn’t a character failing plus it was even MORE important for me to get help because I needed to FOR my baby/toddler.

  113. #30 Carrie…

    Your post concerns me because Zoloft is not something you can just take when it gets bad, you need to take it regularly. I recently started taking it, too, and have had extensive talks with my doctor about it. It can take up to 6 full weeks before all your symptoms have settled down (establishing a normal eating and sleeping pattern, mood, etc) And mood is usually the very last thing to get better. I’m not sure if you actually wean yourself, or just quit cold turkey all the time…but you can go into heart failure by quitting cold turkey. In fact, my pharmacy specifically told me that if for ANY reason I ran out of pills, I was to tell them so they could give me some extra pills until my next Rx came through. It was that important to not miss any! And if this is something you’re doing often (starting and stopping) it can NOT be good for your body!

    How much are your pills? 25 or 50mg? I am sensitive to medication, too and usually only take 25mg (which depending on which pills they give you can be a whole OR a half a pill). The 25mg are light green, the 50mg are light blue. So it may not be that “weird” that you only need “half a pill”. I know people who only take 5-10mg of Lexapro, too. I don’t think a doctor would be surprised at all. Please go talk to your doctor and let them know how you’ve been taking your pills, and establish a continuous routine.

    If you are feeling intermittent anxiety attacks, they can Rx you some anxiety meds that can be taken just when things get bad. You may want to ask about those, too!

  114. #58…

    Doctors ALWAYS have sample stashes of anti-depressants. I’ve had doctors give me 1-3 months worth before. Talk to yours, let them know the situation. Sometimes they have resources you don’t know about. Sometimes the drug companies will send extras.

    I also agree you should talk to the Bishop and ask about financial help.

  115. and #58…

    you can reassure yourself by remembering that the Bishop has seen way, way, waaaaaay worse. lol. :P

  116. Thank you so much for this depression series. I struggle with depression and anxiety and have done so since high school for sure. It runs in my family with bipolar mother, schizophrenic brother, clinically depressed brothers and a sister so mentally unstable we don’t know exactly…

    I’m so grateful that mental illness is being discussed to help out the stigma surrounding it. My brother was psychotic when he participated in illegal activity…religion and schizophrenia have a hard time together…the voices and psychoses take on religious elements from seeing God and hearing him in your head to do things. Now my brother is in prison and his ex-wife’s family considers him evil, a child of the devil and that since we support him we must be also.

    It’s a big struggle to work through the shame and guilt and anger associated with this…it spills over into my spiritual life and have a very hard time ever feeling the spirit or that God even cares or loves me. It’s hard to attend church and read the scriptures when it just feels like everyone and everything says you should be so happy if you’re not then you’re not being righteous enough.

    Then we add in postpartum depression and then book it’s even more magnified and I feel like tossing my kid out the window everyday and then feeling so guilty about it since there are women in my ward who have three times as many kids and can get the house clean, be Primary president and pregnant with her fifth kid.

    So I finally made it into the doc for some antis but haven’t felt majorly better yet. Probably should get in some therapy as well.

    Thanks for letting me vent and share. I find everyone’s stories and insights so reassuring and comforting.

  117. This is going to be a great series. I relate to a lot of the stories here and I am especially interested by the comments of people who are parents and spouses of people with depression. It makes me wonder what my own dad and siblings think of my own struggles with depression (I kind of know what my wife thinks).

    For me little things bother me a lot. Little things I should be able to get over quickly (things most people get past and move on from) hang over me for way too long and have way too big of an impact. So with that, bad day or week can easily escalate into something much worse.

    There’s only been two times in my life where these feelings got to the point where I almost ruined/ended my life and everything I care about. Because it’s been only two times where it became a MAJOR problem in 30 years, I don’t know whether it’s full on depression or what. It seems like it would have been/would be more frequent if I was clinically depressed. So I dunno. I think some people who have major depression would probably consider me an amateur.

    I’ll look forward to part 2.

  118. Kathryn Lynard Soper says:

    Great to hear from you, Matsby.

    Note: Anyone who has seriously considered taking his life is a professional in this field.

