Furious Seasons

May 11, 2009

Big Depression, Little Answers

There was a well-written, yet somehow problematic essay in the New York Times Sunday Magazine yesterday. It concerns the chronic, treatment resistant, suicidal depression of its author, Daphne Merkin, and her three-week hospitalization in 2008 at the New York State Psychiatric Institute in New York City. Merkin has been through the depression treatment mill since the mid-80s and has literally been on everything under the sun and done decades of psychotherapy, all of it to little avail. she walks readers through all of that and a huge bout of depression that hit in late-2007 when she was on three separate anti-depressants plus Risperdal and Lamictal.

Five meds at once for depression indicates just how severe and unremitting Merkin's depression was, as well as how aggressive docs have gotten with the meds. I can assure you there was a time--the 1990s--when docs wouldn't have used more than two meds, but now we are sure in a brave new world. There's no doubt, however, that Merkin's depression is a prime cut of Hell:

"As an adult, I wondered incessantly: What would it be like to be someone with a brighter take on things? Someone possessed of the necessary illusions without which life is unbearable? Someone who could get up in the morning without being held captive by morose thoughts doing their wild and wily gymnastics of despair as she measures out tablespoons of coffee from their snappy little aluminum bag: You shouldn’t. You should have. Why are you? Why aren’t you? There’s no hope, it’s too late, it has always been too late. Give up, go back to bed, there’s no hope. There’s so much to do. There’s not enough to do. There is no hope.
"Surely this is the worst part of being at the mercy of your own mind, especially when that mind lists toward the despondent at the first sign of gray: the fact that there is no way out of the reality of being you, a person who is forever noticing the grime on the bricks, the flaws in the friends — the sadness that runs under the skin of things, like blood, beginning as a trickle and ending up as a hemorrhage, staining everything. It is a sadness that no one seems to want to talk about in public, at cocktail-party sorts of places, not even in this Age of Indiscretion. Nor is the private realm particularly conducive to airing this kind of implacably despondent feeling, no matter how willing your friends are to listen. Depression, truth be told, is both boring and threatening as a subject of conversation. In the end there is no one to intervene on your behalf when you disappear again into what feels like a psychological dungeon — a place that has a familiar musky smell, a familiar lack of light and excess of enclosure — except the people you’ve paid large sums of money to talk to over the years. I have sat in shrinks’ offices going on four decades now and talked about my wish to die the way other people might talk about their wish to find a lover.

"Then there is this: In some way, the quiet terror of severe depression never entirely passes once you’ve experienced it. It hovers behind the scenes, placated temporarily by medication and renewed energy, waiting to slither back in, unnoticed by others. It sits in the space behind your eyes, making its presence felt even in those moments when other, lighter matters are at the forefront of your mind. It tugs at you, keeping you from ever being fully at ease. Worst of all, it honors no season and respects no calendar; it arrives precisely when it feels like it."

I know what she means. Merkin winds up in a psych unit, where they are sure pushing her towards ECT:

"One day early into my second week, I was called out of a therapy session to meet with a psychiatrist from the ECT unit. I still wonder whether this brief encounter was the defining one, scaring me off forever. She might as well have been a prison warden for all her interpersonal skills; we had barely said two words before she announced I was showing clear signs of being in a 'neurovegetative' condition. She pointed out that I spoke slurringly and that my mind seemed to be crawling along as well, adding grimly that I would never be able to write again if I remained in this state. Her scrutiny seemed merciless: I felt attacked, as if there were nothing left of me but my illness. Obviously ECT was in order, she briskly concluded. I nodded, afraid to say much lest I sound imbecilic, but in my head the alarms were going off. No, it wasn’t, I thought. Not yet. I’m not quite the pushover you take me to be. It was the first stirring of positive will on my own behalf, a delicate green bud that could easily be crushed, but I felt its force.
"The strongest and most benign advocate for ECT was a psychiatrist at the institute who saw me three decades earlier and was instrumental in convincing me to come into 4 Center. In his formal but well-meaning way he pointed out that I lived with a level of depression that was unnecessary to live with and that my best shot for real relief was ECT. He came in to make his case once again as I was sitting at dinner on a Friday evening, pretending to nibble at a rubbery piece of chicken. The other patients had gone and my sister was visiting. I turned to her as he waxed almost passionate on my account, going on about the horror of my kind of treatment-resistant depression and the glorious benefits of ECT that would surely outweigh any downside. I didn’t trust him, much as I wished to. Help me, I implored my sister without saying a word. I don’t want this. Tears trickled down my cheeks as if I were a mute, wordless but still able to feel anguish. My sister spoke for me as if she were an interpreter of silence. It looked like I didn’t want it, she said to the doctor, and my wishes had to be respected."

