Do you ever get over depression?

I get asked this a bit. Usually by carers of someone with depression, but sometimes from people who are yet to recover. One went something like this.

One thing I am interested in knowing is you don’t talk about having depression anymore, you speak of it as if it were in the past. Do you ever get over it? Are you on medication? I never really asked you about the medication bit and I am leaning towards it because my girlfriend is on Zoloft and she says that she is a changed person.

It’s a good question – one that I’ve thought about for a while (I think it says a lot that I still think about depression). The answer went like this:

I would say I’ve recovered and no longer have depression but I don’t say I’m cured. Basically what I mean is I am not symptomatic anymore and I’m able to do the things I want in life without being impeded by depression.

I do still have a low level of anxiety quite a bit and have a low resistance to sadness so when I’m too busy or haven’t had much self time I tend to get sad. But other than that I’m happy most of the time.

I have changed though, so things aren’t back to the old “normal”. I do things slower. I do less and pace myself more. I am more intentional about self care. My brain doesn’t work as well. But on the upside I’m more patient, understanding, compassionate than before and value simpler things in life because I’m less ambitious. I’m more satisfied and I know myself and accept myself more.

I’m not on antidepressants anymore but they worked really well in controlling my anxiety. They really calmed me down and gave me the space to face my issues. They were important in my recovery. They have their downside (no sex drive and no feeling of happiness either) but on balance I found them useful. They work best for severe depression and anxiety and are line ball for moderate depression and anxiety. My long suffering wife says within 36 hours of me taking it she could talk to me again. Gold!

Recovery is a journey and depression is episodic so I’m not sure I’ll ever be free of it but can still lead a happy,  satisfying and rich life. I don’t regret having it. I only regret coming so close to dying before diagnosis which is why I do the work I’m doing today.

The Return of Anxiety

I’m home alone this morning. I love being alone. No one talks to me. Being a Myers Briggs iNtuitive, my inner world is really important to me. My wife has taken the kids to church. She’s started going again and the kids love it. I think one of the reasons she’s going is because she’s back on antidepressants so she can manage ok. This time she says she’s going to take them daily until she’s better (my fingers are crossed).

I have struggled for a few months with anxiety. I recently did my 09-10 tax and had a blowout. I was threatening to whack the kids and yelling at them. I was in such a state I was reaching for the beer to try and calm down. I’m not sure how long the anxiety has been simmering, but I didn’t become aware of it until June when I organised a mindfulness seminar. After the two day training I felt really anxious. At times I was sucking deep breaths and the knot was back in the stomach. I wondered how a mindfulness seminar could make me anxious, but I realised after a bit that it had just increased my awareness of what was happening inside me.

There was a little bit of denial that was going on too. I wanted to believe that I was better and was fooling myself into ignoring what was happening in my body.

The”why” took me a lot longer to figure out. Work was fine. My home duties were going smoothly. Parenting was all good. I’m still not going to church so there’s some cognitive dissonance still rattling around down there but I don’t think that’s causing any anxiety. Then I realized what it was.

I was getting to a point of hyper-vigilance with my wife. She was erupting on a regular basis and becoming really tense. Seemingly out of the blue she would crack the shits and start riding the kids. While this would make me tense and increase the heartbeat I wouldn’t get involved lest the wrath be turned on me. I figured the kids could absorb it. There were times that I’d chipped in a thought and received a full dose. I even recorded one of them on my iPhone and it’s frightening. So her anxiety, was causing my anxiety. I was walking on egg-shells afraid of her anger and what she could say. It’s not very tough, but if I’m honest, this is what was happening on an emotional level (the brains more primal limbic system) – not a cognitive one.

It’s really odd how she couldn’t see it though. Even a few weeks ago she was insisting that I wasn’t well and that I needed to go back on medication and get treatment. She felt that I was the problem. But somewhere along the line she’s been able to get some space and get in touch with what’s happening inside her and realise that she’s not well. She has used antidepressants before but pops them like Panadol. The problem with this is that it calms her down, but it’s only after an episode of lashing out and spinning out of control which isn’t much good for us. She’s never followed the psych’s recommendation of being on them for a solid period of time while engaging in talking therapy to unpack what’s going on.

But this time she says she’ll do it. So far, so good. And my anxiety has almost all but disappeared. I’m not vigilant or wary of her anymore – which is a good thing in a marriage! I feel in the main part happy again and calm. Now I only feel anxiety in “normal” stressful situations (meeting a tax deadline, running late for an appointment – that sort of thing). I’m still hyper sensitive to stress where I react to the stress and stress about stress, but I’m working on that. As I say, the only way to make a marriage work is if each one owns their own shit.

Antidepressants; to pop or not?

