Content note: This post contains frank discussions about depression, triggers, and thoughts and behaviours associated with serious depressive episodes. If you are prone to being triggered by any or all of the above, I strongly suggest you stop reading immediately.
This is a piece based on a conversation that I had with a friend recently about my experiences with depression. I had never talked in this amount of detail with her before about depression, and understandably, she had a lot of questions. It was a very productive conversation, so I thought I would put it here for the reference of others who may have similar questions about what depression is like, how it feels, and various social problems surrounding it. When I started writing, it suddenly ballooned, and I realized I had much more material than could be feasibly contained in one single post, and so I have decided to split it up into at least two, possibly three, parts. I hope you will find them educational, engaging, and enlightening.
I have chosen to recreate the conversation in a Q & A format for easier reading. This discussion does not necessarily appear exactly as it occurred—many parts of it have been edited, revised, and most of all, expanded to include other issues or ideas that I feel are important to address, but were not addressed at the time in a relatively casual conversation. Finally, I would like to issue a thank-you to my friend for asking the honest questions seeking honest answers, which inspired me to write this post. I appreciate your genuine concern and compassion, and I’m lucky to call you my friend.
Q: What is depression like? What happens to you when it happens?
A: Not so easy to answer, because it sort of depends. Am I being triggered by something when it occurs, or does it just “happen” to me? If I’m being triggered, a lot of the time I get upset first and it’s very visible—so crying, shaking, etc, would be signs that I’m starting to experience an episode. However, even if I’m triggered by something, it may not be immediately apparent even to me—sometimes, I don’t even realize I was triggered until later on when I talk about it. If depression just “happens” to me, it’s not usually visible at all. Sometimes I literally just wake up that way, and I don’t know why it happens. More recently, this is the more common occurrence, where I can’t really explain why I feel the way that I do, because I don’t really have anything particularly bad on my mind. That is confusing to a lot of people.
As for what it’s like, that’s really hard to describe. You probably can’t really grasp it if you’ve never experienced it. Plus, I get a lot of different symptoms at different times, so it’s never really one, unified experience of depression. That’s the same for most people, and not everyone has every symptom (in fact, most people don’t), so my experience with depression is definitely not universal. But try to imagine the most bored you’ve ever felt. Then imagine the most indifferent you’ve ever felt about anything, that you couldn’t even make yourself care about whatever it was. Now combine the two, and imagine feeling that bored and that indifferent, basically all the time, about everything—even the things that you really enjoy or care about. Imagine suddenly not being able to enjoy anything, even stuff that you really love. Because you can’t enjoy anything, that means that you can’t switch to another activity because you’re bored and indifferent, because you feel that way about everything. Nothing is enjoyable, and everything is boring, and your whole life kind of grinds to a halt, because you start to think that everything is completely pointless. Nothing is fun anymore, nothing feels good. Food doesn’t taste good, sunshine doesn’t feel good, a hug doesn’t make you feel anything. You feel numb and emotionless a lot of the time.
(Important to note: this is a very, very basic explanation of depression as it happens to me. It does not apply to everyone and is not representative of anyone besides myself. Also, this explanation is extremely condensed, because we could be here forever if I talked about every single one of my symptoms at length. Therefore, take this as a basic, baseline sort of explanation of my experience; it is not representative, nor is it complete.)
Q: That sounds really, really frustrating!
A: It really is! It’s very difficult for you to emote properly, because you’re in this weird state of apathy most of the time. So, when I feel this way, it’s really hard—almost physically impossible—for me to cry, even if I see something sad or if something bad happens. Somewhere, I think, I still feel the sadness, but it’s pretty much buried underneath this indifference. If I do manage to cry, I often can’t stop—it’s just a wave of emotion that feels crushing because it’s like it’s been held up behind a dam for all of this time, and now it’s been broken up. So it’s really one extreme to the other, there isn’t much space in between.
Q: You talk about episodes. What is an episode?
A: I use that word in two ways. The first way is the most common, and it’s the medically accepted way to use it: an episode is a period where depression occurs and persists for two weeks or more. (An episode can also, more generally, refer to the recurrence of symptoms in many other psychiatric disorders, but for this post, we’ll use it in a depression-context.) I personally also use “episode” to refer to a crisis period in myself while I am depressed. So if I have a “crisis period”—that is, my depressive symptoms reach a critical point where I lose my ability to cope with them in some way—I’ll refer to that as an “episode.” But really, what I’m saying is that it’s an episode within an episode, and hopefully that isn’t too confusing.
Q: So, when do these episodes happen? What makes them happen? Do you or can you know if it’s going to happen?
A: Episodes happen very unexpectedly most of the time. For me, I can be triggered into an episode, or I can just have one “happen” to me. As I said before, the latter has been the most common recently. In cases of being triggered, any one of my triggers can potentially make an episode happen. That said, just because I experience one of my triggers, doesn’t mean I will absolutely have an episode. Sometimes, things unexpectedly trigger me for reasons that are hard to understand at first glance. If I’m not triggered and I have an episode, then I don’t know what makes them happen, and honestly, neither does anyone else. Not even doctors really know the root cause of depression, and as a result, treatments are limited. This doesn’t mean that the treatment available is not helpful; it just means that the scope of treatments is quite small in comparison to many other illnesses.