  119. Not to disagree with Kathryn, but Matsby–you’ll always be an amateur in my book.

  120. Thanks for the OP. I wish I had time to read all the comments in detail. I just wanted to add to someone who said they didn’t know how bad it was until they started medicine. I had a somewhat similar experience. I’ve been dealing with depression since the birth of my fourth child (I now have 5). I started having thyroid problems after my fourth was born that were obvious, and I started treatment for it. But the depression was more subtle. It wasn’t until I was laying in bed trying to articulate to my husband how I was feeling (“I feel hopeless. I am not looking forward to anything. I hate to wake up in the morning and face my life”) that he said, “You sound depressed”. I was trying to decide what to do about it when I got pregnant and it got better. After my fifth was born, I felt fantastic for a few months. Better than I had felt in years. I jumped out of bed and ran around the house and felt so great. In retrospect, this is likely because my thyroid was going into a hyper phase – giving me tons of energy. I suffer from postpartum thyroiditis, so when my thyroid crashed into hypo (right over Christmas), I crashed hard. But, even then, I didn’t really recognize it as depression. I was just mad and tired and hated my life, etc. etc.

    Anyways, for me, I know that my depression is caused by an imbalance of thyroid and progesterone. I haven’t quite figured it out yet, but it has been an eye-opening experience. I admit I used to think that depression was the result of not being faithful enough or whatever. I never expected this to happen to me. It has definitely made me more compassionate and understanding of those who deal with any kind of mental illness.

    I also suspect that hormones are the root of a lot of depression, particularly progesterone. However, the doctors I’ve dealt with would rather just give an anti-depressant than try to figure out the delicate hormonal balance. I would rather figure out the hormonal balance and try to treat it.

  121. Kathryn Lynard Soper says:

    Thanks, Stephanie. You’re right–there are many, many women whose depression stems from thyroid and/or hormonal imbalances. It’s part of the mix for me.

    It’s impossible to overemphasize the need for competent medical care for individuals with depression.

  122. When I was in college I thought I had depression. I remember talking with my Singles Ward Bishop and he told me “we will pay for six counseling sessions with LDS services. And if your depression isn’t cured after that – then you’re not doing your part. The Atonement fixes and heals everything – six sessions should be enough.”
    I went inactive after that. I still have some bitter feelings towards that bishop.

    Years later, and later a wonderful marriage (to a man with Depression)… four kids later… and four post-partum depression episodes later – I realize that while the Atonement helps fix and heal… I also need the miracle of modern medicine.

    Yes, I thank God for Citalopram – and for humbling me to realize that I needed help and that prayer and faith alone couldn’t heal me of my clinical depression.

  123. Kathryn Lynard Soper says:

    Amen, Alicia. Faith and prayer can work so many ways–sometimes it’s the direct source of healing, sometimes it’s the vehicle which leads us to the right remedies for our situation. Both scenarios evidence the reality of a loving God and the power of the Atonement.

    That can be hard to believe, though, especially for a depressed person (or any person who hasn’t yet had an opportunity to learn otherwise). For a loooong time I was like that drowning guy who prayed for deliverance but then refused the rowboat, life preserver, and helicopter that came his way.

    I’m so glad you’re finding wellness.

  124. I don’t even know how I came across this site and in particular this series, but I am overcome with emotion.

    I’ve suffered with clinical depression since puberty, like many I daresay. This was many years ago and no one knew what to do with me. I’ve thought about suicide many times; even made an attempt while in high school. My children are what keep me alive now.

    I’ve reached the point of leaving the church because of the pray your way out, think yourself happy, guilt inducing, attitude I feel from many leaders and members. (Definitely not all, but the majority). The last straw was a R.S. meeting in which the speaker spoke as a Medical Professional. His focus was gratitude-which I do completely agree is essential for happiness-but when he said the 95% of depression would be cured just by being more grateful, something inside of me finally just fell apart and I gave up. I really feel that there is no place for me in this church.

    I could write paragraphs about this subject. Every comment has touched me in one way or the other. I am more than looking forward to this discussion.

  125. Mary, This situation is exactly why the church needs you. For every person that has depression and speaks up for proper treatment in the church there is at least one person who has been helped. When we stand up to be counted as grateful, faithful people who also happen to deal with depression we make a stride in combating the horrible attitudes you encountered.

