Major Depressive Disorder

A Case of Depression


By Louise from her own experience with depression
Written for Internet Mental Health
February 1998

The Onset

February. Time of joyful beginning, daffodils, snowdrops. What a nuisance to have the flu. Soon it will go. Why then do I find two weeks later a darkness descending upon my spirit? And strange new fears. Here I am in my early fifties living on my own as a widow. Never before have I been afraid. On the contrary, I flourished in solitude.

Next a new experience. My sleep, before so uninterrupted, begins to be broken up. I wake at 3:30 a.m. Then I begin to wake at 1:30, 3:30, 5:30. And the darkness! It is like a black cloud pervading my being.

Things worsen. For a time the darkness lifts by noon and I can forget those terrible early hours. But then the darkness lasts longer and longer. Only in the hour before sleep do I feel at all free from darkness. And I dread going to sleep, to face the wakeful night. Now I know what Hopkins meant: “I wake and feel the fell of dark.”


First Treatments

Between February and July I visit two different doctors who suggest hormone replacement and small doses of antidepressants. Now my problems truly begin as I act upon my preconceived ideas about antidepressants. I react with indignation and horror. “I, antidepressants?!” “I who have always been able to solve my problems by right thinking and by my faith?!” “Surely all I need to do is to assert my will.” “Yes, will-power!” “Yes, positive thinking!”

My decision is to try hormones. But their effect is negative. I become more and more depressed. Each day, darkness. I go off the hormones. There seems to be no solution. And something new appears: anxiety. I have nothing to worry about specifically and yet I feel anxious all the time. Soon my stomach starts to be painful, burning after every meal. As for sleep - I have not slept through the night since February.

Another trip to the doctor and then to a specialist reveals incipient ulcers. The cause? Possibly diet. Then follow three months of the elimination of foods. Nothing seems to help. Every day is pain. Soon I am having almost no variety of foods. My anxiety level increases. And a new dread experience occurs: suicidal thoughts.

August arrives and one thought alone haunts me. “I want to die.” “I never want to endure all this pain any more.” “I never want to face the terrible loneliness of my house and life.” The thought of death stalks me like a monster. And I begin to run to people for help.

I cling to each person I know. Why? I am hoping for assistance. As a person leaves my presence, inwardly I experience a kind of death. My reaction is an inward scream: “Don't go!” “Don't leave me alone!” “I want to die!” “Oh, help me to die, never to experience this dark cloud again, never to be lonely again.” Other people see sunshine and joy; I perceive only the gloom of despair.


Advisers

August to September. I get worse and worse and still stubbornly refuse to consider taking medication. My nights are a horror of sleeplessness. My days are plunged into darkness. People are kind in offering advice on what to do.

  1. Some urge me to take antidepressants.
  2. Others warn me never to take antidepressants under any circumstances. I hear horror stories of what these medications will do to my brain and other internal organs. My resolve to resist medication increases.
  3. Others tell me that they would never take drugs. They look at me with a kind of horror when I suggest this possibility. “All you need to do is to be strong! Exercise! Take a whole range of vitamins.” I listen and try these techniques but the depression does not go.
  4. I speak to those who share my faith. “More prayer.” “Proper prayer.” “Your faith is weak.” “My prayer for you is; bring Louise to her senses!” How I want all this to be true. If I just pray more, trust more, believe more, I'll get well. If I just read the right books, my thinking will be healthy.
  5. Another tells me to avoid doctors and to be busy. “Join this club and that club.” “Go to concerts.” “Make more friends.” “Work more on hobbies.”
  6. Another says that the solution is simple: just relax. “Don't worry about anything.” “Acceptance is the key.” “Accept what comes and be at peace.” How appealing this seems to be; how easy!
  7. “Awake at night?” Take sleeping pills. No more problems.
  8. Another urges meditation techniques.
  9. Another suggests psychotherapy and group sharing.
  10. Another tells me to “pull up my boot straps.” “Stop being so self-centered.” “Go work in the food bank or help unfortunate children.”
  11. Another urges me to be grateful for all my blessings. She is horrified at my condition. “You don't have cancer or some terminal disease.” “Visit the hospital. People there have a right to be depressed. You don't!”
  12. Many people suggest books. Some are religious. Some are self-help books. Some offer profound interpretations of life. Some suggest ways to change outlook or behavior in order to ensure a calm and cheerful mode of life. These books assume that when the intellect grasps the problem and the changes that are needed, the will can easily put into effect what is needed. If only it could be so! “Read, absorb, become!”

October comes. My desire to cling to people for security grows. My fear of being alone intensifies. My pain at seeing people depart increases. But people now flee. They cannot cope. They cannot help. They want happy, jolly conversations. Rejection after rejection increases my wish for death.

And then there are the more devastating experiences. One friend says: “Leave me alone!” Another refuses to let me visit in her home. Another tells me not to come near his young daughter, who knows nothing of sadness. People avoid encountering me. Others impatiently reject me for not taking their advice. Those who are loyal never greet me with a smile. They dread my approach. I try to be cheerful but seem capable only of sadness. People tell me that I am too much centered on my health and that such self-absorption is tedious. It alienates friends. “The time has come, the Walrus said, to think of other things.” While trying to take this advice, I sense that the depression is getting worse.


