My experience with depression leads me to describe one of its worst features: its variable symptoms. These symptoms not only make the experience of depression particularly distressing for the patient but also confuse and mislead those who deal with the depressed person. No one really wants to meet or speak with someone who is depressed. Whenever a positive change occurs, everyone hopes that it is a permanent improvement. When this proves not to be so, impatience soon appears. Depressed persons soon find that many people avoid them. Only the “normal” or “up” phases of the disease are acceptable to others. But rejection during the “down” phases can considerably add to the depression.
In the course of a developing depression, it is common for there to be a wide variation in mood during the day. The morning is generally unpleasant. Darkness of mood prevails. Then as the day progresses, the mood lightens. By night, a person may feel quite normal.
Gradually a change occurs. The dark times get longer and longer. If sleeplessness develops, the morning hours can be quite terrible. It is at this time that suicidal thoughts can appear. The individual cannot envision living in such darkness, day after day.
Soon the darkness may last the whole day and also the evening. The depressed person dreads going to sleep. All that can be expected is a repetition of the same dark pattern. After a few days of this, the wish to die may become very strong. Depressed persons are not rejecting life as such. They are not rejecting any purpose that they may believe they have on earth or purpose that other people may suggest they have. Depressed persons are rejecting what they have become. “I do not recognize this person.” “I have become such a caricature of my former self!” “Look at me!” “I am completely anxious. I am afraid to be alone in my house. I am terrified when I have free time that I might have to spend at home. I am afraid to do things on my own. Anxiety makes me wring my hands incessantly. I am totally tense. I feel foolish, unable to do things that children easily do.” The death of such a creature would seem to be a blessing. At this stage of the depression, one is at the bottom of the roller coaster. Nor is there any hope of going up.
After treatment of depression begins with antidepressants, improvement is slow. Antidepressants do not take effect until four to six weeks. During this time, the depression can continue its insidious growth. One has to cope with the side-effects of the antidepressants as well as all the darkness of the depression. The medication may help with sleep and this is a great blessing. But one is still very much on the bottom of the roller coaster. Great will-power is needed to have hope that some change will come. This period can be painful with regard to other people. Their patience may well wear thin. Most people assume that one's mental attitude is totally self-chosen. If one is not cheerful, it is by choice. During this time one is immensely grateful for a faithful friend.
After some weeks the antidepressants begin to take effect. The depressed person feels less down, at first for part of the day, then for more of the day. But the mornings can still be bad and thoughts of death can still haunt. Side-effects of the antidepressants become less severe but do not disappear altogether.
During this phase a person may feel that all the symptoms are some kind of horrible nightmare. “This can't be happening to me” “I was always able to be cheerful and happy.” “How I want to be off these pills and just be normal again” But the hard and painful truth has to be faced: the depression is real and will not go away by itself. One cannot just throw away the medication, however much this may seem desirable. Human nature has proved to be frail in a most painful way.
At last some light seems to appear. “I am beginning to feel normal” “Up the roller coaster I go. And I will NEVER, NEVER go down again.” What an illusion! Depression is not a weak disease; it is one that specializes in cruel effects. Just as one begins to feel normal, the depression can return with a complete vengeance. This happened to me. On Sunday I feel normal, to some degree. I can ignore the side-effects of the antidepressants as long as I don't feel too bad. On Monday, as I face a series of decisions, I am as bad as I ever was, even at the beginning of the disease. Everything is dark. I want to die, thinking of suicide. I am anxious. I cannot make up my mind about the smallest details. I am most afraid and panic at the idea of being alone. Here I am at the bottom of the roller coaster once more.
What are my choices? None, really. However much I wish to die and wish that this ridiculous person I have become to die, I know that death is not an option. I must continue with the medication and hope that I will go up the roller coaster once more. There can be no facile optimism with depression. I might want to be well NOW. Every person I meet impatiently wants me to be well and never to hear again about depression. But it is not going to be so.
Recovery from depression may take months. Gradually I hope to be able to stay up the roller coaster. With other people, as I go up and down, I may have to learn to be a good actress. With some friends I will be able to speak of my pain. Depression is a roller coaster ride. It has taught me to have boundless compassion for those who are at the bottom of the roller coaster and to share their tears.
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.