Down

Things have been getting worse with time. Yep.

I stopped taking my medication the last time I got out of the internship (aug 11 ish…?).  I was taking Sertraline 100 mg + Valproic Acid 250 mg at night and Fluoxetine 20 mgs in the mornings to help me stay awake.  At first I stopped because it was pointless to continue, I failed again and nothing was getting better, so why would I keep taking pills that were not working?  In a way I was also trying to bring me to the lowest degree of desperation; I figured that if I was going to fall I’d better fall fast, deep and hopefully, permanently.

Instead I fell rather normally.  I was obviously down and desperate but it felt more circumstantial than depression-related.  It was a tangible problem I could talk about with people:  “Yeah damn, I was taken out of the internship!”/ “That sucks girl!”/ “Yeah, I will have to figure something to do to fix it” / “That’s a thought situation, I hope you get through it!” / “okay thanks.”    As opposed to the usual “you look terrible! why are you down?” / “noidea idontknowwhatswrong dontknowwhattosay whatswrongwithme. know what, get away from me” gibberish.  I suppose that for a while, it felt good to have an actual problem that would justify what I was feeling.

But the mood has been going downhill, lower with every passing day.  I’m not hitting rock bottom yet as my moods are still reactive.  This means I can still be distracted, and if the situation is good enough I’ll even enjoy it very much, but as soon as the good situation passes, I’ll fall down.  In my life in general, it’s been very rare to get caught in a true melancholic depression episode, when nothing causes a reaction on me.  Having Atypical Depression, my moods are relatively reactive.  While in theory this is much better than becoming a total zombie, as the episode gets worse, it demands higher levels of “good stuff” and ultimately you stop looking for it.  Also, it becomes increasingly tiring to see yourself feeling better in response to something while being aware that as soon as that thing is gone, you’ll fall back.  That leads to anxiety when something good is happening, with the urge to cling onto it and not let it go.  However, this clinging rarely works: for instance, If I realize a specific tune is keeping my moods up at any given time, I’ll want to make a “mental bookmark” of it, and be able to go stay in that place whenever I need it.  Sadly, after forcing this over and over it loses its effect.  I get bored of the song and the bookmark stops taking me to the desired place.  With people, it’s usually the opposite; if you force it, they’ll get bored of you.  Knowing this, I can get so terrified, that I’ll let them go before they let me go.

All this predisposes to an extreme fear of psychological pain and is a fertile ground for development of  Avoidant Personality Disorder.  I match all the criteria only while in a depressive episode now as it was sort of permanent while I was a kid.  (Note: children aren’t usually diagnosed with any personality disorders as it is thought that the personality hasn’t been “fixed” until humans are 16 – 18 years of age.  Antisocial personality disorder cannot be diagnosed at all before 18 years of age).

I’m reluctant to think this can become the permanent me.  Personality disorders are the terminal illnesses of psychiatry.  In psych class they always talked of people with these as people with no hope of recovery.  It’s frightening.  But lately it seems harder to remember when it was the last time I was not in an episode.

On the up side, I haven’t been suicidal.  The idea hasn’t been seducing me like it has in the past.

I gotta remind the readers though, that I write these blogs as a way to keep up with my own mind, to monitor my progress (or lack thereof) and of course as a cathartic.  I cannot imagine telling this to a person who is looking at me in the eye, so I go coward and just write it out to no particular human.  I am not looking for advice as this is not one of the “tangible” problems I mention above that you can give advice to.  That said, you’re still welcome to read, and thank you for doing so.

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9 thoughts on “Down

  1. Oh boy! I’ve been involved with a beautiful, amazing, wonderful girl for the past two years who not only has major depressive disorder, she also has a personality disorder called “histrionic” – she’s obsessed with being good looking! (Something I don’t always dislike in her 😛 )

    Let me tell you this – personality disorders are sometimes called disorders because they interfere with a person’s function or they are abberations from society – it’s not an illness per se. My girlfriend can be a bit weird at times, but she’s also amazing the other way around – I say, if you want someone who’s amazing, you’re not going to find him particulary “sane” as well. In that respect, you’re lucky!

