Day Six

Today is my sixth day on new medicine. I feel foggy and not like myself, although I'm not sure I remember what it means to feel like myself to know that I don't feel like myself, if that makes any sense at all. Sometimes it feels hard to breathe. I have a cough and I think I might be forgetting things, but maybe that's all in my head. I bought Andrew Solomon's The Noonday Demon: An Atlas of Depression and so far it's amazing. He puts words to experiences I have never known how to describe, while simultaneously communicating that the magnitude of the pain experienced by a depressive is, in fact, far too enormous to be fully characterized with language. He writes, "Depression? It's like trying to come up with clinical parameters for hunger, which affects us all several times a day, but which in its extreme version is a tragedy that kills its victims." He introduces the categorical view of depression, which states that depression is not on the "continuum with sadness," but is unquestionably an entirely different creature. This line seems to be blurred in some social settings. I often hear people say they are depressed when they mean they're sad or down or upset or just having a weird day. The term "depressed" is trivialized in the same way that "bipolar" or "schizo" or "psycho" are used to characterize people's behaviors that others think resemble these diseases. They don't mean any harm, but nonetheless it does further damage to the already negative public perception of these very real illnesses. It's exhausting and lonely to have an illness so stigmatized.

"You own everything that happened to you. Tell your stories. If people wanted you to write warmly about them, they should have behaved better." ~Anne Lamott

"If we empty our hearts every night, they won't get too heavy or cluttered. Our hearts will stay light and open with lots of room for good new things to come." ~Glennon Doyle Melton

"So everything is necessary. Every last thing. This is the hard lesson. Nothing can be dispensed with. Nothing despised. Because the seams are hid from us, you see. The joinery. The way in which the world is made. We have no way to know what could be taken away. What omitted. We have no way to tell what might stand and what might fall." ~Cormac McCarthy

New Medicine and New Hope

I saw a new psychiatrist two days ago. She asked me the normal battery of questions. "Were you ever abused?" "What was your childhood like?" "Do you have a family history of mental illness?" "Do you smoke, drink, do drugs?" "How's your sleep?" "How's your appetite?" "What medications have you been on? How much?" "Do you hear voices?" "Do you have disturbing dreams?" "Do you ever feel the opposite of depressed?" "Do you see things that aren't there?" "Do you ever feel that you've lost touch with reality?" "Have you ever been in trouble with the law?" "Have you ever been violent towards others or yourself?" "Did you have any head injuries as a child?" "Do you feel disinterested, exhausted, dull?" I sometimes wish one of these questions had an answer that would explain my depression, but when asked about what I think triggers my depressive episodes, I have no idea. They seem to have nothing in common. School breaks, before class, after class, in the middle of the night. They don't discriminate. On Tuesday of this past week, I couldn't stop crying in the hallway before my only class of the day. After class, I walked to my car and sobbed and screamed the whole way to the gas station. I called one of the doctors I had seen in the inpatient unit and I couldn't even stop crying enough to choke out many of the things I wanted to tell her. The next day, she called me to check on me. "I'm fine today," I told her. "I don't know why, but I'm fine." It always happens like that. Sometimes I can stop the train of destructive thoughts and other times I can't. If I have something to do that I absolutely have to hold it together for, I usually can. Otherwise, I may fall apart completely. It's always zero to one hundred. I never get a little sad. I get devastated, hopeless, angry, and desperate. I am heartbroken by my brain's own failure to work properly. Things start spiraling out of control in my mind. I'm lonely. I have no friends. I hate my major. I hate school. How on earth will I find a job after I graduate? Will I be stable enough to work at all? Will I ever meet someone and have a family? Will I ever be in the kind of mental state to raise healthy, happy, well-adjusted children? Will no one ever love me because my depression rules my life sometimes? Will people continue to misunderstand my illness? Will the medicine ever work? What if I never find the right medicine? What if I can't stay in school? These thoughts and questions torture me until I calm myself down or someone else calms me down or I go to sleep or I'm so exhausted and my eyes are so dry that I can't think or cry anymore. During particularly bad periods of time, this can happen every other day or even daily. The only way I can think of to describe the urgency and alarm within my brain at the time of these occurrences is to compare them to seizures. If you can picture the terrifying and unnatural movements of someone experiencing a grand mal seizure, this is what my mind feels like. One second, I'm fine. And the next second, my mind is disturbingly and shockingly descending into darkness at a rapid rate of speed.

The attending came into the room about an hour or so into my appointment and told me that she believed my depression was purely biological due to the fact that the episodes seem to possess no similar triggers. I was relieved to hear this. I've often thought that perhaps my depression wasn't biological at all– that medications were a lost cause and that this was just psychological, purely internal, something eating up my brain and soul for no good reason. They decided to double my dose of Effexor, the fourth SSRI I've been on, and add Wellbutrin, a new medication that I asked for specifically. I'm happy that they listened to me. I told the doctors that I'm tired of this game. I understand it– the scientific method and all of that. I get why they put you on a drug, max out the drug, and then try another one. But I'm exhausted. Weeks of moving up incrementally on a medication to hopefully reach a therapeutic dose that might work and might not sounds horrible to me. I've done it before so many times. I've been doing it for six years. So far I've had three doses of my new medicine and I think I feel okay. It's too soon to see actual biological effects, but I feel calm. And I think content. Sometimes I feel nothing and this calmness is reminiscent of that, but not in the same bleak, sedate way that nothingness normally feels... if that makes any sense at all. I don't feel like a robot. My family says I'm quiet and I feel quiet inside, but I think I like quiet. Above all else, I feel hopeful.

"We need never be hopeless because we can never be irreparably broken." ~John Green

"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured." ~Kurt Vonnegut

Anatomy of Melancholy