The Push and Pull of Depression
My depression doesn’t follow a script. It doesn’t look like those commercials where the raincloud disappears and then I’m suddenly playing Frisbee with my dog while wearing a wrap sweater. My dogs don’t play Frisbee, and I don’t wear wrap sweaters (they’re not flattering on my frame).
My depression is a push and pull between the rational and the irrational.
I’ve been depressed when objectively things are going really well for me in my life — good job, good friends, good relationship (or at least good sex). And I’ve been content when everything seems to be going wrong — horrific car accident, bad relationship, or a broken ankle that left me couch-bound and embolism-prone.
When I described the fear of spiraling back into depression following the fractured ankle and endless parade of medical complications that ensued, a psychiatrist told me that — all things considered — I was doing well, and there was no need to adjust my medication. Who wouldn’t be sad about ten weeks stuck on the couch and the ensuing boredom (at least after the first few weeks of catching up on Netflix), dependence on others, and financial insecurity? “All right,” I thought. “I guess I’m pretty rational. Check out my coping skills!”
I briefly saw a psychologist who specializes in REBT, Rational Emotive Behavioral Therapy. It’s like CBT (Cognitive Behavioral Therapy), except for that REBT is based on the notion that there are healthy and unhealthy degrees of every emotional reaction. Your cat dies. It’s normal to be sad, but not to be depressed. You screw up big time at work. It’s normal to feel worry, but not anxiety. REBT argues that the more extreme versions of emotions are, by definition, based on irrational thinking, fallacies and delusions. I disagree. I think depression can totally be justified. “What about when things are truly horrific?” I asked the psychologist. “What about someone going through famine? A refugee crisis? The loss of a child? How is depression not normal then? How can you just tell yourself you’re wrong for thinking everything is awful?”
I stopped seeing him shortly after that.
My mom marched me to a psychiatrist for the first time when I was 12. I was being bullied at my all-girls school where my kilt never fit quite right, and began to withdraw at home. The psychiatrist said I had depression. I cried into my Ramen noodles that night, having learned I had one more thing that set me apart from my peers (which at 12, is the worst thing one can imagine). I felt defective.
I was started on a low dose of Zoloft. Just a few weeks later, long before the chance for any clinical improvements, I was heading to camp, the same Jewish camp in Wisconsin I’d attended since I was eight. I’d always fit in effortlessly. The camp remained my only constant when my family moved from Minnesota to Rhode Island the year before. I returned to the same group of kids each year, getting too absorbed in the daily rituals that are Jewish camp — banging on tables while singing prayers, Israeli dancing, the “Shabbat walk” where pre-teens would pair up and dare to hold hands while exchanging Star of David necklaces — to ever feel sad. With everything else changing, I wanted camp to stay the same. I asked my mom and psychiatrist to let me go off the medication. I told them that having to stand in line once a day with the kids awaiting their Ritalin and Insulin would invite too many questions, would make me feel “othered” in the only place I really felt I belonged. I went off the meds and I had a great summer.
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That fall I transferred from the all-girls school to a public middle school for 8th grade, and I remained happy. In my new school, I was surrounded by so many different people that the only attention I got was gentle nudging about being a white girl with pink hair. My depression all but disappeared for six years; it was just a single blip on my radar.
Freshman year of college I was enrolled in my “safety school” and forced into a triple with a roommate who made the room her own, before I’d arrived. I was lonely, surrounded by similarly displeased freshman in overcrowded housing. I felt more suffocated by a tiny college campus than by the freedom I’d felt the previous year as an exchange student.
So much changed in such a short amount of time. The year before (my last year of high school), I lived in Lisbon, Portugal. I danced through city streets until four a.m., late enough to be drawn into bakeries by the aroma of fresh Portuguese bread.
Being seventeen in Portugal meant freedom, a loving host family, sunshine and few expectations. It meant piercing my ears and not telling my mom.
Being eighteen in Baltimore meant stuck on a suburban campus of twelve hundred students with no money and no car.
Being seventeen in Portugal meant skipping the fares on the streetcars and riding on the exit stairs, leaning back with the wind whipping my hair, jumping off when the conductor yelled at me.
Being eighteen in Baltimore meant hours of free time with nowhere to go, and no one to go with. No dogs, no family, no houses. Nothing felt real to me.
All of the familiar comforts of home were gone, but I had one thing to look forward to, one thing that kept me from falling apart completely — my only sister’s wedding. She was getting married to a wonderful man, and I was to be the maid of honor.
The October wedding was surreally perfect, one of those times where everything seems right, where two strange people have found each other and their love radiates all around. I cried the whole weekend, but when I returned to my dorm, I couldn’t stop crying. I felt hopeless. I remained glued to my bed, trying to hide my tears from everyone when they sprang up in the middle of the dining hall. I had no energy to do anything and no way to hide it.
Overwhelmed and seeking any kind of relief, I wandered into the counseling center on campus, trying to make it seem like I was going in for condoms, which would have been less embarrassing somehow. I wasn’t having any sex, but you can giggle about condoms. You can’t giggle about Zoloft.
