I have Depression. The illness, not the mood. I was officially diagnosed over two decades ago. It sucks.
It sucks because of the uncontrollable mind job it does to you (no pun intended), and because most of the people around you have no idea what you’re going through, or how they can help.
COVID-19 is causing Depression diagnoses to surge, leading to a much higher patient:doctor ratio. End of the day, that means existing patients have greater difficulty getting the ongoing help they need, while new patients may not find help at all. And doctors are stuck in the middle, feeling both responsible to help everyone and overwhelmed by it all.
I’m not a doctor. I can’t diagnose you. I can’t offer you professional advice or help.
What I can do is tell you about my experiences. What I find that Depression feels like, what you can do about it, what you should never do about it, and how friends and loved ones can best offer you help.
What It Is (and Isn’t)
Let’s get one prerequisite off the ground before we go any further. I’m using capital “D” Depression as a shorthand to distinguish it from being depressed. The two are monumentally different.
Anyone can feel depressed. It’s an emotion, on the same spectrum as joy, sadness, amusement, confusion, anger, um… fear… oh yeah and disgust (yes I’m cribbing Inside Out, sue me), and all of the other emotions that color our lives. Maybe you’ve had a terrible day, disappointment pays a visit, or someone kicks you when you’re down. Your feelings are hurt when you’re already vulnerable. Any of those things can make you feel depressed. And those feelings are temporary.
When I use the Big-D version of Depression, I’m referring to a medically-defined ailment. A chronic condition. A very real illness — both mentally and physically — that’s not always dependent on outside events. It has serious physical effects but leaves no visible scars. Big-D Depression is an ongoing condition that you have. Sometimes individuals diagnosed with it are called Depressives.
It’s important to know that Depression not only has physical consequences for a patient, but it’s also a tangible illness that occurs in the brain. There are varying theories, but many if not all mental illnesses are widely believed to be caused by a chemical imbalance or deficiency inside your brain.
I can’t emphasize enough that it’s not a choice. If you have Depression, your brain has short circuited, removing you from your emotional driver’s seat. When I’m having an episode or flare, aka a worsening of symptoms, I find that my emotions (especially anything that leads to crying) are much closer to the surface, and I can’t control them at all.
If that doesn’t sound terrifying, then I’m not telling it right.
There are many kinds of Depression, just as there are different types of cancer or diabetes. There’s Major Depression — which is the one I’ve been diagnosed with, and is the most common. It also goes by other names, like Chronic Depression. Then there’s Seasonal Affective Disorder (occurring mostly during the holidays), Postpartum Depression, Depressive Psychosis, Manic Depression (aka Bipolar Disorder), and many more. Covering each one of these is outside the scope of this article, but I’m guessing you’ve heard of a few of them.
Depression often — but not always — goes hand-in-hand with other illnesses, most of them invisible illnesses, such as Anxiety Disorder. Anxiety is another medical ailment that sufferers have no control over. And just like Depression, there are many forms of Anxiety, such as one of the most common, and worst, PTSD — Post Traumatic Stress Disorder. Ex-soldiers and emergency workers tend to suffer the most from that one, for obvious reasons.
How It Feels
I know what you’re thinking. “How do I know if I’m just depressed, or if I have Depression?”
There’s a huge variety of symptoms Depressives have reported to their doctors. Here’s a sample of some of the most common, but by no means is this list comprehensive.
- Feeling hopeless. This is a big one for me. My unofficial code phrase to my wife — so I don’t have to describe it in front of our children — is that “the dark clouds have rolled in.” I’m not a generally down person. But when a “Depressive episode” hits, everything — and I mean everything — feels pointless. Don’t call it “being sad”; that’s an insult. It’s like every ounce of hope in the world has been drained away. It’s a dark, dark place I wouldn’t wish on anyone.
- Guilt. “What’s wrong with me?” “I’m so self-absorbed, I can’t even be here for my loved ones.” “I can’t focus, I can’t work.” “I’m worthless.” “Why do people put up with me?”
- Loss of interest in doing things you enjoy. Whether it’s cooking or playing video games, scrapbooking or watching your favorite sport… It can involve intimacy with your partner, or an inability to spend quality time with your kids. Your ambition, your passion, drive, motivation — these are things that don’t exist. When you’re having a Depressive episode, the desire to do the things you find pleasure in is gone.
- Insurmountable fatigue takes over. I want you to understand my full meaning about this one. Not counting Depression or Anxiety Disorder, I live with three major invisible illnesses, every one of which causes fatigue (along with pain and what we lovingly refer to as “brainfog”). That’s fatigue x3, that I have the joy of pushing through 24/7. Trust me when I tell you that the fatigue that comes from Depression is in a class by itself. Put simply: I feel like a slug. Not only do I not have energy, I don’t want to have energy. I go to bed early, because all I really want to do is sleep. (I’ve found there’s a kind of pseudo-logic behind the constant sleeping. “If I go to bed now, I can skip feeling this way the rest of the day, and tomorrow maybe I’ll feel better.”) Conversely, many Depressives complain of a wicked restlessness or finding it hard to fall asleep at all. My experience is always a change in sleeping habits so extreme that I wake up early in the morning, which is a big deal. Mornings and I are not on speaking terms.
