The Ugly Truth About Depression
Am I Depressed?
We’ve all seen the commercials for anti-depressants on television. My particular favorite is the one where the woman—it’s always a woman—has a mask with a smile on it in her purse. She pulls out the mask for photos and interactions with friends until she discovers a magic pill that helps her really smile for the first time in years, as if depression were some Rumplestiltskinian shadow that disappears once you’ve said its name.
As someone who struggles with depression, I call b---s---.
Depression treatment is never as simple as it appears in adverts. It’s rarely fixed with the first pill you’re prescribed. And it’s rarely fixed with only one pill. When you do find a medication that works for you, side effects aside, most of the time you don’t see any improvements for nearly two months. What are you supposed to do in the mean time?
What Big Pharm doesn’t say on telly is that there two kinds of depression, and that even if you happen to suffer from a chemical imbalance, medication alone may not be enough to make you better. Where is the advert for people who have been on the right medications, had the breakthroughs with their therapist, made the appropriate changes and progresses in their lives and still struggle with depression?
Don’t get me wrong. I’m happy that the conversation surrounding mental health seems to be more open these days, but when people talk publically about depression, it always seems—at least to me—that they address it as a simple medical problem…like an infection. “I had depression. I used this cream and it cleared up in just three days. Now, I’m right as rain.” Wrong! That’s not how this works.
Deflection Is Normal...For Us
The truth is that the truth is ugly. It’s uncomfortable. It’s overwhelming at times. Even when you do everything right, there will still be days when you just can’t seem to overcome the obstacles. No one wants to be defeatist, but if we’re truly interested in helping people manage their depression, we have to be honest.
My truth is that I don’t know exactly when my depression began. I remember there being times of significant sadness when I was young, but in my mind I had reason to be sad. It wasn’t until much later on that the topic of depression even entered the conversation.
I was in my late twenties when I was first prescribed Prozac (fluoxetine). I had gone to see my doctor because I was beginning to have panic attacks. A car would get too close to me on the highway, and my mind would race and immediately take me to a place where I was envisioning a horrific accident. I couldn’t be in a crowd without feeling like something terrible was about to happen. I couldn’t sleep in the dark. Eventually, I couldn’t sleep at all. For the most part, I was still able to function at work. There at least, I could distract myself. Being alone though, which I was the majority of the time, became a problem. I even began to hallucinate.
I knew that if I was going to have any hope of getting better, I had to be completely honest with my doctor. I wanted help. I just couldn’t admit that things had gotten so far out of control. I made appointment and I told the truth…mostly.
We decided that the root of the problem was my lack of sleep. In addition to 40mg of Prozac which I was to take daily for depression, my doctor wrote a prescription for 2mg of Xanax (alprazolam) which was I supposed to take every night to quiet my brain and help me get a decent night’s rest. It worked maybe a little too well, since I couldn’t sleep without Xanax for the next two years.
If you’ve never been prescribed a benzodiazepine, it’s a scary business. Benzos are powerful suppressors of the central nervous system. They are incredibly effective at treating anxiety, mostly because they essentially block your body’s ability to overreact…to anything. They are highly, highly addictive.
The standard dose for Xanax is 0.25mg once a day as needed. If this dose is ineffective, your care provider can evaluate whether increasing the dose and/or frequency is necessary. My doctor initiated treatment with a dose four times the standard. This was over 10 years ago, and while I don’t think my provider was irresponsible, there was never a conversation about the addictive properties of the medication or how I would eventually titrate down and get to a point where I no longer needed the medicine to sleep.
Unlike Prozac which typically takes an average of six weeks to begin treating depression, Xanax works right away. Eventually, I stopped taking the Prozac because Xanax gave me the relief I thought I needed. I was sleeping better. I was less affected. My symptoms were manageable. Because it had been prescribed with Xanax, Prozac never really got the chance to manage my depression.
Since then, I have been on Cymbalta, Lyrica, Seroquel, Lexapro, B12, St. John’s Wart, and a litany of others I’m sure I’ve forgotten. Not once in 38 years, has a doctor I’ve discussed depression with ever suggested that the problem was not a chemical imbalance that a pill could fix. Not once in 38 years, has a doctor ever suggested that I evaluate my depression by speaking with a psychologist. That’s a problem.
It took the majority of the 10 years I’ve been seeking treatment to discover the balance of pharmacotherapy and psychology that manages my depression and even then, there are still days I don’t want to get out of bed.
I have a good life. I have people who love me. I have friends I see regularly. I have a job I find rewarding. I have the best dog in the entire world. And yet because I have depression, there are still times when all I can focus on is what I don’t have, what I’ve lost, and what could have been if things would have happened they way I imagine I deserve them to have happened.
We need to talk about depression differently. We need to talk about depression honestly. And we need to stop talking about depression as if any one treatment is the answer. It’s been a decade. If a single pill once a day was going to fix this permanently, it would have happened for me by now. I guess the commercial where you still need the mask isn’t as effective though….
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© 2018 Luke Anthony Schulte