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Depression Is No Joke

Pushing back against the fools who don't have the faintest notion of what real depression is.

by
Charlie Martin

Bio

August 17, 2014 - 10:48 pm
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It starts, often, like a case of the flu. Tired. Body aches, headaches, back pain. Nothing actually tastes good. It’s hard to concentrate. You’ve got no appetite, or you only want sweets or chocolate.

No matter how long you sleep, you never feel rested, and it’s harder and harder to get out of bed. Perversely, you may also have trouble getting to sleep, and you may find yourself waking in the middle of the night, unable to get back to sleep. Your digestion is often disturbed — queasiness, constipation, diarrhea, or, thrillingly, alternating constipation and diarrhea.

Then it gets worse. There’s a pain in your chest, an ache that feels like your heart has been cut out with a rusty number 11 tomato can. Your muddy thinking starts to get a little obsessive: you remember every bad breakup — and blame yourself. You remember every time you did something dumb or hurt someone’s feelings, and the shame is as fresh as if it just happened. And — especially the first time it happens — you begin to think it will never improve, you’ll never be better, that the obsessive thoughts that you’re worthless and a burden to everyone are true.

That’s depression.

I know.

Robin’s Williams’ suicide last week has brought the whole topic of depression to people’s attention again. It was quickly followed by a tremendous outpouring of grief and distress — as well as the usual collection of damn fools who don’t have the faintest notion of what depression, real depression, is.

So, okay, what is it?

First of all, people need to understand depression is something essentially physiological. It’s not just a bad mood, being sad. (Look at that list of symptoms: that’s not just me, that’s been observed medically and is part of the standard diagnostic criteria for depression.) Understanding that there’s a physiological basis for depression has been slow in coming, but the discovery of selective serotonin re-uptake inhibitors (or SSRIs for short) like fluoxetine (Prozac) made it clear that there was a neurological basis. (A good description of the studies that established this can be found in Peter D. Kramer’s Listening to Prozac; an excellent follow-on is Kramer’s Against Depression.)

That doesn’t mean life events can’t precipitate it. It turns out that in rats — and very plausibly, in humans — uncontrollable traumatic events lead to physiological changes that are exactly the ones that SSRI drugs help control.

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Top Rated Comments   
No, I clearly come in at least second.
13 weeks ago
13 weeks ago Link To Comment
I have suffered long-term severe depression, low-grade depression, and suicidal-grade depression. I have put a loaded .40 caliber to my head and saw how far I could pull the trigger without it going off. About half dozen times over a year I pulled it about half-way. I have also come back from those depths.

I have come to believe in a theory that's unprovable and few people will believe. That is, depression is a threefold problem -- it's skills-based, it's cognitive-based, and it's spiritually based. The solution is to attack all three, and it gets very confusing from there.

Skills-based means stuff like -- do you actually have some cash? Long-term poverty is depressing. Do you struggle with relationship problems over and over again? You may need life skills work. Are you surrounded by toxic people? You may need some social skills and to find some other friends.

Cognitive means being able to identify and correct your thought distortions and prevent their recurrence; basically, you suffer properly instead of improperly. I believe the bio-chemical imbalances lie partially in this cognitive realm, btw, which sounds crazy, but I really think it's true.

And then there's the spiritual part. I think you can get to a point where you aren't going to be able to use cognitive-behavioral or life skills quickly enough; it's like your soul (or if you prefer) spirit or psyche has been severely weakened and literally begins to eat itself with negative thoughts and you can't fight them all off. When that happens, I believe you can reach out to God through certain spiritual exercises, who is sort of a super-user and can help re-set you and do so enough that you can start to work on the other two.

I haven't been healed miraculously, but I have found God's help and the other two can really help prevent recurrence.

As for the biological basis, the science is there, but I believe the biological basis can, for reasons that I can't fathom or explain, be affected positively by the other three.

That all said, I would never counsel anyone to stop taking their anti-depressants or to ignore their doctor's recommendations. I am just a guy on the Internet with an opinion.

I don't like anti-depressants, and I have taken Tofranil many years ago and Prozac as well. I found that cognitive/spiritual/skills-based (including financial and social) to work more effectively over the long-term. I found thinking of depression as a biological illness was not helpful to me.

