Throughout Mental Health Awareness Month (May 2016), EXPOSING THE TRUTH publishes an interview series to let people living with different psychiatric diagnoses speak for themselves. So far, John* let us in on his experiences with schizophrenia, Anne talked about her anorexia, we learned from Nicole how generalized anxiety disorder feels like, and got an interesting insight in dissociative identity disorder from Matthew*.
Depression is one of the most common mental disorders in the United States. In 2012, approximately 16,000,000 U.S. adults had at least one major depressive episode. This amounts to approximately 6.9% of all adults in the country. Those suffering from depression often have to deal with people misunderstanding their condition, and often face people telling them to just “pull themselves together”, and “stop being whiny”. But depression is more than feeling unhappy for a few days; it is when you’re persistently sad for weeks or months. Besides of feeling low, depression comes with a wide range of other possible symptoms, which will vary from person to person.
As “depression” is more of an umbrella term for many different types of symptoms, I decided that I needed to portray a greater image. Therefore, I speak with Martin* – a 32-year-old college student diagnosed with moderate recurring depression in 2009 –, and Nadja* – a 28-year-old female who is about to graduate from college, and who developed depression in the course of a crisis after experiencing a series of traumatic events.
There are many different types of depression specified in the ICD-10 – a standard diagnostic tool published by the World Health Organization. Examples include bipolar affective disorder**, cyclothymia***, and recurrent depressive disorder****.
Research has consistently shown a strong link between suicide and depression, with 90% of the people who die by suicide having an existing mental illness or substance abuse problem at the time of their death. If you struggle with suicidal thoughts, please reach out for help. If you feel that you don’t have a friend or family member to talk to, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433). These toll-free crisis hotlines offer 24-hour suicide prevention and support. Your call is free and confidential.
Hey Martin and Nadja, nice to meet you and thank you for opening up to me about your mental health. How and when did you first notice that you might be suffering from depression?
Martin: Oh, that’s a good question. I was diagnosed in 2009, but at that time I myself didn’t realize that I might be suffering from a treatable medical condition. All I knew at this point was that I had problems in my relationship, I was feeling low, and retreated socially. Somewhere in the back of my head I was vaguely aware of the possibility that what I was going through might be something that would receive a diagnosis, but at that time my depressive episode was acute, so I wasn’t really able to think about that. Eventually, I went to my physician, and he gave me the numbers of different therapists, and I started going through this list, trying to get therapeutic help…
Nadja: For me, things are a bit different. I experienced sexualized violence when I was in my teens and was diagnosed with posttraumatic stress disorder some time later. When diagnosed with PTSD, there is a high probability of developing comorbidities such as borderline personality disorder, or depression. In fact, many symptoms of other mental illnesses overlap with the symptoms of PTSD. Therefore, I wasn’t really surprised when my therapist told me that while my posttraumatic symptoms are recurrent, I am now diagnosed with moderate depression.
As you are already mentioned it, my next question would have been if you have ever received therapeutic treatment.
Nadja: From 2011 to 2014, I completed an 80-session trauma therapy which contained elements of psychoanalysis. It really helped me a lot to understand and deal with the symptoms of PTSD. But unfortunately, as it sometimes happens in the course of therapy, I started questioning everything, and became really unhappy with my circle of friends at the time, my relationship, and my family. Shortly after I finished therapy, it all fell apart, and I broke up with my partner, lost most of my friends, and reduced contact with my family. Also at that time, I didn’t know where my career was going. Generally, I was lacking a positive outlook. For me, that was the starting point of my depression.
Martin: I started therapy in 2009, and ended up receiving therapy for almost two years. It was a long-term behavioral therapy with over 40 sessions which took place weekly in the beginning and with greater intervals later on. Starting behavioral therapy was rather a coincidence, and depended on what was offered. Also, I was in the lucky position to live in a city with an oversupply of therapists, so I was able to get into therapy rather quickly.