The Turning Point

In desperation, with the help of two faithful friends, I go to a psychiatrist. My resistance to antidepressants remains firm. It happens that the depression has lifted during my first two appointments and the need for antidepressants seems small. At the next appointment I am in a state of anxiety and fear. The need for antidepressants is clear. But I resist. The depressions worsens. I constantly wring my hands in agitation. I want to die. I carry on my work by sheer will-power. And now I find that I cannot make the simplest decision. I cannot concentrate. I have no desire to read and find it almost impossible to do so. People have suggested book after book: they sit unopened, haunting me. “Perhaps the answer is there and I just need to read and put into practice some specific advice.” I become afraid of doing anything, even getting on a bus. To be alone causes complete panic. I rush to person after person begging for help. I speak to several other doctors; each gives the same advice: take medication.

My sleep becomes even more broken. Tears come easily and all seems dark. Finally I not only feel suicidal but think of ways to end my life. And all these experiences seem so irrational because I have not suffered any particular crisis.

When I reveal to the psychiatrist the intensity of my thoughts of suicide, he takes action and says that I must be hospitalized. In hospital I will be compelled to take the medication that he believes will start a healing process. To avoid going into hospital, I agree to take antidepressants, first in small doses and then gradually increased to a therapeutic level.


Treatment Begins

Antidepressants take four to six weeks to have a positive effect. Before that, they can have varied side-effects, mostly negative. It takes courage and commitment to continue the treatment. I soon lose both as I experience:

  1. Headaches with the feeling of a tight band around the skull.
  2. Waking up so drowsy and groggy that getting up becomes almost impossible, even though I have as long last slept through the night.
  3. Feeling like a zombie from 6 a.m. to noon, with eyelids drooping and mouth yawning.
  4. Nausea and stomach ache after each meal.
  5. Weakness in the legs so that walking become more like stumbling.
  6. Dryness of mouth and thirst.
  7. Dampening of spirit so that one feels hardly alive.

After enduring these side-effects for a week with the anxiety, fear, and depression becoming no better, I decide that those opposed to antidepressants must be right. I cut the dose of medication, planning to go off altogether. But this plan is short-lived. The depression worsens noticeably. I become more and more suicidal, alarming several people who begin to believe that I might succeed. Once more the threat of the hospital looms.

I resume treatment with lithium added to the antidepressant. Now there are new side-effects: worse stomach pain and tremors in my legs. I look as if I am shivering all the time.

I remain skeptical about the value of the treatment. But slowly changes occur. My anxiety lessens. I can recognize its arrival and, if necessary, take extra medication. My wishing to die occurs less often. Somehow I begin to feel that my brain is starting to function correctly. My stomach pain lessens and I can eat a variety of foods again. The side-effects of the antidepressants gradually become less. As my treatment continues, I begin to have hope that I will be well again.


The Present

Depression, I am told, is a chemical imbalance in the brain. For months I resisted this view. For months I felt a failure, a weak ineffectual person because I could not “think” myself out of this condition. I tried every means I could: diet, thought-patterns, faith, exercise. But what I found was that the depression quietly, persistently got worse. I became less able to control it. Even then the thought of taking medication horrified me. Other people did not have to live on pills. Their minds and brains worked fine. All I could see around me were “normal” individuals, happy, prosperous, energetic, motivated. And here was I wanting to die! It made no sense. I was flooded by a dark cloud that would not lift. I was afraid all the time. I could not be alone, especially at home. I could not make the simplest decisions and, as soon as I chose one thing, the opposite seemed better. If decisions were before me, I could almost not bear the anxiety of facing them. How awful, I thought, to be able to function only because of medication.

Now as I perceive my symptoms becoming less and healing taking place, as I begin to hope for health, I accept that depression is a chemical imbalance in the brain. Perhaps the cause of depression is psychological, perhaps it is physical. Whatever the case may be, depression can be treated. For me there is humiliation involved in having to take medication to keep me calm and balanced. But untreated depression is much worse. The side-effects of antidepressants are most unpleasant but they gradually diminish. Perseverance brings positive changes. Recovery from depression is very slow. There are many ups and downs. People expect instant recovery but it does not happen. Each day still can bring moments of anxiety and darkness.

Just as I start to “walk”, events make it seem that I am on a slippery slide and down I go. And then it takes courage to “walk” again. Fears can sometimes still haunt me. Loneliness can make me afraid. I find that I have to face the consequences of all my behavior during the worst of the depression. People, to whom I clung, still flee. Smiles on faces are often rare. “Normal or nothing” seems to be the rule in some cases. In other cases, however, as Cardinal Newman wrote, “and with the morn, those angel voices smile.” Some friends welcome me back with genuine joy and my heart rejoices. And I give thanks in particular for the faithful and loyal friend who stayed with me during the darkest times, who moved into my house to be near me, who showed loving concern during all the symptoms of the depression and the side-effects of the antidepressants, and who taught me the meaning of fidelity and courage. I give thanks too for the psychiatrist who showed such patience, understanding, and compassion and who taught me to have tender regard for all with mental illness.

The experience of depression has brought me a deeper understanding of both depression and mental illness. What I have learned in particular is that depression is something that happens to someone. It comes as a most unwelcome companion. Before my own experience I used to imagine that persons with depression or mental illness were somehow responsible for their sickness. I could pity these people and show concern but I felt somehow distant from them and safe from such illnesses. Now I know that people are victims of these diseases. One terrible day something goes wrong and great suffering looms ahead. Much more clearly do I realize how vulnerable we human beings are. References to “the tears of things” now have much more meaning.

At the moment I am still being healed from this present occurrence of depression. In the future, however much I do not want it to happen, depression may strike me again. I have learned to be grateful that medication exists that can help. Antidepressants provide a way to cope. They give hope of healing. I have come to see them as a merciful and divine gift. May they be thus for others too.

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