Phase 2: Depressive Episodes
There’s a lot of stress and fear that goes along with trying to keep a secret as big as clinical depression.
Save me, O God; for the waters are come in unto my soul.
I sink in deep mire, where there is no standing: I am come into deep waters, where the floods overflow me.
I am weary of my crying: my throat is dried: mine eyes fail while I wait for my God.
“There’s got to be a heaven because I’ve already done my time in hell.”
If you are among the 71 percent of Americans who has not been being diagnosed with depression in your lifetime, you don’t really know what it’s like to be depressed.
It's not being sad or grieving, although both of those things can trigger depression. It's more than that: it's feeling hopeless. It’s not knowing where to start to do everything you need to do, and deciding not to do any of it. It’s being surrounded by all the trappings of a good life — a great family, gainful employment, good friends — and still being unable to find hope and happiness. And, worst of all, even though your rational brain knows better, you convince yourself you will always feel like this.
In "Strangers to Ourselves: Unsettled Minds and the Stories That Make Us," Rachel Aviv calls depression "all-consuming nothingness."
“There is a sense of loosely hanging together, not hanging together, at all, of not owning your body or thoughts," she writes. "You lose a sense of being able to predict what you are about."
“Mild depression” was the first mental disorder I was diagnosed with in 1994, when I was almost 21 and being tested for a learning disability that exempted me from the foreign language requirement in college. But I suspect I’ve been clinically depressed since at least my early teens, and in 2002 I got diagnosed with full-blown chronic “depression.” Worth noting: bipolar disorder is under-diagnosed or, in my case, diagnosed later in life, because it often presents as depression.
Between 2002 and late 2010, I cycled in-and-out of therapy and went on-and-off medications, stopping when I was feeling good and, inevitably, heading my way back to the couch and the pharmacy when I wasn’t. I’ve been steadily on different SSRIs since late 2010 and currently take the maximum dose of Cymbalta as park of my daily pill procedure.
The only reason I know Cymbalta works is I’ve had to abruptly stop taking them for several days on a couple of occasions. The first day I didn’t notice, the second day I was quiet, and on the third day I was depressed enough to be weepy. Anything could set me off crying — finishing a book, something adorable my daughter did, any one of thousands of songs, and, weirdly, those commercials with a family of golden retrievers riding around in a Subaru.
But SSRIs are not 100 percent effective and only really work when coupled with therapy. Drinking cancels them out; the reason I’ve stayed on them since 2010 is I also stopped drinking that year. When you’re drunk, you don’t think you need them, and when you’re hung over, you decide they’re not working. SSRIs also have some nasty side effects, including Shitty Sex, Rather Ironically, or what the comedian Neal Brennan simply calls “dick stuff.”
“You probably know people who are depressed, and you probably know people you suspect are depressed. But you also probably know people fighting depression who show no outward signs of being anything but happy.”
And, of course, my negative self-talk, which is what usually triggers my depressive episodes, often overpowers the SSRIs. The medication doesn’t prevent depressive episodes, it just makes the lows seem less low and sometimes reduces the time I’m stuck in the episode.
Sometimes.
While many people usually cycle between depression and feeling normal, my bipolar disorder adds another challenge: I will usually cycle from a depressive episode right into a manic episode, a phase I’ll discuss in an upcoming post, that’s even worse than being depressed.
You probably know people who are depressed, and you probably know people you suspect are depressed. But you also probably know people fighting depression who show no outward signs of being anything but happy. My uneducated and untrained theory is an anxiety diagnosis so often pops up with a depression diagnosis — there’s a lot of stress and fear that goes along with trying to keep such a big secret.
The only reason I started “Fun With Bipolar” is to fuel an open and honest discussion about mental health. I’m not looking for sympathy — everyone who reads these words has problems bigger than mine (although I do appreciate the kind and supportive messages). The stigma around depression and mental health prevents too many people from getting the help they need, and this is my way of trying to make a little difference.
I’ve worked jobs where I called in sick and admitted I was hungover. There was never any judgement or repercussions; if anything, I got a chuckle— often from a boss who had been next to me at the bar the night before — and an “atta-boy” for being honest. But I would never call in sick and admit that I was having a depressive or manic episode (hypomanic episodes, which I’ll write about soon, and a dash of my ADHD are actually quite conducive to work. They’re destructive, but at least they have a silver lining).
Responsible adults get an annual physical and get their teeth cleaned every six months. But what if everyone went to see a therapist — once a year? every six months? every three? — for a quick mental health checkup. It’s an absurd idea in our current healthcare system, but I also think it’s a good idea.
There are loads of online depression screening tools — and I highly recommend everyone screen themselves every month and compare how the scores change over time. If you’re going steadily down with no real outside reasons, it’s time to get help.
The online tools are good and have saved lives, but therapists can tease out more than a simple online quiz. They can help people who don’t know they’re depressed make connections to see their illness. They teach strategies to help manage it. In the best case scenario, they can give you a clean bill of mental health, terminate therapy, and send you on your way.
But far too many people view going to therapy as a character flaw instead of treating a legitimate medical problem. Too many people propagate the stigma that treating mental illness — in others or themselves — is a character flaw.
Too many people don’t get help.
I didn't get diagnosed with bipolar 2 until age 49. The medical profession uses depression as a catch all, in part because it's less stigmatized. I haven't read all your posts but here's an idea: Almost everyone says they're "depressed." But there is a huge difference between feeling overwhelmed in your circumstances and a clinical psychiatric disorder. The real thing is house arrest for life.