Let’s Talk About (Managing) Depression (Pt. 6)

Another cross-post from my newsletter. I felt like it was a super important one, and wanted to share for all who need it.

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“One of the hardest decisions you’ll ever face in life is choosing whether to walk away or try harder.”
—Ziad K. Abdelnour

 

 

It’s been a bit since I’ve answered a question from the newsletter. This one came through from M, and as I was responding, I realized it might be something that could help some of you out there who are suffering with Depression but haven’t yet found the answers on how to manage it. I share it with the hope that it helps. It’s LONG. You’ve been warned.

Hey Joe,

I’ve read your post about depression and I want to ask if you are on any medication? The reason I ask is that I too am dealing with a bout of depression that has been going on for about six months. I am not as self-aware as you are so it’s taken me about five and a half months to recognize why I start crying several times a day. There are other more worrisome symptoms I won’t bother you with. You mentioned cognitive behavioral therapy, which I don’t think I’ve tried yet. I have tentatively decided to make an appointment to see a psychiatrist because I need help badly but I don’t know what help I need. If that makes any sense. I’ve tried the talking kind of therapy several times in the past, but it usually makes me sadder because it just brings up old stuff and then I get stuck in that stuff and never get out of it. I think I want to try medication now and I’m interested in your thoughts on/history with medication.

(The rest is deleted because it’s not relevant — Joe)

Take care,
M
First, thank you, M, for reading my newsletter, and also thank you for opening up and replying. It means a lot that you’d trust me with this question, and I want you to know that I admire the bravery (even if it comes from a place of desperation, it takes a LOT for anyone to trust someone with this kind of question, and that’s not lost on me).

I’m going to answer your question about drugs right up front, so if that’s enough you can skip the essay below: The drugs are good, but they don’t fix you. When used properly, they’re tools you use in the construction of your new way of thinking. I was on medication for a little over four years. I don’t take medications now, but that wasn’t always the case (as I will explain below). I used the drugs to slow my brain down and balance my moods during the worst of it so I could combine it with Cognitive Behavorial Therapy and learn how to think a new way, so I wouldn’t need them the rest of my life. In some cases, they might be a requirement for keeping balance, but with work and lots of hope, they can be minimized or even eliminated. But there’s far, far more to it than just that.

So, if you want to know the rest, I must warn you: this is going to be long. I am typing that out at the very beginning of my response, not going back after writing everything and putting it in. I say this because it’s VERY important to me that you know, from the outset, that I know exactly how long this email is going to be, because I know exactly how long it took me to walk my path to now. I want you to read every single word. No skimming. No jumping ahead. You don’t have to, of course. It’s your email, you can skim or delete if you like. But I want you to read every word. So, now that you know what I want, you can choose to do it or don’t.

And that’s literally the point of everything I’m about to write. YOU get to choose. Do it or don’t. There’s no universally right path. There’s only the right path for you. I’m going to share with you my path, and you can choose to do what I suggest, or find your own way. Both are 100% valid. Both are 100% healthy. There’s no wrong answers on finding how to balance your mental health, there’s only consequences. And no matter what you choose to do, there WILL BE CONCEQUENCES.

Unfortunately for us, we aren’t born with the innate benefits of having a “normal” life. I’ve come to believe that there’s no such thing as a “normal” life, but for the purposes of this email, I define “normal” as a life without the issues that come from depression, bipolar, or other such mental health hangups. That means one of four possible outcomes, all of which I consider consequences:

1) suffering the rest of your life.
Pros: It requires no effort, aside from the energy it takes to cry. Not really much of a pro, now that I think about it.
Cons: it sucks.

2) Self medicating and living a life of excess and distraction to avoid pain, and then eventually suffering even worse.
Pros: It’s fun in the short term. Alcohol. Drugs. Sex. Concerts. Travel. Distraction, distraction, distraction.
Cons: Like every addiction, tolerances get built, and it takes more and more and more to do the job of keeping you from realizing how much pain you are in. You will formulate either chemical or emotional addictions. You will destroy people in the process. You will suffer each time you hurt someone, and you will suffer worse each time someone wises up before you can wreck them and they wreck you first. And then ultimately, no matter how hard you try, you’re still left with the other three consequences, at which time, Number 3 gets WAY harder than if you start it now, making either number 1 or number 4 far more likely. (Hint; I did this. It lead me to number 3, which is why i know the work is SO MUCH HARDER after doing this. If I could possibly beg you to do anything ever, it would be to skip this step if you choose number 3. Please for the love of god… Don’t do this. You may anyway. You may have to to get to the point where you’re convinced number 3 is the right choice. I know I did. And if so, no judgement. Like I said, I did. But much like a parent watching a kid make the same mistakes, I want in my heart more than anything in the world for you to skip this part if you possibly can).

