Notes on Depression

Oh no! Is this another gush of Too Much Information that no one really wants to hear? I guess it could be. As it happens, I’ve accumulated a lifetime of insights into depression that could be lost if I happen to suddenly fall over dead. It would be a shame to not pass it along, so here goes.

Background

It dawned on me some time ago that much of the emotional agony I experienced as a young child seems to have been early manifestations of what would be a lifetime of struggle with depression. Except for a parental divorce when I was ten, I had a normal rural pre-teen upbringing in the vast corn and soybean fields of Iowa. Summers were hot and sticky and winters were extremely cold. We had vast pastures and river banks to explore and badgers to watch out for. We detassled corn and pulled weeds by hand in the bean fields for a few weeks every summer. Field labor was not my favorite thing.

It was the 1960’s and black-and-white television was full of news about the space race and the crazy hippies and Viet Nam. Hippies were using drugs and rioting, astronauts in cool spacesuits were riding capsules into space and F-4 Phantoms were flying and sometimes crashing in Viet Nam. This was the frame of reference of the time.

I was pretty lucky as the eldest of 5 kids. Despite the divorce of my parents and all the upset that goes along with it, we had wonderful grandparents. They stepped in and provided considerable care and comfort in our lives. While this family upset was an aggravating factor in my depression, it wasn’t at the root of it. There was something more fundamental to it.

Everyone experiences dark periods in their lives that somehow expire and normal emotional being returns. I had episodes of this as well and they would subside. Growing up has its ups and downs, learnings and misunderstandings. What began to happen was that these dark periods would last for weeks and months with no obvious triggers that set it off. Those around me couldn’t understand why the darkness persisted in a kid who outwardly had nothing to be sad about.

Added to this was the fact that I had no natural athletic abilities other than dashing to get out of the way and no interest in sports. My family was in a quandary about what to do with a boy who didn’t like sports. This contributed to social isolation that, frankly, I enjoyed. Solitude was something that I craved but got only too infrequently. I still crave solitude.

Jumping ahead on the timeline

Depression is a state where you lose hope, ambition, social contact, interest, energy and sometimes even the will to live. It is a potentially deadly condition that deserves attention by medical professionals. There is talk therapy, drug therapy and probably a few other things I’m unaware of. Speaking for myself only, talk therapy helped me to get a greater understanding of the condition itself, but really not much else of lasting effect. I still got and remained depressed. I needed drugs.

I have been trying various antidepressants since the late 1970’s with unequal success. I started with imipramine at age 19 but it made me sleepy and inattentive with dry mouth so I eventually decided to quit using it. It is a tricyclic antidepressant introduced in 1957 and was prescribed by a general practice MD. Deciding to discontinue drug therapy is a common problem practiced by many depressed individuals and I did the same numerous times.

I managed to get into college and get a BA in chemistry without antidepressants. However, in grad school I went back to drug therapy with Prozac and Paxil. After some dosage adjustments I found it to be very helpful for a while. Eventually my depression overwhelmed the drug. What I eventually realized was that I was in a situation that was very stressful even without depression. My depression was aggravating my situation which was grad school which was amplifying the depression. There was a feedback loop. I needed to self-actualize. I needed a major achievement giving me more control over my life. I wanted to be a chemistry prof.

I finished grad school and went on to a 2-year postdoc. Unfortunately, my marriage failed a few months into the move to Texas and my postdoc. Suddenly I was alone in a large Texas city with no vehicle and a very low paying job. Texas being Texas, there was no decent public transportation so I spent a good deal of time walking and thinking in the miserable heat and humidity.

One day as I began my morning walk to the university lab where I worked my mood started out … normal. Halfway there my mood began to darken abruptly as though a curtain dropped blocking the light. I had nothing depressing on my mind that might have triggered it. The light of a normal mood state just extinguished.

This continued for many months. I again went to a general practitioner MD and he put me on lithium. I took this for 2 months. It did absolutely nothing other than to make me dizzy. At least I wasn’t manic depressive. I went off it and found a shrink across the city for help. He took a lot of notes over many sessions and never spoke. I talked and he listened. Eventually he said that he wanted to prescribe an MAO inhibitor. He handed me a prescription. Back at the university I did a deep dive on this class of medications to see what they were about. I concluded that, given the many risks and side effects, there was no way I’d take this. Never went back to that shrink again.

Years later, after enduring the depression over a 5 year career in teaching, I got an industry job. The company folded 10 months after I arrived so I went to work in construction to feed the family while searching for another chemistry job. I got the chemistry job and worked for about 10 years while on Prozac and other SSRI’s. But eventually the depression had become unmanageable with the meds I was taking. My family doc gave up and made some suggestions about what to do. It turned out that he had depression too and left medicine.

Eventually I found a shrink who ended up being quite good. This time there was titration involved. We spent a year or two fine tuning a mix of medications. What worked was the combination of bupropion and escitalopram. I eventually figured out that a large part of what I had thought of as “just” depression in fact had an element of uncontrolled anxiety to it. The medications I was taking did nothing for the anxiety. Bupropion has been shown to have beneficial effect on anxiety associated with depression.

But something unexpected happened. My anxiety was suppressed so deeply that I wasn’t worrying about much of anything. A person needs to have enough anxiousness to stay on top of life’s challenges. We made an adjustment in dosage and things are now fine.

Things I’ve noticed that are helpful

• Get the right help early. Family practice docs can only go a short distance into treating depression. Mine eventually gave up and handed me a list of shrinks. It worked, but only after I was way down the timeline.
• Well intended folks may suggest alternative medicines or greater religious devotion. I’ve never found these things persuasive or useful.
• Sometimes talk therapy or attitude changes just do not work. Don’t feel bad if they do not work for you.
• Exercise can be very helpful.
• Reclusiveness is an effect of depression. I’m still not over this part.
• Don’t pay attention to famous scientologists who talk down drugs. They’re idiots.
• A shrink is a physician who has specialized in psychiatry. Psychiatry today is substantially about medication. These folks have a deep understanding of the pharmacology of the different meds and what constitutes reasonable expectations.
• Depression meds may not fix basic personality issues. If you’re an asshole while you are depressed, you could still be one when you are better.
• Finding better help may seem difficult. You have to reach out and contact people which may be undesirable. You might be unduly pessimistic about the benefits of finding a shrink. It’s like digging a tunnel into rock. You have to keep showing up and swinging the pickaxe against the wall. Eventually you’ll get through.
• The source of your depression and anxiety may be more than just brain chemistry. Your life situation might be genuinely awful as well. Fighting depression may require that you change how you are living and who you are around. Some people are toxic and a greater distance from them may be needed.
• A course of self-improvement can be helpful as well as a change in living arrangements.
• Avoid suicide. It might seem like the fastest way out of the pain, but it really is a permanent solution to a temporary problem**. Also, your suicide is likely to be the main thing people will remember about you. You wouldn’t want that.
• Depression can get worse as we age. Be aware of this.
• The world is truly a beautiful place full of wonders to discover. Dive in. Be curious.

** The phrase “permanent solution to a temporary problem” is admittedly a bit pollyannish. This would be of no comfort to someone in a death camp or gulag. While not words of universal relevance, I must assume the Dear Reader and a great many others are not in a death camp. While not useful advice to everyone, it still applies to a large number of people.