There are currently some high-profile types on social media who are scoffing at clinical depression. They use their platforms to tell their millions of followers that, “Everyone gets sad but the idea that you need drugs to be treated (usually in air quotes) for depression is nonsense.” Then depending on what sleazy brand of snake oil is hip this week there is a recommendation for exercise, vitamins, essential oils, or crystals. Usually with a brand name on it. Do I sound just a little hostile? Good, because it was meant to. I left out all the times I wanted to use fucknuggets, douchenozzles, and assholes because it just got redundant. When you have clinical depression and deal with the effects every day, this kind of bullshit makes you want to tear holes in the sky. They do not know what they are talking about, have not bothered to do the research to know anything, and do not care who they are hurting. I had originally intended to post links to the videos in question but fuck them, I really don’t want to give them the clicks. If you really need to see the shitdrivel go to YouTube and search ‘Depression is a choice’. There are also some very good response videos to their ‘motivation videos’ but it doesn’t change the fact that there are doctors telling people depression is not a mental illness and they just need vitamin D.
When I see a meme with a pair of running shoes (or a forest) on the top of the page and pills on the bottom with the caption ‘You Need These, Not These’ I just want to scream. Diet, exercise, getting enough sleep, less stress, and sunshine, are certainly helpful in combating depression but they are not cures. Not any more than they will cure my epilepsy. Anyone with epilepsy will tell you that it brings along depression like smoke comes from fire; it may not always get you but the odds are good. I do not doubt that there are people who have had great results from vitamins and other supplements for their depression. The placebo effect has a powerful, if temporary, effect on people who desperately need a change from the feeling they are having. However, if you have an extreme chemical imbalance in your brain this is not going to last and the crash may be worse than the initial problem.
One of the many things that people do not understand about depression is that it is possible to be happy, sort of. The things that always made me happy, going to a concert with friends, finding a new book by a favorite author, completing a project I have been working on for a long time, can still bring joy just as they would for someone else. The level is just set somewhere about a quarter to half of what it would be for most people. Then when I get home from the concert and close the door to my apartment, the happiness vanishes. I am right back in the same place I was before. Men get caught in this trap all the time. They have been trained to bury many of their emotions so they do not feel ‘sad’. They might feel angry or frustrated, all the fucking time. So they don’t see what is happening as depression. Many people with extreme depression can handle themselves moment to moment; functioning on a daily basis but the desolation is a constant state. One trigger can create a maelstrom that drags them under, sometimes to their death.
“25 million Americans suffer from depression each year” and “over 80% of the people who have symptoms of clinical depression are not receiving specific treatment for their depression.” If that does not tell you this is a real fucking problem the American Foundation for Suicide Prevention reports “Over 50 percent of all people who die by suicide suffer from major depression.” Personally, I never thought of suicide though clearly many people with depression do. For me it was the feeling that it would be nice to have never have existed rather than feel the despair that locked my soul.
I have heard people, even some I respect – looking at you, Henry Rollins– say that suicide is for cowards. Well fuck you all very much. No one can judge how they would react to being totally overwhelmed by a sense of despondency, to feel like your soul has been crushed, until it happens to them. When you reach that level of abject misery talk to me about cowardice. I have noticed people get the most judgmental when it is a person who has talent and money, like somehow being skilled on the guitar or having a full bank account is going to keep someone safe from the ravages of brain chemistry. I repeat until you have this issue yourself, do not fucking judge.
Blue Cross Blue Shield reports that diagnoses of clinical depression have risen by 33% since 2013. In the report, they call depression the “second most impactful condition on overall health for commercially insured Americans,” with high blood pressure being the first. This is because people who have depression are more likely to have other health problems, like chronic illnesses and substance abuse. Which mean they are going to have more health care needs, experience worse health outcomes, and cost the insurance companies more. Depression fucks people’s lives up in ways even those of us who have it do not realize and it has a very direct effect on society.
Part of the problem with diagnosing and treating depression is there are a number of different types, causes, and conditions that look like depression but are dangerous to treat the same way.
Major depressive disorder has a whole bunch of different names, clinical depression, unipolar depression or simply ‘depression’. This includes low mood, loss of interest and pleasure in usual activities, as well as a shitload of other symptoms. The symptoms have to be experienced most days and last for at least four weeks for a diagnosis of major depression.
Melancholia is the term used to describe a severe form of depression where many of the physical symptoms of depression are present. One of the major changes is that the person starts to move more slowly. They are also more likely to have a mood characterized by complete loss of pleasure in everything. For the assholes who want to say that depression is a new complaint, there are stories of melancholia back to the 1500s. There is a reason it is a bit of a stereotype.
The symptoms of dysthymia are similar to those of major depression but are less severe. However, in the case of dysthymia, symptoms need to last longer. A person has to have this milder depression for more than two years to with dysthymia. People who just feel ‘down’ often won’t go for treatment even if those feelings have lasted for years. This is dangerous to their health and personal life.