And do you currently receive treatment?
Martin: No, at the moment I don’t, but I had an initial session two months ago, and… I don’t know. Right now I don’t really know how to proceed. I guess at the moment I am doing better because of the weather, because of spring… The cold and dark fall and winter months always worsen my depression. I generally feel more lethargic during the winter, which for me goes hand in hand with being less able to expose myself to interactions with others.
Nadja: Yes, I do, and I have to say I feel quite well-supported. I regularly see a psychiatrist as well as a behavioral therapist, and go to occupational therapy weekly to learn different tools such as progressive muscle relaxation and mindfulness training to better cope with my symptoms. Plus, I engage in self-help, have a great physician who is quite understanding, and also have a go-to person at a drug-counseling center for emergencies.
Let’s talk about symptoms, if it is okay with you. Would you be willing to go into a bit more detail about how depression feels like for you?
Nadja: As I mentioned before, shortly after finishing my first therapy there were some big changes in my life. I felt alone, unstable, and as if everything spiraled out of control. As a coping mechanism and due to my already low self-esteem at the time, I started some unhealthy, abusive relationships, drank too much alcohol, and did drugs – which of course made everything worse. I made some really horrible experiences at that time which I still think about a lot, and which I am currently still trying to process. After one particular incident, I remember waking up one morning and feeling completely empty. Like all of the energy had been drained from my body. I tried to get up, but I didn’t find the strength. After lying in bed, crying for hours, I finally managed to go to the bathroom just to see a stranger in the mirror: I didn’t recognize myself anymore. I couldn’t even look at myself, because I despised myself for everything that went wrong, and I thought everything that happened was entirely my fault. I remember thinking that I had finally internalized what I really am: completely worthless. I spend the next weeks in bed with a blanket over my head, each day wearing the same stained hoodie my ex-boyfriend left when he moved out. I only left the house to go to work for a couple of hours, or to go grocery shopping at night with a hood on because I didn’t want people to look at me. I didn’t talk to anyone at the time, didn’t answer the phone. I slept a lot, but always felt exhausted even after the smallest things. At some point I even started to hear voices, which I have to say I find quite alarming retrospectively. What was particularly destructive was that in order to punish myself for what I thought were my mistakes, I started to dehydrate and starve myself. When I had to eat and drink something because I couldn’t take it anymore, I felt even more disgusting afterwards. Now I am able to say that this was definitely a major depressive episode, and a lot has improved in the past months.
Martin: Well, I was diagnosed with moderate recurrent depression. Retrospectively, I can say it runs through my biography since puberty. It comes and goes. And while in the past it slowly crept in on me without me noticing, I became quite sensitive to feeling it coming over the years. To me, it feels like standing still, like being totally feeble. My thoughts start to become somehow heavy, and I find it hard to focus. I won’t be in the here and now anymore if that happens, and my mind will start to evolve around things that are bothering me, things that are in the past. It’s a mind spiral that doesn’t stop. Also, it is worrying me that so much time passes while I am sitting at home, feeling this way, and am not able to stop it. It bothers me that I can hardly control it, that it feels like I am wasting my time, and that I didn’t choose to spend my time that way.
A symptom of depression is suicidal thoughts. How is that with you? Did you ever have to deal with that?
Martin: Interesting question. Suicide is not an option for me, and I don’t think about suicide. I was maybe 17 or 18 the last time I thought about that, and even then I guess the thoughts weren’t specific. It was more of a stuck in adolescence hate towards the world with depressive tendencies on top of that. But, I have to say even though I don’t have acute suicidal thoughts, I often think about death. And I don’t mean that in a philosophical sense. Especially in the last one and a half years I often thought about letting go, in the sense of that it just would be a lot easier to leave it all behind. Because depression has a lot to do with discipline for me, with forcing yourself to do stuff, even though you don’t want to, forcing yourself to socialize, to go outside… Wouldn’t it be much easier to let go? But every time I catch myself falling back into this train of thought, some other thoughts start coming up like a mantra: “I want to live. I won’t do it, no matter what happens”. And this mantra, these thoughts, are so fixed that nothing can happen.