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The counseling center didn’t have psychiatrists available, so if I wanted more than counseling, I had to look elsewhere. I went off campus to Shephard-Pratt, a renowned Behavioral Health hospital. I saw a nice, Indian psychiatrist for meds, while I kept seeing a therapist on campus. Neither of them helped. We tried upping the dose. It didn’t help either. I was barely making it to class and had to summon all my energy to keep doing my schoolwork. Negative thoughts about my self-worth swirled constantly around my brain. I’d feel tears rising up my throat out of nowhere and run to the bathroom before anyone saw. I went off the meds and felt even worse.
I sat next to a happy lamp in the counseling center. I liked its pulsating glow, but it didn’t help either. I thought maybe it was my environment. Maybe I could be happy again. Maybe it was like camp. I transferred to another college, a big one, in a big city. Objectively I was happier. I could state rationally all the ways this new school, this new city was a better fit for me, but after the honeymoon wore off, my depression worsened. There were nights I was glued to the floor of my bedroom and my boyfriend would drag me up and would not “allow” me to go to bed early. I would sob uncontrollably, my eyes puffed up and face smeared with snot, for hours. I resisted going back to therapy, going back to meds. That would be admitting that this thing that was wrong with me wasn’t just my environment; it was me, and it would follow me wherever I went. It was not a single blip but a full Doppler image. My camp fix hadn’t worked.
I joined a research study of people whose depression hadn’t been managed by their first attempts. This time the choice was entirely mine. I didn’t even consult my mom or tell her my symptoms. I wanted to try something on my own. My mother never was a big proponent of medication, at least not as a long-term fix. In the study, I began therapy, and I tried a new medication, Effexor. It made me jumpy, edgy, anxious. I called my psychiatrist crying. I quit the meds and threw up for days. I began to think that no medication would change the heaviness I felt, the dark thoughts I had. I tried a new, expensive medication, Pristiq. I threw up if I missed a dose, and I gained weight. Pharmacies would frequently be out of it, or the prior authorization (insurance will only approve a fancy, newer drug if your psychiatrist documents that you’ve failed on older, cheaper drugs) wouldn’t go through in time, and I’d spent the night by the toilet praying for the morning, or driving to half a dozen pharmacies to locate it. But after a few months, something incredible happened. I started to feel better. What had seemed so muddy suddenly felt clear. I wasn’t glued to my floor anymore. I felt like friends were more willing to listen to me because I was talking from the other side of the fog.
Still, I resisted. For several years, I didn’t want to accept that depression was a permanent part of me. I thought I could go off the medication when big stressors passed, or after I’d been on them “long enough.” I knew about other people with just one or two depressive episodes, people who only needed meds once in their lives. My mom’s words echoing in my head, I thought, “The meds are fine for now, but I can’t be on them forever.” I still felt deficient in some way for needing them; the pill was a daily reminder of my inadequacy. So, after a time, I would wean myself off the meds, sometimes with the doctor’s knowledge, sometimes without. But, like clockwork, a few weeks after stopping, the sadness would return viciously, seeking to punish me for my stupidity.
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Two years ago, I went off the medication for a medical procedure. Swiftly, and before the full brunt of my symptoms returned, I made an appointment with the Psychiatry Department at the University of Pennsylvania. I was going to get ahead of it this time. I recited my ever-growing depression history. I said I was fine going back on the Pristiq; I’d deal with the side effects, I just didn’t want to spiral down again. The doctor suggested trying another medication, Cymbalta. I remembered the commercials: “Depression hurts. Cymbalta can help.” That sounded more promising and straight-forward than the Pristiq commercials, the ones with the weird wind-up doll,
The psychiatrist said Cymbalta was in the same drug class as Pristiq, but it was cheaper because it had a generic form. It also had fewer side effects. He said it couldn’t hurt to try, since I wasn’t on anything anyway. I tried it.
It worked. Really well. I started to feel happier than what I’d always thought was just my baseline. I didn’t get sick when I was late with a dose. And it cost basically nothing. When my psychiatrist asks about my depression, or when I’m telling friends about it, I say the same thing: “I think I’m happier than many people who don’t have depression.” And I just about want to burst with pride when the doctor hands me back my sheet to bring to the front desk. “Major depression, recurrent episode, FULL REMISSION.”
If someone’s cancer is in full remission, they don’t still have cancer. Unfortunately, depression doesn’t work that way. I still have depression and I always will.
Medication feels like magic to me sometimes after so many years of struggling, but it isn’t. I have bad days. More than some people, fewer than others. I have days I don’t want to get out of bed, days where the dogs or strangers’ kids or people who make me hold the elevator to ride just one floor really piss me off. I have days when I just feel sad or anxious and can’t pinpoint why. I’ve had inexplicable panic attacks even recently. Maybe someday I’ll go through something so stressful that nothing will work. Maybe I’ll have post-partum depression if I decide to have children. Maybe the Cymbalta won’t work anymore. But I finally understand that I deserve to use everything at my disposal to be the best version of myself, and that it is always, always worth it to try. I think the only wrong way to treat depression is not to treat it at all, to believe you don’t deserve happiness. My depression is a push and pull, and it can be irrational. It doesn’t make me weak or defective. It’s just a part of me, even if it is more than a blip on a radar.