Depression - it's not just feeling down

I have been struggling with depression for much of my adult life. I am technically diagnosed as bipolar, but I have not been subject to many of the symptoms of mania. This is especially true since I reached the age of 35. I haven't had a single manic episode in twenty years. I have experienced some symptoms of hypomania, such as irritability and anger, but this is almost always in what is known as a “mixed” episode. In other words, I still have severe depression, but it is coupled with some of the symptoms of hypomania.

In addition to making my own life miserable, usually this makes me a very unpleasant person to be around. Don't get me wrong, I do not mean I've been in a depressive episode my entire life—I've had periods, sometimes years long, that have been quite pleasant and productive. I've held very good jobs, been creative, lively, and happy. But those periods when I am depressed can be hellish. They have also been torturous to those who love me. I am not the only one who worries that “this time” might be the time when I don't come back from a major depressive episode.

For those of you who have clinical depression, I don't need to be very descriptive. You know what it's like. You understand the inner voice that tells you, “death must be better than what I am living through now.” For those that have never experienced it, I'd like to write a little bit about what it is really like. There is one serious problem with this, however. When I am depressed, I cannot write. I mean, no matter how much I want to write, I just can't do it. I am as unable to proceed with my writing as if I were illiterate.

When I'm in a period of remission from depression, it is hard to describe the depth of misery that encapsulates me in my depressive state. It is not that I can't remember the depression, it is just that our minds have a protective mechanism which works to try and keep us from going back to those times that were most painful. This is why people with Post-Traumatic Stress Disorder aren't always able to remember all the details about a traumatic experience. So, I will do the best I can at this time, which is in early remission from an episode lasting about a year.

Depression, clinical depression at least, exhibits different symptoms in different people. I am only able to really describe the symptoms that are relative to my episodes. The first thing I notice when I start getting depressed is a general lack of energy. I just feel tired. Sort of like the tiredness you have after a day of swimming or other heavy physical activity. Along with this tiredness, I start having trouble sleeping. I usually initially attribute the tiredness to this lack of sleep even though the tiredness really comes first.

Over a period of a few weeks, I sleep less and less and become completely exhausted. Everything seems to be too much of an effort. Eventually, even brushing my hair becomes so overwhelming I just can't do it. I become unable to work, to read, to write, to keep house, do laundry, even talk. I talk less and less. My communication with others becomes very limited, and I slowly isolate myself. I gradually move less, physically. I often sit in the same chair for days at a time, only getting up to go to the bathroom, as my mind becomes filled with horrible thoughts.

I dwell on the worst possible scenarios for every situation that is coming up in my future and on all the things in my past that I am ashamed of and mistakes I have made. I start to become quite paranoid, perhaps due to the lack of sleep—who knows why really. I become mired in fear—that someone is going to break into the house, that my loved ones will get into an auto accident, that there will be an earthquake, volcano, hurricane, or other natural disaster. No unreasonable or senseless terror is too distant from my mind.

I especially fear making a wrong decision due to my compromised cognitive faculties. My ability to problem-solve goes out the window. When my last depressive episode began, I was teaching at a state university near where I live. By the time it was in full swing, I couldn't understand the directions on a box of cake mix.

The physical pain from my fibromyalgia and other chronic pain issues increases exponentially, to an intolerable level, and my intake of pain medication rises accordingly. The pain medication magnifies the sense of exhaustion and worsens the cognitive problems that I have whenever I am depressed. But without it the unceasing pain becomes unbearable.

I begin contemplating suicide just to escape the pain. This is easily justified in my own mind, because I feel worthless, flawed in my very being, and a burden on everyone I know. Suicide begins to look like the only reasonable alternative, but fortunately, like everything else in my life, I just don't have the energy to complete the task.

I can remain in this state of being for months, even more than a year at a time. This description may sound overblown but in reality is the typification of understatement. I am unable to give a truly representative account of the horror of these episodes. The fact that I have survived many of them is a miracle—in my understanding of that word. Obviously this is much different than a simple case of the blues or sadness at the time of a loss. While there is great grief involved, it is not natural grief that one feels at a job loss, the death of a loved one, or diagnosis of a chronic illness.

So has my description shone any light on this thing we call depression? I believe my description varies from someone who has a diagnosis of major depressive disorder, simply because my own experience is complicated by hypomania typical of bipolar disorder. I also have multiple chronic pain issues that get worse with an episode. That does not mean my experience is worse, simply different. One of the biggest mistakes we can make is to “compete” with others who struggle with illness. Everyone hurts in their own way. I would love to have others experienced with depression to comment here on their own experiences and struggles.

For many years I was ashamed of my conflict with mental health issues. To write something like this in a public forum would have terrified me. Now I know that my experiences may help others struggling with similar issues. I have made the decision to include this page in my blog for this reason. Please enter your own comments below.