Being depressed did not make me “an innocent in hell”

People suffering from clinical depression are often likened to an innocent in hell by medical professionals and their loved ones. It always stems from a well-meaning attempt to lift the depressed individual from the quicksand of self-loathing and self-beratement. You are not any of those things you say you are. You are not evil, you are not selfish. I know you. You are an amazing person and you are suffering due to no fault of your own. Basically, an innocent in hell.

I disagree. Yes, it was never my fault that I was depressed, but I am in many ways flawed, just as you are. I am not innocent, just as you’re not.

The only difference is that those who are depressed feel the weight of their flaws, and the flaws of others (though mostly their own), far more intensely than those who are not depressed.

While deep in depression, I mulled and mulled over how I hadn’t fulfilled my duties as a daughter, how I’d been too absent as an older sister, how I was too uncaring as a friend, how I was a terrible girlfriend, how I’d been irresponsible with the resources entrusted to me, how I’d wasted so many opportunities in my life, how I was terribly hypocritical as a Christian. All those things are true to a certain extent. It’s just that while depressed, I was so crushed under guilt and regret and I wasn’t able to be realistic or to move forward.

And as we all know, depression distorts our perception. The key word here is distort. Depression doesn’t just make stuff up out of thin air to torment you. Depression reaches into the recesses of your memories, pulling up real memories of real thoughts you’ve had, real things you’ve said, and real things you’ve done (or have not done, as the case may be). You become hyperaware of these things — your flaws, deficiencies, failures — and that’s all you can think of. You’re so aware, too aware, that these images eclipse any positives you might still remember. And yes, it later magnifies them, such that you come to think that the damage is so big that you can’t ever do anything to rectify things.

And then the self-fulfilling prophecy is set in motion. Believing I was an irrevocably depraved person, I started thinking and behaving like an irreparably depraved person. I would sometimes try to drag my then-boyfriend down into “hell” with me so I wouldn’t be so alone in my inescapable misery. I shudder at this confession, thinking about how I acted like the thief who “comes only to steal, kill, and destroy” (John 10:10).

Too often, though, we are told that “depression lies to you”. I cannot count the number of times I heard this while deep in the throes of depression. I have a big problem with this phrase. It creates in the mind of the depressed person an impossible dichotomy: either I am the horrible person I make myself out to be in my head, or I am completely innocent of all the things I am accusing myself of. It seemed like wishful thinking to believe the latter, and so I’d stubbornly cling to my own (distorted) assessment of myself. The fact of the matter is that I am neither of those things, and there exists that middle ground we are so afraid to tread: I may not be a good person, but I can change that. And I have to start somewhere. Will you help me?

Thanks to medication, counseling, prayer, spiritual direction, and the support of those who love me, I am now a lot better. But I choose to remember the things that were brought to the surface while I was deeply depressed. They are real and I am making use of the energy and optimism I now have to seek healing. In myself, I am hoping, by the grace of God, to overcome my flaws. And in my relationships with other people, I am seeking to love and serve better, with Christ as my guide. He, after all, is the great physician.

There is great temptation for those coming out of depression to frolic in “the land of the living”, leaving all the pain behind. I fell into this temptation as I recovered from my previous cycle of depression. I was too eager to see myself as a good person, and I swept all my failings back under the rug, where they’d been for so many years of my life. But I now believe that God allows us to go through suffering not just so we can appreciate its absence. Suffering can grow, refine, and even heal us. We just need to sift through the rubble to find those hidden treasures. St Faustina wrote: Suffering is a great grace; through suffering the soul becomes like the Saviour; in suffering love becomes crystallised; the greater the suffering, the purer the love.

I would encourage anyone, clinically depressed or not, to occasionally sit amidst the rubble and ask God what you ought to do with the mess around you. Mend those broken relationships. Forgive those you haven’t forgiven (including yourself). Ask for forgiveness from those you have wronged (intentionally or unintentionally). Overcome those self-indulgent habits. Pursue a vocation that, rather than helping you not to run away from the messiness of the world, allows you play a role in healing it. And be there for those who were there for you, as well as those who weren’t, because you now understand the darkness of suffering alone, and you understand the power of solidarity and grace.

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With a little help from antidepressants

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This month, The American Recall Center is encouraging conversations online and offline about medication safety (check out their post on the newly-discovered side effects of Xarelto). Judy, their Outreach Coordinator, got in touch recently asking if I’d be willing to write about my own experience with medication. I realized I’ve hardly (publicly) talked about the role of antidepressants in my road to recovery, and so I thought this could be a good place to start.

