Flirting With Depression A record of how I became clinically depressed and how I cured it.
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Note: I am not a doctor and have had no medical training. Nothing I state should be taken as a recommendation. My experiences may have no relevance to anyone else's. I am posting this page only as an isolated example of one case so that others might get an idea of what was involved in this particular case of clinical depression.
While it's true that 40-percent of all men suffering a heart attack end up with some level of clinical depression, it would be simplistic to say that that was the cause of my flirtation with this debilitating condition. The truth is that events had set me up for a fall over the previous year.
It started in summer of 2004 when I discovered I needed surgery to correct a double hernia. To someone who's been in the habit of working out almost every day for several decades the idea of having to spend two months without doing so during convalescence, and the loss of muscle condition resulting from this, was frustrating in the extreme. Four months after the operation, when I was just getting back in shape, I got hit with a second blow: while weight lifting one day I tore a tendon in my left rotator cuff that required surgery to correct. This knocked me out of working out for an additional three months. Then, when I'm almost back into condition from that I had my heart attack, which not only once again eliminated all the conditioning I'd fought to regain over the previous year but threatened to limit what I can do for the rest of my life.
Immediately after the heart attack, I volunteered as a test subject in the Revitalize Study, an experimental program to see if heart tissue could be repaired using one's own stem cells. There were many complications during the procedure that left me so physically and mentally weakened that two days later I was once again in the emergency ward. It seemed like I was being punished for volunteering to help science.
Combined with these three physical set backs was an additional, and unrelated, emotional frustration. Over the previous year four houses had sold in close proximity to mine. Prior to this the neighborhood had been neat, clean and quiet. The new neighbors seem to have no regard to property values because they let the lawns in their front yards deteriorate and regularly leave trash laying around for weeks. To helplessly watch your neighborhood devolve into a slum, and realize that the property value of your house has been reduced by tens of thousands of dollars, is enough to sicken anyone.
One last possible influence is that because I was used to working out almost every day, I had become used to the endorphin (an opiate-like drug produced naturaly) euphoria working out creates. When the heart attack prevented me from working out it deprived me of my daily dose of these endorphins. In effect this was similar to a junky not being able to get his daily fix. I suspect the withdraw-type symptoms may have been a contributing factor.
Assaulted by these five pressures I fell into a clinical depression two weeks after the heart attack.
So what does it feel like to be depressed? The first thing I noticed is that I went a week without laughing or even smiling once. My mood was one of defeat and apathy. I'd sit for hours doing nothing, not even watching television. Sometimes I'd dwell on what had gone wrong in my life (the heart attack and the life changes it represented) but more often than not I'd just sit in a sort of vegetative state not thinking about anything, just existing. I lost all interest in hobbies and activities that had filled me with excitement just two weeks earlier. I was never suicidal, but many times I honestly felt that things would have been much better had I never woken up from the heart attack. During this period I was still fully functional. I could relate to other people and do chores around the house, but there was no enthusiasm for these activities. They were done mechanically, as if I was just a machine doing what it was supposed to. I continued to eat normally, though I had little or no enthusiasm for it, and I slept normally, though a bit longer and deeper than before.
Fortunately, even during the darkest moments I retained the ability to occasionally step outside of myself and observe my mental state. I did this as a matter of habit held over from my inclination and training as a research engineer, not because I cared about how I felt. While doing this I was able to recognize I had a problem and even though I didn't care about getting better, intellectually I decided that it would be better both for myself and those around me if I did something about it. My ability to identify the problem and make the decision to do something about it suggests that the level of depression I was experiencing was not severe.
While I didn't care whether I got better or not I realized it was something I should do. Everything I did to get better was done in a state of apathy.
The first step was to see my general practice doctor and ask for him to refer me to a psychologist or psychiatrist. He said that would not necessary for mild to medium states of clinical depression. He had me fill out two check-the-block questionnaires. One had twenty questions answered by circling the words "low," "medium," or "severe" regarding my attitudes and moods. The second was thirty yes-or-no questions in a similar vein. In spite of my desire to be as honest as possible in retrospect I recognize that in several cases I answered questions in a more positive light than I felt, particularly as regards my attitude about living or dying. (More on this later.)
Using a numerical grading guide, the doctor counted up the points from each answer and added them together to create an overall rating of my level of depression. He explained that while the error bar on either test by itself was large, when both tests agreed within a few points of each other the overall evaluation was very accurate. My numbers suggested I was suffering of medium or moderate clinical depression. He then gave me a short oral examination with more specific questions to verify this diagnosis.
Based on what he had found he prescribed 5 milligrams of Lexapro, something called a serotonin reuptake inhibitor, a day. While I have no inhibitions about taking medication, I don't like the idea of taking mood-altering drugs. When I questioned him about this he explained that my depression was being caused by an unusually low level of serotonin, a hormone naturally produced in the brain. When the levels of this hormone are low, it chemically forces the brain into depression. Because the brain is depressed, it doesn't produce serotonin. Because the seratonin level is low, the brain is depressed. This results in an endless, self-reinforcing, loop. The Lexapro would slowly raise the level of serotonin to normal levels. Once the balance has been returned to normal over the next 3 to 6 months the drug can be tapered off and I should be back to normal.
I began taking the Lexapro and for the several days felt nothing. I'd been warned that it could take three to four weeks to notice any difference.
Although my state of apathy hadn't changed, I still held to my intellectual decision to cure the depression. As an engineer I have the life-long habit of evaluating and solving problems. Although I didn't care about getting better on an emotional level, it was still a problem and my mind automatically began evaluating this problem and figuring out solutions. I came up with a few that may or may not have helped. I can't tell how much of my cure was do to the medication, how much is do to my own actions, and how much is the result of the natural healing that occurs with the passage of time.