Recently I was invited to speak to a few groups who train people in suicide prevention using a one day course. It’s a brilliant course, one that I completed last year and thoroughly recommend. I generally share my story of depression and having strong suicidal tendencies which led me to research deadly methods to end my life. In the course of conversation afterward the topic of anti-depressants arose and the fact that those under treatment are notorious for not taking their medication. For those of you who’ve cared for someone on medication I’m sure you’ve all asked the question “did you take your meds today?”

Asking that question is a bit like my uncle who as a boy climbed up onto the roof and as his father was passing underneath dropped a brick on him and asked “did that hurt?” It’s going to attract the same kind of response my grandfather had. He hauled the mischievous boy down, gave him a hiding and said “did that hurt?” Be prepared to don a flack jacket and helmet prior to asking the question.

So we got onto talking about why people go off them all the time and in the main it’s basically all about the downsides:

Firstly there’s the stigma. One bloke describe them as “old lady pills” – and even old ladies don’t want to take old lady pills, let alone the rest of us. For someone with depression whose self esteem is scraping rock bottom, the blow of having to take meds is yet another bitter pill to swallow (no pun intended). It took me months to fill the script I had while I struggled to accept that I needed them.

Second I had no feelings on antidepressants. I didn’t feel angry, frustrated, and irritable which was great – but nor did I feel any joy, hope, or happiness either. Interestingly I didn’t even feel fear when I should have (riding a mates Yamaha 450 dirt bike through the scrub at full tilt should have triggered some red lights in my head but it didn’t). I just felt totally calm. It was millpond still inside, but in an uncanny way.

Finally my performance in the sack took a big nose dive – one thing I like to think I was pretty good at (what guy doesn’t?). Now I sucked at that as well. My libido went on holidays and didn’t leave a forwarding address. This is the biggie and this is the one that was raised by the suicide prevention group leader. Everyone she knew who was medicated went off them frequently because they didn’t like having a non-existent sex life. I found that by going off them for 48 hours things worked again, but the crankiness returned pretty quickly and I was back on them again. Still, having my libido back even if it was just visiting was a good thing.

So do I recommend taking antidepressants? It depends. For severe depression it’s highly recommended. That in conjunction with therapy is a proven effective treatment. The meds are like floaties. They’re not the solution, but they do support you while you learn to swim. For moderate depression – maybe. But studies show that talking therapies (in particular CBT or Mindfulness Based CBT which I prefer) work at the same rate of effectiveness. For mild depression meds aren’t recommended. There’s a whole host of things that can help there from exercise to eating well, sleep, recreation etc. that will do wonders. For more on what works for depression, check out beyondblue’s comprehensive publication (clicking this link will download the pdf)

For us, medication was critical. Within 48 hours of starting, my wife said I was totally different and that she could talk to me again and have a normal conversation. Profound peace and calm returned to me and all the aggression and irritability totally dissipated. I was much better to be around. It was the pressure relief valve I needed to give me the breathing space to deal with the issues that had caused me to become so ill.

For you? That’s something that only you can and should work out for yourself.

Parenting with a mental illness

I’ve been invited to work with a national group called Children of Parents with Mental Illness to develop a new website for dads who have a mental illness. I’ve attended a panel interstate and am contributing to a wiki which will then be morphed into the website. Next month, they’re flying down to film my story for the website.

In the course of disgorging what I’ve learned about parenting with mental illness it struck me (eventually) that parents with mental illness who are in recovery can actually make better parents! It was one of those light bulb moments for me because I realised that I’d been teaching my kids emotional and coping skills that were never taught to me.

One thing that mental illness has taught me is an emotional vocabulary. Before my mental illness, I was an emotional neanderthal. Most men are. If you ask Average Man how he’s feeling, you’ll get grunts to the effect of “not bad”, “fine”, “stoked”, “dunno”, and “alright I s’pose”. None of which are really feelings, and none are very nuanced. In fact he may not even know how he’s feeling. (Yes girls, it’s shocking!) That’s what it was like for me.

I’m still learning to be able to know and describe my feelings, but I’m on the way. Mindfulness is helping me observe my emotions impartially and notice where they are in my body and their intensity. Yes I know it’s all a bit girly by normal standards, but normal standards aren’t helpful. What I’ve found is that to be in touch with one’s emotions is to be fully human.

So these are the things I’m teaching my kids. To notice their emotions and to be able to describe them honestly and without judgement. To accept them, and yet to not feel compelled to do anything about them. Emotions are the like the car on the road outside our house. They come, and they go. We don’t jump out of our chair and race to the door and feel like we have to do something about them (unless you’re a dog). We can acknowledge emotions, experience them, and be kind to ourselves about what we’re experiencing but we don’t have to be ruled by them or carried away by them.

