letter to a friend, on depression

8/30/2011

I can’t believe you just wrote to me about how much you’re hurting because, seriously, I JUST got back from seeing a psychiatrist. I mean, I literally left the office, drove home, walked through the door and read this email. It was the first time I’ve seen a psychiatrist: I’ve seen psychologists and family doctors who have prescribed my anti-depressants (Cymbalta) and Xanax (for anxiety), but I finally went to a psychiatrist. I am going through depression again since we moved here and it’s become all I can do to pick the boys up from school without crying and running into a bathroom stall. (I cry ALL THE TIME when I’m depressed, something I haven’t heard a lot of people say; some people have a total lack of emotions.)

Anyway, yes, it sounds like you are suffering and I identify with everything you’ve written here. It’s true that people think of depression not being real or the “real you,” but when you are going through it, it does feel very real: perhaps more real than anything else ever has. I think it’s true that you can’t trust the fear you have that you will always feel like this, or that your personality is permanently altered, but one of the kindest, truest things you can do is allow yourself to believe what you are feeling is real. And, it’s sad. But it will be OK and you won’t always feel this way. I don’t blame Chris for this, because god knows it’s hard on him too, living with my spells of depression after 7 years together, but he changes the way he acts around me and treats me during my bad spells, because he tells himself, “it’s not her; it’s just depression.” I understand this, intellectually, when I’m not depressed, but when I am, it’s just devastating, because it feels like my depression is me; if a person loves me, they also need to “love” my depression. That’s how real it feels.

OK, so the other thing is sleep. You have to get sleep. I also have excruciating insomnia and I HATE taking anything for it, but the less sleep you get, the more you will believe you may be going crazy and then you understand why people welcome suicide. Remember, sleep deprivation is a form of torture. If you are enduring tortuous levels of insomnia on top of depression, you know that will make things so much worse. So, what do you do? I’m not sure about the meds; this is why I went to a psychiatrist myself. I can tell you what is going on with me and maybe it can give you ideas. My psychologist in Lawrence recommended Lexapro back when the boys were 18 months old. I took that recommendation to a family doctor who said, based on my high-anxiety symptoms accompanying depression, Cymbalta might be a better choice. (Lexapro inhibits the natural re-uptake of serotonin; Cymbalta does this, plus another neurotransmitter, norepinephrine.) He seemed to be right; 60 mg of Cymbalta a day worked, and even helped me sleep. I know people say it takes 1-4 weeks to get benefits, but I swear I started getting better in the first 72 hours. The psychiatrist I just saw confirmed that this is possible, but it also means I have tendencies towards being bipolor, which makes me especially sensitive to medications. Anyway, yes, I agree that the time you are supposed to wait for the meds to start working is infuriating, especially when you’re suffering from the side affects.

Anyway, the Cymbalta worked like a charm for two years, until I got off of it to have Sola. I was fine without anything for another two years, until last fall. This impending move, teaching, and writing all sort of pushed me over the edge into another depression, this time with insomnia that kept me awake for 3 days at a time. I got back at Cymbalta on a lower dosage (20mg) because it’s so physically uncomfortable getting used to it. But my anxiety was still keeping me awake at night, so I started taking a Xanax to sleep. (I tried Ambien for one night and hated how it made me feel; when one didn’t work, I took another and was so out of it that in the morning, Sola had fallen off the bed and was crying and I didn’t even react. That was a horrible morning…)

The psychiatrist I just saw increased my dosage of Cymbalta and changed the Xanax to Klonipin, a less severe anti-anxiety medicine that isn’t addictive. So, that’s what I’m doing now, medicine-wise. He says if these things don’t help, he may give me a mood-stabilizer, which sounds totally scary.

I should add, this is all happening to a person who truly believes in the mind-body connection and thinks wellness should be addressed primarily through diet, exercise, body work, meditation, etc… But I also think you gotta do what you gotta do. When you are at your worst, you are desperate for a reason.

It’s true that I feel I learned something after hurting so much last fall and after coming out of it. The scariest thing is the “sea-change” you referred to, and the feeling that it is Real and Permanent. It’s definitely not permanent, and it is “real” only in the sense that everything is real; that’s to say, for that moment it is, and then the moment is gone.

The only way this is going to change you is that you will be stronger for it—at the risk of sounding cliche, I’ll even say you will be a better writer, mother, person. I just wondered last night if everyone is capable of feeling the same depths of sadness I feel sometimes. It just doesn’t seem like it. And I don’t mean to say that I’m “better” because of it, or somehow more special or creative, but I just hope there is a richness in life I’m able to reach that isn’t common. I guess that’s a way of hoping for a reason.

I don’t consider myself a particularly intellectual person, especially scientifically, but one thing that helped me once I accepted that I suffered from depression was understanding more about it. It seemed like a cognitive thing my mind could hold onto. One book that helped was Understanding Depression by J. Raymond DePaulo and another is a touchstone for cognitive therapy: Feeling Good by David Burns.  The latter has a list of cognitive distortions that I find myself struggling with. I see them happening in you: especially trying to come up with a list of what else you could do if you can never write again. I almost sent you my own list last time I wrote you. 🙂

I think it makes sense that this has happened after you worked so intensely on a project that you loved and felt obsessed with. Be kind to yourself: how in the world could you anticipate exactly how long a “break” you would need and what it would look like? Besides, as soon as you became a mother, “breaks” as you used to understand them became things of the past.

All of the good will come back. I promise. It just will. But for now, treat yourself like you would if you had a serious physical illness. Mother yourself. If it hurts to be around friends, don’t be around them unless you feel comfortable enough to hurt and be a “changed” person with them. If you feel like you can’t be the person you want to be with your children, arrange for them to be with other people who love them. You have to let yourself heal in whatever ways you need to. If anyone you are with doesn’t understand this, you have to get away from them. (That being said, be careful not to completely isolate yourself. I have a bad habit of doing this even with people who love me unconditionally.)

Okay, I need to go get the boys from school now. I hope all this rambling helped. If you have more specific questions or thoughts on anything I touched on here, let me know. You are going to be better and then you might not even recognize the person you are now, even though she is just as lovely and lovable.

-mp

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11 thoughts on “letter to a friend, on depression

  1. I don’t know you, Maria, but I so appreciate your beautiful and raw honesty about depression. I myself have not suffered from this, but as a psychiatric nurse (soon-to-be nurse practitioner) I work with this deep suffering daily. I would love to gain your permission to share these words of hope with patients of mine who may need it. Again, thank you. It is unfortunate that mental health issues such as depression are vastly common and yet so hidden. We need more people like you to gracefully bring them to the light.

  2. And I appreciate your appreciation, Monique. I would love for you to pass this along. My hope is that talking so candidly about my experience might help even one person who identifies to not feel so alone. Depression tells cruel lies: “You are alone and no one understands” is one of them. -mp

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