I love how a psychiatrist tried to lure Merkin into ECT by telling her she'd never write again without it. That's verging on an ethical violation and clearly, in Merkin's case, the evidence argues against it: It's a year later and Merkin has written. So much for that doctor's wise counsel.

The piece closes with Merkin, her depression somewhat lifted (but not by much) sailing the seas of Remeron and, drum roll, Abilify and able to get out and about to a degree she couldn't before. It's a fine piece overall, well worth a read.

Here are some quibbles.

1. There's a lot of talk of ECT in the piece, but no mention that NYC is damn near ground zero for use of shock therapy. I know a psychiatrist in NYC, who used to practice in Seattle, who tells me that ECT is used at least three times as much in NYC as it is in Rain City. I find it interesting that an editor didn't want some kind of stats on ECT use, because you could walk away from the piece thinking docs turn to ECT in all places at the same rates, when that's not the case. I congratulate Merkin on pushing ECT away, however. Good for her.

2. It's apparent that Merkin was rapidly tapered off meds (five of 'em) in about 10 days when she enters the hospital. Then a doc has the nerve to tell her she's neurovegetative, when Merkin has clearly gone through a fast taper off multiple meds, an experience that would leave any human a little dazed and scrambled and acting vegetative. It's interesting to me that Merkin seems unaware of this as an issue.

3. Merkin has been on meds for depression for over two decades and writes that she's only been off them for very short periods of time. If she's getting such crap results from medication, then why the heck wouldn't she try being off them altogether for a time and seeing what happens? It cannot be any worse for her than what she's been doing. All I know is that approach finally worked for me and I had what several psychs called treatment resistant depression (within the context of bipolar disorder, of course). Call me biased.

4. My final quibble is with the magazine itself. Whenever it runs a big essay on some mental health matter (once or twice a year), its writers typically focus on the most extreme cases where no one ever gets better (Merkin's kind of depression would only account for a thin slice of all the cases of depression out there in the land). Happily, it's not all that bad all the time in depression and bipolar land, but it sure seems like the magazine's article choosers have a tough time getting their minds around that. It's not like any journalists haven't pitched them articles in the last year or so on people who've recovered from bipolar and depression. I haven't seen anything like that in the mag. Call it institutionally-biased.

Posted by Philip Dawdy at May 11, 2009 12:01 AM

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Comments

Decades of psychotherapy, and just as many decades of, more or less, massive drugging - hm. Although only a few speak out about it (because it might ruin a career in the mh system to a certain extent), it's well-known among therapists, who practise something else than the "slightly more sophisticated" version of psycho education, aka CBT, who at least try to practise real therapy, that people who are on psych drugs don't benefit as much and as fast from therapy - if they benefit from it at all - as those who are not on any psych drugs. - I don't think I need to mention why that is so. Just a quote from the article: "...a stranger to myself." And it's not only ECT, that brings this alienation about. Psych drugs do too.

You're right. It would probably be worth a try for Merkin to get off the drugs, that don't seem to help much anyway, and maybe give therapy without drugs - or other non-medical approaches - a try. Sadly, she seems completely stuck with the idea, that the mh system alone has all the answers. Even though it obviously hasn't, and actually has failed her for decades.

Posted by: Marian at May 11, 2009 01:50 AM

Hi Phillip,
Re: Quibble #3: You could probably answer that question with the contents of #2. Any brief periods off meds were probably quick tapers or cold turkey which would certainly leave you feeling worse. I doubt she was ever told about withdrawal. When your brain is being damaged, logical thoughts like; “No results from 2 decades of meds, maybe I should try something else”, don’t come as easily, if at all. I assume that’s why many agree to ECT. She was lucky to have that much intelligence left to say no. Most of that time was also before the internet. By the time this information (meds don’t always work/have side effects, etc. etc.) could be found on the internet, I was already into years of brain damage, without having a clue. Not until things got MUCH worse, did I even think to question the doctor’s “expertise” and look into it.