    As far as depression is concerned – yes, out of personal experience with my girlfriend and out of a lot of book-wisdom I have on the subject – depression is a chronic, life-long affliction. It is not, however, not manageable. Depressed individuals can have and sometimes more than any other – a meaningful, amazing, and yeah, a HAPPY life. The idea is to know how to handle it, to be able to take it like an adult and not to let the “demons” get to you. Consider it some kind of an annoying devil that’s always after you and you simply have to be smart enough and to know how the little rascal operates. There may be crying and panic attacks, things I’ve witnessed and prevented on my own – but these can be overcome and they ALWAYS, I mean ALWAYS end. The person underneath the depression can be stronger than the affliction.

    Also, at this point I’d like to say that not taking medicine is a horrible idea. Anti-depressants are a wonderful tool to make depression more manageable. They’re not magic cures and sometimes they contain nasty side-effects, at least in the beginning. But this is nothing compared to being a prisoner in your mind. And I’ve seen this happen. Don’t stop taking medicine, and eventually, evolve the medicine you take until you find the right cocktail. When you do (and trust me, I’ve seen ’em all!) – you’ll know it was worth it!

    Good luck, kiddo, sending you the best of wishes –
    An Atheist from Israel (and a fully recovered former PTSD patient)
    Freidenker.

  2. I have a new cocktail of meds now. I have decided to start it again. As frustrating as it is, and as inconvenient the side effects are, I can’t risk falling down again. I could not bounce back.

    Thank you for coming around here. 🙂

  3. The idea is to know how to handle it, to be able to take it like an adult and not to let the “demons” get to you. Consider it some kind of an annoying devil that’s always after you and you simply have to be smart enough and to know how the little rascal operates.

    You claim extensive knowledge on depression, yet betray yourself immediately with the above quote. Your analogy is a failure. You imply that a person unable to manage their depression is child-like. By doing this, you reveal just how little you understand depression.

    It is not a demon. It is not outside of yourself. It contaminates the very faculty necessary to manage it—your mind. It alters and inhibits your ability to reason. Furthermore, anti-depressants do not help everyone. It does not matter how smart you are. You can have an inordinately high IQ and be so overcome by despair that you cannot even rise from bed. Your apathy can be such that you do not care about your condition anymore. You can have dealt with it for so long and been so resistant to treatment that you realize your life will continue in this way barring miraculous advancements in medicine. It is a chemical imbalance that is indifferent to your intelligence, your worth, your strength and anything else. Willpower will not defeat it. You are at the mercy of your own body, and since your mind is housed within your brain and your brain is part of your body . . . you are very fucked, to say the least. Conversely, you can have moderate depression that is very responsive to anti-depressants, you can have little knowledge of your condition, you can be inordinately stupid, and yet you will recover. Moreover, some people are extremely low all of the time. There is never a time when the depression lessens enough for them to operate. No recovery time. Only a perpetual bleeding of physical and mental resources with the only logical and inevitable conclusion being termination.

    Here is a more accurate analogy of depression for you: understanding the intricacies of a tsunami, knowing how fast it approaches, how severely it will damage you, seeing all forms of rescue are unattainable, knowing you are alone and those around you unable to help you (assuming you have anyone around you) . . . will not change the fact that you cannot outrun the tsunami and it will get you. It all comes down to how you embrace your reality from the present until the eventual devastation. It all comes down to how many times you are willing to drown and endure torture, but the most important factor of all is whether or not you have anything worthwhile at the other side of a possible but realistically unlikely good future to live for.

    Before you offer advice and perpetuate the misconception that combating severe depression is a matter of maturity and intelligence, you may want to investigate the person you seek to advice. What you would be wise to do in the interim, is do more research on depression.

    Let me tell you this – personality disorders are sometimes called disorders because they interfere with a person’s function or they are abberations from society – it’s not an illness per se.