It’s a great way to approach difficult emotions such as pain, suffering, grief, anger, frustration, hatred, rage, jealousy, and rejection to name a few. These are really uncomfortable and hard to process for all of us, so giving kids tools to do it sets them up for life.

My fragile resilience aka easily cracked

Since I posted about feelings of happiness beginning to emerge late last year, these have continued to be more frequent occurrences. My son and I hiked to the highest peak in our state a few weeks ago and covered some 30km during the 2 night walk and it was exhilarating.

I catch myself feeling happy from time to time and bask in the feeling like the warmth of the sun emerging from clouds. I try and appreciate and savor the feelings, knowing that emotions are just like the sun on a cloudy day. The warmth comes and goes almost unpredictably. And I’m ok with that. If I can practice my mindfulness, I’ll be even better at observing and relishing those emotions when they come.

Happiness aside, my mood is generally one of being fairly neutral-contented. I’d say this is what I experience around 80% of the time. The rest of the time is divided between happy and sad. Who knows, this might be the case for a large portion of the population.

I think the thing that concerns me most at the moment, is my fragile resilience. I crack easily.

Honestly, it doesn’t take much to make me crack. A couple of weeks ago, I’d gone for three weeks without doing any pleasurable activities – fishing and the like. I had to help my father with an emergency on the farm so I flew over there to do that. I’d been cutting wood for winter, and I don’t really have a babysitter that’s easily organised like I did last year (a high schooler living around the corner from us has now gone to live with her boyfriend).

It was doing my head in and I’d started to crack the sads. I was getting irritable and frayed. My head space was narrowing. I finally got sick of it all, threw the kayak on top and left the next morning having asked my wife to come home early to meet the kids off the bus. I put in a big day on the water for only one fish, but still enjoyed it. On arriving home late around 8pm, I came home to chaos. The dishes were lying around, pots and pans and food were left out, and my wife was watching  TV. I was dismayed – I could feel my heart sinking into my socks. And that’s where I lost it.

I accused my wife of taking advantage of me. She knew I had the next day off so basically she’d done the bare minimum – feeding the kids and putting them to bed – and now I was left with the mess. It felt like going fishing for the day was a pointless waste of time, because it meant I’d be paying for it by having to deal with what appeared to me at the time to be an overwhelming mess. Of course it wasn’t, but to me it looked like it. On top of that I felt she wasn’t really pulling her weight.

If my resilience had been better, maybe I would have looked at it differently. I could have thanked her for coming home early and for at least feeding the kids and putting them to bed. I could have rolled up my sleeves and probably got it done in an hour. But I ended up blowing my fuse, giving her both barrels and storming off to bed, thinking how pointless it was to make the effort to do something to improve my wellbeing.

Three nights ago my wife, under the guise of “open communication which is good for our marriage” expressed that she still feels hurt that she’s not a Facebook friend of mine. She went on to say that I should friend her and that it would be a public display of our love which is so important to her. She wonders what other women think when they see that I haven’t friended her. She told me that if I consulted a marriage counselor about friending my wife on Facebook they would be amazed to find I hadn’t. I told her I didn’t give a toss what marriage counselors had to say about Facebook.

I read between the lines (right or wrong) and heard the same old tapes that always play along the lines of “if you really loved me, you would __________” which I’ve been hearing for the last 18 years. I told her to build a bridge and get over it. I told her to deal with her insecurities and to forget what anyone else thought. The language was brightly colored. I explained that I’m sick of her trying to change me, and that she can either accept me for who and what I am today, or not, the choice was hers. Just don’t try and change me.

If I had been more resilient, perhaps I could have acknowledged that she was feeling hurt and been understooding, and let it be. Or maybe that would have been just too professional and clinical. Maybe she should be telling someone else how hurt she is….

Needless to say, we haven’t been talking the last few days. Like my friend said “isn’t it worth going the extra mile to get the silent treatment?”

It’s frustrating that my resilience is so low, that if anything emotionally challenging arises, I just seem to crack so easily. My mood plummets again and stays low, until like a tug of war, I manage to pull it up again, and recover. I hope I get stronger. Self care is challenging.

And the good news is….

I remember distinctly a few months ago pulling out of a department store, crossing the road with the kids in the back seat and I realised I was feeling happy!

My first thought was “that’s novel. I like it. I actually feel happy”. It was fleeting – it lasted about a block until one child started bickering with another and my emotions fell back to earth. But it was great. Feeling happy was like finding an old friend again.

Over the last few months that feeling has become virtually the new norm. The listless, dull, low mood that was the tidemark has slowly and gradually been replaced.

In the leadup to Christmas we travelled across two states to the coast to join my sisters and their families. I came down with a virus which then morphed into an evil sinus infection and I spent four days in the motel bedroom without food. I dragged my sorry carcass off to the doctor and came away with some antiobiotics and came good on Xmas day, only to leave the seaside resort the next day. But there was good that came out of it. I didn’t slide back to the low mood. Emotionally I was able to maintain my good spirits. So it turns out that it was a good test.