So here’s my Quibble: After 2 decades of meds, why didn’t any psychiatrist or psychotherapist ask that question or make that suggestion?
I went to a psychiatrist every 3 months for 13 years; NEVER was I told; the meds could be causing your headaches, hair loss, memory & attention problems…

On a different note; I would love to here about anyone who has this type of depression at a young age that doesn’t get put on meds and recovers to live a normal life. I’m sure they’re out there. Maybe we don’t here about that because when that happens, people leave it behind and think of it as a “troubled adolescence/childhood” and never think about it again? Maybe those that were depressed as kids/teens and were not put on meds don’t have the need to search the internet for answers because they found them and are living normal happy lives and didn’t go through decades of despair.
I’m curious and wondering what could have been for me. I’ve initially told my story as; I was married to an alcoholic, stressed at home with little kids and was put on meds for “situational depression”. However, due to the amnesia from the meds, I had forgotten that’s not where it started. I tried to commit suicide at 14, before doing any type of drugs! I think any teen who is depressed these days is going to be put on brain damaging meds if they seek any kind of help and some, even if they don’t. I’d like to hear about successful alternatives BEFORE someone gets brain damaged and has to live with that too.

Posted by: Damaged at May 11, 2009 05:55 AM

"She pointed out that I spoke slurringly and that my mind seemed to be crawling along as well, adding grimly that I would never be able to write again if I remained in this state."

These are clearly not symptoms of depression, but drug side effects. Slurring is a symptom of depression? These docs are just throwing whatever they can at a problem that has not yet bowed down to their lab coats. Slurring. Puh leazze.

Posted by: MedsVsTherapy at May 11, 2009 05:59 AM

Depression seems to be the one constant affliction of writers.

Several years ago I read an article about a reporter who was afflicted with depression from an early age. She now controls her depression with no meds but has to jog 30 minute everyday. Walking did not help her but jogging did. Of course, if a person is so depressed they can hardly move, then this is an option which is doubtful.

However, some writers can't move while on SSRIs - such as Kurt Vonnegut.

Here is an article about Kurt Vonnegut which appears on www. SSRIstories.com Following this article is a news flash out of Baghdad that a U.S. soldier killed five fellow soldiers at a stress clinic in Baghdad. I suppose we will never know what med he was taking but SSRIs are the most common med given for PTSD to soldiers.

http://www.ssristories.com/show.php?item=1515

Paragraph 5 reads: "When I was at the Writer's Workshop in Iowa, the University of Iowa medical center realized they had a lot of professional writers to study,'' Vonnegut remembers. '`It turned out a lot of us were monopolar depressives from families of monopolar depressives. That explains why my mother committed suicide. I've been hospitalized twice for really bad depression, and I've tried Prozac. It's bad news for people who have to be self-motivated. If you have a boss and a routine, it's probably good, but not if you have to get yourself out of bed. It put me out of business.'''
__________________________________________________

FINAL WORDS AUTHOR KURT VONNEGUT SAYS HIS LATEST IS HIS LAST
Rocky Mountain News (CO)
October 7, 1997
Author: Alan Dumas
Rocky Mountain News Staff Writer
Estimated printed pages: 3

What would have happened if Dostoevsky had taken Prozac?

``He would have just farted around until someone told him to get a job,'' Kurt Vonnegut Jr. says.
And what if the young Vonnegut had been treated with the same drug?

``I'd still be a PR man in Schenectady,'' he says.

Vonnegut, a great American novelist and monopolar depressive, will appear tonight at the Tattered Cover Book Store in lower downtown.

http://www.foxnews.com/story/0,2933,519788,00.html

5 Dead After U.S. Soldier Opens Fire at Baghdad Base

Monday, May 11, 2009

DEVELOPING: A U.S. soldier opened fire on coalition forces attending a stress clinic at a military base outside of Baghdad International Airport Monday, and at least five were killed, the Pentagon and U.S. Command said.

It was unclear how many U.S. soldiers were killed in the shooting at Camp Liberty, but a defense official said the shooter is alive and in custody. Three were wounded, but it was not immediately clear if the shooter was one of them.

