Back when I was 14 or 15, my sister ran away from home for a month and it straight-up wrecked me. We had no idea where she was or if I would ever see her again, and it was the first time we had been apart for that length of time. Growing up, we were pretty close; she protected me from the neighborhood bullies because she was a little spitfire and I told her stories and made our meals when Mom was occupied. We had often made a game of running away together, planning our escape route and the best time to steal away; but this time, she left without me and I had never seen it coming. She was one of the only people I felt I could rely on.
During that month I was in a haze. I remember being even more quiet than usual, and it felt like I was moving and thinking through cotton — slow, muffled, distant. When I got home from school, I didn’t know what to do or what I had the energy for, so I would sit on the floor and stare at the back of the couch until it was time to go to bed. Looking back through decades of experience, I can say that was the first time I ever had an episode of major depression.
Major Depressive Disorder is a mental illness that affects over 200 million people worldwide; it can strike anyone at any time, but it tends to affect women more than men and first diagnosis frequently happens between 20 – 35 years old. Common symptoms include a persistent, inescapble low mood; anhedonia, or an inability to experience pleasure — even with things that you used to love; feelings of guilt and worthlessness; insomnia; fatigue; loss of appetite. There are a number of depression disorders, besides. Atypical Depression, for example, tends to manifest earlier and sufferers will respond to good news with an increased mood, but also eat more with low moods and tend to sleep more during episodes. People with atypical depression also have a very high sensitivity to social rejection.
There’s Persistent Depressive Disorder or dysthmia, a less-severe but chronic state of depression lasting for over two years. There’s Bipolar Disorder, where a depressive state “swings” into a normal mood or manic state. There’s Post-Partum Depression, in which a woman experiences a disabling episode of low mood after giving birth. There’s Seasonal Affective Disorder, where bouts of depression happen during a particular season. All of these conditions can cause real difficulties in the lives of people who are coping with them. They affect our ability to be consistent with our work, attentive in our relationships, resilient with our setbacks, content with our lives. These mood disorders make it hard for us to maintain an even perspective about ourselves and the world around us, even with treatment.
That’s because depression is a disease that affects the brain, the one organ we rely on to interpret all the stimuli we get everywhere else. Because the brain is so complicated we’re not entirely sure how depression is caused, but we do know there are several areas of the brain that tend to be affected. Neurotransmitters — the chemicals that stimulate brain activity and give us the ability to think, feel, and make connections — tend to have a harder time working in depressed people, and some areas of the brain are different. The hippocampus, the part of the brain responsible for long-term memory and recollection, tends to be smaller in depressed people; the amygdala, a group of structures associated with base emotions like fear, sadness, and arousal, tends to be more active as well. This combination, especially in depressed people, could explain why it’s easier for us to remember past events that are associated with intensely negative emotions while we tend to forget the things that counteract the internal narrative that preserves our low self-esteem.
Because depression can be caused by either having too few neurotransmitters, or having receptors that are too sensitive or not sensitive enough to them, or an overly-aggressive reuptake system that sweeps them our of our synapses, it’s difficult to say with any clarity which treatment works best; every one of us who deals with depression has a distinct mix of physical, neurological, genetic and environmental factors. Some of us that respond well to medication might have a lot of trouble with talk therapy, while some of us who can manage quite well with lifestyle changes and behavioral therapy might suffer intense side effects with medication. For most of us, some combination of therapy and medication often does the trick — though it can be a process finding the right therapist and/or medication. No one treatment is better than any other; the best treatment for your depression is the one that makes it more manageable for you.
Depression can manifest differently depending on your age, gender, environment and cultural background, but there are no hard and fast rules. Men tend to be more irritable or have trouble controlling anger; women might become more withdrawn; young people might become more reckless or less able to concentrate. It can be really difficult for Black Americans with depression to receive proper treatment for a host of reasons — we are often expected to “fight through” emotional pain, and the cultural stigma about mental illness is still fairly strong. There is a distrust of doctors, especially psychiatrists, and there is too little value placed on openly discussing our feelings. Beyond that, the dominant culture often misreads the expression of a mental illness and either misdiagnoses it or misses the diagnosis completely. While the field is just starting to take a culturally competent approach to mental health care, it still has a long way to go.
