Hope is not an emotion

This past year has taught me a precious lesson. I have, for many years, grossly misunderstood the nature of hope. And the more I longed for my imaginary version of hope, the more elusive hope became.

Hope, as it turns out, is as misunderstood as love. Like love, hope isn’t an emotion. In fact, hope doesn’t have to feel good in the least. Like love, hope is a choice and a commitment. A commitment to what? A commitment to keep choosing the path of life — in spite of feeling hopeless.

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When I first started dealing with periods of severe depression about three years ago, I came to believe that one does not simply choose to have hope. Those seasons of unspeakable, impenetrable internal darkness convinced me that sometimes, one is completely robbed of the capacity to have any hope at all. As such, I began taking for granted this notion that the only way to get out of those psychoemotional abysses was to hang in there and “wait it out”.

I don’t mean to say it doesn’t work. Sometimes, staying alive in itself can get so difficult that that’s all the work you can do. With your loved ones standing by your side and giving you just enough to not quit on life, and you dutifully taking your prescribed medication, the storm eventually dissipates, and you start to see the light again, and you find reason to get back on your feet.

But over the course of my last depressive episode, I noticed something rather peculiar. It started when my therapist told me, “You know, at some point, you’re going to get tired of despairing, and you’re going to want to do something.” This was after many sessions of me walking in simply because it gave me something to do, while remaining unreceptive and unwilling to acknowledge that things could get better. My first reaction to her remark was of annoyance and anger. Get TIRED of despairing? You make it sound like I’m choosing to despair. You make it sound like I know some kind of alternative to this terrible existence. But deep beneath all that maudlin angst, I knew she was on to something.

I was noticing that there comes a time when despair becomes your comfort zone. Comfort zone?! Yes, a very uncomfortable comfort zone, but a comfort zone nonetheless. It’s that zone where you’re no longer thrashing, kicking, writhing, screaming — but you’re floating in that murky, slushy, stinky cesspool of despair. Despairing, loathing, and bemoaning your existence has be come second nature, and the thought of recovery is actually scary. Despair is familiar; recovery is foreign. Not wanting to live has been your default state of being for so long that learning how to live again is intimidating.

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‘Niedergedrückt’ by Melancho Blumenbunt

I reflected on this further, and then I went back to my therapist and admitted to her that I was afraid of recovering. I was afraid that if I should start making some changes to my mental and physical routines, I would start to feel better, but still find myself loathing my lot and my existence, and I would have no more excuse to be less than functional. I would have to accept the terribleness of my existence, and simply deal with it.

This admission to my therapist, but mostly to myself, was an important turning point. Of course, I didn’t make an instant 180 to start making tangible progress — I continued hemming and hawing for a while — the bad cognitive and behavioral habits that develop over months of despairing are so difficult to shake off. But there came a day when I decided I would find a way to start moving again. No, not because I felt better, not because I received a sign from heaven that all issues would be resolved. Simply because I realized I had nothing to lose.

It’s funny how that works. The flip-side of despairing about virtually everything is realizing that you have nothing to lose. And suddenly, you find there’s this untapped reservoir of boldness welling up within you. Call it tragic optimism, or a just darn clever biological mechanism that kicks you in the direction of recovery, but you can choose to ride that wave, or choose to continue thrashing.

It became a psychological discipline to bat away negative thoughts, especially about myself. It doesn’t mean all of a sudden knowing what’s true and what’s false. Instead, the inner dialogue sounded a lot more like this: I know, I know, I’m useless and stupid… But I’m gonna be radically okay with it, and see how far I can go. And so I go about my my day having shelved that particular thought. I read a book, I go for the job interview, I enter into a conversation I would typically have avoided. Oh, yes, and I’m a cruel, heartless, wretched human being undeserving of love… But you know what? People seem okay with it. Let’s see how long I can go before I’m exposed. And again, I go about my day, agreeing to meet a friend, or attending a get-together instead of making excuses to stay home. Oh wait — how about the fact that I’m doomed to a lifetime of lonely misery and will never find happiness? Soon enough, I started being able to say, oh just shut up already. 

Perhaps it all boils down to putting aside your pride. We despair because we are unable to accept ourselves and our lives, or we believe the world cannot accept us, or both. It’s not an easy decision to make, but when we choose radical acceptance, magic happens. Slowly but surely, I started experiencing improvements in my mood. The more I put myself out there in spite of the forces threatening to engulf me, the more the clouds began to clear. My thoughts became more realistic, my emotions more stable, and my social anxiety markedly reduced. I became less inward-focused and could start loving and caring for other people again. At the very core of it, I came to recognize the inherent good of being alive once more.