Posted by: Rosie at May 11, 2009 09:00 AM

I agree that Merkin doesn't seem to have any clue about the confounding effects of treatment and improper withdrawal. I don't care how beautifully and poetically she describes the "black dog" she doesn't seem to "get it" about what's really been happening to her. Who knows where her "treatment resistant" depression would be if she hadn't taken the fork in the road that led to meds and therapy for decades? I get discouraged when I see these narratives come out in mainstream media.

Posted by: Sara at May 11, 2009 09:16 AM

It was a well-written article, I thought, which made the poor fact-checking really disappointing. There's an aside about drug side effects fairly early on in the piece which says that tardive dyskinesia is extremely rare. No source is given for that factoid, but Merkin's own case is surely proof of how many drug-induced movement problems go unrecognised.

Posted by: ds at May 11, 2009 09:19 AM

Who wouldn't be depressed if they had as one of the headings of the article says (in offensively bad handwriting) "sat in psychiatrists offices for 4 decades taking about my desire to end my life." After the first oh 10 years, shouldn't she have gotten a clue that it was the notion she needed help that was keeping her unhappy?

I think in the end her expectation not to be unhappy was childish and immoral. Her experiences those of a drug addict. The fact that the system enabled her, reprehensible.

Learning how to live and function in spite of feelings of despair and unhappiness is called growing up. Drugs and "therapy" prevent this. Perhaps, and of course this does sound callous, in the end this sort of wallowing really is bad behavior which is why EST which is a form of physical punishment does work to get some of these people on the right road.

The idea that I should feel sympathy for a major tranquillizer addict doesn't work for me.

Posted by: Sally at May 11, 2009 10:44 AM

Hi—(Please—do not post my e-mail.) Posting anything is new for me but the Merkin piece & your response with comments inspired this. My story strangely reverses the Rx depression conundrum. I’m a 60 yr. old retired/writer/wife with a long history of the blues. Tried to kill myself at 16, typical drugs & alcohol of the era, etc. A few medications tried but had side effects so for 40 yrs. only modest exposure to psych. meds. Went to shrinks from the very start (forever), learned coping skills slowly, never got diagnosis of major disorder. Stopped substance abuse 25 yrs ago, ended up in great marriage (in middle-age), reliable friends & got writing published, also cancer recovery. Even took up meditation trying to cure myself since I could still have written a lot of what Merkin described. The ‘blues’ never left; along with reformed behavior, the anomaly of good life with camouflaged self-lacerating thoughts persisted. I used shrinks as support tools. Couple of years ago I read an article about an older depression Rx. and, unexpectedly, decided to try it. Family doc wrote prescription—and it made profound shift. I no longer look through the bars of a cell. Still get regular sad/mad/joyful feelings but my former mantra of ‘oughta be dead’ is pretty much out of commission. Oddest experience of my life. The air is cleaner and I haven’t moved ground. My husband who is anti-drugs was amazed & silenced. I am no living psch. miracle (repeat—no living miracle) but, for now anyway, to live a life that I don’t have to second-guess and one in which I do not turn on myself in a snap, that is good enough. H.

Posted by: H. at May 11, 2009 12:18 PM

Thanks for the post. I especially appreciate comment number 3. While I found the article/essay quite interesting and well written, I did have trouble with the "happy ending." My experience is very similar to Merkins' in that I have been on meds for 30+ years. I have been off them for 3 months now, and have vowed not to go back on. But it's a daily struggle not to call the psychopharmacologist. They have been weaving hope into my psyche for decades. And sometimes the hope that something might work is better than the despair that you are currently living with.
Marco http://bipolarized.wordpress.com

Posted by: Marco Dante at May 11, 2009 03:06 PM

H., I'm very pleased for you.

As for the article, I could have written it--if I could write that well.

Here's what I thought was missed and glossed over: the reference to an abusive nanny and very neglectful parenting. Considering what we know about the long term effects of childhood abuse and neglect, that's a pretty big omission. But, sadly, not a surprising one.

Early, pre-language abuse some of the hardest to deal with. Talk therapy is useless with this stuff, really, because there is no language for what happened.

I have actually remembered abuse that happened pre-language but didn't know what I was remembering until my perpetrator told another family member. A real Aha Moment.