    I thought my generation had a better handle on this – then I met a couple at church younger than I am who are leaders and actively preach unhelpful attitudes about depression. It is hard to speak up when dealing with depression but when I think about how horrid that pain is (having depression and being told by those who should help you that it’s all your fault) it motivates me to loudly speak up! This monster is too big, dark and ugly to allow false labels to perpetuate the pain.

  126. Great post series, BCC.

    Me?

    Over a number of months, I became increasing weak and unable to engage in physical activity for sustained periods. I figured that I (like lots of my genetic relatives and apparently others here) had some thyroid disorder. So I go into my g.p., tell him of my increasingly weaker physical condition and the particular thyroid autoimmune disease my relatives have, and ask him to run some blood tests to see if I’ve got the same thing. At this point, I’m really hoping that I do have an autoimmune disease, because after the first several months of medication-adjustment, it seems a liveable sort of problem.

    My doc examines me, asks me a couple of questions about my physical condition, and says: “It sounds like we should run the blood tests on the autoimmune disorder, so we’ll need to draw some blood. The tests will take 2 weeks for results. In the meantime, I’d like you to try taking Effexor.”

    Me: What’s Effexor?

    Him: It’s an antidepressant.

    Me: I’m not depressed.

    Him: I think you may be, and if I’m wrong, you haven’t really lost anything.

    Me: What about side effects?

    Him: Well, if I’m right, the first side effect is that you’re going to start feeling a whole lot better.

    (Yes, my doc is a smart-alec.)

    I ultimately consented, though I’m not really sure why I did. And I started taking a pill a day. For the first several days, I noticed nothing at all, other than minor side effects. Then, five or six days into the medication, my entire world went from black-and-white into color.

    I had energy again.

    I could think clearly again. I was no longer wrapped up in my own thoughts and my own thinking.

    I had had no idea that I’d been depressed until I wasn’t any more, but upon emerging and seeing things more clearly, I hadn’t felt that good (which was — I infer — for most people, essentially, “normal”) for several years.

    Many long stories later, I’m totally the poster child for the truth of “you can be wildly depressed and completely unaware of it.”

  127. Kathryn Lynard Soper says:

    greenfrog, thanks for your comment. If someone as committed as you are to health and serenity can become clinically depressed, then anyone can. I’m glad you’re feeling better!

    Mary, I echo jendoop’s words. I hope you’ll stay with us, as painful as it is to be an LDS with depression. You’re in good company.

  128. Y’all have no doubt already seen it, but I haven’t seen it mentioned so far in comments (but I may well have missed it, there’s been a ton of comments):

    New York Times discussion of Depression’s Upside

    The article is fascinating and very good. Some key passages:

    Darwin, of course, was wrong; his recurring fits didn’t prevent him from succeeding in science. Instead, the pain may actually have accelerated the pace of his research, allowing him to withdraw from the world and concentrate entirely on his work. His letters are filled with references to the salvation of study, which allowed him to temporarily escape his gloomy moods. . . . For Darwin, depression was a clarifying force, focusing the mind on its most essential problems.

    The mystery of depression is not that it exists — the mind, like the flesh, is prone to malfunction. Instead, the paradox of depression has long been its prevalence. While most mental illnesses are extremely rare — schizophrenia, for example, is seen in less than 1 percent of the population — depression is everywhere, as inescapable as the common cold. Every year, approximately 7 percent of us will be afflicted . . .

    Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

    Their first speculations focused on the core features of depression, like the inability of depressed subjects to experience pleasure or their lack of interest in food, sex and social interactions. According to Andrews and Thomson, these awful symptoms came with a productive side effect, because they reduced the possibility of becoming distracted from the pressing problem.

    But the reliance on the VLPFC doesn’t just lead us to fixate on our depressing situation; it also leads to an extremely analytical style of thinking. That’s because rumination is largely rooted in working memory, a kind of mental scratchpad that allows us to “work” with all the information stuck in consciousness. When people rely on working memory — and it doesn’t matter if they’re doing long division or contemplating a relationship gone wrong — they tend to think in a more deliberate fashion, breaking down their complex problems into their simpler parts.

