B-What's Wrong With Me&;#063;

Depression is sneaky. It's not like a broken bone, or a flu virus,
that announces itself in no uncertain terms. If it did, more people
would be treated. Research shows that one in every four women and one
in every eight to ten men will suffer a major depressive episode during
their lifetime[1], and even more will suffer with a low-grade chronic
depression through most of their lives. These numbers surprise most
people. They certainly startled me. But even more startling is the fact
that these numbers represent cases that have been diagnosed and
treated. However, eighty percent of those suffering with depression
either don't realize what is happening to them, or they refuse to seek
treatment. There is still a strong stigma attached to mental illness of
any kind, and many would rather endure the torment inside themselves
than face the torment others can inflict with their judgments. I was
one of these.

My latest depressive episode snuck up on me. I have since found that my
experience was closer to the norm than I would have believed. In
October of 1997, I began having periodic headaches. Since my voice
would also get gravelly, and I had a history of sinus problems, an
infection was my first assumption. After six months of antibiotics and
decongestants from my general practitioner I noticed no improvement. I
began seeing an ear, nose and throat specialist. Eventually, after cat
scans and tests too icky to mention, he determined that the vocal
problem was not due to sinus infections, and the headaches were
migraines.

Thrilled to finally know what was wrong, my general practitioner and I
began trying different medications for migraines, moving into different
combinations of drugs when the first attempts failed. It was April,
1998 when we started, but that September I was in severe pain daily. I
had withdrawn from nearly everyone, attributing it to the pain and the
need for quiet. I wasn't eating much, but nausea came with migraines,
so I wasn't alarmed. I was having trouble going to sleep at night, but
once I did fall asleep, I slept for ten or eleven hours at a run. I was
worried about my job, and increasingly worried about my health. It's
upsetting to know something is wrong, but not be able to find the
cause.

Mama can't remember what prompted her to talk with my father, but the
two of them decided she would consult with our family physician. I
don't know the details of that conversation, but I remember finding it
strange that I had a doctor's appointment that I couldn't recall
making. Mama said she had called when I had such a hard time with the
pain medication the Friday night before. Not thinking clearly, and
aware that I was forgetting an unbelievable number of things in the
recent past, I didn't question her further. The doctor's suggestion of
Prozac came out of nowhere.

No one in our family or known acquaintance had ever been diagnosed with
major depression, so we had no frame of reference for my symptoms. This
is very often the case, and one of the reasons depression is so often
undiagnosed. There were perfectly reasonable explanations for the
physical symptoms I was experiencing, and the emotional ones were
assumed to be the result, not the cause. Again, in almost every case,
external causes are the first to come to mind. After all, "If I were
mentally ill, I'd know it." Unfortunately, the sufferer may well be the
last person to realize what is happening to them.

Looking back, I can identify at least two other major episodes, but
they weren't as debilitating as the most recent episode, and the
recovery time was much faster. Only I didn't really recover. After
learning about depression, and the different guises it wears, I
realized that I have a condition called dysthymia. It's a constant,
low-grade depression that never seems to lift. Pessimistic and gloomy,
I told people that it was just my personality. I liked stormy days and
dim rooms, and Edgar Allen Poe stories. I always saw, and fully
expected, the worst. Rarely cheerful, I was a real bundle of laughs.
Again, no one who knew me had any idea about depression, so they
thought it was just my personality as well. I'll tell you more about
dysthymia a little later on.

