So I have to rethink some things. Specifically, I have to rethink some things about mental illness and me.
As regular readers may already know, I had a recent bout with depression, starting in late 2012 when my father died and I was diagnosed with cancer. It wasn’t my first time at the rodeo: I’ve had two or three other fairly serious depressive episodes in my life. But I’m not someone for whom depression is a staple of my everyday life. My depressive episodes haven’t been trivial, but they’ve been intermittent. If I added up the months that I’ve been depressed, I’d put it at about 10% of my adult life.
And until recently, I thought of myself as a basically mentally healthy person, with something of a vulnerability to situational depression.
But apparently, I have to re-think that.
In my last couple of sessions with my psychiatrist (I’m seeing a therapist weekly for talk therapy, and a psychiatrist every few months to talk about meds), now that I’m feeling better, we’ve started talking about my long-term care plan, and my future with meds. I’d been assuming that we’d eventually taper me off the anti-depressant meds, and that we’d just be discussing the when and how of that. But apparently, not so much.
Apparently, if someone’s had three or more serious depressive episodes in their life, the current standard of care (as my psychiatrist understands and interprets them, anyway) is for them to stay on anti-depressants. If someone has had three or more serious depressive episodes, the chances are very high that they’re going to have another one — and when that happens, it’s better, for a zillion reasons, to already be on medication. So the current standard of care is to stay on anti-depressants. Indefinitely. Forever.
I don’t mind being on the meds per se. Especially now that we’ve dialed down my dosage. I’m on Wellbutrin, if you’re curious, and the side effects for me are pretty minimal: I’m a little jumpier than usual, my attention span is a little spazzier, and my alcohol tolerance is lower (I can only have one drink per evening, one and a half tops). Big whoop. When I hear about other people’s side effects with their anti-depressants, I thank every non-existent god there is that I got off so lucky. The meds are fine. And I can absolutely see the reasoning behind staying on them. This is not a care plan that’s been foisted on me in any way: my doctor suggested it, but we discussed the pros and cons, and he made it clear that it was my choice. We decided on this plan together, and I’m completely in agreement about it.
But I’m definitely unsettled by it.
I’m unsettled because I now have to shift the way I see myself: from “basically mentally healthy person with something of a vulnerability to situational depression,” to “person with chronic depression who is going to be on medication for it for life.”
Some of that unsettlement is the stigma, for sure. There is a stigma attached to mental illness and the people who have it. As I wrote before when I first started on anti-depressants: Once I started taking actual psych meds for depression, it felt like I’ll have “Mentally Ill” stamped on me forever. That’s even more true if I’m taking those meds forever. But honestly, I’ve dealt with so many stigmas in my life, one more hardly seems worth worrying about. Given the stigmas against being queer, being bisexual, being kinky, being poly, being an atheist, and more — having a diagnosis of chronic depression, and being on meds for it, doesn’t add that much to the pile. I’m okay with that.
I think most of my unsettlement is the significant shift in how I see myself. I’ve always seen myself as a basically upbeat, optimistic, happy person: seeing the bright side, finding silver linings in clouds, putting the most generous interpretation I can on people’s behavior until I’m absolutely proven wrong, hoping for the best until it’s certain that those hopes have been dashed. Sometimes annoyingly so: I have a tendency towards reflexive Pollyanna optimism, and I’m not always good at commiserating or even just listening sympathetically without trying to find bright sides and solutions. And I’m awful to be around on election day. (“Prop 8 could still go down! The votes aren’t all counted yet! Don’t despair!”) But on the whole, seeing myself as a basically upbeat, optimistic, happy person… well, it makes me happy, and it works pretty well for me and those around me.
So now I’m trying to figure out how I can see myself as a basically upbeat, optimistic, happy person… who suffers from chronic depression, and who is going to be on medication for it for life. That almost seems like a contradiction in terms. I’m trying to find ways that it isn’t. (Maybe I could look at the meds as preventative, rather than as a treatment? Almost like a vaccine against depression?)
And I’m somewhat concerned about what seeing myself as someone with chronic depression is going to feel like: day to day, week to week, year to year. When I’m in the middle of a depressive episode, or when I’m coming out of a depressive episode and my mental health feels somewhat fragile, I make an extra-special effort to make time for mental health care — getting exercise, getting time outside, getting social time — even if I don’t really have time for it. Will I have to keep doing all of that forever? I mean, I like exercising and being outside and hanging out with my friends. But I also like staying inside for eighteen hours working and dicking around the house all by myself. I don’t want to have to give that up. Plus, when I’m in the middle of an episode or coming out of one, I do a lot of careful monitoring of my emotional state. “Is this a torpor that’s turning into a vicious circle, or am I just tired and needing to rest?” “Am I being anti-social and isolating myself, or do I just want to focus on my work for a day or two?” Do I now have to do that for the rest of my life? That seems seriously no fun.
In fact, it seems downright depressing. Seriously. I’m somewhat concerned that rigorous monitoring of my mental and emotional state, and constantly asking myself, “Am I depressed now? How about now? Okay, now?,” could itself contribute to my depression. And I’m somewhat concerned that simply seeing myself as someone with chronic depression might, in and of itself, be somewhat… well, depressing. Obviously, knowing the early warning signs of depression and knowing how to take action on them is a whole lot better, a whole lot less likely to result in a bad episode, then not knowing. I just need to find a way to do that — not just temporarily, not just while I’m in an episode or emerging from one, but as a permanent fixture of my life — that doesn’t result in hyper self-consciousness, hyper self-monitoring, and a re-assessment of my basic identity and character that is, in and of itself, depressing.
Of course I’m going to accept this reality. That’s what I do. Whenever I hear religious believer tell atheists, “You can just choose to believe in God,” I literally have no idea what they mean by that. I don’t understand how you could choose to not know something once you know it. So now that I know this truth, now that I know that I am someone with chronic depression, I can’t un-know it. Even if I wanted to. Which I don’t. And not taking the meds wouldn’t make that make this reality go away. In fact, it would make it a whole lot worse. I get that. I’m not questioning this decision. I’m just looking for ways to come to terms with it.
Thoughts? If you, yourself, experience chronic depression, how do you manage that? How (if at all) do you keep an eye on it without a constant self-conscious self-monitoring that is, in and of itself, anxious and depressing? And how do you accept yourself as a depressed person without it… well, being depressing?
Wellbutrin_SR_tablets_150mg image by SergeSF, licensed under Creative Commons, found at Wikimedia Commons.