Women are at an increased risk of depression during pregnancy (known as the antenatal or prenatal period) and in the year following childbirth (known as the postnatal period). Almost 10 per cent of women will experience depression during pregnancy. This increases to 16 per cent in the first three months after having a baby and can occur up to three years after the birth. Many women experience the baby blues (as much as I hate the term), which is related to hormonal changes and affects up to 80 per cent of women. This is a common experience, but very different from depression. Depression is longer lasting and can affect not only the mother, but also her relationship with her baby, the child’s development, and all of the mother’s relationships.
SAD is a mood disorder that has a seasonal pattern. The cause of the disorder is unclear, but seems to be related to variations in light exposure in the different seasons. SAD has mood disturbances, either periods of depression or mania, which begin and end in a particular season. Depression that starts in winter and subsides when the season ends is the most common. There is a diagnosis after someone has had the same symptoms during winter for a couple of years. People with SAD depression are more likely to experience a lack of energy, sleep too much, overeat, gain weight and crave for carbohydrates. SAD is a major issue in Alaska and is so common there are hundreds of SAD lights sold every year.
In extreme cases, people with a depressive disorder can lose touch with reality and experience psychosis. This can involve hallucinations or delusions, such as believing they are evil or that someone is someone is watching or following them. They can be paranoid or that they are the cause of illness or catastrophic events. The lack of sleep, poor eating, lack of social contact, and brain chemical imbalance seem to be the cause of the psychosis.
Then there are the conditions that look like depression but can be a serious issue if misdiagnosed.
Bipolar disorder, called ‘manic depression’ back in the day, because the person experienced periods of depression and periods of mania, with short periods of level mood in between. Bipolar disorder seems to have a genetic component and it affects approximately 2 per cent of the population. Stress is a major trigger for people with bipolar and unfortunately, it often gets misdiagnosed as, depression, alcohol or drug abuse, and a whole host of other things. This is what comes of psychiatrists doing diagnoses from the gut after a 45-minute meeting and not using a medical model. People can go for years without receiving an accurate diagnosis for their bipolar disorder. A good diagnosis depends on the person having an observed episode of mania. The problem is that someone will recognize that something is wrong when they are depressed but during a manic phase, they feel good so self-reporting can be spotty.
It is possible to be critical of the medical field and still feel it is the best option we have, overall. I understand why people would turn to woo alternative cures when they hear about or have to deal with these kinds of problems but the fact we need medical science if we want to get better. Depression is not easy to treat but it does not go away by itself and as I said, jogging or snake oil does not work either. You need a combination of therapy, medication, good life style choices and coping skills.
I have heard many horror stories about medications as an excuse for not using modern medicine. The sad part is some of the stories are probably true. When you start messing with people’s body chemistry, especially if you do it irresponsibly, there can be terrible results. We know about as much about the human endocrine system as we do about the brain which is, just enough to be dangerous. We have a decent enough handle on some of the most basic aspects of treatment and how people function under controlled conditions. The problem, obviously, is life IS NOT a controlled condition and when you are dealing with people almost nothing is basic. Drugs are always going to be a mixed bag and if you put all your faith in the first one they put you on, you will be disappointed.
The fact is the doctor is only guessing as to what is going to work for you. It is a highly educated guess based on your symptoms, what other drugs you are taking, previous medication experience, and your background but it is still a guess. They have started using genetic tests to match drugs to people but right now that is mostly for cancer patients (and is fucking expensive). If you need an antidepressant, the doctor can handle the drug dispensing in a few different ways. One, the proper and safe method, would be to prescribe you a small dose of the drug they feel would work and slowly titrate it up to the point where you felt better, stopping if there were unpleasant side effects. Sometimes this might include combining more than one drug to boost or lessen the effect at certain times of day. The other method is to prescribe something at full dose and hope for the best. If there are side effects from the medication, well you just have to hope they are not as bad as the depression.
If the side effects are ones you do not want to live with then you have to go off that drug and onto another one. The problem is many drugs have nasty side effects when you quit. It has to be done gradually and this means taking the new drug the same way, in a slow titration. For someone who is suffering serious depression, this changing back and forth can feel like the classic water torture. The changes are so gradual it seems there is little to no effect except for side effects along with a constant drain on time and resources. Then there is the day when things seem to be better and the patient wants to stop and hold everything right there. No more changing things, no more futzing around with the medication and feeling like crap every morning. It does not matter that this might be a temporary respite, they are so desperate to be ‘normal’ that they will grab onto this moment and fight to keep anybody from changing it.
One of the most difficult things I had to do as a person with epilepsy was accept all the ways it changed my life from the large, not driving, to the small, making sure I took my medication every day. It took me much longer to realize the same thing about being a person with depression. I am not going to be just like everybody else. I have to be careful about how much sleep I get and how I eat sure but I need to be aware of where my head is at on a daily basis. What for most people would be a slump could be my medication needing to be changed or I am going to crash and burn. Being vigilant of how I am handling situations and keeping to self-care is vital because it is very easy to lose myself in the darkness. Most of all it is important not to let the bastards win.
Suicide Hotline – 1-800-273-8255