Depression is a liar. An asshole, and a liar — a very convincing one.
The biggest lie I am susceptible to is that I don’t care about or want to do anything. I can spend the majority of my time in bed for months-long stretches, reeling from incapacitating apathy — the primary manifestation of dysthymia, my particular flavor of depression.
Dysthymia, or Persistent Depressive Disorder depending on the edition of your diagnostic manual, is like a low-grade, long-term depression that can jump to major depression without much warning. Poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness all merge into what often just feels like a massive case of the blahs. I’m in a tenuous financial situation and (like most people) don’t have time to sleep 20 hours a day, so I live with a fair amount of anxiety over when the next work-limiting blah spell will descend upon me. It’s impossible to meet deadlines when you don’t care that they exist and feel nothing about your lack of caring.
Since depression and all of its offshoots are such excellent liars, it’s possible to know that your illness is playing you and still be unable to mount an effective defense. Those of us with the types of depression that ebb and flow, insidiously creeping up when we least expect it, might not have our shields up and ready when the tide comes in. But a few months ago I happened to feel another bout of depression looming before it knocked me off my feet and accidentally discovered a strategy for fighting it: tapping into my emotional memory.
When I experienced my first post-proper diagnosis flare of dysthymia flare, I’d had just enough treatment for a bad day to finally be discernible from any other day. I pleaded with my therapist — who I lovingly call “Doc” — to tell me how it happened and how long it would last.
“We don’t know,” Doc said.
I panicked at the thought that there might be no clear-cut cause or duration, that I might just be subject to these open-ended waves of apathy and exhaustion. “But there must be risk factors or something,” I said. “What can I do? Or not do? Or take or not take?”
“We’ll just have to see what happens. It may take a few spells for us to get any kind of handle on how you can best manage your way through.”
It took almost three months for the fog to lift, three months I couldn’t afford. But the hours spent at doctors and the weeks spent waiting for new medications to kick in represent just a fraction of the hurdles. Because medications all have potential side effects, many have to be introduced one at a time, which means secondary disorders go untreated and complicate discerning the effectiveness of the current protocol. Days or weeks can be lost waiting to see if side effects will subside as dosages are increased to achieve a therapeutic effect — all while still dealing with the symptoms of the disorder you’re taking the medications for. Depending on how many disorders you have and how interconnected they are, you can (like me) spend upwards of two years focused on the first couple of conditions or symptoms, and find that there are still more underneath waiting to be revealed and you slowly become more capable over time.
Though I’d initially felt relief and optimism starting treatment I’d been waiting almost twenty years to access, when I woke up feeling fucking awful one day in March after only two months of functioning decently well, all I could think was “GOD DAMNIT.” I was exhausted, sad, fighting a headache, dehydrated, unmotivated, apathetic about work and life, and disappointed. I was so drained I was having an impossible time doing anything. I knew I should be excited about the work assembling on my to-do list, since I’d ended my last stressful contract and everything on my plate was there by choice. But as I looked at the list of tasks I felt overwhelming dread. “What is wrong with me?” I said aloud. (My cat JoeBlack had no answers for me.)
When I scooted to the end of my bed and stood up to get some food, I recognized the body aches that had accompanied the first dysthymia spike over the winter. Oh! I KNOW WHAT THIS IS! I thought with a slight hiccup of excitement.
My primary care physician’s next step (after my psychiatrist helps me find a regimen I can live with) is to properly diagnose what she’s pretty sure is fibromyalgia — which inconveniently also causes fatigue, apathy, inattentiveness, and insomnia. Discerning symptoms when you’re dealing with multiple diagnoses and just getting started on unrelated below-the-neck ailments is a real trick, and I often write things off without recognizing what’s happening. Almost not recognizing which disorder was causing that day’s problems isn’t about denial; it’s about sourcing similar symptoms and whether the weather, new medications with possible side effects, or something temporary like a virus might factor in. For me, recognizing a new dysthymia flare as it was starting was pretty thrilling — and then deflating. I turned my anger on my brain chemistry: “I should be really excited about this piece I should be writing, and it really pisses me off that you’re trying to take this away from me.”
That’s when the lightbulb went off. Identifying what was happening meant I had caught it early enough to remember how I felt before the apathy and motivation drain started. I had been excited, and I knew it. Two days ago I couldn’t wait to write this piece, and all that had changed was my illness, tapping me on the shoulder and lying its obnoxious head off.
“If I was excited and my depression is a liar, then that means I actually still am excited,” I thought. “I just can’t feel it right now because it’s being cloaked in uninvited chemical nonsense.”
I let that thought fully process — difficult in the midst of depression fog. I was patient with myself (a lifelong challenge) and decided if I was pulling that off, I could also try trusting myself. I did remember being excited — I could still almost feel it, just by closing my eyes and mentally putting myself back into the day before. I’d caught the dysthymia so early in its onset, I wondered if I could draw on the memory to weather the flare. Maybe I could even shorten it.
Determining whether or not a depression coping strategy works can be almost as tricky as determining what disorder is to blame for a bad day. I was able to dig in that day and meet my immediate deadline, and the high of having possibly discovered a strategy pushed me through the fog. I still had a rough couple of weeks, but I managed — a distinct improvement over the previous bout.
I don’t want to make it sound like knowing is half the battle or anything as cliche and unhelpful as “it’s all about the energy you put out there!” Optimism doesn’t cure mental illness. But a diagnosis, support, and a subsequent strategy for getting through the bad stretches can be life-changing. A lot of managing any chronic illness is lifestyle-related; finding ways to sleep and eat and create a balance that fosters health is a frustrating process. Incorporating whatever is required — medications, therapies, etc. — into your treatment can also take time. For me, uncovering management techniques — like tapping into recent emotional memory and recognizing how it feels when I begin to slide into a bad flare — has been an invaluable means of reducing my frustration and bridging the gap to something more sustainable.
I never expect to be cured from my depression. That’s not realistic for someone with my neurobiology and trauma. “Sustainable,” for me, looks like a full slate of diagnoses, weekly time with the therapist I trust, and a solid medication protocol that gives me the ability to manage my symptoms, my work, and my life. I know that my needs will change over time, and I’m okay with that if I can get some break time between crises.
While I may not be throwing confetti around or announcing that I’m cured, I find that I have less fear and anxiety about the inevitable next unwelcome bad day, week, or month. I’ve discovered there is some power — and maybe even some healing — in knowing that managing, perhaps, is possible. I do still want more from life than to merely manage, of course, but it’s been years since I truly felt able to weather unscheduled and unpredictable bumps in the road as well as I currently am. For now, I’m happy just having some relief.
Katie Klabusich is a contributing writer for The Establishment and host of The Katie Speak Show on Netroots Radio. Her work can also be found at Rolling Stone, Truthout, RH Reality Check, and Bitch Magazine.