Note: This piece discusses issues and experiences that may be triggering for some readers.
I am not depressed.
I know this because I wake up each morning and gingerly take stock of my emotional state, like someone checking for broken bones after a car accident. Right now, I feel fine. Life has meaning. I am capable of completing the many tasks and responsibilities that my life as a working single mom requires of me.
I notice this because as someone who suffers from chronic, medication-resistant depression, this state of being is not a given.
I was diagnosed with major depressive disorder in college and have been medicated for it mostly ever since. Now 35, I’ve been on a long list of strangely spelled medications that seem to lean heavily on the last few letters of the alphabet ― Lexapro, Paxil, Celexa, Wellbutrin, Rexulti, and now Trintellix and Viibryd with a small booster dose of Abilify. When I recently saw an advertisement for Sprite Zero’s new Lymonade, I thought to myself that the name looked like something I’d been prescribed before.
There always seems to be some trade-off with these drugs: You’ll feel better, but you’ll also gain 20 pounds! Or, you can feel better, but you won’t be able to have orgasms anymore! Rexulti was the first drug I took whose side effects actually frightened me, as users are warned it can cause compulsive behaviors like gambling, shopping and sexual acting out. I experienced those urges, along with a crackling, edgy restlessness in the two weeks before I decided feeling less depressed wasn’t worth the trade-off.
But the worst thing these medications do, by far, is stop working. This happens to me every few years like clockwork, as my depression creeps back in so slowly I often don’t notice until the situation is dire.
You probably think of the concept of relapse as it relates to addiction. I’ve been in recovery from drug and alcohol addiction since I was 25, so I’m well familiar with that concept. But depressives are prone to relapse as well, or “recurrence” as some doctors define a depressive episode that takes place six months or longer after treatment and recovery. According to Medical News Today, “about half of the people who experience an episode of depression for the first time will remain well.” For the other half of us, depression may come back once or chronically throughout our lives, outsmarting our medications and forcing us to summon the superhuman strength required to seek help. “On average, most people with depression will have four to five episodes during their lifetimes,” according to WebMD.
My depression is a part of my life that I have to manage continually, like my weight or my sobriety. But for me, it’s not as easy to notice and respond to as an extra 5 pounds.
Some women I know joke that every time they get their periods they’re relieved to know that they’ve been experiencing PMS and not just wanting to kill themselves. Depression is tricky like that, too. I never experience the symptoms of depression and think rationally to myself, “I am experiencing depression.” I always think at first, sometimes for a long while, that I am actually a bad person with a bad life, that I am right to feel this way because everything is just so hard. The feelings feel like facts.
My depression exacerbates this by manifesting in new ways with each bout. The last time I got sick, it was like a tape was constantly playing in my head telling me that I was a bad mother, a bad person and that I should kill myself. The suicidal ideation, which I had never experienced before, was specific and regular. I never felt that I was in danger of ending my life, only that I couldn’t stop thinking about it. But I remained able to function in ways I had never been able to before when depressed.
Eventually, it clicked that pervasive thoughts of suicide were a clear sign that something was very wrong, and I sought medical help, but for months I thought if I could brush my hair and make it to work on time, how could I be depressed?
The time before that consisted of mostly weeping. Weeping, and fatalistically projecting worst-case scenarios of terrible things that could happen to my loved ones, and then weeping about that. Again, it didn’t occur to me for months that I was depressed, only that I had failed at everything and the good part of my life was now over.
Depression, also like addiction, is one of the few diseases that can convince you you’re not even sick. Even as you’re drowning. Even when there are life preservers all around, should you just realize you need one.
But realizing you’re depressed is only half the battle. Because once I finally realize what’s going on and summon all my internal resources into asking for help, my doctor and I begin the guessing game of finding a medication or combination of medications that is going to fix the problem.
Last time it went like this: First, we upped the dosage of the medication I was already taking by 20 milligrams. After a few weeks, when I still felt like I had no skin and the whole world was scraping up against me, we added a new “booster” medication, indicated for use as an add-on for those with major depressive disorder “who have an inadequate response to their antidepressant.” More weeks of waiting, and living inside a black, drooling monster feeling ― so ugly I could picture its fangs and claws. The side effects of that drug proved to be intolerable, and the resulting crash when I went off it left me worse off than before. At this point, it was time for a new drug altogether, one that may or may not work for me, but takes 4-6 weeks to find out. Meanwhile, even listening to music hurt.
On the one hand, the fact that all I have to do is swallow something smaller than a Tic Tac each day to feel better is a goddamn miracle, one no one should ever feel bad for using. I feel endlessly grateful to live in a time when antidepressant medications exist, instead of just having to live in misery as would surely have been the case at any other point in history.
Still, I wake up each morning afraid of my own brain chemistry. Afraid that this is the day it outsmarts the formula and weasels its way through the barriers I have in place. Afraid that this is the week that I stop being able to get out of bed. Afraid that without this vigilance, I won’t even recognize the relapse when it comes.
I guess I hope that writing this article will serve as some kind of talisman against the next bad time. If I can sit here in self-awareness and explain to you the stages my mind and body go through during a relapse, then I’ll recognize the next one before I find myself in the middle of the deep end. But sometimes it feels like even when I’m doing fine, my depression is doing push-ups, growing stronger for the next time we battle. That even as I am evolving to better understand and take care of myself, this dumb, shitty disease is evolving too, staying one step ahead of me.
But there is solace: When the medication does begin to work again, it feels like the windows opening in my brain and letting in sunshine on the first day of spring. I feel the same sense of relief I used to feel after throwing up from drinking too much, the moment of unexpected well-being after expelling a poison. And I slip back into myself again, and I’m OK for another day.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.