BTW, when it comes to suicide, you always have a choice. Saying you have a choice doesn't minimize the pain in any way, or ignore the biological disease aspect of it, or mean we can't have compassion for those who have done it. It just mean you always have choice not to do yourself in. Suicide is an act. You can always not do it. Repeated suicidal ideation shows a failure of perspective. Get help if you need to. Many people will understand.
13 weeks ago
13 weeks ago Link To Comment
This is absolutely and patently bullsh*t since I'm a believer and often described as "annoyingly pious" by those who know me well.
Also my grandfather's very religious sisters suffered from depression and killed themselves. It might help if you view depression as "a flaw in human nature that keeps us from experiencing the forgiveness and love of G-d." At least it feels like that to the believers.
If you've never experienced it, it's not the force of your belief, but a gift from above. Be grateful.
13 weeks ago
13 weeks ago Link To Comment
All Comments   (157)
All Comments   (157)
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I feel depression is like being on the plane Krypton
13 weeks ago
13 weeks ago Link To Comment
"the dark days from about Thanksgiving to Valentine’s Day really were dark days for me" "Someone in a deep depression has obsessive thoughts that it will never ever get better" <--- fits me to a T at times.

The loss of all hope is the final straw I think. Staring into the black abyss, all the emotions and thoughts wringing in your head turned to 11, fear turned to 12.

I wonder if God ever gets depression?
13 weeks ago
13 weeks ago Link To Comment
Keith, if you haven't gotten treatment for this already, call the number above, look around your local neighborhood, email me at chasrmartin at gmail dot com.
13 weeks ago
13 weeks ago Link To Comment
Thank you Charlie, for caring. Yes, I am under treatment, and also taking melatonin for helping me sleep. Will try the Vitamin D this Fall/Winter, thanks for that tip.
13 weeks ago
13 weeks ago Link To Comment
God's brain is healthy, so no.

But because he's hip to what goes on in everyone's mind, he comprehends the suffering on a molecular level, moment to moment, agony to agony.
13 weeks ago
13 weeks ago Link To Comment
Well, there's the whole made in his image thing, so it was just a whimsical question. Seeing how his creation is turning out, I wouldn't be surprised if He gets down in the dumps every once in a while.
13 weeks ago
13 weeks ago Link To Comment
I'm a great believer in fluoxetine, having used it for many years to keep myself even. Depression and bipolar disease run in my family, and I've experienced great depths, but fluoxetine, exercise and vitamins (particularly D), and having a dog, all not necessarily in that order, have kept me on my game for a long time. People (like Matt Walsh) who dismiss all that have absolutely no understanding of human nature, human physiology, or the nature of despair.
13 weeks ago
13 weeks ago Link To Comment
Glad you've found stuff that works for you.

People don't understand that there are TONS of moods and states of mind that get called "depression."

We're only talking about one kind, here: the kind that comes from neurotransmitter deficiencies. It's not like being in a deep funk or wallowing in self-pity At. All.
13 weeks ago
13 weeks ago Link To Comment
Everybody's dancing around Matt Walsh's concern — Let's not idolize suicides

We're not dancing around it. The concern that we not idealize suicide by saying "Genie, you're free" was the pretext for offering his little "YOU HAVE A CHOICE" pablum.

I retweeted that pic, not because I think suicide is just groovy but because I knew he'd been in awful torment and I was provisionally happy for his release.

My druthers? That he's still alive and doing what he loves.

But I don't have a vote.

Outside of emo teenagers who are enamored of Grand Romantic Gestures, I don't know anyone who romanticizes suicide, least of all the suicidal.

I'm sure most of them would choose coma over death if it were feasible. Anything to make it stop.

I don't know the 'right' way to talk about depression and suicide

Depression: Man, that sounds like a tough row to hoe. I'm sorry you have to go through that.

Suicide: Please don't leave us. Please let us help you find a way to live another day.

See?

