06 January 2012

Owning It: a Candid Discussion of Depression

Caveats of caveats, all things are caveats. First, let me say this is not a pity party for me or anyone else nor is it an invective against anyone else or me. This is being open and honest and hoping to create a conversation about something which, quite frankly, it disgusts me that no one really talks about.


Over a year ago now a friend of mine, a bright star in the darkness that life can all too often seem, committed suicide. When that happened I had vowed to finally open up and talk, publicly, like really fucking publicly, about my own battles with depression as a way of owning up to and hopefully helping others open up and own up. I never did.

The issue was and is that most people who do not have depression, and even many who do, do not admit what it really is, what it really means and what it really does in one's life. As such, I was afraid to talk about it. Well here I am and as a young professional ever-grasping for more opportunity this is a risky thing to be talking about on something that comes up under the top three Google results of my name but I forge on. 

To be upfront, depression is a disease. The same way a cold, canker sores, MRSA and syphilis are diseases. And like all of the above, especially the latter, requires treatment. Being a twenty-something male in a patriarchy such as ours makes it damn hard to admit that but this is a fight one cannot fight alone. If you do not get antibiotics for MRSA you will end up with a wooden leg and none of the perks of a pirate ship, syphilis, just look at Stalin. It has to be treated. That said, there are many ways of doing so. Too few people, and this is the result of the rampant negative characterization on many fronts, turn to medication. I remember reading a Times article which had the audacity to crack jokes about the sexual side effects of one of the more popular anti-depressants; the one I happen to take. If there is anything that is going to scare a twenty-something male in desperate need of treatment away it is telling him that he is going to end up with ED as a twenty-something. I can't speak of the side effects for women but it goes without saying that they are not wanting for any more reasons to have their sex-live stigmatized.

I "wrote a letter" as we curmudgeons are wont to do but it wasn't published. I argued, essentially, that while there are side effects, usually the benefits far outweigh them. Diminished sexual function vs. the ability to function at your 9-5? Yeah, I'll take the latter thanks. It didn't help that the Times (and many others) compared the effects to those of placebo. Yes, sometimes one course of treatment does not work. That's why there are lots. Some are even gummy, I hear.

The Times comparison to a placebo is more nuanced than it seems however and might not even be that bad. Based on some research I read about in the New Yorker it appears that the brain can actually heal the body just because it thinks it can. Harvard researchers are seeing signs that people who have been told they are taking a placebo start feel better anyway. There are a wide range of science-y explanations and questions for this but it all adds up to chemicals in the brain. This might not work for say, your splintering, post-MRSA shin, but it probably means a lot for things like depression.

Depression is widely attributed to an imbalance of the neurotransmitters Serotonin and Norepinehprine. The chemicals usually used to treat the disease are typically "reuptake inhibitors" responsive to one chemical or both. "Reuptake" refers to the fact that the cells that produce these chemicals often suck them back up when they are supposed to remain floating in the brain. This also, is where the side effects come in. An SSRI (e.g. selective serotonin reuptake inhibitor like Prozac, Celexa, Lexapro) blocks the "reuptake" of serotonin but it can also block the normal uptake of the chemical causing depression to get worse among other things. 

What's important in all the technical jargon above is that depression is based on chemicals, involuntary productions that do or do not occur the way they are supposed to in your brain. Essentially, it is not your fault. 

It is not your fault.

What is your fault is refusing to do anything about it. Man up and admit you can't do it alone because you can't and guess what, no one anywhere has ever done anything alone. Yes there are go-getters out there (I consider myself one) there are trend-setters out there (I hope to be one) there are unique individuals out there (I know I am one) but none of those things happen in a vaccuum. You can't be top of the pack without a pack to beat, you can't set a trend without people to follow it, you can't standout without a background. Everything relies on something and someone else. That is how evolution built us. Don't fool yourself into thinking you are bigger than the problem by refusing to ask for help. Asking for help, admitting you have such an unfortunately stigmatized disease, is the bravest and best thing you can do to deal with it.

But wait there's more!

Don't set it and forget it. You can't just go to the doctor, get a bottle of pills and start seeing roses and sunshine and unicorns, but if you can, let me know which doctor you see cause I want in on it. From personal experience, an anti-depressant essentially makes it easier for one to treat oneself. Before the medicine I would wallow, quite literally, in whatever I was feeling (with depression it is often that you feeling nothing at all) and would just sleep or browse the internet aimlessly. What Prozac has helped me do is see that I am not well and take my own steps to get better. Yesterday morning I was feeling that way. I woke up late and just wanted to stay in bed. I figured the cards were already stacked against me because I missed out on much needed time to be productive. It can happen. No medicine is not a cure all. When you get an infection you have to take amoxicillin and usually do something else like rest or eat better. With depression you have to take medicine and take care of yourself. Without Prozac I might have just stayed in bed and let everything get one hundred thousand times worse but I got up and kicked its ass. I picked up my bass, put on some real angry, gritty, nasty Black Flag songs and went to town. I played like I was in my high school pop-punk band again, in my apartment, in my underwear but unfortunately without that one cheerleader who always used to stand near the front at our shows. But hey, it felt good and I ended up making use of the rest of my day. Was it one or the other or both? The answer is probably all of the above with the most importance being that I took the situation into my own hands (specifically my now very blistered fingers) and did something with it. That's the key.

Move and you will move on.

With the help of a friend, I recently discovered the depths of misery and then simultaneously the heights of self-affirmation. To make a long and yet to be concluded story short, she did something bad to me but I got over it in part because I was able to take the energy I had for feeling like crap and turn it into energy for lifting weights and reading lots of books and also because a friend is a friend no matter what happens. Would I have been able to put all that negative energy to positive use without help? I doubt it -- no wait -- I know I would not have been able to snap out of that without help.

There are so many cliches, "bad things only happen because good people do nothing," "life is what you make it," blah, blah, hopelessly-optimistic blah.

But it's all true. If you don't want to be depressed. Stop being depressed. There are a million ways to do so. Find yours. Don't be afraid to admit it starts with a trip to a doctor or therapist. It's better than the alternative, trust me.

If you still don't think it's manly to be honest about your feelings, here are some videos of a guy who could definitely beat the shit out of you telling you about his. They're long videos but they're worth it.

This post is dedicated to the memory of David Sommerhauser.

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