For 3 months or so, I’ve been getting by with a little help from Lexapro (or escitalopram). Owing to my own stubbornness, compounded by my ignorance about the nature and effects of antidepressants, I waited almost 6 months into this current cycle of depression before agreeing to be medicated. There are a few things I wish I’d known earlier, which I hope could be helpful to you or someone you know:

Antidepressants are not magic pills that will “make us forget all our pains” a la Helen’s drug in The Odyssey, as many people might assume. People looking for a “quick fix” would be disappointed, and it is unfortunate and irresponsible that antidepressants are overprescribed to people who don’t necessarily need them. On the flip side, they are underprescribed to those who actually need them, but are wary and skeptical of antidepressants. I belonged to the second camp.

I was under the impression that antidepressants were mood-altering drugs that would do no more that make me numb to my problems. So to me, to take antidepressants would be to live in denial. And since living with integrity is of paramount importance, this was a huge no-no. For half a year I resisted my parents’ and then-boyfriend’s persistent efforts to get me to see a psychiatrist, until eventually caving in only because I felt guilty for making them so anxious. “Oh, you’re definitely depressed,” the doctor told me as I tried to argue incoherently that I was simply seeing the true terribleness of my existence. She prescribed Lexapro. I brazenly told her, “This is not what I need. What use would it be to feel better and still be this despicable person that I am?” She asked matter-of-factly if I had anything to lose. I guess I didn’t. Perhaps at the very least I would stop embarrassing myself by sitting on road curbs or hugging lamp posts while sobbing about being alive.

Most antidepressants take about 4-6 weeks before they start taking effect. (There’s also a very real possibility that a particular antidepressant may have no effect, or none that is substantial, even after that period. In that case, your doctor would put you on a different antidepressant.) I first noticed it when I began moving around a lot more than usual while in the shower. Considering that I’d recently found myself curled up in a fetal position under running water, that was a big deal. On the same day, I also found myself having enough energy and motivation to finally clean up my bedroom from corner to corner. Overall, I began feeling generally “lighter”, while remaining acutely aware that I was still struggling with negative thoughts and a low self-esteem.

That leads me to the next point: the first symptoms to improve will be energy level, concentration, and motivation. And the last to improve will be your low mood and feelings of hopelessness. I was experiencing improvements in my ability to think, read, articulate myself, and perform basic, everyday tasks. And yet I continued to hate myself and have a bleak outlook on life. I mistakenly thought this was a confirmation of my initial understanding of antidepressants.

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That period before your mood begins to improve can be dangerous. While my suicidal thoughts used to be purely fantastical, during this period, I began to think they were actually quite reasonable and doable (it scares me to admit this now). This is a very real danger for anyone starting out on antidepressants: you might begin to have energy and cognitive ability to actually execute suicide plans. If a loved one is relatively new on antidepressants, please be more attentive and vigilant than usual. It is also important that they are taking these antidepressants under regular consultation with their doctor. He/she will be able to assess how well the patient is reacting to it, if there’s a need to adjust the dosage or switch to a different kind, etc.

I have come to a point where my mood has improved remarkably, and where I’m starting to have much healthier and more realistic thoughts. There is still one more thing I or anyone in my position should remember: do not stop taking your antidepressants at this point. During this cycle of depression, I was informed by my doctor that at whichever point I start feeling “fine”, I will actually need to stay on my medication, and at that optimal dosage, for an additional 9 months to maintain the balance within my body.

I’m also seeing a counselor regularly, even though I didn’t think I needed it anymore. When I found out what a long wait list there was, I told her, “You know, you should just give my slot to someone who needs it more than I do. I’m honestly quite okay nowadays.” However, she told me that given my history of recurrent major depression, it’s important that I continued to see someone to process what’s happened, and also so that the symptoms can be caught much earlier when depression returns. Experience with previous episodes confirm this: inadequate treatment can lead to relapse and recurrence. We should also note that it’s been well documented that the risk of recurrence increases with each subsequent episode. It’s not something we want to gamble with.

Lexapro is an SSRI, or selective serotonin reuptake inhibitor, one of the main classes of newer antidepressants. SSRIs act on a chemical in the brain called serotonin (a neurotransmitter), which helps relay signals from one area of the brain to another. Its many functions in the brain include the regulation of our moods, and many researchers believe that a serotonin deficit leads to depression. SSRIs elevate the level of serotonin in the brain by inhibiting its reuptake. They do not alter our personalities. I also strongly recommend talking to a counselor to complement the medication, and your doctor will most likely say the same. The medication will help us be better receptive to adjustments to our thought processes achieved through counseling, so these go hand in hand!

While depression distorts our perceptions, there are very real hurts in our lives that need to be healed, and real problems to be solved. We need to be in the right frame of mind and have adequate energy to be able to deal with them, and that’s where antidepressants come in. We are “dependent” on them only in the sense that someone with a broken foot has to depend on crutches until he recovers.