    Thomson has cut back on antidepressant prescriptions, because, he says, he now believes that the drugs can sometimes interfere with genuine recovery, making it harder for people to resolve their social dilemmas. “I remember one patient who came in and said she needed to reduce her dosage,” he says. “I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great,’ she told me. ‘I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’ ” The point is the woman was depressed for a reason; her pain was about something. While the drugs made her feel better, no real progress was ever made.

    The new research on negative moods, however, suggests that sadness comes with its own set of benefits and that even our most unpleasant feelings serve an important purpose. Joe Forgas, a social psychologist at the University of South Wales in Australia, has repeatedly demonstrated in experiments that negative moods lead to better decisions in complex situations. The reason, Forgas suggests, is rooted in the intertwined nature of mood and cognition: sadness promotes “information-processing strategies best suited to dealing with more-demanding situations.” This helps explain why test subjects who are melancholy — Forgas induces the mood with a short film about death and cancer — are better at judging the accuracy of rumors and recalling past events; they’re also much less likely to stereotype strangers.

  129. It was also linked in the sidebar yesterday.

  130. Huh. I’m not seeing in the sidebar, just the New Yorker piece (which is also very good, but not the same one).

  131. From Boston, everything in New York looks the same :)

  132. I believe many of the incidents described here are further demonstration of the proposition that “depression” is a symptom of a variety of different underlying conditions.

    The problem of course, is that the use of a term to describe things with a number of wildly different causes leads to a litany of logical errors. People incorrectly make the following argument all the time: A causes B, therefore A is the only cause of B.

    If your only experience, especially your only personal experience is with the form of B caused by A, it is easy to conclude incorrectly that B – always and everywhere – is the sort caused by A, and if the affected individuals would only follow the steps necessary to eliminate A, all would be well, even though more serious, and rather more intractable causes D, E, F, …. may also exist. Such that mitigating A might help, but not enough. As if the person lacked faith or something.

    That is my complaint about the use of the term “depression” as if it were some sort of originary cause. Strictly speaking, it isn’t. It is a cluster of symptoms (i.e. a “disorder”) that indicate that something is wrong, and which thing that is isn’t exactly obvious, and often not even discoverable.

    Imagine if we rewrote the entire discussion in terms of headaches instead…

  133. Neal Kramer says:

    Let me say a couple of personal things.

    For most of my life I experienced what I would call indicators that I was highly susceptible to clinical depression. These took too many forms for me to articulate them. They hit hard during parts of my mission, during the hardest parts of graduate school, and when I had s disaster at work.

    Each of those trigger moments launched me into deep trouble.

    I became suicidal after the disaster at work. My wife saved me and continues to save me every single day.

    Because of her intervention I was able to counsel with church leaders and professionals who all gave me either medicine, advice, blessings, or therapy that have kept me going.

    I have been frustrated with the consequences of all this. I don’t like the way I feel when medicated. But without it I will die. I think a promising career was cut short. I have not been able to access my better intellectual self in ways I had hoped to do.

    But with this help, I continue to work. I continue to love. I feel spiritual strength and power. I am able to fulfill church callings. I firmly believe that my testimony and my temple marriage (in reverse order) have blessed me beyond my ability to say. My wife has been truer to her covenants than seems humanly possible. She has carried so many burdens and reached out with so much love that I can sometimes smile for five or six days in a row. For those of you who have not experience the gaping hole in your soul that is chronic clinical depression, you have no idea why this is so important.

  134. Re: the “upside of depression”

    If the fellow described doesn’t either have a relatively mild case, or isn’t in some sort of (relatively) temporary stage of a bipolar disorder, the idea that depression is likely to make him a better researcher is something bordering on laughable.

    A severe depressive disorder will lead to total brain shutdown. One of the things that will go along the way is short term memory. In the beginning, the gradual loss of short term memory may lead to extra care and diligence. Perhaps the withdrawal from friends may give more time or inclination to address some interesting intellectual challenge or another.

    However, you can practically identify a severe case by things going much further than that. Any case that isn’t associated with a much reduced ability to perform any real world task simply hasn’t progressed very far. More power to all the affected individuals whose familiarity with the disorder is limited to the stage where it might make them more productive rather than less. For many, that is just a change of scenery on the trip to much darker regions than that.

