Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. – World Health Organization definition of health
I am writing right now about something that is very important to me, and it’s going to be a very long message. It’s so important to me because it has been a constant confounding variable in my life through which I’ve had to fight. I know many people have written about depression (and I know you’ve probably read about it as well), and although in modern times it doesn’t carry the stigmatization it once did, a diagnosis of Major Depressive Disorder still holds its reign of shame over many people like a dirty little secret. That’s why I’ve decided to add my one small voice to the many others who have already spoken about this issue. I have done a lot of research into depression in my quest to understand and help myself, and while I do not consider myself an authority on the topic by any means, I do at least have a firsthand and informed point of view.
Some people may insist that depression is no longer stigmatized, what with the prevalence of antidepressant prescriptions in the medical industry and the increasing availability and mainstream acceptance of therapy. Hopefully for most people this holds true and they are able to find unwavering support as they heal their illness. Unfortunately for me, this wasn’t exactly how it panned out. One of the things I faced when seeking help for depression were the stigmas, and unfortunately, they came from my family. Depression derailed me, but the stigmas and judgments stood themselves directly in front of me afterward, blocking me from seeing the way back to the tracks. I was exposed first hand to the devastating effects stigmas can have on those with mental illness. They impede progress. They accomplish nothing, except shaming people who already feel enough shame.
I want to address these stigmas, both with factual information, as well as trying to explain, as eloquently as possible, the way an episode of depression “feels” to the depressed individual.
Transient Depression vs Major Depressive Disorder
I want to start off with a differentiation between feeling depressed in a situation, and Major Depressive Disorder. The term “depression”, although often used as a short form for Major Depressive Disorder, simply means “low mood”. Situational depression is normal if it occurs after a traumatic life event: job loss, the death of a family member, etc. It is normal to feel grief and sadness after a traumatic or stressful thing happens. The problem is when it does not go away or get better with time. Then it may be indicative of “Major Depressive Disorder”: pervasive, persistent, disabling, effects all aspects of life, and accompanied by physical ailments. It also may or may not have been precipitated by stressful life circumstances.
The Stigmas and Myths vs The Facts
I think most, if not all of the stigmas regarding depression stem from one main faulty idea: that depression is not a real illness. Depression is generally not viewed in the same way as other illnesses which have a more viscerally visible affect on the body. I think one of the factors contributing to this idea is that the main physical problem that the disease is often attributed to – low serotonin levels in the brain – cannot be physically tested until a person is deceased. There is no test for brain levels of serotonin on a live person (blood levels of serotonin can be tested, but that is not necessarily representative of what is going on inside the brain), so doctors have to rely on an accumulation of information regarding both physical and patient reported symptoms.
Let’s Get Physical – What Evidence Shows that Depression is a Physical Illness?
I’m going to keep it fairly basic here, because books can be written on the subject. If you decide you want to research further into the science behind depression, there is an abundance of literature on the topic!
So let’s start with serotonin. If you’ve never heard of serotonin, or have but are not sure what it does, here is a little background information. Serotonin is a neurotransmitter found primarily in the digestive tract and the central nervous system. There are several different kinds of neurotransmitters, and in simple terms they are chemicals in your brain that relay messages back and forth. They are also located throughout the body. They play a part in regulating many different functions, from physical arousal and nausea to mood, cognition and memory. Serotonin specifically works in helping to regulate mood, appetite, sleep, gut movement, memory, learning, and body temperature. Depression occurs when there is a problem with this system of serotonin; specifically, it is low.