My final concern, and this will be pertinent to fellow Christians, is where psychiatric medication falls in our theological framework. We recognize the limitations (and dangers) of psychiatry when taken to reductionist, materialistic directions. It is preposterous to oversimplify mental illness as “chemical imbalance in the brain”, though I have definitely been guilty of that. The Church teaches that the human being is a union of body and soul — what affects physically will also affect us spiritually. We need a physician for our body, and we most certainly and desperately need a physician for our soul, and that is Christ. Seeking medical treatment is not to turn our backs on God — all truth is one; the wisdom amassed in the field of psychiatry, when rightly applied, is part of God’s gift to us. (Highly recommended reading: The Catholic Guide to Depression by Aaron Kheriaty, MD with Fr. John Cihak.) At the same time, we also don’t want to come to view antidepressants as a guarantor against suffering, for we know that in this lifetime there will always be suffering. But we take comfort in that with God we can offer our suffering for something greater than ourselves (I will save this another time — I know it’s not an easy thought to swallow — I will admit it is also rather difficult for me at this moment and I have much to learn from the saints who so lovingly carried their crosses).

I’ll end here for now. Unsure about anything? Talk to a medical professional. All I can share is based on my own experiences, plus some information from trusted sources — I am in no way qualified to dole out expert advice!

When I told my professors about my depression

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Last week was spent bedridden with a fever fluctuating in the 100-103F range. It also happened to be finals week, so I wasted no time in requesting deadline extensions. I was relieved, though not too surprised, that my professors were generous and understanding enough to grant extensions stretching beyond finals week. But it made me wonder why reaching out to my profs with this request was such a no-brainer, when I was so reluctant to do the same last year when I was struggling with depression. If you think about it, what’s a better excuse to ask for help academically? When your body is sick, or when your brain is sick?

It took me a long time to muster the courage to tell any of my professors about my problem with depression. My counselor, knowing how much the condition was taking a toll on my mental capabilities, had advised me to inform them as soon as possible. At first, I didn’t think it would be necessary (it also seemed like TMI — would they even care?). As the depression got worse, I wondered if I was just using depression as an excuse for my stupidity and laziness. After all, I was spending most of my time just lying in bed and/or staring off into space, or playing brainless iPhone games. If I would just open a new Word Doc, I’d be able to work fine, wouldn’t I? (Wrong.) I suppose that was around the time the depression began to convince me that I wasn’t really depressed. Eventually, for the sake of my grades, I did email my professors about this, even though I remained half-convinced that I was a terrible person for exploiting this “little” medical condition.

This was Prof S.’s response to my email asking for Pass/Fail (instead of a letter grade). She was the first prof I’d told about how depression was impeding my academic performance. Not only did she grant my request, she graciously offered a Pass without requiring me to turn in a final paper at all:

Dear Karen,

I have struggled with depression on and off all my life; it is genetic in my family. It will pass! I will give you a P for the course. Meanwhile I hope that you are receiving the proper medical help.

No need to hand in a paper. If I can give you a word of advice — please be sure to consult both a counselor and a psychiatrist. Some depressions run their course in 9-10 months even without medication. But often medication is needed, even if for a show period of time. There is nothing  wrong with taking antidepressants. It is tricky sometimes to find the right antidepressant but when they start to work, they are worth their weight in gold.

S.

And this was Prof L’s response. I couldn’t afford to Pass/Fail this class because it was a requirement for my major, so instead I asked for deadline extensions:

Hi Karen,

An extension would be just fine. There is no need for an explanation, but I am glad that you are getting the appropriate medical attention. I know how difficult it can be to respond to treatment and to be open to people around you, so I am happy to see that you are taking the right steps. I’ve seen a lot of students who are too scared to get the help that they need, both medically and academically, when dealing with a mental illness, so know that you are handling this in exactly the right way. Let me know if you need anything, and also let me know if you’ll need some extra time on the final assignment.

R.

The genuine empathy and concern in both professors’ replies astounded me. They assuaged my fears of coming across as lazy or weak. And more importantly, in my confusion about my own mental state, they gently affirmed that depression was a complex illness that crippled people in very real ways. I know some college students who don’t feel like they can or should inform their professors about their depression. I would strongly encourage anyone in that position to do so without fear of judgment. Nobody talks about depression in class, but this doesn’t mean our professors know nothing about it. If they haven’t personally experienced it, given the amount of stress in academic circles, and also the number of years they’ve lived, our professors are a lot more likely than our own peers to have personally known someone who’s battled it. Either way, they will understand.

Note: Taking  a leave of absence from school might be a better option for others, especially if you are having recurring suicidal thoughts. Do discuss your options with your counselor and people who know you well!