And so I learned that you don’t sit around waiting to feel hopeful. Often, we imagine hope to mean seeing the light at the end of the tunnel, when it’s more like digging, grasping, and clawing your way through the dirt until you see the light. Hope is hard work. To decide that you are willing to try is a huge victory over despair, a huge cause for celebration for the people who have been rooting for you, and the beginning of a scary but empowering journey.

Hope is courageous: it is letting go of the dogged notion that you need X, Y, and Z to live, and being willing to attempt forging a new path. Hope is humble: it is admitting that you don’t know everything, and that your forecast of doom and gloom is fallible. Hope is radical: it is a commitment to stop comparing yourself to others (you know, the “happy, productive, and functional” folks), and focusing on doing what you can do in a given moment.

And finally, you may or may not agree, but I believe that true, lasting hope requires faith. I know that any of my efforts to reject the voices of my inner demons would have been unsustainable without faith in a loving and merciful God. What made those psychological disciplines possible was a deeply spiritual discipline: to begin each day offering up my fears, anxieties, and regrets to God, and trusting like a child that He is already paving for me a new path my eyes cannot yet see. For hope that is seen is not hope at all. And faith is confidence in what we hope for, and assurance of what we do not see. This hope will not put us to shame.

I thank God for the gift of faith, and for loved ones who, having exhausted creative means to motivate me, beseech me to turn to God.

We are not the sum of our weaknesses and failures. We are the sum of the Father’s love for us, and our real capacity to become the image of His Son.

–Pope John Paul II

Thank you for continuing to accompany me on this journey. 🙂

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A new season, a new diagnosis

If you’re a frequent reader, you may have noticed that I’ve been posting at a markedly reduced rate. The arrival of spring has, for me, coincided with a new season in life.

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Frankly, ideas no longer come to me as readily as they did over the last few months. Or if they still still do, then perhaps it’s the words I need to convey them that are no longer at my beck and call. I’m aware of how my fingers no longer chase after words that once spontaneously spilled onto the keyboard.

Does it bother me that it now takes a more deliberate, concerted effort to condense my thoughts into the written word? That socializing is no longer as easy breezy? That I now get tired more easily and sometimes struggle to stay alert at work? That I now need afternoon naps and more snooze hours? A little bit, yes, but while all this might sound like a melodramatic lament, I’m actually surprisingly okay with these developments.

It’s not the most pleasant feeling, but at least I’m not terrified. Two years ago, I had no idea what was happening to me, so best guess was that I was losing my mind. I vividly remember having a horrifying existential breakdown in front of my computer while struggling to comprehend some class-assigned readings. In retrospect, I probably over-exaggerated the problem. It probably wasn’t quite that I understood NOTHING, as I ran around exclaiming in despair to me helpless roommate. More likely, I simply could no longer read, comprehend, and process at the super-speed I’d come to regard as “normal”.

And when it happened a year ago, I assumed it was the onset of another bout of depression. It happened to be crunch time for my B.A. thesis, the pinnacle of my undergraduate career, and also the dreaded job hunt season. I grappled and clamored and clawed to keep my head and my “sanity” above the quicksand, only to get sucked right under. Before I knew it, I found myself on the floor of The Stacks, spilling tears and snot all over musky old books (I apologize to everyone who had to touch those books after me), freaking out about being “the most pathetic human being to ever exist” and begging my hapless boyfriend not to make me get on the plane to Pittsburgh for a final interview.

In this space I’ve freely written about my travails in “recurrent major depression”, but never once mentioned my brewing suspicions of a misdiagnosis. Over the last few months, I’d begun to suspect that my “condition” should rightfully be termed and treated as bipolar II. With each article read, each forum scoured, and conversation had (with friends who have had similar experiences, friends in med school, helpful folks on Quora…), I grew increasingly certain. But it was only about a week ago that I received affirmatives from my general physician, as well as a psychiatrist.

