The road to recovery from depression is long and, sadly, backwardly turning. The most effective treatment of this disease is the use of antidepressants. Some mysterious cause has brought about a chemical imbalance in the brain. This imbalance must be righted before one can feel well again. The use of antidepressants is not easy. They are not pills that simply cure a problem in a few days or weeks such as antibiotics. They are not pills that have virtually no side-effects like pills for high blood pressure. Antidepressants take time to take effect. In the early stages of their use they have various unpleasant side-effects. Each individual responds differently to these medications. Often it proves necessary to change from one antidepressant to another. This changeover can be a distressing experience but one that needs to be endured. The doctor has the expert knowledge to know what dosages are correct and cannot, however much it would be desirable, make the pills act faster than they do. The treatment, therefore, of depression is complicated. There are many temptations during it to stop using the antidepressants, to assume that no help is possible, and, tragically, in some cases to take one's life. The determination to persevere in treatment, however, can bring reward.
The presence of depression is like a constant, poisonous gloom. Somehow it casts a mist over the eyes that makes one see nothing as it is and everything is clothed in gray, dull tones. “I used to like this - but not now.” “That would bring me delight; now it seems stupid.” Worst of all, what pleases other people brings pain: sunshine, flowers, mountains covered in radiant snow, children's laughter, enjoyable activities. Life loses all brightness. The dread that this condition can and might continue causes a longing for death.
Mercifully, depression begins to lift. It starts to do so with very slight glimmers of light. It feels as though one has been in a darkened room day after day, shades drawn, room closed up. The room becomes cluttered as no interest in different activities occurs. Dust covers everything, for there seems no need to make the room livable. The worse the condition of the room, the deeper the depression. Suddenly, for a brief moment, the shades open and the light appears. With a great surge of hope, one breathes softly in gentle relief: “there is life after all.”
The shades snap shut again and the gloom swirls as relentlessly as before. “What did I see?” “Was it real?” “Is there vibrancy, energy and perhaps even joy?” “Can it be that my eyes saw something real?”
The gloom is back again. The suffering seems to be such that it will never end. The individual cries out in agony: “why, oh, why? Will I ever understand?” Days pass and there is only pain and activity by sheer force of will. Yet again, all of a sudden, the light appears once more. It is real! Strangely within a life-force seems to arise. It comes up from the heart and pervades the brain., Its presence is mysterious and inexplicable. “I cannot explain it but I am so grateful that it is happening.” The mist departs from the eyes. The beauties of nature can now be appreciated in all their rich variety. The joys of family and relatives become possible. Friends rejoice as they see new-found life increasing within. They lurk in corners and hide deep within. But their presence seems in some way limited. They have lost their pervasive power.
As one begins to come out of a depression, there occurs a reluctance to admit to self or to others that healing is taking place. One fears that the departure of the depression is not real. One also fears that others will expect the appearance of perfect health that will not change again. Relationship to friends becomes an important issue. As one goes through a depression there are some people who are faithful and loyal. There are others who from fear or lack of understanding will not be there. As one comes out of a depression there is a great sense of gratitude for those who have been true friends. “You have stood by me in my trials; you will ever be written on my heart.” With the departure of the depression there is often a change of behavior with even faithful friends. They begin to be more distant. They perceive that the need for them to be constantly attentive has lessened. Those who have been depressed feel alarm at this distancing. For them the dark specter of depression still haunts their days.. There is, however, a great difference now: this darkness and gloom seem to be outside, not within one's very person. But what this darkness and gloom threaten to do is to attack and pervade the person again. The question asked with genuine dread is: “what if the depression comes back again and stays?” One wants so to be well and greatly fears to be sick. One also realizes that friends would not in any way wish to hear that the depression had returned. The landscape, somewhat bare of friends, makes emergence into the light a little frightening. This stage is one of the final battle scenes of depression and it too has its particular pains.
If all goes well the glimmers of light become stronger and stronger. One begins to feel the way one used to. The old self starts to reappear. As the world was seen before, so it is seen now. One gradually makes judgments as in earlier times. Work seems appealing and absorbing again. Activities of fun seem attractive. Purpose starts to instill each day. Life has meaning once more. In this emergence from the dark-filled room, one has to cling, cling to the light and never look back. If the darkness approaches again, it must be fled with all one's strength. Gradually the light becomes more steady and sure. There are pockets of darkness within but one can watch them warily and put up resistance to their snares. In depression mornings are always the worst time. Now they are filled with sunlight. The singing birds proclaim hope. During the day, when moods used to change with gloom and darkness pervading every activity, a new zeal for life and its challenges appears. In the evening, when all could be dismal and gray, now a quiet contentment is felt. Instead of a longing for death, one is deeply grateful for life and for all those -doctor, friends, relatives-who cared.
As depression lifts, another emotion is felt. Sheer joy and gladness. Joy that the depression did not last. Joy that it was gradually leaving. Joy that one did not give up on life in the darkest days. Joy that life was waiting, beckoning, offering its gifts. Joy that God was merciful and sent healing strength. Joy that there were those who still cared and loved and warmly welcomed back. Joy that even if there might be other suffering in future days, life would ever hold sweet moments. The departure of depression is like a new dawn breaking. One can live again.
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.