As to whether or not I can know if it’s going to happen…again, it’s really hard to say. Sometimes I can feel it coming on, and I just know it’s going to hit me within a few days. But that’s quite rare, comparatively. Most of the time, I have no idea that it’s coming, and it just hits me, sometimes in minutes, without warning. Episodes, for me personally, occur in a pretty random pattern a lot of the time. Of course, they often correlate with difficult times in my life, but that is not always the case—I don’t have to be “going through something” to be depressed, and recently, the more common thing has been depression happening for no reason at all. I don’t have what some people refer to as “situational depression”—i.e., depression that happens as the result of bad or difficult life circumstances. Although that can certainly happen to me when I’m having a difficult time in my life, for me it’s much more complicated than that.
Q: Are episodes completely random, then? How do you cope with episodes if they are random and difficult to predict? It sounds so inconvenient.
A: Yes, major depression is—among so many other things, of course—extremely inconvenient. Depression doesn’t care what you have to do on any given day. It doesn’t care how important this job interview, or this paper you’re writing, or this deadline that is coming up, is to you. It comes whenever it comes, uninvited, and you have to just manage to deal with it, somehow. If you have a good support system, it’s easier. But many people don’t have a good support system precisely because they are depressed. Lots of people tend to bail on you when they realize you’re a “problem” to them. It’s sad, and you may not want to believe it, but it’s absolutely true, and not exclusive to depression. Many people bail on friends when said friend is undergoing seriously crappy circumstances (for example, the loss of a loved one, the loss of a beloved career, or another very painful situation that might make someone less fun to be around).
Q: What are triggers? What do they do?
A: Triggers are exactly what they sound like—they are agents that can potentially ‘trigger’ an episode. Triggers can be almost anything, from people, to objects, to media, to…well, anything, really. Triggers are usually agents that are associated with some kind of trauma, but this does not always have to be the case. Anything has the potential to be a trigger, because people are triggered by entirely different things. As you can imagine, that’s why it can be very tricky to figure out how to approach things when it comes to people with depression or other types of mental illness. It’s difficult to know what might trigger them, not only because of the wide variety of triggers, but also because the person in question may not even know all of their triggers. It’s a hard balance to strike between having appropriate trigger warnings and making everything into a trigger warning.
Q: They have treatments for depression, though, right? You said you’d been on medication before. Did that help?
A: Yes, I was on medication for almost two years. As to whether it helped, that’s a complicated answer. Yes, it was helpful for a while. I experienced a really rare and severe side-effect, so I had to stop taking it. Besides that, though, I got what is called a “wash-out effect.” That means that you take a certain med for a while, and it works, but eventually, its effectiveness begins to wane over time and your symptoms return despite you taking it.
I took a few different drugs, and there are different types of anti-depressants. I took Prozac at one point, which is an SSRI, or Selective Serotonin Reuptake Inhibitor. SSRIs are a classification of anti-depressant, and also include drugs like Zoloft, Paxil, and Celexa. An SSRI is most likely what you would be prescribed first, and they all work in a similar manner: they regulate the serotonin chemical in the brain, which is thought to be related to depression. (Please note that I am definitely not a psychiatrist or a neurologist, so my understanding and explanation of brain chemistry is very, very basic.) Later, though, I was on a drug called Effexor XR (extended release). Effexor is a newer drug for depression, and it regulates serotonin, dopamine, and norepinephrine, all of which are chemicals in the brain believed to be associated with depression. It attempts to inhibit the neurotransmitters in the brain that are believed to be associated with it.
Medication, like all treatments, isn’t for everyone. Unfortunately, there’s a pretty huge stigma surrounding psychiatric medications, which makes it very difficult for people who want or need them to continue taking them. It also puts people off of trying a treatment that could potentially be very effective for them.
Q: What is the stigma around medications? Don’t people know that it’s none of their business?
A: God, I wish they did! Too many people think it’s perfectly okay to comment on other people’s use of psychiatric medications, without any knowledge of what the drugs do or more importantly, what that patient is experiencing that made them need to take the drugs in the first place! They are also often pretty ignorant of what the drugs really do. (“They make you into a zombie!” “They’ll take your soul away!” Uh, no. They don’t.)
Listen, I am all for not medicating people when they don’t need it…but who gets to define “not needing”? If you are experiencing serious mental illness—serious enough that your doctor is okay with prescribing you medication—then that’s enough to convince me that you’re taking those drugs for a good reason, and it’s not my place to judge you. Taking medication is a choice made with your medical professional, and who cares if I have a problem with it? (For the record, I certainly don’t, but even if I did, commenting on it is extremely inappropriate.)
You wouldn’t tell someone to stop taking their kidney medication because your kidneys are strong enough without them! Don’t give in to the pressure! Your kidneys definitely will not fail if you stop taking your medication! I can see them right now, you have strong kidneys, you will be just fine, my friend!