My wife asked me what the reasons were for the turn around, but there aren’t any. I think it was just the slow trajectory of improvement and the final change from negative back to positive.

Even though I’m feeling a lot more contented and positive, I’m not my old me again. I never wanted to be my old self when I thought about recovery. Some things are not like they used to be.

I still have trouble making simple decisions. Yesterday I took the kids for a bike ride and couldn’t decide what to wear. It was warm enough but a cool breeze made me think I should wear something more than a T-Shirt. I couldn’t figure out what and went without and ended up feeling cold. I have trouble figuring out small change so it’s easier to just use a note and get change back than paying for things with loose change. The brain is just a bit fuzzy.

I’m not very ambitious. I don’t have great plans. It’s school holidays, but I don’t plan much. I’m not hoping to achieve much with the kids. We take each day as it comes. I don’t look ahead very far – that takes too much computing power.

I do things a lot slower. I drive slower, I walk slower, I talk slower. Part of it is because my brain works slower, but most of it because I just want to move through life slower. Going slower allows one to lower anxiety and experience more. If you haven’t done it before, google the slow movement. It’s fascinating.

I don’t try and exercise much control over others or situations. I used to be type A, so I used to be quite good at imposing myself, but I don’t bother now. I think I’m much more “live and let live”. Control takes a lot of energy and is largely ineffective anyway. I’ve realized I’m responsible for myself (and the kids because they’re dependents) but not for anyone else.

I haven’t allowed work to take over – partly because I’m only doing two days per week in the mental health support service. It doesn’t consume much of my thoughts when I’m away from work. I do think having the right kind and amount of work has been instrumental to getting well.

I was interviewed recently by a researcher from a leading university on depression. I told her than my brain function had dropped, but luckily I was a genius prior to burning out…. you had to be there.

Oh, by the way, the guy who invented the smiley face Harvey Ball, never trademarked it. He received $45 for it. Sucks to be him!

Ruminating like a cow. Why I may have four stomachs.

I’ve realised as part of my recovery and ongoing wellness, that I need to have time alone. Being an introvert, this is just the way I’m wired. I must say also, that I believe even extroverts need time alone, but are even less likely to get it or plan for it.

So I structured time alone – often at home. I’d get the kids off to school, and pretty much have my housechores done (the bare minimum usually) and then slum around. I get on the net, check emails, fart about on Facebook, blog a bit, read forums (freshwater and fly fishing of course), look up interesting things like how to repair the fins on my Hobie kayak and how to build my own custom fly rod.

I’d make cups of tea, drink a couple of beers, rarely check the TV unless I’d recorded a program, but even then, rarely watch it. And of course I’d warily watch the time….. knowing that at 3.45 pm hordes would descend on the house, crash through the door and pillage our family home leaving carnage and crumbs everywhere.

But most of all, I noticed that I experienced a low mood on these days. I think I have been ruminating – like a cow. Cows have four stomachs you know. And they chew over things, again, and again, and again. I do that. I ruminate over things, again and again. But not very helpful things. So they don’t really get digested. And they probably should be expelled. I saw a cartoon recently that said “don’t hold your farts in. They travel up your spine and into your brain and this is where shitty ideas come from”. I probably have that going on.

So it’s a dilemma. I know I need time alone to rejuvenate, but it can’t be unstructured, aimless, pointless time alone. I need to have something to do. And this is why it’s a dilemma. I’m a recovering Type A, performance driven, alpha male. I’ve realised how I ended up burned out and it’s because I’ve lived as a human doing for too long, instead of a human being. I don’t want to be like the masses who are so busy with their lives that they don’t have time to just ….. be! But on the other hand, if I’m not doing something, I ruminate – and research has shown that people who tend to brood, have higher rates of depression.

So after much thought (I do sometimes ruminate on useful things), I’ve decided that it’s not so much having something to do. It’s having something to focus on or aim towards. There’s a subtle difference. I might focus on repairing something, or tying up some flies, or reading a book, or writing stuff, but it’s a focus. It’s like having a game plan for the day – a road map if you like. But I try not to let achievement and performance dictate the focus – because I don’t want to end up where I’ve already been. That would make burnout pointless, and I can’t afford for it to be pointless.

It’s a fairly subtle change in approach to my cave time, but I think it’s going to work out a little better. I also know that this approach also helps depressed people in their recovery from the great darkness that it is. For really unwell people, having a list (below) can be quite a powerful aid to recovery, without which, they may never even venture out from under the blankets.

  • get out of bed
  • have a shower
  • have breakfast
  • go for a walk
  • read a book