    Incorrect. It is an illness. By your flawed logic, a person with manageable diabetes— by means of medication—will have no illness because it no longer interferes with their daily lives. All you need do to observe the irrationality of this, is to remove their medication.

    You need to make a distinction between originality and mental illness. A person can be unique and not have a mental illness whereas another can have an ordinary personality and suffer from a severe mental illness. Do not confuse the behaviour that comes as a result of a mental illness with originality. An ordinary person will act ordinary when their illness is under control whilst an unusual personality, also in a maintenance stage and therefore devoid of the irregularities of their illness, will still be unusual. An individual with mental illness will cease to have one only when there is nothing that requires managing—note this is the natural state of a person without one.

  4. It does not matter how smart you are. You can have an inordinately high IQ and be so overcome by despair that you cannot even rise from bed.

    I was thinking about this in the afternoon too. For years, I gave myself a hard time because I considered myself a smart person, but I still couldn’t rationalise my way out of depression. I was already consumed by intense feelings of worthlessness so it wasn’t hard for my brain to conclude that I just wasn’t smart enough. Maybe I was the kind who just does good in school and really has not much talent for other things, and so on. The intensity of this thought fluctuated depending on my mood obviously.

    I was under the misconception that you could somehow get over it if you were mature or smart enough. I had the information from the books and the articles on one hand, and I had my own feelings of wortlessness on the other. I am supposed to always follow the evidence, and if I was a robot, I would have immediately understood that the biggest chunk of evidence points towards depression being a real illness no different than physical ones that is not respondant to willpower. But in the middle of depression I could not help feeling like a fraud anyway. And what if depression indeed exists but other people have it and I’m just someone who is weak and pathetic?

    I think that’s the sad thing. This is an illness that affects your control tower… Like you said: “you are very fucked”. No better way to say it really.

    Fucking hell.

    That said, I still agree that not having any more options, my best move right now is to keep looking for a better combination of medications. So far they have worked only partially and never for too long. I am off them at the moment.

    Using your analogy, I can see the tsunami slowly coming and I am just not sure that the new model of floaters will be enough. None of them have prevented me from almost drowning. But I’ve decided to give them a try knowing that there’s nothing else to do about it.

    Let me tell you this – personality disorders are sometimes called disorders because they interfere with a person’s function or they are abberations from society – it’s not an illness per se.

    About this part, I think I understand what freidenker means. There is no blood test for mental illness much less for specific personality disorders. The limits are very blurry. The definition according to the American Psychiatric Asociation: “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” can be very misleading, as this could mean, that just because you as a person don’t fullfill specific expectations of the culture that surrounds you, then you have a personality disorder. In this context, I would diagnose myself with one immediately. Psychiatry books aren’t even in consensus. Are personality disorders mental illness or are they only extremes of the bell curve?. The DSM-IV adds a criteria “The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning..

    It is a confusing soup of definitions that could go one way or the other. The person exhibiting personality disorders doesn’t usually perceive their own behaviour as problematic (egosyntonic), with the exception of Avoidant Personality Disorder which is for the most, egodystonic.

    Long story short: Personality disorders are a bitch. I loved studying about them, but they were never clear despite that.

    I can only say, that according to the definitions, having Hystrionic personality disorder IS a problem. It goes beyond a peculiar aspect of a person who just wants to look good. It’s way more complex than that -again according to the current definitions by the respective authorities in the subject- A person with Hystrionic doesn’t only exhibit a certain pattern of behaviour but probably has a background of poor self image and a traumatic experience in the past or present.

    You need to make a distinction between originality and mental illness.

    Sadly, this is something that not even mental health professionals can do precisely given the number of diagnosis they give to people that might only be “original”.

  5. “You claim extensive knowledge on depression, yet betray yourself immediately with the above quote. Your analogy is a failure. You imply that a person unable to manage their depression is child-like. By doing this, you reveal just how little you understand depression.”

    Well, being somewhat of a personal caretaker apart of merely a boyfriend of a girl who’s got major depression, I know a bit on how it works. I don’t claim extensive knowledge of depression, I just claim personal experience with one depressed individual and some book-wisdom on the subject.