- The fatigue contributes to an inability to concentrate. The slightest thing can distract you — or set off a horrible irritability. Good luck making decisions, following what someone else is saying, or staying on point. You still care about others, but it’s hard to be thoughtful or helpful.
Some patients report extreme changes in eating habits that can cause you to lose or gain weight. In the very worst of situations, those “dark clouds” might be so oppressive that they can lead to thoughts of ending one’s life.
We’ll circle back to that topic in a minute, but I want to get this in more than once: if you ever find yourself entertaining thoughts of ending things, please call 1–800–273–8255 for immediate help.
What to Do
Coping and living a full life with frequent or infrequent flares of Depression is very possible. But I’m not going to lie to you. When you’re in the middle of an episode, it takes an extraordinary amount of determination and will power to function. Depression wants to suck every ounce of determination out of you.
That will power doesn’t mean you have to “fix” yourself. It means you have to take some important steps toward letting some important people help you.
There’s a social stigma attached to mental illness. You know it, I know it. Particularly admitting that you have a mental illness. Steps have been taken in the last few years to shed light on the truth of mental illnesses like Depression, but there’s still a long way to go.
In the meantime, there’s one thing you absolutely must do. Find yourself a psychiatrist. Nobody wants to tell friends or family that they’re seeing a psychiatrist. It immediately conjures mental images of you on a couch, detailing your problems to an older gentleman who’s holding a clipboard and looking over the top of his glasses, asking, “And why do you think that is?”
The dude with the couch and the clipboard is a psychologist, a highly trained professional. Some people call them therapists. A psychiatrist is a specialist doctor — not unlike a podiatrist or an ophthalmologist — trained to treat mental health disorders. He or she is an expert on antidepressants and other medical methods that help manage your Depression, or in the best of cases, send it packing entirely.
Incidentally, there’s nothing wrong with going to see the guy with the clipboard and the couch. Many people find tremendous help from various forms of therapy, and for some it can be just as effective as medications, if not more so. Your doctor will tell you if he or she thinks you should see a psychologist.
I resisted going to a psychiatrist for years. When I finally relented, it turned out to be one of the best decisions I ever made. How I wish I’d gone sooner! Over the course of several months, my psychiatrist and I worked through trial and error to find the right combination of antidepressants and dosages that were right for me. Eventually, we found the right formula, and those meds did their job by compensating for the chemical imbalance I mentioned earlier. I don’t claim to understand the mechanics of it; I just know it helped me feel “normal” again.
Unfortunately, my body has a tendency to adapt to Depression meds, and after several months, or sometimes a few years, their potency wears off. That’s when I go back to my psychiatrist and we start tweaking the formula. Sometimes it takes longer than usual, but it does work in the end. This may or may not be your experience.
Incidentally, there are other methods that have proven to help some Depressives overcome their illness. Exercise, meditation, and drastic changes in eating habits, to name a few. All of these things are terrific, but in my experience, these self-actualized cures are the exception, not the rule.
There’s one caveat to always keep in mind about medications — and this goes for any kind of drug, not just mental health related. My rule of thumb is that any prescription medication ultimately means trading one symptom for another. A migraine medicine might take your headaches away, but it might also cause dangerous heart palpitations. Your blood pressure medicine could calm your heart, but it could also give you uncontrollable jitters.
It’s up to you to decide which symptom you can live with — the pre-med issue you saw the doctor for in the first place, or the new symptom(s) caused by the medication he or she gave you. Complicating matters more: Some doctors will give you additional drugs to try to compensate for the horrible new side effect a different drug is causing. It can quickly become a vicious cycle.
The symptom-trade not a blanket rule. There’s always the chance you could find the miracle drug that works wonders for you, with no side effects. Every human body is different, and I might react with aggressiveness to the same drug that makes you drowsy.
No one can ever predict how their body will react to any drug. At the end of the day — and don’t hate me for saying this, every doctor I’ve ever had — the doctors who prescribe medications that might work for you are making guesses. Highly educated guesses, but guesses nonetheless.
How to Help (and How Not To)
Dear friends and family of Depression sufferers,
If you’ve made it this far — and kudos for that — then that means you care very much about someone in your life that lives with Depression, and you want to help them. Thank you! I’d like to do what I can to give you a hand with this task.
When a person living with Depression tells you about it, invariably the first thing you want to ask is, “Why?” In other words, what are you depressed about? This is one of the most frustrating things you could say, because it shows how little you understand what we’re going through.
While we’re at it, a few other things you should never, ever say to a Depressive:
- “Cheer up. Snap out of it!”
- “You could be imagining this whole thing.”
- “You think you’ve got it bad…”
- “You don’t have to be so sensitive.”
- “Everyone feels like this sometimes.”
- “Everybody has problems. Just focus on the positive. Think about everything you have to be thankful for.”
- “Stop feeling sorry for yourself all the time.”
- “Try harder. You can beat this.”
- “I can’t be that bad.” And/or: “It could always be worse.”
