Finding the Words… Depression

Depression… that is a word that I find difficult to speak… difficult to write. As a child, I remember telling my mom I felt guilty. Now feeling guilty may not seem out of the ordinary, but I’d tell my mom I felt guilty ALL THE TIME. I had this feeling inside me that I couldn’t quite describe, and so I tried to name it… to understand it.  As absurd as it sounds, I would say I felt guilty because I thought my bags in the trunk were too heavy and costing too much gas for the car. I was grasping for words to explain this feeling deep inside but I couldn’t quite find them.

I’ve always struggled for words to describe feelings. When my mom would ask me if the pain I felt was “sharp” or “dull”, I’d ask her, “how do I know what sharp and dull feel like?” How can you describe something if there’s no precision – no way to test if what you are saying is correct.  And that’s how I feel about depression – I’m not even sure it’s the right word.

A couple of years ago, I was dealing with some significant stress, and I decided to seek counseling.  I looked for a Christian counseling center because my relationship with God is important to me and I looked for a practice with psychiatrists on staff because I know me that there can be chemical components to mental health problems.  And so I started seeing a counselor weekly and after a few months, I didn’t really feel like I was improving.

My counselor suggested I consult with the psychiatric APRN in the practice to see what she thought.  And so I decided to make an appointment.  My biggest complaint was that everything was hard (I have 3 kids so people would say of course it’s hard!). But I felt overwhelmed most of the time and was also struggling with sleeping.  I had a difficult time falling asleep and an even more difficult time staying asleep (waking up between 3 and 4 most mornings unable to fall back to sleep). I never felt sad but I was irritable – snapping at my kids and then feeling guilty (right word this time!). I was only getting ~5 hours of sleep and I really need 9 so I was not at my best to say the least.  After describing this, as well as my family history of depression, to the psychiatric APRN, she said she thought that a low dose of Zoloft might help. She didn’t give me a diagnosis, just a prescription which I needed to decide whether to fill it or not.

I recently listened to a TED talk by Andrew Solomon in which he says “And I also started reckoning with this terrible question: If I’m not the tough person who could have made it through a concentration camp, then who am I? And if I have to take medication, is that medication making me more fully myself, or is it making me someone else? And how do I feel about it if it’s making me someone else?”  The full talk, which has helped me put some words to these feelings inside can be found at http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share.

So should I start taking medication? Would it change who I was? Would it mean I was weak – that I didn’t have enough faith? I decided to start taking the medication to see if it would help me sleep.  A concrete outcome – something to be measured precisely and accurately was important to me. My feelings of being overwhelmed were just that – feelings – and so they are harder to measure and harder to talk about, especially for those like me who like the concrete. And a few weeks later, I found I was sleeping through the night. And a few weeks after that, I was able to fall asleep without any problems. And I started feeling less irritable – not sure if that had to do with getting more sleep or the medication but I definitely was snapping at the kids less.

And so, I became a person who took Zoloft to help with my sleep. But I still wasn’t ready to use the word depression. I had read that insomnia was often a sign of depression and so the idea was there but I wasn’t ready to put a word to it. I’m still not sure I am.  But I do know that listening to Andrew Solomon describe depression feels familiar to me. I could have spoken this quote in particular:

“The opposite of depression is not happiness, but vitality. And it was vitality that seemed to seep away from me in that moment. Everything there was to do seemed like too much work. I would come home and I would see the red light flashing on my answering machine, and instead of being thrilled to hear from my friends, I would think, “What a lot of people that is to have to call back.” Or I would decide I should have lunch, and then I would think, but I’d have to get the food out and put it on a plate and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.”

And so, I started to wonder, have I been struggling with depression all along?  Were my feelings of “guilt” really feelings related to depression (the DSM-V does include guilt/worthlessness as a symptom)?  Was I person who was taking Zoloft to help with my depression?  The DSM-V requires a “depressed mood or a loss of interest or pleasure in daily activities for more than two weeks” along with other symptoms to diagnose depression. But I would never describe myself this way – I never had problems at work, was able to take care of three kids, and was even able to maintain a regular exercise regimen – not things I would call depressed. But it was all so hard. Instead of walking through air, I felt like I was pushing through sludge, barely able to do it all.  But I am stubborn and so I pushed through the sludge. But I wish I hadn’t. I wish I had realized earlier that maybe these feelings weren’t normal and maybe I had a chemical imbalance that could be helped by medication.

This week, I came across two articles about depression with two very different messages. One was a recent article in the LA times which discussed how antidepressants are now the third most prescribed drug and primary care providers use them as “do something” drugs ( full article can be found here: http://www.latimes.com/science/sciencenow/la-sci-sn-antidepressants-not-for-depression-20160523-snap-story.html?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=29927204&_hsenc=p2ANqtz—nhbFhHnpF2TDsg4M9FBwtWfMnbT-j2zsMAWZGm06YazrYStAQPbgYGE90AK6sEJAvNDSSa11Keb7aXOwbE-v37IkSQ&_hsmi=29927204).  This concerns me as I think primary care providers are not the right doctors to be prescribing antidepressants and I think they are likely over prescribed. This is one reason I really love the Christian counseling practice I go to – they require that you keep an active relationship with a counselor (for me this is only once every 3 months now) to continue to be prescribed medication.

The second article was one my husband shared from The Mighty entitled We Cannot Continue to Overlook “High Functioning” Depression (full article can be found here: http://themighty.com/2016/05/high-functioning-depression-we-cant-overlook-the-overachievers/). This woman shares her story of being diagnosed with severe anxiety and depression in the midst of high achievement (4.0 GPA and active in extracurricular activities).  This is not the picture people have of depression.  The diagnosis of depression requires impairment in one or more areas which can be hard to see in an overachiever, something I think may have prevented me from seeing my own depression. And so, in honor of Mental Health Awareness Month, I want to share my story with others – not because it’s anything special but because it’s anything but special.