Everyone gets depressed. Disappointments and losses leave us sad, or
demoralized for a short time. There's nothing wrong with sadness and
grief. In fact, Jesus wept at the death of a friend. (See John 11) But
major, or unipolar, depression is beyond a typical "down in the dumps".
Dr. Francis M. Mondimore explains it this way:
1
[Mood] does include concepts like happy and sad, but mood goes further
or perhaps deeper than this and includes our sense of physical
well-being, our attitudes toward others, or feelings about the future,
our self-esteem and confidence, and our attitude towards ourselves as
well. [1]

This was certainly true for me. My entire life was effected. Every
thought I had was colored by the depression. A compulsive writer by
nature, I began a journal the Tuesday I started taking Prozac. That was
October 28, 1997. Here's part of that first entry.
I can get up with little or no headache, purpose to go to work as soon
as I can get ready, and by the time I've showered and put on my
make-up, I am dizzy, nauseous, and have a screaming headache. I sit
down in my recliner to calm down, and I end up just siting and staring.
Sometimes, in the early afternoon, I'll sort of come to.
It's like my mind glazes over and I just stop processing. I can't
concentrate to read, which makes me crazy, and if I do manage to read
for twenty minutes at a run, I don't remember what I've just read. I
forget all sorts of things throughout each day. I'm sad almost all of
the time, and it takes practically nothing to make me cry.
Personally, I can't imagine being less functional. The last few days
I've had a minor victory in just getting out of my nightgown and into
my sweats. Dealing with anyone except family or church people seems
insurmountable.

Now I can see why my family was concerned. I lived in my own apartment,
so they didn't realize the full scope of what was happening. But they
did see enough to know I needed help.

The clearest definition of depression I have found is "a disregulation
of the brain's reaction to stress" [2]. It involves the chemicals in
the brain and their absorption. We will look at the possible causes
later, but we need to start with the basic types of depressive illness
and their symptoms.

Major depression is the most common of the depressive illnesses, so
much so that it is often called the "common cold" of psychiatry. There
are two classifications, reactive and clinical. While both involve
chemical reactions in the brain, the triggers differ for each. In
reactive depression, a stressful event of some sort, positive or
negative, serves as a trigger and due to the chemical imbalance that
results, the person seldom pulls out of what starts as a normal period
of loss or disappointment. In his article published in Time magazine,
Philip Elmer-Dewit states 5\% of those who go through the grieving
process move into a major depressive episode.

Almost every initial depressive episode is to some degree reactional.
We will see later that in my case a genetic predisposition exists, but
ordinarily, it takes the trigger of some event to begin the downward
spiral. The biblical account of Jesus we discussed earlier shows a
strong emotional trigger, His impending death in a painful way. There
are other accounts of depression in the Scripture, and we will see some
others as we go along. All of them can be viewed as reactional.

In clinical depression, the imbalance occurs spontaneously, with no
identifiable trigger. As we discover the biochemical nature of
depression, we'll see why clinical depression comes to be. In rare
cases, the initial onset can be spontaneous, but it is more often the
result of multiple episodes throughout a period of years. The symptoms
for both reactive and clinical depression are the same. I'll start with
the symptoms I struggled with first.

Persistent feelings of sadness or emptiness
Journal entry from 11/6/97.
All I want to do today is cry. I'm not sure why. The urge has been just
under the surface all day long. Lurking, that's a good word; a whole
atmosphere comes with it, a dark, secretive, sinister feel.
It's like I'm being stalked. It's close enough that I'm constantly in
a gray twilight, with the black just inches away, and I have to run as
fast as I can just to keep it that way.

I cried for no reason at all, for a large part of the day the first few
weeks. Everyone goes through weepy seasons for some reason or other.
But if you cannot isolate a reason, and it has continued for two weeks
or more, depression may be behind it.

Loss of pleasure or interest in activities normally enjoyed
The term for this is anhedonia. It's a fancy word for emotional
flatness. My diagnosis came as my church geared up for our Christmas
musical. I loved this time of year. Having a degree in Theatre from a
Southern Baptist University, I'd never felt more alive than when I was
working on a show. But I couldn't bear to go watch rehearsals, let
alone be involved with set, or actors, or blocking. Missing out on this
time left a huge emptiness in me, feeding the first symptom we looked
at. I also have two nieces that are the center of my world, Jordan and
Carly. While I still wanted them around, something had changed. The
eagerness to play wasn't there anymore.