    In any case, according to 3 psychologists and two psychiatrists I’ve consulted the topic with – there IS an important personal factor in the ability to manage depression. It’s not just the pills, it’s not just the psychotherapy, it’s got a lot to do with personal will. Hell, I’ve even heard this said by depressed individuals themselves! And not just my girlfriend, at that. I never said, no where no how, that the inabilty to manage a depression is child-like. That’s absurd – being depressed is HARD, and having a mental incapacity is hard, I know that from personal experience. After my mother died abruptly, I had PTSD for almost two years – I had panic attacks which I could not control, and no one could tell me to stop and there was nothing child-like about having them.

    “Furthermore, anti-depressants do not help everyone”

    True. They do, however, according to detailed surveys for the past few decades – help MOST patients. There is, of course, ECT and similar “nuclear bomb” treatments when all else fails. I don’t believe that AD help EVERYONE, but they’re a tried and tested method of helping and alleviating depression. That they’re not panacea should only deter idiots from administrating them.

    “Incorrect. It is an illness. By your flawed logic, a person with manageable diabetes— by means of medication—will have no illness because it no longer interferes with their daily lives. All you need do to observe the irrationality of this, is to remove their medication.”

    Ah, wonderful. This is actually something I quoted from the numerous psychologists I’ve visisted, the numerous psychologists my girlfriend visited, oh, and, well, the APA: “”an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”

    It’s not a disease in the classic meaning of the word. A disease is an incapacity that results of contamination or mutated genetics – it has to do with material alterations of the person’s bodily organs and functions. Since a personality disorder is defined by behavioral patterns – you cannot use the standard definition of disease for it. This is not the same for depression – in depressed patients, there is a genetically (to an extent)-linked proclivity to either not secrete sufficient amounts of Serotonin or Norepinephrine. This is not always the case or it does not define personality disorders.

    In that respect, I’m sorry to say you’re wrong. This does not mean that personality disorders aren’t real problems, of course – but diseases? That’s not clear-cut, at least not yet.

    “You need to make a distinction between originality and mental illness. A person can be unique and not have a mental illness whereas another can have an ordinary personality and suffer from a severe mental illness.”

    I’ve been to enough psych wards to note how the mentally insane behave. They’re original and unique simply because no sane person, which is usually the majority of the population, thinks the same way. That said, originality, although not necessarily a result of mental illness – is correlated with it – simply because of the constraints mental illness imposes on thought patterns.

    “sing your analogy, I can see the tsunami slowly coming and I am just not sure that the new model of floaters will be enough. None of them have prevented me from almost drowning. But I’ve decided to give them a try knowing that there’s nothing else to do about it.”

    Asuka – let me tell you something that might seem trivial, but it’s not: Life is all about struggling – you know you’re doing the right thing when you’re setting yourself to fighting with all you got against your predicament. This is not an act of despair, this is an act of maturity and resilience.

  6. according to 3 psychologists and two psychiatrists I’ve consulted the topic with – there IS an important personal factor in the ability to manage depression. It’s not just the pills, it’s not just the psychotherapy, it’s got a lot to do with personal will.

    Well this is something, but, evidence in big controlled studies > Anecdotal evidence. Me being in the medical field, I have encountered more than one mental health professional who doesn’t have it straight.

    I’ve even heard this said by depressed individuals themselves

    Having depression doesn’t automatically make one an expert in the subject, in the same way having high blood pressure doesn’t mean you know more about it. Your interest in the subject might be higher than the average person and you can read a lot then, but it’s not automatic.

    There’s also the fact that a depressed individual will carry lots of self guilt. Just like I kept blaming my lack of willpower even when I knew it was not about it. Then there’s the “recovery” cases, who claim they were strong and thought good thoughts and suddenly got out of the pit because of it.

    They do, however, according to detailed surveys for the past few decades – help MOST patients.