Another physical problem observed in those with depression is the continued and sustained release of cortisol, the “stress hormone”. Cortisol is what is secreted in your body during stressful situations, causing the “fight-or-flight” response. A constant production of this hormone over time causes significant damage: it lowers immunity, decreases bone mass, suppresses the thyroid, causes high blood pressure, contributes to blood sugar imbalances, and even increases the chances of heart attacks and strokes. (This is why doctors are always on our cases to de-stress!) For more information, here is a link to a study regarding depression and increased cortisol: http://www.pnas.org/content/97/1/325.full.pdf
These two physical abnormalities therefore have the power to not only cause depression, but wreak havoc on the body. For me, a depressive episode comes along with the following: a digestive system that seems to be going insane; random aches and pains; insomnia; cognitive disturbances such as needing to read a simple sentence over and over, forgetting what I’m saying/doing in the middle of saying/doing it, and calling things by the wrong names; extreme fatigue; being cold all the time; catching viruses and getting infections much more frequently; common illnesses turning into more serious ones (a simple sinus infection turns into pneumonia because my body can’t fight it); and sudden drastic changes in appetite and/or weight (stop feeling hungry all together, or feel hungry all the time no matter how much I eat). I experience very little to none of these physical problems when my depression is resolved.
As further proof that depression is a physical illness, I point you to these studies regarding brain abnormalities in depression, shown on MRIs:
Brain imaging shows brain changes in depression http://psychcentral.com/news/2010/09/02/brain-imaging-shows-brain-changes-in-depression/17541.html
Neuroimaging shows prolonged stress causes morphological abnormalities in the brain, such as reduced hippocampal volumes observed in individuals with depression http://archpsyc.jamanetwork.com/article.aspx?articleid=482848.
And this study, which should urge anyone with depression to seek help if they’ve been hesitant: Depression and anxiety disorders damage your brain, especially when untreated http://www.psychologytoday.com/blog/heal-your-brain/201107/depression-and-anxiety-disorders-damage-your-brain-especially-when-untre
As for the question of how a traumatic event can cause an illness in an individual who once was healthy? The explanation is that one or several traumatic events actually have the power to physically change the brain. Here is one example regarding the damaging effects abuse has on brain development: http://www.psychologytoday.com/blog/you-illuminated/201210/the-damaging-impact-abuse-brain-development
The Discoloured World
“It was not really alarming at first, since the change was subtle, but I did notice that my surroundings took on a different tone at certain times: the shadows of nightfall seemed more somber, my mornings were less buoyant, walks in the woods became less zestful, and there was a moment during my working hours in the late afternoon when a kind of panic and anxiety overtook me…” – William Styron, Darkness Visible (Source=http://www.wingofmadness.com/what-does-depression-feel-like/)
Now you know some of the facts, so I’ll try my best to talk about how it feels. I can only explain how depression has manifested in my mind and what my own perceptions were like. Although most people fall along a spectrum of symptoms, just like everything else in life everybody is a little bit different. Mine was nudged along by a sustained trauma, but even if a person had no specific event precipitating the onset of depression, that doesn’t change how real the depression is.
Trying to explain what depression feels like is difficult. It may be hard for a non-depressed person to understand, because a depressed person’s very perceptions change.
This is what it’s like for me: (Warning – possible triggers if you are depressed)
Colours take on a different quality, almost like they lose some saturation. The world seems strange like I’m not seeing everything right, although it’s hard to place how it’s different. It’s almost like I’m intoxicated by some really, really not-fun drug. I seem to literally forget what I found fun about things I used to enjoy passionately. It’s hard to focus my eyes. It’s hard to keep track of conversations. All of my senses go into overload: sounds are all too loud, lights too bright, touch feels uncomfortable. There is a constant feeling of something that is like dread or grief. There’s nowhere to place it, no logical, rational reason for it… it’s just there. It’s an unshakable, ominous feeling. Everything suddenly takes 100x the effort. Walking to the corner store is like walking 20 miles wearing a suit of sand. (This is where some people like to say depressed people are just inherently “lazy” – except when I’m not depressed I kick ass at being productive and even feel good doing it, so there goes that theory).
Everything, no matter if I used to love and enjoy it, no matter how happy it once made me, seems scary and awful. I have trouble remembering happy memories even though logically I know they exist. It’s like I can only feel this one foreboding irritating emotion no matter what happens around me, and that’s it.