Early abuse really can be the gift that keeps on giving--just ask those poor baby monkeys that abusive a**hole put into the "well of despair" isolation tank in the 70's. You know, the guy who gave some of them wire mothers. That guy.

He proved the pervasive and permanent effects of early neglect. His colleagues watched him and people paid him to abuse animals shamelessly. And now the profession doesn't even have the decency to bother to remember what his abusive "experiments" taught them.

Posted by: Sherry at May 11, 2009 05:13 PM

"...Her scrutiny seemed merciless: I felt attacked, as if there were nothing left of me but my illness. Obviously ECT was in order, she briskly concluded. I nodded, afraid to say much lest I sound imbecilic, but in my head the alarms were going off..."

That's the trouble with social etiquette and authority worship... The appropriate response would obviously have been "fuck you, asshole," but we're denied that as an option - we're required to be polite. Mind you, even if we were to construct a form of words that amounted to a polite version of "fuck you, asshole," the quack would ignore the objection, megalomaniacs that they are, and press on towards the objective that they'd already set.

One day, maybe, one of Merkin's quacks will treat with her as though she genuinely has some say in her treatment. And until these quacks realize that coercion is the very lifeblood of depression, they will continue to get pisspoor results.

Matt

Posted by: Matthew Holford at May 11, 2009 05:42 PM

Matthew,
To say "Fuck you, asshole" to a doctor in a US nuthouse would be dangerous. I have seen people hauled off by several large security guards and sedated against their will for less. Creepily, they don't return, are sent to another, more secure ward.

I am always VERY polite and submissive in those places, nothing at all like my usual self. If honesty is the way to mental health (and I believe it is at least a huge component) the typical middle class psych hospital is not a place where you'll find mental health.

If her sister hadn't been there to speak for her, if her sister was not ABLE and willing to speak for her, my guess is she would have had ECT. My sister would have been so frightened by the authority figure she would have urged me to submit.

I had to have two people speak up for me, my husband and my PhD psychologist. They got me out of the place ASAP but it took several days to get me out. My friend's husband and wife had to hire a lawyer to get her out of a place where she'd voluntarily admitted herself.

Hope all's well on your side of the big water.
Sherry (who misses Ireland a lot)

Posted by: Sherry at May 11, 2009 07:37 PM

Sherry:

Decades ago, when I was an undergrad, I worked a year as an aide in a private psych hospital. One of the treatment goals was to get the psych patient to accept the diagnosis of the hospital staff.

"I'm a rebel."

"No, you're a very sick girl."

Etc.
If you ever want to get out of a psych hospital with staff approval, you have to accept staff's assessment of your situation.

Posted by: ogre at May 12, 2009 05:38 AM

Very well written essays by Daphne Merkin- the description of the living hell of depression so well illustrated suggests that Daphne opened a vein as it was composed. This is what severe depression is- it could have not been described better.

Posted by: Dan at May 12, 2009 07:13 AM

Dan,
Yeah, it was so incredibly well written.

ogre,
You really have to play ball or you don't get out. Oops, unless your insurance stops. Then it doesn't matter what's going on--you're pronounced "cured" and out you go. If you've been a real pita, though, you could end up in the state state pit, oops again--"hospital." I was always a veerrrry good girl. The staff loved me. The more middle class you can look and sound--the more like your keepers, in other words--the better off you'll be.

None of that should be so, of course, but it is. Partly because mere mortals run these places but mainly because their main function is, like that of any other societal institution, to maintain the status quo. In the case of us "mentally ill" people we are to sit down and shut the fuck up. Or else.

Sherry

Posted by: Sherry at May 12, 2009 12:29 PM

I didn't know you have written this article Philip.
I saw it at Susan's wrote a post.
I became a pretty amazed with the way it all ends.

"And then, the Sunday afternoon before I planned to return to 4 Center, something shifted ever so slightly in my mind. I had gone off the Remeron and started a new drug, Abilify. I was feeling a bit calmer, and my bedroom didn’t seem like such an alien place anymore."
She lives happily ever after.
This is the way I see it.

