Saturday, August 14, 2010

Oh, yeah. Depression.

I was talking to someone this week about my worries about Bob's health, my health, my upcoming trip and my fears about life in general. She asked me how long I have been depressed. I was surprised by this. I didn't realize I was depressed. But as I turned it over in my mind over the following 24 hours, I had to admit that what I've been feeling lately is familiar from the time(s) in my life when I was depressed: the inability to sleep, the default bad mood, the lack of pleasure in things that used to cheer me up, the heightened level of anxiety and certainty that things are about to go wrong, the feeling that there's nothing to look forward to. This last one is particularly striking to me because my favorite time of year is coming up: cold. One of the reasons I moved to Chicago was for the cold weather and I anticipate it every year, especially the protracted Christmas season that the U.S. now begins October. I love all that and the end of August signals that it is close. Yet I slump around.

It's interesting for me to think about being depressed. While it's possible to feel depressed for a day or a week as a response to a specific stressor, the state of depression is a psychiatric diagnosis. I thought I was feeling exhausted and drained by the ordeal of Bob's hip replacement surgery and being his only hospital advocate and caretaker. But it's been a couple of weeks now and he's doing great, so if my mood continues to drag, I guess there is another reason. Certainly having a husband who's pulling through so well (he's now walking without a cane!) plus having a fantastic trip to Peru with my seasoned traveler father coming up on August 28th should have me walking with a bounce in my step. Life is good, things are going well at my job, I have excellent friends and my family is still sending supportive cards as they monitor Bob's healing from long distance.

But even without an official medical diagnosis from a psychiatrist, I suspect this is correct: I'm depressed. Not severely, but enough to interrupt my daily habits, make me worry even more and sap my enjoyment of life. Knowing this has given me more patience and perspective. Having been through depression a couple of times, I have a better grasp of the difference between reality and what's in my head. Now when I feel annoyed with someone or impatient with a situation, I can remind myself that this is just my interpretation of events which is currently darkened by the chemical imbalance that causes clinical depression. Imagining coming out on the other side of this period of depression is what gives me hope that life won't always feel this way.

But I feel bad about my husband. The last time I went through a depression, I lived alone. If I dragged myself through my days just to slump listlessly in front of the TV all evening and then toss and turn all night, I was the only one who had to put up with me. There were weekends when I spoke to no one and knew it was for the best. The stream of insults and cuss words that I had for the world should not have been spoken out loud and as long as I had no interactions with people, there was no fear they would be.

I console myself that the way I feel now is nowhere near how I felt then. Back then, I envied people whose obituaries showed up in the news, felt scared all the time and wondered if my life was worth anything at all. None of that is true now. This is a milder depression and now that someone whose opinion I trust has pointed it out to me, I will work to put it behind me. Still, Bob will have to live with me until then. Sadly, he's housebound and this means that the only person he sees each day is his depressed little wife. I'm making an effort to stay aware of his feelings so he doesn't think I'm upset with him. I don't want to be the woman in the depression medication commercial who sits despondently in the blue light of the TV while her family peers at her anxiously.

Years ago, at the same time that a psychiatrist diagnosed me with clinical depression, a therapist also identified me as a depressive. That felt right. I don't have a problem thinking of myself as someone with mental illness. We all have our health challenges that are influenced by both genetics and environment. We inherit certain tendencies towards diabetes or obesity or arthritis or mental illness and a tendency toward depression is a part of who I am. My challenge is to manage it, stay on top of it and not let it take over as it has before.

At what point does my usual pessimism about life slide into depression? I don't know. I always believe that life sucks more often that it doesn't and remain unconvinced that life is better than the alternative, but I'm not always depressed. Those are just part of my usual personality and I can be very cheerful and fun in spite of my belief that we're all screwed. But under prolonged stress, the darkness takes over and I lose sight of what's good about each individual day. I withdraw and snap at people and feel like crying too much of the time. Guilt becomes a constant and I start wishing someone would punish me. I should have known I was depressed, but it's hard to see from the inside. Each time I've dealt with it, someone else has had to identify it for me.