Easy-peasy.
13 weeks ago
13 weeks ago Link To Comment
Everybody's dancing around Matt Walsh's concern - which is, let's not idolize suicides. He is afraid if suicide is represented as a merciful release, we will encourage suicides. He has a point. If I were an atheist, I'd be dead long ago. He is also worried about the survivors' guilt. He has a point there, too. I don't know the 'right' way to talk about depression and suicide, but I don't want to encourage anyone to kill themselves and I don't think survivors should beat themselves up too much.
13 weeks ago
13 weeks ago Link To Comment
I'm not sure of the right way to talk about suicide, but I'm pretty sure that not understanding how a person in deep depression might choose suicide is the *wrong* way to talk about it.
13 weeks ago
13 weeks ago Link To Comment
"... depression is something essentially physiological. It’s not just a bad mood ..."

It can start as a bad mood, but then it gets a life of it's own. Even when you have mentally overcome the "trigger" that started it, it doesn't mean you are over it .. far from it. Your body has gone to a "bad place" and the journey back is long and hard.
13 weeks ago
13 weeks ago Link To Comment
Not understanding something like clinical depression doesn't make one a fool, especially when it shares a name with the simple depression that everyone has experienced to some degree. Ignorance requires education. But your vitriol and condescension do nothing to educate, nor do they make people more predisposed to care.
13 weeks ago
13 weeks ago Link To Comment
If you aren't a surgeon but go around with a scalpel, attempting to slice into people, I think you can safely be classified as a fool, and a dangerous one at that.

nor do they make people more predisposed to care

Because people need to be "predisposed" to care about lung cancer, diabetes, compound fractures, 3rd-degree burns, Alzheimer's, and cerebral palsy.

Ignorance requires education [for its remedy]

I know what you meant, but it's also true that to be as ignorant as some people are requires a great deal of formal education.
13 weeks ago
13 weeks ago Link To Comment
Not understanding is one thing.

Standing on your own ignorance while holding forth - worse, saying things that will, frankly, make depressed people more likely to commit suicide if they take you seriously - is something very different.
13 weeks ago
13 weeks ago Link To Comment
I remember from forty years ago the first lecture in medical school on depression. The professor said: "The hallmark of depression is an overblown sense of self-importance.".
13 weeks ago
13 weeks ago Link To Comment
The hallmark of depression (and anxiety) is pain.
13 weeks ago
13 weeks ago Link To Comment
Amazing how medical science has advanced in 40 years.
13 weeks ago
13 weeks ago Link To Comment
Well, you know, Charlie, you could both be right!

Seriously, a perfectly fine and well described article. Best, T
13 weeks ago
13 weeks ago Link To Comment
How ironic I would read this article after being gone the better part of a week.

I came in this afternoon from Houston to celebrate my oldest daughter's 25th birthday, only to discover a childhood friend, a dentist, had hanged himself.

And all I can think of is the children and wife he left wondering and hurting, who will never be the same.
13 weeks ago
13 weeks ago Link To Comment
I read somewhere that dentists have one of the highest rates of suicide (along with psychiatrists) of any of the professions (maybe because nobody is ever happy to see them)...

Sorry about your friend.
13 weeks ago
13 weeks ago Link To Comment
Damn shame. Your point illustrates as well as anything the abject hopelessness
that covers some like a wet blanket. I don't want to imagine, ever, what my life would be if I were unable to factor my family in...which tells you exactly what a horrific state this guy was in. He lost all reason to live.
13 weeks ago
13 weeks ago Link To Comment
Depression is not suicide, and suicide is not depression.
To the extent that Williams has been "reviled" by anyone of note, it has been for committing suicide, not for suffering depression.

Depression is a horrible thing, and to some unknown (and possibly unknowable) extent, outside of your control.
Suicide is a horrible thing, and is completely under your control.

Suffering depression does not rob you of agency.
It just feels as though it does.
Yes, I've been there, looked into the abyss, and got the T-shirt. I am responsible for all the harms I did to myself and others while in that state.
13 weeks ago
13 weeks ago Link To Comment
Suffering depression does not rob you of agency.

Actually it can, especially when it's low-phase bipolar, exacerbated by cocaine and alcohol abuse and the early stages of Parkinson's.

If you were able to say no to the suicide monster, it's because you still were healthy enough to say no.

Williams suffered decades of highs, lows, and God knows what else. He hung on as long as he could.

Like someone grasping a rod over an abyss, you hang onto it for dear life until your fingers weaken and you fall. He'd been getting help, doing rehab, the whole nine yards.

He just wore out and could no longer fight the compulsion to kill himself.
13 weeks ago
13 weeks ago Link To Comment
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