I don’t look forward to anything. I have to actively look for the humour in situations that normally I’d find funny, but now just sort of make me sad, or irritable, or feel nothing at all. I am ashamed about feeling this way. If I let go of depression long enough it starts to become unbearable. I keep asking myself “WHY ARE YOU SAD (afraid/lonely)?” and I can’t answer the question. Nothing bad is happening or going to happen, yet there’s a feeling in my stomach akin to that of someone about to make a big presentation, except they’re terrified of public speaking.
I could tell myself I have no reason to feel this way, intuitively know I have no reason to feel this way, yell at myself and tell myself to stop feeling this way…but still, I feel this way. I could try to rationalize with my brain and assure it that really, everything is okay…. but it’s like my brain’s on to me and instead it says “lol no it’s not”.
This is the hardest part to explain. So many people just want you to cheer up, think happy and snap out of it. But many depressed people actually can’t do this. At least not without help. This is the analogy I’ve come up with, although it isn’t perfect, it’s as close as I can think of:
I’m sure at some point you’ve been sleep deprived for a couple days in a row. You were pulling all nighters studying for school, or your baby kept you up, or you just couldn’t sleep for one reason or another. Then you had to do something (go to work, write a test, anything) when all you wanted to do was sleep. It’s not easy, is it? Sure you can get through it and keep yourself awake, you can drink coffee, slap yourself in the face, etc… but you can’t, through sheer will, convince yourself that you are not tired and don’t need sleep. Especially after a prolonged period. A few consecutive days without sleep and soon you will have more than a little trouble staying awake. Your perceptions will start to feel a little off. Everything around you might start to get a bit fuzzy. You might start misplacing things or losing your place in conversations. You might feel sort of nausous or clammy. You may even start to feel dissociated from reality. You can’t just “get over” your exhaustion and will your way out of it.
This is the best way I can try to describe depression. Eventually, it starts to take over your perceptions and your body, and no amount of willing it to go away is going to be effective. Let it go untreated for long enough, and it will take the person into very dark places.
Recently, I made the big decision to go back onto antidepressants. If you’ve read my previous entries about SSRIs, you saw that I tapered off of them. Unfortunately, I had a remission. I gave it several months, but it was only getting worse over time. Clearly, something about my serotonin production just isn’t jiving in there. My stubbornness to rid my body of medication just isn’t worth giving up my happiness, my passions, or my sense of self (or my previously very happy relationship which was being put under a lot of strain).
A big hurtle I had to cross in deciding to go back on them was my own stigma. Admitting that I need them to function, maybe for the rest of my life, seemed like admitting defeat to me… like admitting I’m weak.
Then I thought of it this way: when I had a heart defect, I didn’t think twice about going in for surgery to correct it. I didn’t feel weak for having that illness and needing the surgery. It wasn’t my fault, it was just something that needed fixing so I could be healthy. Depression is the same way.
I hope this has helped debunk some myths even a little. A depressed person is not such by choice or weakness, and they can’t just snap out of it. If you are depressed, you can’t just “be stronger”, as I thought I needed to be. Trust me. I’ve dealt with quite a few blows in life and none of them required as much strength as just existing through depression did. Deaths of loved ones didn’t even make it so hard to get through the day. At least then, a friend could cheer me up, or a hug from a loved one could provide comfort. Depression says nothing about a person’s strength, or drive, or intelligence. In fact, it says nothing about that person at all, except that for some reason they’re sick. It’s an illness, and an illness only.
End Note: There is always hope for a depressed person. If you are depressed, seek help. You don’t have to tell anyone if you don’t want to, but never feel shame in yourself for it either. Once you start to recover, you will not regret it.
P.S. This is a fantastic blog that states everything so perfectly, while being funny and including cute drawings: http://hyperboleandahalf.blogspot.ca/2013/05/depression-part-two.html