Nadja: Yes. And although I thought about suicide before when I was suffering from acute posttraumatic symptoms, the last incident for me one night in August 2015 was really a wake-up call. I couldn’t take being that depressed anymore. Therefore, I wrote a suicide note and started piling up all of my sleeping pills in front of me, all while I was feeling totally numb and apathetic, like in a dissociative state of mind. Luckily, I somehow managed to pick up the phone, called my new partner, told him that something strange was going on with me, and that I think that I am going to kill myself. Although he had been fast asleep before I called, he knew that this wasn’t a joke. He immediately ran all the way over to my house, while still talking to me on the phone. First, he wanted to take me straight to the hospital, but then we ended up talking all night long. I promised him that I would start a new therapy, and decided that I would finally give antidepressants a try as I used to be very critical towards psychiatric drugs. Also, the next day my boyfriend moved in with me, and stayed for almost six months until I was feeling better. If it hadn’t been for him, I don’t know where I would be today. I kept the note that I wrote that night to remind me that things get better in time.
What would you say to someone who suffers who suffers from depression and thinks about suicide?
Nadja: I would advise anyone who struggles with suicidal thoughts to open up, and to tell someone close to them about their feelings. You don’t have to go through this alone. There are people who can, and who want to help you. And even if right now it feels like no one loves you, and no one would ever miss you, and even if this sounds like an awful cliché: I promise you that it gets better. Someone loves you, even though you might not be able to feel it at the moment. You are worthy, and you will get through this.
Martin: That’s a difficult question for me to answer because depression can come in many different varieties and I myself don’t have experiences with acute suicidal thoughts. But as a friend, I would try to support the person affected as much as possible, and would try to get them into some form of psychological counselling, even if it is no real therapy. I think to get them into some form of psychological primary care would be essential.
Speaking of suicide: One paradox side effect of antidepressants is that they might cause or increase suicidal thoughts. What do you think about antidepressants? Did you ever receive a prescription and is that something that you would recommend to others dealing with depression?
Martin: I don’t have any experiences with antidepressants, because my therapist didn’t think it was necessary for me to receive medication at the time, and I wanted to try to recover without medication first. But I have some people in my social environment who use them and I have to say I would do so too. I think they can change something for the positive. And I have to say especially during the past six months, when I was more severely affected by depression, I asked myself the question whether or not I would take something, even though this kind of medication has some severe side effects. And I have to say I would. Because I think psychological pain is comparable to physical pain: if the side effects are tolerable, then why should you go through it? Nothing good comes from this. It neither makes you stronger nor a better person. Of course antidepressants shouldn’t be seen as a universal remedy, but I think they can help to alleviate symptoms insofar as they become psychologically treatable.
Nadja: After my “almost suicide attempt” that I just told you about, I made an appointment with my psychiatrist, and told her everything that I was going through. She diagnosed a major depressive episode, helped me with finding a new psychotherapist, and also gave me a prescription for Sertraline*****. Although this kind of medication isn’t something I would unconditionally recommend because of its severe side effects – especially in the beginning and if you are a long-term user – I have to say that I wouldn’t be where I am today without the help of psychiatric drugs. I don’t think that it would have been possible for me to regain any quality of life, or to rebuild a repertoire of positive experiences, because I was sunken too deep into this depressive state. I hope that I will eventually be able to live life without any medication at some point, but for now I just enjoy feeling better, and slowly taking steps towards recovery. Now there are starting to be more good days than bad ones, and I feel like I am finally regaining a bit of control over my life – it’s a relief.
Would you say that your experiences with therapy have been positive so far?