There are people who don't believe in depression. They think it's a pharmaceutically-supported, made-up diagnosis for people who are too lazy to take responsibility for ourselves. They see the prolonged incapacity caused by depression as the self-indulgence of people who refuse to engage with our lives. They think someone like me should snap out of it, get a hold of myself, put mind over matter and stop acting this way. They think it's a choice and my problem is all in my head.

I agree with them: the problem is all in my head. That's exactly where it is. We're all born with a certain capacity to produce and keep in balance the brain chemistry required for regular functions. Some of us don't have adequate production of the hormones and the receptors that would keep our moods in the same balance as most others. Our brains need a little help.

Here are the things that help my brain regain its chemical balance so I don't feel depressed:

1. Physical exercise.
2. Sweets.
3. Medication.
4. Falling in love.

I exercise regularly, but it's not quite enough to get me back in balance if I'm dealing with a great deal of stress. Sweets aren't practical over the long term because they do their own damage. The early falling in love crush feeling is also hard to sustain. That leaves meds.

One thing that drives me crazy is the belief that there's something wrong with being on medication for mental illness. I think this is often held by the same people who think there's no such thing as mental illness because we should just snap out of it. But it's also held by people who think mental illness is shameful, which includes many of us who live with it. We want a cure for our disorder. We want to put the diagnosis behind us and never identify with it again.

This is very sad. We should not feel ashamed of something we have no control over. Here are some things people should never feel ashamed about:

Skin color
Sexual orientation
Inherited conditions such as diabetes, anemia, chronic illnesses
Mental illness

Granted, we aren't always born with mental illness the way we are born a girl or a Mexican. I believe my depressive tendency is the result of a combination of genetics and the life circumstances that have manifested depression, more than once. Given the right circumstances of family, environment, culture, etc. maybe I could have lived my whole life without ever becoming depressed, but I don't live in such a fantasy.

I will grapple with my brain chemistry and my gloomy tendencies once again and probably not for the last time. Maybe I'll go back on the meds, maybe I'll try some new treatments. I will do this with a particular focus on being gentle with my husband, who has done nothing to deserve being married to a women who's in a long bad mood. In the meantime, I'm grateful for the insight that allowed me to see that my familiar challenge is back.


Mick said...

Just because somebody mentions depression doesn't mean you are depressed, it reminds me of the person who reads the medical book and imagines all sorts of conditions.

I don't doubt for one minute you did suffer from depression before but by your own words this is milder. That suggests you are more likely mentally drained probably due to the worry about Bob plus all the running around. Its quite often tougherfor relatives than the person getting the treatment.

You could also be showing signs of anxiety, worried about something else, perhaps the holiday as I believe you are not a big traveller. On that note when did you sneak that in can recall reading about it, Peru will be fun one of my aims is to visit South America sometime, believe it or not I was reading about a holiday to Peru in a magazine sent by one of the holiday companies I use.

Regina said...

Mick, it's okay for me to be depressed. You don't have to try to make it not be true.

A mild depression is still a depression and that's okay. There's nothing to be afraid of, Mick. I appreciate that you are trying to make me feel better, but thinking of myself as depressed does make me feel better. It's like getting a diagnosis for a pain people kept telling you wasn't real. It's not great news to learn that you really have a problem, but it's a relief to finally know what you're dealing with and know there are steps to take that will make you feel better.

Depression is familiar to me, not scary, although I realize that's not true for everyone. I'm okay, thanks.

Regina said...

Mick, also the person who identified me as depressed this week was a licensed therapist.

Monica said...

This is a great post. Glad I came across your blog! I've dealt with very similar situations and now I'm also a newly wed. You really do have to approach those moods completely different when there not only you but a loved one to consider!

Regina said...

Thank you, Monica. I'm learning NOT to take for granted that my husband always wants to hear all the negative stuff going on in my head. Being married doesn't mean I get to endlessly tell him everything that's going on with me. I thought that was what getting married was about, so this an adjustment.