Hopelessness or pessimism, feeling that things will never improve
Hopelessness had taken root and been growing in my mind for months
before I was diagnosed. The pain of migraines had plagued me for a full
year, and each time I tried a new treatment or drug, I got my hopes up,
dreaming my life would return to normal. As time went by, and
treatments didn't help, I fell deeper into the certainty that my life
was never going to change. It seemed I would live with pain and
isolation until I died.
During this time, I can't remember being anything but a pessimist. When
it came to God, I believed He could do miracles, but I didn't think I'd
ever experience one. I was always the one who warned that what we
prayed for might not be the will of God. I was a talented devil's
advocate, and practiced regularly.
Others experience this symptom as a radical change from their normal
point of view. People often recall memories as sad, even ones that were
previously seen as positive. This is not a choice to dwell on the
negative. A person in the throes of depression is often unable to
control their thought processes. This surfaced in nightmares for me. I
would wake up crying, every dream I had ended tragically.

Overwhelming guilt or feelings of helplessness or worthlessness
Journal entry from 11/11/97.
I just feel like my past has been a waste. I mean, I'm thirty-one years
old, and what do I have to show for it? My family still has to take
care of me financially and emotionally because I'm such a wreck. I
can't deal with making two phone calls, let alone spending a day at
work. I have to hide in my Mom's house with a completely nonjudgmental
dachshund.

As hopelessness gripped me, what little self worth I had crumbled. My
family has a very strong work ethic, which I embrace entirely. But when
I became unable to cope with my job, that work ethic became a huge
source of guilt. Not being able to support myself ate a hole deeper and
deeper into my emotions, leaving room for little else.

Sleep disturbances
Some people experience this symptom as insomnia, and remain unable to
sleep for long periods of time. Some fall asleep quickly and easily,
but wake in the very early morning hours, unable to go back to sleep.
My experience was that I couldn't fall asleep until my body was ready
to drop, but then, I would then sleep for ten to eleven hours at a
time. In what's called atypical depression, the person may have even
greater problems staying awake. Sleep disturbance is often the first
noticeable symptom of depression.

Appetite and weight fluctuations
The most common scenario is a drastic loss of appetite, usually causing
a rapid weight loss. Since so much of our society puts a high value on
being slim, this is often applauded and encouraged. This tendency was
at work in my depression. Nowhere near slim, I had been walking daily
in an attempt to lose weight. I had lost thirty pounds in the months
preceding my diagnosis. I didn't see this as a symptom of anything, but
a victory.
Occasionally, again in atypical depression, the person has a marked
increase in appetite, causing weight gain. This can often lead a person
further down in the emotional spiral, reinforcing feelings of
hopelessness.

Loss of energy, persistent fatigue, or feeling slowed down
I actually have two journal entries that show this symptom. They were
on 11/4 and 11/11 respectively.
My motivation had been nonexistent. I did manage to shower and dress. I
just keep trying to pull something out of myself. It's like I go deep
down into myself to search for some impetus, some desire to do
something.

It's like there is an invisible line drawn that I cannot cross; there
is an elusive but definite limit as to how much can be accomplished in
a day. I keep thinking I should be getting more done, have more to show
for all this time.

This symptom is a physical dragginess, like I wrote about, and even a
slowing for mental processes. Occasionally, even speech is noticeably
slow. Between this energy loss and the loss of pleasure, most
activities become too difficult, and not worth the bother.

Restlessness and irritability
While I could sit in one place for hours, staring into nothing, I was
difficult to live with. I was frustrated that I wasn't as restless as I
thought I should be, but my natural irritability skyrocketed. I'm
afraid I'm not a patient person by nature, and if I get frustrated,
with myself or someone else, I'm not hesitant to express my
displeasure. This symptom often pairs with insomnia, leaving the person
nervous or jumpy. Some people find they are more easily provoked,
leaving everyone around them walking on eggshells. If this "bad mood"
persists for more than a week or two, and doesn't seem to have a cause,
it's a warning sign.

