Today's post comes from abby jean who blogs at think on this. She recently wrote a series on her experiences with, and knowledge of mental health.

eta: this post was previously titled depression 101, which incorrectly suggested that it was an authoritative or comprehensive discussion of the topic. it is not. it is a pile of information colored significantly by my own experiences and perspectives.thanks to those who raised this with me.

depression is what i have the most experience with - with myself, my friends, my family, my clients. prevalence numbers for depression (and any mental health condition) are notoriously difficult, as lots of people are never diagnosed or treated so aren’t captured by statistics. but the feds currently estimate (pdf) around 8% of adults have had an incident of major depression in the past year, with higher rates of incidence and lower rates of treatment among low-income folks and immigrants.

depression is commonly used to mean a sad mood and is often used in common parlance. “the media coverage of the town halls is totally depressing.” “i’m so depressed about that huge stain on my favorite shirt.” but the clinical definition of depression, from the Diagnostic and Statistical Manual 4th edition (i’m putting aside issues with the DSM for another time) is very specific:

Five or more of the following symptoms present during the same 2-week period and represent a change from previous functioning - one of the first two symptoms required to be present:

  • depressed mood most of the day, nearly every day, as indicated by either subjective report (ie feel sad or empty) or observations from others (ie appears tearful)
  • markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • significant weight loss or gain (change of over 5%) without dieting, or decrease in appetitie nearly every day
  • insomnia or hypersomnia nearly every day
  • psychomotor agitation or retardation nearly every day, observable by others
  • fatigue or loss of energy nearly every day
  • feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • diminished ability to think or concentrate, nearly every day
  • recurrent thought of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for suicide.
these symptoms must cause significant impairment in social, occupational, or other areas of functioning. (in other words, if you’re still fine at work, maintaining your social relationships, etc, you’re not clinically depressed even if you have these symptoms.) the symptoms must also not be associated with an objectively destabilizing event, such as loss of a loved one.

quick neurochemistry refresher: the brain works by passing signals between neurons. one neuron releases neurochemicals which then activate another neuron to act. the neurochemical serotonin is understood to be affected by depression, and it controls the feeling of “satiation,” of having had enough, which is why eating and sleeping are affected by depression.

when i experienced major depression, i had a whole bunch of those symptoms. more than sad, i felt “flat affect” — like i was wrapped in cotton wool or a thick layer of fog and nothing could penetrate that to affect me. so i didn’t feel especially happy or sad, i felt like i was incapable of feeling anything at all. i also lost interest in doing anything at all except lying in my bed. this included going to class, talking to people, taking a shower, and eating. my friends would try to get me out and about, but nothing sounded even vaguely interesting - since i would feel flat and empty whatever i did, i might as well just stay in bed.

i also felt completely hopeless that things would ever change and didn’t just believe, i knew that i would continue to feel that way forever. so what was the point of doing anything? no need to make sure i wasn’t failing a class, because who cared if i graduated or not? wouldn’t make any difference. nothing would ever make any difference.

so, i might as well die. no sense in prolonging my useless pointless life of doing nothing and feeling nothing - i was burdening my friends, annoying my roommate, letting down my parents, disappointing my professors. and since things would never, ever, get any better, it’d be best to just let everyone off the hook and get out of their way. nobody would miss me because who cares about a smelly lump girl who just stays in bed?

somewhere deep inside i could still hear a part of me that was a bit freaked out by the thought of dying. i got a card from my mom and pictured her face when being told i had killed myself and realized she probably wouldn’t be happy to be rid of me. but these voices were so small and so soft and i could barely hear them through the chorus of “you’re stupid and a waste and a burden and will be forever” that pounded through my head every second of the day.

the practical effects: i could not carry out tasks that were painfully simple. i remember a day i skipped all my classes because the idea of opening my closet and trying to figure out what to wear was too overwhelming. i got derailed very easily and had a hard time following through if there was even the slightest barrier. (i made myself walk over to student health to try to see a counselor, the woman wasn’t at the desk, i gave up and went home and it took two or three weeks before i could try again.) by far the easiest option for taking care of anything that came up was just to kill myself so i wouldn’t be bothered by anything.

clearly, i didn’t do that, although i have made a number of serious attempts. i have had friends so unable to find any relief that they tried and tried until they were successful in dying. my treatment (medication combined with literally thousands of hours of therapy) has been successful to the point where i have hope for the future and think life is worth living. but i can feel the fog come back sometimes and if it comes back strong, i know that overwhelming agony will shut out all hope and optimism and i’ll be right back where i was.

the knowledge that that possibility is always there is terrifying - i could be knocked down by a recurrence at any moment. i’m always vigilant - is this negative mood because of a reasonable reaction to an event? is it free floating? how serious is it? is this the time it will overtake me for good?

(Originally posted here.)


At Mon Oct 05, 06:29:00 PM niemaodpowiedzi said...

Great post. It resonated pretty personally with my unmedicated, self-diagnosed depression.

i remember a day i skipped all my classes because the idea of opening my closet and trying to figure out what to wear was too overwhelming.

I have those days. Oh, sweet FSM, I have those days. But the blankets are comfy! I rationalize to myself. Won't I be happier in bed today? Won't have to deal with listening to people, won't have to deal with maybe crying in front of them for asinine things like the hiccups. Yeah,
and I'd have to get dressed. That settles it then. Bed.

but these voices were so small and so soft and i could barely hear them through the chorus of “you’re stupid and a waste and a burden and will be forever” that pounded through my head every second of the day.

That overwhelming chorus drowns out the little, positive voices so thoroughly that when I can hear them, all I hear is such a contradiction of my understanding of myself that I can't believe much of anything good about who I am. And in the process, I tend to push those who would challenge my poor sense of self-worth away. So the cycle - the self-hating, bitterly negative cycle - continues until enough people challenge me, and then I change by margins.


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