Posted by: Ana at May 12, 2009 02:38 PM

I agree that Merkin doesn't seem to have any clue about the confounding effects of treatment and improper withdrawal. I don't care how beautifully and poetically she describes the "black dog" she doesn't seem to "get it" about what's really been happening to her. Who knows where her "treatment resistant" depression would be if she hadn't taken the fork in the road that led to meds and therapy for decades? I get discouraged when I see these narratives come out in mainstream media.
Posted by Sara at May 11, 2009 09:16 AM

I agree with Sara. It's even beautifully illustrated but I rather read literature. Willian Styron's "Darkness Visible" don't only describes each symptom, he arguments.

Posted by: Ana at May 12, 2009 02:58 PM

"My therapist, a modern Freudian analyst whom I had been seeing for years and who had always struck me as only vaguely persuaded of the efficacy of medication for what ailed me — when I once experienced some bad side effects, he proposed that I consider going off all my pills just to see how I would fare, and after doing so I plummeted — had suddenly, in the last 10 days before I went into the hospital, become a cheerleader for undergoing ECT.

Wow! This analyst is far to "modern".
Analyst DON'T PRESCRIBE and WOULD NEVER PROPOSE ECT.
I see no difference in therapy and psychiatry in US.
It's amazing!

Posted by: Ana at May 12, 2009 03:21 PM

"...Creepily, they don't return, are sent to another, more secure ward..."

Well, quite. Nevertheless, when one is being coerced "fuck you, asshole" remains the appropriate response!

Matt

Posted by: Matthew Holford at May 12, 2009 03:41 PM

Matt,
I so totally agree. But I'm afraid I would never come back from being physically overcome. That's why I would never benefit from ECT. Even if it pulled me from the depression (temporarily) the rage I would have at being physically overtaken/overwhelmed/fucked with would be so enormous I would have to internalize it, lest I burn down my village.

So I chose to keep my mouth shut and smiling, as a survival strategy. I do agree with you, "Fuck you" would be ever so much apro pos, but I lacked the ability to be appropriate in that situation.

Hospitals of any kind are coercive places. I hate them.

Posted by: Sherry at May 12, 2009 05:40 PM

Sherry wrote:
"...Hospitals of any kind are coercive places. I hate them."

Yes, it's interesting, isn't it..? It seems that to many, including many mental health workers, "mentally ill" equates to "educationally subnormal" and "incapable of decision-making," when I've found the reverse to be the truth. As such, one is not permitted to question the decisions that one is having made for one, because one is not intelligent enough to understand what is going on, obviously!

Perhaps it should be compulsory for mental healthcare workers to come on a blog such as this just to see if they can participate in a discussion. You never know, it might tell them something about the people they're treating as incompetents!

Matt

Posted by: Matthew Holford at May 14, 2009 06:15 PM

Ah, but Matt it's a thin line we must walk to survive the mental hospital environment unscathed. If you exhibit too much intelligence and fail to tug on your forelock with the appropriate enthusiasm you become a threat, at least to psychiatrists and some psychologists. I've never run into that with OTs or nurses, just PhD psychologists and psychiatrists.

I think most mental health workers, psych nurses and OTs would listen and learn here. We've seen what happens when MDs show up, though, at least the chatty ones. Not a pretty sight, that.

Posted by: Sherry at May 14, 2009 07:29 PM

ogre said: "If you ever want to get out of a psych hospital with staff approval, you have to accept staff's assessment of your situation."

You don't have to *accept* it; you just have to repeat it back to them.

Posted by: Francesca Allan at May 14, 2009 08:01 PM

Sherry wrote:
"...If you exhibit too much intelligence and fail to tug on your forelock with the appropriate enthusiasm you become a threat, at least to psychiatrists and some psychologists..."

LOL. God forbid that they be required to treat their patients as fellow, sentient human beings! I think you'll find that there are people in this world who genuinely believe, on a completely non-negotiable basis, that they are better than others. This mindset permits all kinds of stuff, I've noticed.

On the other hand, there are those who have ventured on here who apparently honestly don't understand what our gripe is, when the treatments are cutting edge, as far as they're concerned. I think one just has to avoid attacking these guys personally, but rather discuss where one believes that the model fails, because it's all very well (and easy), to say "you're shit," but if one is able to say "you're shit, because..." one may still come across as aggressive, but at least one is being constructive!