Nadja: I am definitely conflicted. Sure, it can do a lot of good, and it has helped me a lot to cope with symptoms of PTSD. On the other hand, I have never felt so low in my life as after therapy. It took me some time to realize that although I went through a really difficult episode for quite some time after therapy, what had happened and how I felt was neither my fault nor that of therapy, but rather the result of an accumulation of shitty experiences, and of people who didn’t do me any good.
Martin: I cannot stress enough how much good therapy has done for me. I think, if it is sufficiently treatable, the form of therapy fits you, and if you have found the right therapist for you – because the chemistry between you and them has to be right –, then therapy can change a lot more than just cure some symptoms. It can empower you to create a life for yourself that you want, and that you wish for. Even if it wasn’t possible for years before. And since therapy I made a whole lot of profound experiences that were really good for me… Of course, job, family, friends, generally at which point of your life you stand, all of those things play a role. But therapy can give you chances that life and the circumstances might not have offered you before.
Do you think by tendency that depression is a curable condition or are least manageable?
Martin: On the background of people that I have met so far, and on my own introspection, I have to say that there are different characteristics and there might be great differences in which way it manifests itself. And also a psychological diagnosis is only a frame of reference, trying to label a number of different symptoms. I can imagine that there are some severe forms of depression which might be incurable, I think that is possible. But on the other hand, I think that therapy can help you a lot, and can do a lot of good for you. Personally, I think that the depressive tendencies will always be a part of my life, because I have been living with depression for a long time now, and have been shaped by it. But my therapy has helped me a lot, insofar as to develop different strategies to be able to arrange my life around them so that they hardly ever come up again, and even if they start to show up again I have an inventory of things that I could do to deal with those symptoms. In general, I become a lot more relaxed in dealing with depression. If I am feeling low I can say to myself now: “Well, that’s just a day that I will spend in bed – it’s not the end of the world”. If I had to compare the past and how I am feeling now, I have to say that depression generally affects me a lot less.
Nadja: I think neither depression nor any other kind of mental “illness” defines who you are as a person. For many years, I thought that suffering from some kind of mental issue was part of who I am, part of my identity, something I couldn’t imagine living without. For the first time in my life, I don’t want to be this person anymore. I want to fully participate in life, take all the chances I can get, meet interesting people, make new friends, go outside… Yes, it sounds terribly clichéd, but really: there is a lot to live for. And although I think that therapy can help you with managing different symptoms, there is more to becoming subclinical. You will need a whole lot of social support, and a stable, safe environment. Friends, family, or self-help can do a lot of good. But I think first and foremost you have to be the one to take the right steps towards recovery, which might be exceptionally hard to do if all you feel like doing is lying in bed and staring at the wall. Getting better takes a whole lot of strength, patience, and serenity.
Finally, a simple question: how do you feel at the moment?
Nadja: Right now I am doing great. I feel like this year will bring on many exciting changes in my life.
Martin: You have caught me in a very positive phase of my life. I just moved to a different city, which is a lot of work, but also a lot of fun and a new start which gives me a positive outlook on the future. And also it’s spring time. I had to fight a lot in the past months, but right now I am doing well, and I think and hope that I will be using the “good” time of the year to work on the challenges that still exist.
* Name changed.
** Bipolar affective disorder: characterized by at least two episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (mania or hypomania), and on others of a lowering of mood and decreased energy and activity (depression).
*** Cyclothymia: marked by a persistent instability of mood, involving numerous periods of mild depression and mild elation.
**** Recurrent depressive disorder: defined by repeated episodes of depression without any history of independent episodes of mood elevation and overactivity that fulfil the criteria of mania. Individual episodes of any severity are often precipitated by stressful life events.
***** Sertraline (trade names Zoloft and others): an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class, primarily prescribed for major depressive disorder in adult outpatients as well as obsessive-compulsive disorder, panic disorder, and social anxiety disorder. In 2013, it was the most prescribed antidepressant and second most prescribed psychiatric medication (after Alprazolam) on the U.S. retail market, with over 41 million prescriptions.