I don’t simply drift in and out of depression — I ebb between a few months of depression, and a few months “hypomania“, a lesser known term. You can easily find descriptors of the common symptoms of hypomania, but generally, I would classify them all as basically being a Super version of yourself: quicker, more creative, more productive, more sociable, more adventurous, more energetic (but on the flip side, often more impulsive, which can lead to poor judgment and bad decisions). A word they often use is grandiosity. But me being naturally more reserved, the grandiose, less inhibited version of myself often just seemed healthy, confident, and fun.

Doesn’t sound bad, does it? In fact, you’d find many people with bipolar II asking questions like, “How can I extend my hypomanic episodes and shorten my depressive episodes?” Unfortunately, it doesn’t quite work that way because your brain is essentially on over drive during hypomanic episodes, so to indulge in it would likely result in a harder crash. And I can only imagine how drastic spikes and falls, left uncalibrated, would mess up one’s brain in the long run.

I now wonder: How was it humanly possible that I churned out an average of 4 full-length blog posts and 2 original drawings per week? And all without sacrificing my full-time job, volunteer commitments, self-directed study plan, occasional Netflix binges, and a healthy social life? No, now it doesn’t quite seem humanly possible. And I am accepting that it’s not supposed to be.

My “superpowers” have been taken from me. And that’s more than okay. When I speak of a “new season” in life, I don’t mean a new season marked with reduced activity and inspiration, because that wouldn’t exactly be the first time. It is a new season in that I am now aware of what’s going on in me. I know what body of knowledge I should be tapping into. I know when and where to get help if needed. I know what to encourage, and what not to. I know what feelings can be indulged, and what shouldn’t. I have a good relationship with my psychiatrist and therapist, and I am actively involved in making decisions about going on/off medication, making plans to learn to self-regulate where possible, and so on.

Why did it take me so long to consult health experts about my brewing suspicions? I was afraid. I didn’t like the idea that the periods in my life where I actually liked myself and liked being me, I was in fact just “hypomanic”. I yearned for those to be “normal”, not things that might potentially need to be repressed, regulated, corrected, or even medicated. Basically, I was afraid to acknowledge that I might not really be me when I’m at my best. But over the last few months, I’ve come to realize that there’s no such thing as a “real” you. The depressed me is still me, the hypomanic me is still me, and same goes for everything in between.

Perhaps I’m not as “consistent” as I would ideally be, but who is? We’re at times lazy, at times driven. At times selfless, at times self-indulgent. At times insecure, at times self-assured. At times fearless, at times cowardly. And at times we are lost in the fog, at times we find a good vantage point to see past the fog, and at times we even find our footing in the midst of it all.

I am learning to be okay with uncertainty, and with a lack of control. And it helps to realize we can only ever have perceived certainty and control. When we think we know what tomorrow will bring, it’s really just an illusion, isn’t it?

Thank you for accompanying me on this journey. Peace be with you. 🙂

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More than we desire peace, we desire meaning

[I]t can be seen that mental health is based on a certain degree of tension, the tension between what one has already achieved and what one still ought to accomplish, or the gap between what one is and what one should become. Such a tension is inherent in the human being and therefore is indispensable to mental well-being. We should not, then, be hesitant about challenging man with a potential meaning for him to fulfill. It is only thus that we evoke his will to meaning from its state of latency. I consider it a dangerous misconception of mental hygiene to assume that what man needs in the first place is equilibrium or, as it is called in biology “homeostasis”, i.e., a tensionless state. What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him.

–Viktor Frankl (neurologist, psychiatrist, and Holocaust survivor)

How do you maintain your grip on reality?

About a year ago, I wrote a letter to my future self. It was barely three months after what had been my debilitating bout of depression to date, and I was a little nervous. To realize that for eight out of twelve months I could have been so wrong about so many things, so blind to so many truths, so caught up in the half-lies of my distorted reality — it was a world-shattering realization. (In my previous post, I write in greater detail about the distorted thought patterns of a depressed person.)

I say world-shattering because most of us grew up being told to believe in ourselves, that if we believed something about ourselves then that’s true. Or at least, that what we see in ourselves is supposed to be more valid than what others see in us. Never let anyone else have the final say. They are but naysayers. Trust your heart. 

I was finding that that wasn’t so great of a mantra to live by. In my depression, I believed that what I had was not a treatable illness, regardless of what anyone told me. I also believed God had either abandoned me, or He simply hated me, regardless of what anyone told me. Because it sure seemed that way to me.