    The great merit of anti-depressants and similar medications is that they are uniquely effective at moving a person from the darkest regions (bordering on total incapacity) to the area where a productive life is actually a realistic possibility again.

  135. I’ve no doubt that garden variety depression/negative mood is a useful aspect of human growth and development. I’ve no doubt that clinical depression is destructive of the same.

    Certainly, it doesn’t do anyone any long-term good to mask problems with antidepressant medication. Individuals with deep situational distress might benefit from a short run on antidepressants if they’re unable to function, but the causal problem isn’t going to magically go away. That’s just common sense. Doctors who overprescribe meds in these situations are doing their patients a disservice.

    But the depression we’re talking about in this series of posts is another matter. It’s a condition where the disorder CAUSES the problems. First episodes are usually triggered by situational distress, but that distress doesn’t become clinical depression until it essentially takes on a life of its own. In other words, solving the initial problem doesn’t relieve any of the symptoms.

  136. I don’t mean to downplay your experience, Kathy. But I think that the NYT article and the research they’re citing is about clinical depression.

    Read the description of Charles Darwin’s symptoms, cited in the piece:

    The Victorians had many names for depression, and Charles Darwin used them all. There were his “fits” brought on by “excitements,” “flurries” leading to an “uncomfortable palpitation of the heart” and “air fatigues” that triggered his “head symptoms.” In one particularly pitiful letter, written to a specialist in “psychological medicine,” he confessed to “extreme spasmodic daily and nightly flatulence” and “hysterical crying” whenever Emma, his devoted wife, left him alone.

    While there has been endless speculation about Darwin’s mysterious ailment — his symptoms have been attributed to everything from lactose intolerance to Chagas disease — Darwin himself was most troubled by his recurring mental problems. His depression left him “not able to do anything one day out of three,” choking on his “bitter mortification.” He despaired of the weakness of mind that ran in his family. “The ‘race is for the strong,’ ” Darwin wrote. “I shall probably do little more but be content to admire the strides others made in Science.”

  137. Lehrer himself points out that the study he cites at length is widely criticized, and the problems that all theories based in evolutionary biology have are abundant here. Nonetheless, I think it’s useful and necessary to examine the phenomenon of depression from _outside_ of the paradigm of experience. As everyone on both of these threads has pointed out, the experience of depression is so widely varied from person to person that narratives of personal experience tend to be atomizing, rather than illuminating. Perspectives grounded in evolutionary theory, or in population studies, or ethnographic observation are the only way, I think, that we ever move beyond individuals describing their feelings to psychologists, and psychiatrists throwing drug cocktails at individual brains to see what works.

  138. But the depression we’re talking about in this series of posts is another matter. It’s a condition where the disorder CAUSES the problems.

    Strictly speaking, no. A disorder is not a “thing”, it is a cluster of symptoms. You can’t say that a cluster of symptoms causes problems, at best it is statistically associated with them.

  139. By the way, the New York Times article is a perfect demonstration of the confused thinking that comes from assuming that a cluster of symptoms is always and everywhere associated with the same underlying condition.

    The perspective that the article is almost entirely devoted to is what I call the psychological fallacy, the idea that depressive and other similar disorders always and everywhere have psychological rather than biological causes. Who would have known that the primary cause of rumination is rumination?

  140. Perspectives grounded in evolutionary theory, or in population studies, or ethnographic observation are the only way, I think, that we ever move beyond individuals describing their feelings to psychologists, and psychiatrists throwing drug cocktails at individual brains to see what works.

    Yes. Totally agree, Kristine.

  141. Mark D., I’m fixin’ to program our spam filter to block all comments containing “the psychological fallacy.” You’ve made your point; don’t force us all to ruminate on it.

  142. Kathryn Lynard Soper says:

    Kristine, I’m all for learning everything we can through studies, including the ones mentioned in this NYT article. In fact, last week I asked our group of permas to read that article (along with the New Yorker one and the Newsweek one) in preparation for a coming post.