Matt

Posted by: Matthew Holford at May 15, 2009 05:13 PM

Matt,
I am working on that. I'm human, though, and sometimes I just stop being polite. It doesn't raise the level of discourse, however, which is why I continue to work on it.
S.

Posted by: Sherry at May 15, 2009 07:38 PM

"Maybe it was the fear of ECT," from the article.

Was discovering she had some choice, and that she did not want (to-kind-of-die) E.C.T. and chose life (liking herself/her brain-mind) instead of death (suicidal/killing herself) that made her feel better? Lucky she got the choice to back out of ECT.

Posted by: mark p.s.2 at May 16, 2009 05:19 AM

On 11 May, “Damaged” voiced an interest in hearing the stories of young people who become depressed and recover without medication. I believe I have something to contribute.

I became severely depressed in March of 2008, when I was 26. I watched myself become more and more dysfunctional, and I didn’t care. Finally, the fact that I was failing all of my classes (I was a full-time student) stirred up some motivation, and I saw a psychiatrist, who put me on medication (prozac) and recommended therapy. I responded to the low dosage that was meant to be added to in two weeks, and so I never took more than 10mg at a time. That summer, I felt good. I started dating, painted my new apartment, socialized. I didn’t go to therapy, because I couldn’t afford it. Late that summer I forgot the prozac a few days in a row, so I figured I’d just stop. I did, and later that fall I suffered another episode of depression. The threat to my dreams of being a highly qualified teacher led me not only to seek professional help, but also to reach out to my family.

Medication was suggested again, but I said I didn’t want it. I felt that I had regressed because being on the medication hadn’t actually changed anything; it hadn’t taught me anything new. I was still suffering from the same thought patterns that had allowed me to take a back-seat to my life, and I didn’t want such a surficial recovery; I wanted healing, not symptom-relief. My psychiatrist was hesitant but supportive. He helped me find therapy I could afford, and saw me monthly for the next five months.

Now, six months later, I am more functional, happy, and confident than I have ever been. I truly believe it was the therapy that has made all the difference. I am very glad, also, that medication helped me through the summer of ’08. I was profoundly depressed, and saw no way out. Even though it was short-lived and shallow, I’m glad I was able to take such a breathing spell; I didn’t have much fight left in me at that point. However, my healing came not from the medication, but from therapy and social support. I could probably have done without the drugs, maybe without the therapy, but absolutely not without the full support of my friends and family. No one told me to get that support. My psychiatrist didn’t emphasize in, my therapist didn’t push it (as of course she couldn’t). My family insisted in aiding me with my recovery, and through my own research about depression I insisted that my friends be active partners as well. As a result, I believe that all of our relationships have been strengthened.

While medication is often touted as a deceptively “easy fix,” I don’t believe therapy is the whole answer either. I believe that it is human connection that really gets us to believe in the world again.

Also, since no one else has commented, I did just want to make a passing comment that Sally, who also posted 11 May, seems to have low awareness of the process and disease of depression. As I contemplated medication and the revelation of being depressed, fears of being “a drug addict,” “childish” for not being about to pull myself out of it and face reality, and not “grown up” because I could not support myself, all served to make me hesitate before seeking help, and were obstacles I had to overcome through therapy and the stories of friends and family.

People who are depressed are not “wallowing.” And expectation of happiness in life is not “immoral.”

Posted by: Elisabeth S. at July 1, 2009 02:23 PM

Sorry - I also wanted to mention:

I notice Merkin mentions several times how depression creeps up on one. Because, in my therapy, I have focused so much on changing my thinking and realistically planning for challenges, I have also increased my awareness of signs that I am depressed or on my way. As a result, my family regularly asks me how I am eating (when I am depressed I don't, and when I am spiraling down I eat store-bought comfort food irregularly) and sleeping (when depressed I sleep a LOT - late wake-up times and naps - when spiraling I stay up very late). Awareness of these behavioural changes allows me to be more objectively aware of depression "sneaking up on me." I know it does that, but I believe that through self-awareness we can be more vigilant for the warning signs.

Posted by: Elisabeth S. at July 1, 2009 02:48 PM

Elisabeth S.

Thanks for posting your story!

"I believe that it is human connection that really gets us to believe in the world again".

I agree.

Posted by: Damaged at July 2, 2009 09:43 AM