Decades ago I'd attended a class in psychology where the lecturer made a statement that stuck with me all these years. He claimed that if someone wanted to believe in something all they had to do was pretend to believe in it and over time pretending would turn into steadfast belief. While at the time the discussion was pointed at religion, I reasoned that it might be applicable to to my depression. If I pretended not to be depressed, then perhaps in time that might help me work my way out of it. I began doing things I used to do for enjoyment: watching my favorite shows, shooting pool, working in the garden, etc. I didn't derive any pleasure from these activities but went through the motions with the belief that doing so might reawaken some of my previous enthusiasm for life.
Next I reasoned that it's harder to be depressed when outside in the sun than sitting in a dark room. I began spending as much time outside as possible. Even if I fell into one of my brooding moods I forced myself to do so outside in the sun. Part of the idea to use the sun to combat depression was based on something I'd read called Season Affective Disorder, or SAD. It occurs most commonly in northern latitude winter months where people go for long periods with little or no sunlight. Lack of sunlight causes a chemical change in the brain that can lead to depression. I reasoned that if the lack of sunlight can cause depression then extra sunlight might help alleviate it.
Finally, I recognized that was harder for me to be depressed when surrounded by bright colors than bland ones. I began bringing in cut flowers from the garden and keeping them close around me.
Again, all of these steps were done mechanically, without enthusiasm, with the plan that they might help.
It began very slowly. A week after I started working on the cure I noticed one morning that while I wasn't really happy, my mood was slightly less dark than it had been. The odd thing was that my initial reaction was to resist the change. It was almost as if I preferred to remain depressed than get better. I reasoned that this was not the way I wanted to go and exerted myself to embrace the improvement. Over the next five days I was able to feel a steady improvement in my mood. It was like walking up a shallow ramp from darkness into light. Things I was doing mechanically slowly became things I enjoyed doing. I began smiling at funny scenes in shows and by the end of the second week caught myself laughing out loud at a humorous commercial. (It's an odd sensation to laugh for the first time in over a month. My reaction was to look around and wonder where the laugh had come from.)
During this period I never felt drugged or giddy from the Lexapro. My over-all mood simply improved and it felt in every way natural and normal.
One month after starting the cure I felt almost 100-percent. I occasionally have downturns in my mood but believe these are normal emotional fluctuations anyone in my situation would experience. I plan on taking the Lexapro for at least three months, as directed by my doctor, not only to insure I don't backslide into another depression but also because researchers have found that Lexapro increases the survival rate of people with heart attacks. Besides the curative advantages of not being depressed, some of these researchers theorize that the Lexapro may have a physiologically positive effect on the cardiovascular system.
FINAL UPDATE!!! When I got down to my last 20 doses of Lexapro I decided that it would be better to taper off than stop cold-turkey. I divided the remaining pills into 4-pill groups and added one day between taking a dose for each group. The first group was every other day, the second every third day and so on. I experienced no let down or back slide into depression. I'm completely off the Lexapro and feeling great. It's entirely possible that left alone without any medication I would have gotten better. It's equally possible that the dosage was so low that the placebo effect cured me more than the medication. It's also possible that had I not gone to my doctor the depression would have deepened to dangerous levels. All I know for sure is that I took the medicine and got better.
Looking back on my depression I realize now that I was in a much darker place than I had thought. It was like being lost in a pitch-black cave and not caring about ever getting out. Although I had thought I was at least acting normally, my wife said that it was like a large part of my personality had died.
I sincerely wish someone would come up with a different term for depression. Even the healthiest people have sad moments and it's common to say that they are depressed. This is completely different from clinical depression. Using the same word in both instances is confusing and misleading, suggesting that someone who's clinically depressed is just going through a bad moment and given time should come out of it by themselves. It trivializes what can be a serious illness.
About Not Wanting to Live:
I mentioned a couple of times on this page that I am an engineer. This is an understatement. By nature, inclination and training I habitually apply reason and logic to strive to optimize every aspect of my life. I seldom achieve the desired goal, but that doesn't lessen my drive to identify and work toward achieving it.
One aspect of my life I've occasionally evaluated for optimization is how long it should be. This is not an emotional process, but strictly an exercise in logic to evaluate the pros and cons of deciding how long my life should be. I want to make it clear that I am not suicidal. But, I firmly believe that just as the design of a building can be optimized so can the design of a life.
I mention this because it made answering the most important question on the two tests my doctor gave me, "Have you every thought about ending your life?" extremely difficult to answer yes-or-no honestly. Yes, I have done so merely as an intellectual exercise and yet "no" I hadn't done so as the result of being depressed and thinking my life wasn't worth living.
Personal note: Wondering about death has never saddened or bothered me. I look at it as the way to answer the greatest question in life: Is there something more after death? If there is I'll learn the answer, something any researcher like myself values and looks forward to discovering. Having said that I readily admit to concerns about the nature of my death.
I would not consider a long, protracted, painful illness with limited or no productivity to be a life worth extending. As a consequence I support the Right To A Dignified Death movement, with adequate safeguards to insure it isn't misused. The system used in Oregon is a good example, though I would ease up on the requirement that the person has to be diagnosed by two different doctors who both conclude that the subject will die within six months. Why should someone who might live a year in excruciating mental or physical pain before dying have to endure six months of agony before meeting this criteria? I believe quality of life is more important than eminent death as a criteria for letting a rational individual decide when and how they want to end their life. I do not think it is a sin or immoral for someone to decide to do so under certain conditions.
Return to the main page for more medical topics or to browse 80 other subjects: everything from kites and rocket engines to the weird world of lucid dreaming.