    Mark D, we all get what you’re saying about cause and effect. What I meant was this: depression corrupts perception in a way that leads people to see problems that they wouldn’t see if they weren’t depressed. Or, probably more frequently, greatly exacerbate the magnitude of a given problem. So yeah, people shouldn’t cover up problems that trigger depression. But what about problems that the depression triggers?

  143. Perspectives grounded in evolutionary theory, or in population studies, or ethnographic observation are the only way, I think, that we ever move beyond individuals describing their feelings to psychologists, and psychiatrists throwing drug cocktails at individual brains to see what works.

    Don’t you think you have perhaps neglected the entire field of medical science? I don’t know, but it doesn’t seem to me that sociology is likely to help very much. And evolution won’t tell us anything particularly useful (let alone falsifiable) about the problem until and unless specific genetic factors are identified.

  144. What I meant was this: depression corrupts perception in a way that leads people to see problems that they wouldn’t see if they weren’t depressed. Or, probably more frequently, greatly exacerbate the magnitude of a given problem. So yeah, people shouldn’t cover up problems that trigger depression. But what about problems that the depression triggers?

    I think a key issue here is whether the perspective of a individual with a serious depressive disorder is rational when controlled for the reality of the condition he finds himself in.

    In other words, in the absence of a reasonable expectation of an effective treatment (especially prior to any treatment at all), isn’t a negative outlook about such things as future employment prospects an entirely rational conclusion to draw from the reality of severe, present incapacity of one sort or another?

    Can we clearly distinguish the rationality of the outlook of a patient who has just broken his leg from the rationality of the outlook of a patient who cannot do his job effectively due to a slowly worsening short term memory problem?

    In both cases, adopting a more realistic, grateful, hopeful attitude will help considerably. No one thinks that an attitude reformation will heal the leg however, while the crux of the debate is whether an attitude reformation will everywhere and always cure such symptoms of depressive disorders as chronic fatigue, headaches, memory problems, and so forth.

    I suspect the problem with the studies quoted in the NYT article is that they mix too many people with the same superficial symptoms and different underlying conditions or causes. The most infuriating thing about the scientists quoted is that they imply that we would all be better off if even the most serious of conditions went untreated. That level of callousness regard to the latter boggles my mind.

  145. I know it’s late and the series has moved on, but I want to add my story here. I hope someone sees it and can benefit from it.

    Alcoholism and diabetes run in my family. Mom is Irish and she claims the Irish are genetically depressed. She said the men generally treat it with alcohol and the women with sweet foods. As unscientific as that is, there’s definitely something that rings true in that for our extended family. I have one great-grandfather and one first cousin who committed suicide. My mom was suicidally depressed for most of her life and had terrible post partum depression with my older sister which was never recognized or treated.

    I was abused as a child by older siblings, starting from babyhood. In addition, my father was also rather abusive, though the oldest got the brunt of that. He was just rather cruel and arbitrary in his parenting style. My mom was very loving and good to us, but did act as an enabler to the abusive older siblings. If I complained to mom of being burnt, or receiving electric shocks, or whatever, she would answer “well, you shouldn’t have been so stupid.” So that was that. I completely believed I was being abused because I was stupid and annoying and deserved it. I didn’t really understand that wasn’t true until my 40s, when I realized that a baby can’t deserve to be abused, and it started in babyhood.

    I was still a very happy child for the most part. I remember my childhood as being almost entirely idyllic, in fact. I used to play by myself for hours and was healed by contact with nature. I did have some insomnia and depression in elementary and middle school, though, and woke up sick every day for all of 8th grade, I remember. My mom just said “you’re not sick” and made me go to school but it was horrible. 4th through 8th grade was the low time of my whole life. I was the Reeking Lizaveta of the class, and was constantly picked on.

    As a teenager I made a wonderful group of friends who were funny, smart, and a little wild. We did crazy, dangerous things and we drank, but I felt very happy during 9th through 12th grade, though still had insomnia and some low times.

    When I was a Junior in HS our good friend committed suicide by shotgun. We all were sad and horrified and felt partially responsible, if only for not paying more attention. Most of my friends got over it in a few weeks, as one does, and went on with their lives. But I continued to grieve deeply over that for over a year. That was another signal that something wasn’t right with me. I had a big crush on that guy, who was funny, sweet, and just a wonderful person. Even 20 years later I sometimes had thoughts that there was an unspoken suicide pact between us and I was only putting off my half, an obviously delusional thought.