    This depends on what kind of depression they have, if it is reactive or endogenous, if there’s a clear family history, if there are medical comorbidities, and what the associated vegetative symptoms are (insomnia, lack of appetite), among other. Depression has been as prevalent as 15% in the US at least. Because of definition, it includes anyone presenting the symtoms for over a few weeks. Some patiens with major depression will have epìsodes that last from weeks to months. These are usually highely responsive to treatment, even then the rate of compliance is still very low because of the stigma, side effects, and overal difficulty of having to be under close surveillance.

    About HALF of the patients with major depression willl have another episode. HALF. Some patients don’t respond well at all to the first set of treatment, they either relapse or don’t get better at all. This is chronic depression or treatment-resistant depression and it’s an illness much harder to treat and has a much worse prognosis, with higher risk of suicide and disability. It’s a time race between being too despaired to survive and finding a treatment that works. Compliance is even more compromised in this population due to the high rates of failure and the worsening of the symptoms and requirement of more medication with worse side efect profiles. Even if the right cocktail is found, the treatment might have to go on for life.

    Antidepressants are very far from being a great option. Research on electro therapy like ECT and Vagus Nerve stimulation has proven to be more effective in chronic, but we’re still far.

    Life is all about struggling – you know you’re doing the right thing when you’re setting yourself to fighting with all you got against your predicament. This is not an act of despair, this is an act of maturity and resilience.

    Okay, but I’m not sure I get what you mean. I have never said I want a life with no challenges in it, but there’s a difference between fighthing hard no matter if you win or lose, and the tsunami scenario I talked about.

  7. Nessa wrote:
    I was under the misconception that you could somehow get over it if you were mature or smart enough.

    Understanding is paramount. Even so, it is not enough. If you are severely depressed and resistant to treatment, you can only hope that the next drug you try will tip the scales, allowing time to replenish your resources faster than your condition depletes them. Until medicine advances enough, it will remain a game of chance—or more accurately, Russian Roulette. You do not control your trigger finger or how many bullets are inside. Your condition does. All you can do is understand what is happening and brace yourself however you must for the consequences.

    This is not to undermine the importance of self-reflection, analysis, and the insight gained from such endeavours. It is the only means of control you have. Not control over your condition mind you, but control of your internal conversations so as not to aggravate the problem. In essence, you must consciously train your mind. People can train at this for years and in the end total control is not possible. Imagine asking this of a depressed individual, whose energy stores are already far below the average person’s. Nonetheless, you are still expected to use your stubbornness to repeatedly counteract the misconceptions others would impose on you, and those you would impose on yourself. It never ends.

    Nessa wrote:
    And what if depression indeed exists but other people have it and I’m just someone who is weak and pathetic?

    I know this idea haunts you. Yet, lets entertain the idea to see where it takes us. Even if you were weak and pathetic, those traits are not keeping you depressed. If you found a drug that worked for you, it would only manage your condition. It would not make you strong. In other words, it has no relevance on your depression. This is positive. It means that you need not wait for possible recovery to explore your mind and increase your strength.

    freidenker85 wrote:
    I don’t claim extensive knowledge of depression, I just claim personal experience with one depressed individual and some book-wisdom on the subject.

    You would have us believe your knowledge is superior. You have books and a few mental health care professionals behind you. It is not superior. You only act as if it were. In the end, you do not do Nessa and/or I an injustice. Instead, it is your girlfriend and anyone else you care to bestow your ‘wisdom’ upon.

    freidenker85 wrote:
    It’s not just the pills, it’s not just the psychotherapy, it’s got a lot to do with personal will. Hell, I’ve even heard this said by depressed individuals themselves!

    Most people are misinformed, depressed or not. Worse, they have listened to the misconceptions of those around them, telling them a large aspect of recovery is will power. Their loved ones may mean well, but they only create more issues in the end. Your misconception of will power seems to work on the surface with people who are responsive to treatment. Their responsiveness gives you the impression your theories are correct. They are not. Pitied against individuals who are highly resistant to treatment, it is exposed as a failure. Hopefully, this is a result of misinformation and not a personality issue, as the former is easier to fix.