Difficulty concentrating, memory loss, or difficulty making
decisions
This was a huge problem for me. I went through every possible variant
of this symptom over and over again. My journal entry for 10/30
reads,
I'm not sure about eating lunch. I'm not really hungry, but dinner
won't be before six, since Rick is coming. I could heat up a little
goulash. What an appropriate meal the day before Halloween, huh? I'm
afraid if I don't I'll be too hungry at dinner and consume everything
in sight. I just can't seem to make decisions lately. I wonder if that
due to the depression. I'll have to ask Pastor Roger.

Eighteen months later, I find that passage amusing. But it was the
common script my mind played any time I tried to make a decision, no
matter how small. Imagine having to go through that argument just to
talk yourself into going to the bathroom now instead of half an hour
from now. An earlier entry mentioned my frustration in attempting to
read. In the older person, this symptom can be mistaken for oncoming
senility.
While everyone has trouble deciding what restaurant to go for Sunday
dinner, a depressed person is incapable. And many of us get home from
the store without something we needed most of all. But if you are
listening to people talk and have no idea what is being said, or you
begin forgetting major events, or important things, like medication,
it's a symptom.
1
Preoccupation with death, talking about suicide, even if jokingly
I was blessed not to experience this one. While not everyone who is
depressed becomes suicidal, almost every one who attempts suicide is
depressed. But this symptom doesn't always present as an attempt to
take life. It can be a strange attention to the obituary section of the
paper, or with tragic news stories. It can be casual comments about the
pointlessness of living, or what method they would use, if they were to
attempt suicide. This is one of the most dangerous symptoms, and
professional help should be insisted upon immediately. Never disregard
this symptom.

Physical complaints with no apparent cause, or that do not respond to
treatment
This I had. My first journal entry showed the dizziness and nausea that
were everyday occurrences, along with the headaches. Sometimes it felt
like the flu, my body sore all over. The most common complaints are
headaches, joint pain, intestinal disturbances, and chronic pain in any
location. Because of these physical complaints, most doctors attempt to
treat the symptom as if it were a disease, and most patients agree with
them.
I firmly believed that relieving my migraines would allow me to get
back to normal, and any emotional problems would lift. If you asked me
if I was depressed, I would answer, "Who wouldn't be if they were in
constant pain?"

Withdrawal from personal contact
I'm not talking about run of the mill shyness here. Withdrawal is often
the first symptom that others notice. I justified my withdrawal because
light and sound made the migraines worse. This is entirely true, but it
was not the complete answer I thought it was. As the fear of inadequacy
overwhelmed me, I became so convinced that I would be rejected. It was
easier to be by myself at that time. I inherited the solitary nature of
a hermit from my father, and spending time alone had always been vital
to my remaining civil in public. But when depression took hold, I
didn't want to have to act normal all the time, or try to follow
conversations, or explain why I never smiled. My apartment was quiet
and dark and safe.

Neglect of responsibilities and appearance
Frankly, if you find yourself of no value, you're not going to take on
any responsibilities you can avoid. And the forgetfulness that plagues
so many often appears to be neglect. I went through this as doctor's
appointments slipped my mind, picking up my own medication would
disappear like I had never been on medication. Appearance declines as
the depression deepens, as the person has no energy to waste on it. At
the depth of depression, many people walk through entire days in their
pajamas or housecoats. I upgraded to sweats, but that was as far as I
would go. I would shower, brush my teeth, maybe brush my hair, but I
didn't wear make-up for almost two months.