No, because that would be supremely unhelpful, weird, and totally inappropriate. Because that person is obviously taking kidney medication precisely because their kidneys are not strong right now, their kidneys probably will fail if they stop taking it, and you are not the person to tell them that their kidneys are doing okay now, because you are not a doctor, and you have—surprise!—no magical insight that the patient or the doctor does not have about the condition of the patient. You are not aware of anything special that they’re not already aware of, and your “advice” and “concern” about their medications comes off as patronizing, annoying, and invalidating.
Let me tell you what you’re really saying when you tell someone to stop taking their anti-depressants. You’re saying, “I don’t believe you.” You’re saying, “You’re weak for taking what makes you feel better.” You’re saying, “I don’t really care about how you’re actually feeling, even if these medications are making you feel better.” You’re saying, “My opinion is more important than your health.” You’re saying, “I am not someone you can rely on for help in these, or perhaps any, troubling situations.” You’re saying, “I need to be right. I need to have the last word. And I am willing to do this at the expense of your mental health, even though I’m now aware that that is an area in which you are experiencing problems severe enough that you and your doctor have decided to put you on medication. In other words, I don’t really care about you or how you’re feeling, and I am the most important person right now, and your actual problems don’t really matter to me.” Most of all, you are saying, “I am not someone who can be trusted.”
If you have real concerns about the implications of psychiatric drugs, that’s okay. Lots of people do, and there may be some valid critiques of their usage and distribution. But the time to express those concerns is not to the person taking them, who is suffering. After all, they didn’t invent the drug; they’re just hoping that it will help to shift the huge cloud of despair and purposelessness that is hanging over their whole lives, and their trusted medical professional has said, “Here, this may or may not relieve some of the pain.” And when you’re in that much pain, frankly, you are willing to accept any risk necessary to alleviate even some of it.
Besides that, lots of people are worried about the implications of all sorts of drugs, not just psychiatric drugs. Mysteriously, however, it’s usually only people with mental illness who get an earful about how bad and wrong their medications are. That’s because we as a society have a problem with mental illness. We don’t understand it, and we have a general contempt for people who experience it. If we didn’t have those things, we might still be worried about psychiatric drugs, but we definitely wouldn’t be blaming people with mental illnesses for taking them in an attempt to assuage their pain.
Finally, these drugs exist because they genuinely help people. Everybody has a story about some horrific side-effect, and it’s true, it happens….but many, many people find medications helpful. If they didn’t, they would not still be available. I know, drug companies, Big Pharma, conspiracies, mind control, etc, but really. Really. They really help people. And most people don’t need to take them forever, and most people don’t take them forever. They are frequently used as a short-term solution just to help people keep living life and not jump off a bridge. When they are a long-term solution, well, that’s between a patient and a doctor, not between a patient and the rest of the world. So please…keep your unwanted opinions to yourself.
Q: Is there any chance that your episodes could or will go away in the future? How likely are you to experience another episode?
A: I wish I had more straight answers for you, my friend, but when it comes to depression—and most mental illness in general—there are very few clear answers, very few things that anyone can say for sure, including mental health professionals. That’s part of what makes it all so difficult to deal with—it’s all quite unpredictable.
Is it possible that my episodes might magically disappear? I suppose anything is technically possible. However, is it likely? I don’t think so, and neither does my psychiatrist. It is, once again, complicated…
You see, technically anyone can experience a major depressive episode. Yes, even neurotypical people can have them sometimes. You, as a neurotypical person, could potentially have an episode yourself—one episode in your life, probably triggered by a major life event, and then, you might never experience symptoms again. That’s the tricky thing, because lots of people become clinically depressed at some point during their lives, but not as many people experience chronic, repeated, treatment-resistant depression like I do. I am in quite a different situation to those people, because every episode that I have increases the probability of having another. Given that I have had, oh, probably hundreds of episodes in my short lifetime, the probability of having another episode at some point is pretty much a sure thing. But that is definitely not the same for every person, because again, some people have a single episode and never have another as long as they live.
Q: Does the weather affect you? I know it affects me, even though I’m not depressed. Do you get more depressed in the wintertime?
Q: This is a question that comes up surprisingly often, and I can see why: the weather gets a lot of people down, so the logical conclusion is that if you’re depressed, it would make you more so, right? But I think you’re confusing me with someone who experiences SAD, or Seasonal Affective Disorder. They experience depression in direct relation to the winter season, and it can be quite difficult for them. I don’t have SAD, though; I have MDD, or Major Depressive Disorder. There is a common misconception that depression is one, unified illness, and it’s really not—there are several different types of depression, and beyond that, every specific case of depression is unique because not all people have the same symptoms. It’s important to make these distinctions in order to avoid mislabeling or invalidating anyone, and to create an environment that is inclusive of everyone’s unique experiences with their illness.
That’s it for this first installment of the series on depression. I will be posting a second (and possibly third) part of this series in the near future, so if you enjoyed this one, stay tuned for another one soon.