Cue hopeless-feeling eyeroll.
These kinds of reactions show a remarkable lack of sympathy. Someone who suffers from Depression desperately wants someone to understand, and if you’re talking about it, then that person is you. But most Depressives lack the tools to express to you what they’re experiencing. Remember all that fatigue and difficulty concentrating I mentioned above?
So never, ever criticize a Depressive for having this illness, such as in the examples I listed above. Never give impression that it’s somehow their fault.
On the other hand, we can’t really blame you for reacting poorly to something you know so little about. If I admit I’m fighting Depression, then people might look at me funny, walk on eggshells around me, or try to cheer me up. (That last one is the worst thing ever. Just don’t.)
If you want to help, start by just being there for us. Depression is a dreadfully lonely place. I always feel better knowing my wife is there, and will listen. Knowing that we’re not alone is one of the best gifts you can give us. Be there physically. Be there emotionally. Be our support system.
A rather obvious thing you can do is encourage or guide us to go see a professional for help. Maybe your friend or loved one is afraid of going, afraid of what other people there might think of them, or what the doctor might diagnose. Psychiatrist, psychologist, even a general practitioner… Assure them that this is the right thing to do, a positive start, and that no matter what, you’ll be by their side all the way.
Everyone is different, but for the most part, you’ll want to wait for us to open up about it, instead of asking. Asking applies unwanted pressure, usually when we can’t even fathom the notion of trying to explain things. That said, the occasional “how ya feeling today?” is appreciated by most. If you know about it at all, then we’ve already chosen you as a confidante. So just be available, as much as you can, for when we’re ready to talk.
One trait unique to women is that more often than not, most of them want their husbands to notice when something’s wrong, instead of having to tell them about it. (Wives always want to be noticed by their mates, and God help you, friend, if you haven’t figured that out yet.) Partners, be sensitive to your Spidey-Sense should your significant other seems different. Always down, unable to smile, that sort of thing. Ladies, this is one where you should have pity and just say it, rather than waiting on that idiot you live with to figure it out.
The Big One
Finally, one of the biggest mistakes a friend or loved one can make is to not talk to the person suffering from Depression about suicide.
I get it. It’s an icky subject. No one wants to bring it up. It’s like talking to your kids about sex. It’s super uncomfortable.
Here’s the thing. If you care about this person’s life, you need to talk to them about not ending it. Sometimes there are warning signs, sometimes it’s impulsive, aka the “no one saw it coming” scenario that happens all too often. In any case, you have to push past the awkwardness and make this a subject that’s okay to talk about out loud.
If your friend or loved one admits to sometimes having suicidal thoughts, that’s not a crime. (I have them. Every Depressive does. But I’m sticking around.) It doesn’t mean it’s time to call 911 and have them placed on suicide watch at the hospital.
Having these thoughts doesn’t happen by choice, any more than talking about them does not make it more likely to happen. In fact, experts say that talking about suicide removes the stigma surrounding it, often helping individuals to rethink their opinions about it, and “look at it from a different angle” than they may have considered before.
There’s a saying that’s been repeated so many times that it’s probably a cliché, but screw it. Remind them that suicide is a permanent solution to a temporary problem.
Don’t tell yourself, “Well all this may be useful info for others, but I know ______ would never, ever commit suicide, so I’m not worried about it.”
Don’t talk about it in a judgmental, guilt-laden, or condescending way. Don’t assume that they’re being selfish for thinking about it. Having serious suicidal thoughts is a sign of deep, personal suffering. A little genuine compassion could go a long way.
Don’t take this lightly. According to 2019 statistics:
- For people 34 and younger, suicide is the second leading cause of death in the United States.
- For 35 and older, it actually has a higher rate of occurrence than younger individuals, globally.
- The number of deaths by suicide has increased year-over-year consistently for the last decade.
By the way — Hey, I’m talking to you! This is important, pay attention! — suicide does not happen only in cases of mental illness. That’s one I can’t overemphasize. A suicidal person may be perfectly healthy, but find themselves undergoing crippling stress, devastating circumstances, or unimaginable grief. Maybe they’re bottling it up inside and are looking for a way to end their suffering.
In all cases: Be gentle. Listen. Don’t ask a lot of questions, but do try to give them opportunities to be vulnerable by assuring them that you love them no matter what. Give lots of hugs! (Unless he or she is one of those rare people who don’t like being touched.) Do a little research from professional sources, if you can. Learn. When you’re done listening, listen some more. Be there.
If you fear that regardless of the help they’ve received or how their circumstances may have changed, that someone you love is seriously considering suicide, call 1–800–273–8255 immediately. And it goes without saying, but if you find the individual actively engaged in trying to take their own life, call 911.
Depression is an awful disease that can happen to anyone. Remember that there’s no guilt or shame in admitting that you have Depression — or any other mental illness, such as PTSD or Anxiety.
Don’t worry about what other people think. Worry about you. Get information. Get help. And find someone to lean on.
This article is a heavily edited and extremely expanded version of a chapter from the author’s book, The Invisible Illness Survival Guide.
Which absolutely no one read.