It can be easy to dismiss depression as an “imaginary” disease simply because the factors that determine its causes, diagnosis, and treatment are so complicated and can often feel subjective. I understand how it can look from the outside that those of us within the mental health space are just stumbling around in the dark, guessing at definitions and such. But just because something isn’t well-understood doesn’t mean it isn’t real; just because our understanding about something is fuzzy doesn’t mean that thing can’t be pinpointed exactly.
I’ve been dealing with depression for my entire life, and I’ve only recently been fortunate enough to have the ability for treatment. I’ve attempted suicide twice due to my depression, and I still fight through it every day in order to live the best life I can. I know that I’m more likely to have depression because I’m the child of a schizophrenic, and the hereditary link between that mental illness and offspring is well-established. I’ve seen every one of my siblings suffer with their own issues; I know one of my nephews will need to learn how to cope with it. These are facts.
My personal experience with depression has taught me a few things about how to relate to it. All the stuff they tell you about sleep, diet and exercise? Absolutely true, with perhaps sleep being the most important. Being active really does help, especially if it gets you outdoors and in the sun for some time. I can often feel when an ’emotional trough’ is coming on, because it becomes harder to concentrate and I find myself unable to be interested in things; when this happens, I can ‘prepare’ for what’s coming by making sure I focus more on self-care than productivity. It doesn’t stop it from happening, but it becomes easier to ride out.
Depression, for me, is intensely associated with self-worth. I become paralyzed by the idea that I have nothing worthwhile to say or that I can’t say anything in a way that engages or affects other people. I feel stupid and boring and permanently, unfixably broken. It becomes too much effort to do more and more basic things, and my world shrinks steadily because so much becomes unreachable. Cooking something to eat feels like an ordeal; talking to someone to explain how you feel is impossible; doing something for the joy of it feels pointless, and doing something productive feels inconceivable.
My worst spells have all heavily featured unchecked emotional eating (candy and salty chips in alternating waves), being unable to leave my bed or couch, and an overwhelming desire to just sleep forever. Being active, sticking to my routine, finding something to stimulate different parts of my brain — that’s something other people can do. I can’t. Sometimes, even breathing feels painful and exhausting. I need some kind of stimulation, like a TV show or music, but the stimulation doesn’t bring pleasure — just a reprieve from my own thoughts.
Thankfully, I haven’t had a really bad spell in about ten years thanks to Prozac and cognitive behavioral therapy. But I know that it’s unlikely I’ll be off medication at any point in the future, and I’ll need to constantly work on myself to develop better habits and coping strategies. For many others, depression can be a more-intense but less-chronic condition. Some of us have very long cycles that enable us to be fine for years before something knocks us back into that headspace. Some of us will have to wander in the wilderness for a very long time before we find a treatment that works for us.
No matter what, it’s important to remember that depression is a real illness and those of us who cope with it must do so with significant complications. We might not be able to put energy into practices and routines that would help our brain chemistry. We might not be able to afford proper treatment or medication. We might not have a support network to rely on for the things we need. We might have cultural barriers that prevent us from seeking the help we need or getting the proper treatment. It’s a hard enough illness on its own; combined with social, economic and environmental factors it can be that much harder to deal with.
So please, if you can, be easy with the people who are dealing with depression. Recognition and encouragement are vital to shift not only our perspectives, but the perspectives of those around us as well. People with depression aren’t hopeless or crazy; more likely, we’ve just never been given the chance to get the knowledge and help we need.
This is part of a series of post for Mental Health Awareness Month. For more information about what you can do to help build awareness for this often-neglected aspect of our personal health, go to this website: http://www.mentalhealthamerica.net/may.