While the first two symptoms are almost always present, the remainder
can show up in any number of combinations and the severity of each can
vary from person to person. I've included a checklist in the Appendix
that you can use to evaluate yourself, or to take with you to the
doctor, as a way of opening the subject. Remember every one is
different, and what was a problem for me may not appear for you at all.
Not having one symptom doesn't mean there isn't a problem. That's part
of the reason depression is undiagnosed so much of the time. Presently,
there is no biological test for depression, and the person affected is
often the last to notice the symptoms.

Another type of depressive illness is manic-depression, or bipolar
disorder. Periods of depression, with the symptoms above, alternate
with episodes of mania. Mania is identified by the following seven
symptoms.

Overly optimistic mood, exaggerated self-confidence, bravado
Needs less sleep but shows no signs of fatigue
Excessive or rapid speech
A great increase in activity, restlessness to the point of agitation,
even aggression
Easily distracted, flighty
Reckless behavior, no regard for consequences or personal safety
Heightened self-importance, even grandiose delusions

The periods of depression and mania may last anywhere from days to
months, sometimes without an identifiable pattern. Again, the person
dealing with manic-depression is likely not aware of their behaviors.
Clear, rational thought is clouded in both states, to the extent that a
patient will not remember any of their behavior while in the other
extreme.

One of the rarest of the mood disorders is Seasonal Affective
Disorder, more commonly known as SAD. It normally sets in during the
late fall, with the shortening of the day. Not only is there a
depressed mood, but many other symptoms of depression are exhibited.
However, in SAD, the person is more likely to overeat and sleep to
excess. It's almost like hibernation. What differentiates SAD from
depression is its pattern. As the spring sets in, and the days begin to
lengthen again, the symptoms slowly disappear, leaving the person in a
normal state throughout the summer. Then, with the fall, the symptoms
show themselves again. In order to be diagnosed with SAD, you must have
had the cyclic symptoms for at least two consecutive years, and at
least three years total.

Dysthymia, as I mentioned earlier, is a mild, but chronic form of
depression. Symptoms must have existed for two years or more for this
diagnosis to apply, although in children and adolescents it may be
considered dysthymia after lasting only one year. Rarely totally
disabling, many people suffer for years. Even more than its more severe
counterpart, dysthymia remains undiagnosed, normally until a major
depressive episode occurs in conjunction. Often referred to as "double
depression", this form is particularly difficult to treat. Most people
with dysthymia have been in a depressed state for so long, they have
accepted it as "their personality".

I experienced this double depression. While a born again child of God,
and active in ministry, I remained pessimistic, even cynical. I have a
strong appreciation for the absurd, and no fear of pointing it out when
I see it. Not even my family could explain my largely negative
attitude, as it wasn't the norm for our home. When rejoicing over
victories God had granted, it was more a feeling of relief than joy. I
adopted the belief that if you expected the worst, you were either
correct, or pleasantly surprised. I gravitated to the Romantic period
in literature, finding an entire movement led by people with my
sensibility.

When I began treatment for the major depression, within a couple of
weeks, we discovered that I had no reasonable frame of reference to
determine if I was improving. Once my family and I learned the
symptoms, we realized I had been dealing with dysthymia for better than
fifteen years. When this double depression occurs, it may take longer,
and be more difficult to treat and manage. In essence, the patient will
have to learn an entirely new way of viewing and interacting with the
world around them.

So we know what depression looks like. Great. I was depressed. I didn't
like it, but I had to deal with it. If you are at all like me, you want
to know why this happened. I'm forever asking God why. I can't claim to
know the reason I am living with depression, because I don't. But God
does. Am I saying He gave me depression? I'm not so sure. I've said
that mental illness is not indicative of a spiritual problem, any more
than cancer, or diabetes, or high blood pressure is a spiritual
problem. But God allows certain things to come into our lives, for his
reasons.
Right now, I'd like to show you a little of what I have learned about
the biological reasons for depression. This knowledge helped to
alleviate much of the overpowering guilt I felt at what was happening,
and I believe it will help you. Stick with me here, and some things
will start making more sense.