    In college, things got acute. I started out making Dean’s list my first term, and wanted to have 12 of those certificates when I graduated, but soon my depression nixed that plan. Quite often, I was unable to even get up and go to class at all. Homework became something I put off until the very last minute. Sometimes I would start studying for a test at 10pm the night before, even if I’d done no homework and rarely gone to class, and work with serious focus until around 6am, sleep an hour or two, then go and make a B. So I eked by in engineering, having way more social life than most of my peers, and barely studying. Many times I would feel suicidal and worthless over my bad grades. Friends and family would say “just go to class and do your homework” or “snap out of it!” But it never was that easy. It was so hard to motivate myself to do anything at all. Still I made a great group of friends in college and we had a lot of fun and a great social life.

    I had my first “misery night” as I called them, when I was about 20. On these nights I couldn’t sleep, felt excruciating mental anguish, felt worthless and toxic. I felt like King Midas except that everything I touched turned to ash instead of gold. I felt that I had a horrible effect on my friends and family, and that everyone would be so much better off if I were dead. My first suicide watch was then. I would battle with suicidal feelings on and off for another 20 years or so after that.

    Usually when I finally fell asleep, I would feel a little better the next day, although misery nights sometimes came several in a row, and rarely fewer than a few times a month. Each misery night I would sit and fight against the feeling that I should kill myself. I would get the knife and just cut a little bit on my wrists, maybe, to see what it was going to feel like. Fighting against the feeling, but still flirting with death. During this time friends helped tremendously, many times staying up with me all night long just listening and reassuring me. They saved my life many times. I lost a lot of friends, too, as most depressed people do, because of being too needy, drawing too much on their patience and camaraderie and love. I understand perfectly why it was so difficult to be my friend, then, and don’t blame them a bit. Everyone has to set the level of love they can give to someone who never gives back but only takes. Sometimes, I’m sure, it wasn’t even a decision but just a realization that there was nothing left there to give, at which point they’d drop me.

    I found out in my 30s that my mom had struggled with suicidal feelings all her life too. I cried then because I wished she had told me. It would have helped so much just to know I wasn’t alone, that it wasn’t just me.

    From time to time I did counseling, which didn’t help at all, and was just me crying and talking and boring someone who was a “professional boree”, as I’ve heard psychologists described. I decided that a friend who actually cares about you is 1000 times better than a professional, and also began acting as that friend to others of my acquaintance who went through misery times.

    One thing I gained through this experience is unlimited sympathy for suicidal people. In this way I made some of the closest and strongest ties of my life. In my experience, people who are suicidal all have some special spark of brilliance, love, creativity, musical talent, artistic ability, and spiritual bounty. I’m not at all sure why that is. But my friends that I made by helping them when they were at their low points are all people who are truly gifted, and whom I love immensely and admire, and bask in the glow of their awesomeness.

    I developed a theory that I can only describe by the metaphor that such people have “brighter flames” than ordinary people. Because their flames burn so much brighter, they need a lot more spiritual fuel than most people do, in the form of love, respect, attention, admiration, and connectedness. If they don’t get it, their flames sputter and threaten to extinguish themselves. That’s the reason they feel suicidal. What they need to do is learn how to feed their flames well, with medicine, exercise, diet, sleep hygiene, sunlight in the optic nerve, loving close friends and family relationships, prayer, music, art, dance, poetry, books, worship, and meditation. Once their flames are well-fed, they give off a lovely spiritual light that feeds, in turn, all those around them. In the next post I’ll tell how with the Lord’s help, I cured my depression.

  146. Kathryn Lynard Soper says:

    Thank you, Neal and Tatiana. I’m pleased to hear from you both.

  147. This may be a bit late, but I read your inquiry regarding Mormons, no use of beer and depression.

    I am a 60+ year old Mormon convert of 34 years. I had been diagnosed with clinical depression. I had symptoms of it from my youth until about 17 years ago.

    If you are still seeking input, email me your questions.

  148. Interesting and good stuff. Keep it coming. I am always interested in the story

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