I remember being 15 or 16 and watching supermodel-turned-talk-show-host Tyra Banks instruct the teenage girl on her show to “go home, take a post-it, write I am beautiful, stick it on your mirror and recite it to yourself every day until you believe it.” The live audience promptly rose to their feet for a watery-eyed standing ovation. I remember grimacing at my laptop screen, not because I disagreed that this girl looked perfectly pleasant, but because all these women were essentially telling her to completely disregard her own conviction. And they expected it to work? I won’t pretend to know how one overcomes Body Dysmorphia Disorder, but I doubt that was it. I don’t think they let the poor girl say anything, but I knew that if I were her, I would have thought supermodel Tyra Banks was just patronizing me by telling me I was beautiful when I really wasn’t. It’s not going to work. Not unless our culture stopped worshipping self-belief and self-determination above all else. Because sometimes, many times and for many reasons, we are going to be misguided and we are going to be wrong.

Who, then, can we trust to tell us truths that can be so counter-intuitive?

Back to the letter I wrote to myself. I hoped for this letter to protect me against depression’s most powerful trick: the distortion of perceived reality. This is part of what I wrote to a future self who might be caught in another raging mental storm: If that’s what’s happening now, hold on to this golden nugget of truth: Many things in life have failed you, but God will not fail you. If you’re going to succumb to the lies of depression, fine, but this is one thing you can vouch with all your mind, heart and soul is true. Otherwise, strive to know more of Him and His plan for your life, his role for you in His kingdom. Go into storms confident that you are standing on solid rock. . . . You are a daughter of God and He loves you more than You could ever know.

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This was written solely to myself, and no one else has seen it till this moment. I thought this would be foolproof. It’s in my handwriting, and it’s sincere — how could future me distrust it?

But I did. About six months later, I opened this letter again and I wanted so badly to rip it to shreds. I read my own words and chastised myself for being so delusional at the time of writing. For the second time, I became obsessed with the theory of depressive realism: depressed individuals make more realistic inferences than non-depressed individuals. While everyone around me insisted that my depression gave me a negative cognitive bias, I believed in myself so much that I thought it was them who had a cognitive bias — a positive cognitive bias. And I, being supposedly depressed, had the more accurate appraisal of myself and the world.

What arrogance, Karen.

I remember my then-boyfriend trying to tell me I was being arrogant. It made no sense to me at the time. How could I possibly be arrogant when my self-esteem is at rock bottom?

It turned out that while depressed, I lost many things — self-esteem, self-love, empathy, love for others — all but my idolatry of my own intellect. I suppose it didn’t help that I’d been immersed in an academic environment that worshipped the intellect as the harbinger of Truth.

Recently, I talked to my RCIA instructor about my struggle to retain my faith during depressive episodes. He said that we consider the human person, we often don’t look beyond the intellect, the emotions, and the body. Our free will, he says, is a very sacred gift God has given us. It operates outside of intellect, emotions, and body. He has given us our will so we can know Him, and choose whether or not to love and follow Him.

I see now that as a Christian, I must, using my free will, submit my intellect to God. While this must sound like blasphemy to any post-Enlightenment atheist, I declare this unashamed because there is no better option.

To people for whom religion is but a tool of rationalization, I say the same of secularism. It comes down to the question of which is the more reliable tool. Well, my religion is not quite a tool, but a relationship with the true and living God. He gave me my capacity to think and capacity to rationalize. When my brain is “broken” and doesn’t perceive things quite accurately, I can turn to its manufacturer to tell me what I ought to be perceiving. Thank God for the Church that has been entrusted to guard and dispense God’s truths, so we will never be left as orphans (John 14:18) flailing around trying to make sense of everything given our limitations.

I repent of my life-long arrogance and self-idolatry. I will end this post with one of the most-cited verse of the Bible: Trust in the Lord with all your heart, and lean not on your own understanding. (Proverbs 3:5). I used to think this applied mostly to those who “aren’t smart enough to come to their own understanding of things”. I take that back, and I would even add that this is particularly relevant to those we consider to be highly intelligent.

What I needed was not a letter from me. What I needed was God’s Word and the teachings of His Church, and the humility to trust Him over myself.

I know not all my readers share my convictions, so I’ll open this up to you: how do you maintain your grip on reality? Or more broadly speaking, how do you know what’s true?

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

Recommended reading: In Miracles, C.S. Lewis demonstrates how the fact that we can even reason and rationalize is a great argument for the existence of a transcendent Creator. Or go to Wikipedia for a summary of the argument from reason.

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!