Depression 101

The last time I saw Dr. Fink, when she upped my medication dosage for what she thinks will be the final time, I asked her how good I am supposed to feel on it. She told me that I could expect the meds to bring me up to the highest state of depression that I normally experience. It took me a while to figure out what she was actually saying, probably because I didn’t want to. I know that I gaped at her; that I gave her a long, blank, very perplexed stare. Somehow it was not computing. You mean I can still expect to be depressed on the anti-depressants? When it sank in, I was more than a little disheartened. I don’t like taking them. I don’t necessarily trust western medication, plus they have side effects, some of them potentially serious. If I’m going to take them, I think it’s only fair that they help me feel significantly better. Though it seems, in my case anyway, the most I can hope for is to remain just topside of the black hole. In other words, in the dial tone. Not a bad thing, I guess, considering what the black hole is like, just nothing near what I’d hoped for.

It’s hard for me to write about taking medication. It took me a while to decide if I should or not, would or not. I realize, even though I KNOW that what I am experiencing is biochemical, I am still aware of a real or imagined stigma. It’s why I ultimately chose to write about it. Bring all the discomfort into the light of day. If it’s an important part of the journey, write about it.

As the truth of Dr. Fink’s info becomes real, it strikes me that if I truly want to ascend above the flat line, if I really want to feel better and vital and interested again, if I want to live again from a place of possibility, I’m going to have to help myself. I am both pissed off and relieved. Walking to my car, I think about the book I’d come across and bought a couple of days before. The Mindful Way through Depression. I drive from her office to Ex’s, where I stay when I’m in the Bay Area, and I dig in, and immediately feel the magnitude of this that I plus so many others are dealing with. Here are some simple, staggering statistics: Twelve percent of men, and twenty percent of women will experience a major depressive episode in their lives. It is beginning earlier and earlier, with the first episode now generally happening in the early 20’s, though often in the teens. At any one time, 5%of the population is experiencing severe depression, 20% any and all types of depression. Once one episode is experienced, there is a fifty percent chance it will return even after a full recovery; after a second or third episode, recurrence rises to between eighty and ninety percent. And maybe most astounding, ten million people in the US are taking prescription anti-depressant medications.

It hits me, maybe for the first time really hitting me, not as a concept, but as embodied knowledge, that what I’m dealing with is real. I’m learning that there is a difference between those who have experienced depression and those who have not. That in a first episode of depression, the brain forges certain connections between sadness, negative thoughts, and mood, that forever remain, and that render those people less able to cope with sadness than those who have never been afflicted. So, when I was 23 and experienced a major clinical depression, it actually changed something in my brain that makes me more susceptible to becoming depressed again. Maybe it's a no-brainer, but I honestly had no idea. And, now that I've had my second episode, it's eighty to ninety percent likely to recur.

In another book, Undoing Depression, the author refers to depression as a disease. I read that it is an epidemic, that more people are experiencing more depression than ever before. That people born after WWII are more likely to become depressed, with Baby Boomers at particular risk. That it is not only a phenomenon of the US, but that other countries are reporting that with each generation, depression is coming on earlier and happening more often.

For those who have never experienced severe clinical depression, it might be confusing, and it is often misunderstood, not to mention misdiagnosed. Depression is far more than feeling sad. It can feel like a descent into madness, with a host of psychological and physical symptoms. Life as it is known is ripped away, plunging the person into darkness, fear, despair, hopelessness. It is extraordinarily painful, in a way that is both physical and not, and that defies ordinary description.

Reading these books, learning more about the brain piece, seeing my experience confirmed somehow changes things in a big way. Compassion grows, along with a certain sadness, empathy. Then, I am both encouraged and discouraged. And full of questions. What has happened in our world that ten million of us in this country alone are on anti-depressants? Is it environmental? Genetic? Emotional? Spiritual? Solely physical? A combination of many of these? It is known that depression is a "unique" disease in that it responds to both medication (the physical aspect) AND psychotherapy or cognitive behavioral therapy (the mental/emotional/spiritual aspect). Do all ten million of us really need to be on anti-depressants? Is it a cop-out, by a medical community that doesn't otherwise know how to respond to things like stress, exhaustion, grief and other emotional pain, anxiety, addiction? Is it because we fail to see human beings in their totality; that we are mind, body, emotions, and spirit, and that one does not change without affecting all the others, and to be whole and healthy, all need to be flourishing. On the other hand, what about those who don't, for one reason or another, get treatment when severly depressed, or for whom treatment is otherwise unsuccessful?

(Though, as Cheri Huber says in The Depression Book: Depression as an Opportunity for Spiritual Growth, maybe the better question is, what is it that we, individually, and collectively, are de-pressing?)

Maybe these questions are all rhetorical, but I don't think so. Something is changed, has changed. And it's huge. Millions are affected personally, not to mention the impact to their partners and other loved ones. Depression's economical impact is enormous, approximately $44 billion a year, second only to the treatment of cancer. And it is often a fatal disease, with 15% of people with major depression ending their lives by suicide.

The good news is that so much more is known about depression now than ever before. I'm learning some fascinating things and I feel encouraged. I also get that to "help myself" is going to take hard work, commitment, and huge slabs of discipline, the kind of which has not come easily to me in the past. Mindfulness means paying attention on purpose, in the present moment, and non-judgmentally, to things as they are. It means being basically awake and aware in each and every moment, something that takes an enormous amount of practice, patience, self-acceptance, stick-to-it-iv-ness. And it is something that cannot even begin to happen while existing in the black hole. For that reason alone, I am intensely grateful for the medication that has pulled me up and out.

Will this approach truly help? How motivated am I to really feeling better? How committed? How able? I honestly don't know. I do know that the desire is there. Plus a little stab of excitment at the challenge. Intrigue at the possiblity. Mindfulness is something that's been on my horizon for a long time. Here, now, is a compelling reason to get serious about it.