    Depression is an illness that removes will power. Will power is usually considered synonymous for strength, however, this is incorrect. It is possible for a healthy individual to possess plenty of will power and little strength and/or average pain threshold, whilst a highly depressed individual can have little to no will power left, but be very strong and have an abnormally high pain threshold.

    I can guarantee the average person will not be able to handle the pain of a severely depressed, highly resistant to treatment person for one week. For the latter, torture is their way of life. The human mind eventually gets used to such levels and is able to endure it. This works in your favour if your depression remains the same. In theory, the greater your resistance to pain, the better you are better able to handle your condition. Yet, here is the crutch. With the severe cases, the pain increases as fast as you are able to handle it. The longer you have it, the worse it gets. To observers, such a person appears very weak. They see no change in their behaviour. Inside however, that person has gotten stronger. It is just that their depression has gotten stronger as well.

    Now this theory—unlike yours—can be applied to all cases of depression. It is not about will power then. Like Nessa has said in her latest post, it is a race against time. Mind you, that is in ideal conditions. In ideal conditions, those you love along with health care professionals are very determined to find your temporary ‘fix.’ In reality, these are the people that tend to fuck you over the most, whether they mean to or not.

    freidenker85 wrote:
    I never said, no where no how, that the inabilty to manage a depression is child-like.

    You said, “The idea is to know how to handle it, to be able to take it like an adult and not to let the ‘demons’ get to you.” You use the logical conjunction AND, indicating that knowing how to handle depression is reliant on being an adult AND not letting the ‘demons’ get to you. If you cannot take it like an adult, then the only alternative is to take it like a child, who would either not ‘take it’ or would do so poorly. Furthermore, by stating you should not let the ‘demon’s get to you, you imply the person has a choice on the matter. If the ‘demons’ get them, they were unable to overpower their ‘opponent’ and are therefore weak. In other words, the inability to handle depression can only result from immaturity and personal weakness.

    You have two major problems. One, you make statements without bothering to understand their implications. Two, you believe your experience with PTSD helps you understand depression. It is why you continue with the useless and misleading analogy of demons. Mild depression is very difficult to understand, much less severe depression. Even those who are mildly or moderately depressed do not understand severe depression that has lasted years. Understand where your limitations lie, then listen and learn from those who know better.

    freidenker85 wrote:
    Life is all about struggling – you know you’re doing the right thing when you’re setting yourself to fighting with all you got against your predicament. This is not an act of despair, this is an act of maturity and resilience.

    Everything you say associates managing depression with maturity, and not doing so with the reverse. You take many liberties, freidenker85 and make too many assumptions. Life is not all about struggling. The average person is not always in a constant state of struggle. The life of the average person is mainly smooth, with bumps along the road. The life of a person with severe depression is not the least bit smooth. It is a very bumpy downward spiral. To fight against depression is not right or wrong. It just IS, in the same way that your lungs fight to expand and intake air. To exist with depression is about knowing when to fight and when not to. It is not a demon that you can dodge, kick or deliver any other kind of debilitating blow to. It is a raging current of despair and torture with a constantly increasing threat level. It is neither aware of you nor does it care about you. That Nessa has survived this long is a testament of her resiliency. If she decides to try new medication, it is not a sign of maturity—this is not to say she lacks it, only that it is not a factor here. An immature person is just as able to get medication. Seeking medication is only right if it furthers her priorities. It is important to note, this may not always be the case.

    Nessa wrote:
    This is chronic depression or treatment-resistant depression and it’s an illness much harder to treat and has a much worse prognosis, with higher risk of suicide and disability.

    It is very much like the saying, “Just because I’m paranoid, doesn’t mean no one’s out to get me.” When a person with chronic depression that has spanned years believes it is all pointless, they are not necessary being illogical. The majority will never recover. The rest of their lives—barring miraculous breakthroughs in medicine—will be almost exactly as their current reality, only worse. For some, a torturous existence that spans years is worse than death. Not because they are weak, but because they believe the value of life is directly related to quality of life.

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