3) doing the work.
Pros: You get to live a life that has a far greater chance of fulfillment. You also will learn who you really are. You will learn how to shed what hurts you, bleed out toxins, deal with pain from your past, cut off toxic relationships, and find your own way.
Cons: You’re going to suffer more than you do now, in the short term. But you burn through it much much faster than if you choose number 1, which is ultimately a PRO. You also have to spend a lot more time doing the work than if you didn’t, which means spending time on your own mental health instead of “fun” things that other, “normal” people get to do with their days. But again, there’s a PRO at the end: You get to be a whole person, where the rest of “normal” people get to live a life of delusion where they think life is just a roller coaster ride. You will be empowered in a way no one else in your life gets to be. You will own yourself. I cannot possibly overstate how important that is. NO ONE will control you, but you. And to me, that’s worth every single second I could spend playing video games or hitting bars or dating the wrong person or any number of other things.

4) suicide.
Pros: literally none.
Cons: You have zero opportunity to even explore the chance to see what life would be like if (and when) you get this under control. In the meantime, everyone you ever loved will be a shambling emotional wreck for a while. There’s no upside. Don’t do it. Not that I think you will — you’ve written me asking for help [and you reading this now have subscribed to this newsletter] which tells me this probably isn’t an option, at least right now. But it’s somethingI must address. People in our situation have no choice but to be realistic about the possibility that we may, in the throwes of severe pain and despair, decide none of this is worth it and decide to hurt or kill ourselves. To pretend this isn’t a possibility is folly.

So, clearly I advocate number 3. It’s where I ultimately settled. But I didn’t get there until I tried Number 1, then Number 2, then number 4 (I even revisited number 2 after the divorce, but I think everyone does to some extent. It’s part of the divorce playbook. It’s just how it goes).

Which brings me to the drugs part.

In 2011, I tried to kill myself. I’d spent many years undiagnosed with bipolar disorder. I saw a psychologist for many years. He never diagnosed me as bipolar, because the type of bipolar I was ultimately diagnosed with is “Type 4” which is simply super, super manic, with pits of depression here and there. If you know anything about my past, you saw this in action. There’d be literally a year of constant output of work — writing, web development, design, advertising, touring on art shows, all that — and then a few weeks where I was super, super down. That’s not necessarily normal bipolar, it’s simply mania that I presumably had under control. But ultimately, it wore me down to a point where i had a few weeks of reflection where I realized, I’d built a life where I’d made every one I love dependent on me so they wouldn’t leave (codependency). This was borne of a deep psychological scar from childhood, where I suffered abuse and developed a litany of dependency and “mommy and daddy” issues.

So, I tried to kill myself. I was stopped by my ex-wife and spent a few days in a psychiatric institution. Those days were ultimately the most powerful and impactful of my life. I learned so much about so many things. I won’t bore you with the clinical stuff. I’ll only share with you the moment I decided things needed to change:

In one group session (of which there were 6 each day, and they were mandatory), we were all asked “Do you think you’ll be back here?” The question was designed to be a thinker of a question: do you think you’ll ATTEMPT suicide again, or do you think you’ll do the work and get healthy, or do you think you’ll be successful the next time?

One of the councilors, who was a former patient, was a pretty blunt lady. When she asked me that question, I said “I don’t want to be here ever again.”

She asked me directly: “Does that mean living or dying?”

I said “Oh, living definitely.”

She then asked, “So what are you going to do differently to make sure you never end up here again?”

I didn’t have an answer. She waited nearly a full minute for me to reply, and I didn’t. And I’m not sure if you realize how long a minute can be. Do this right now: Look in a mirror and ask yourself any question on earth, and then start a timer and wait for 60 seconds to go by before you answer. It’s a LOT longer and far more uncomfortable than you think it’d be when you simply read “It took me a full minute to answer.”

She finally broke the silence and said “If you’re truly committed to never coming back here again, and you plan to live, you need to decide if you intend to try re-living the life that got you here in the first place, or do what’s necessary to make good on your promise never to come back.”

I want those words tattooed on my arm. But there’s already tattoos there, and I don’t want to ruin them. So, I just keep them in the back of my mind 24 hours a day, 7 days a week.

When I left, they prescribed Lamictal and Zoloft. I was told specifically how each drug worked. Lamictal was originally an anti-epileptic drug. They found that it had mild mood-enhancing effects, but more importantly, they learned that it slowed the synapses down in the brain so that it literally thought slower. It helps keep spiraling thoughts at bay. It forces you to concider your thoughts before you say or do anything, because your brain is literally running at a slower pace. Zoloft is an MAOI that you’ve heard about. It’s an anti-depressant. It was prescribed to me for the short term, to lift my mood out of the depths of being suicidal and allow me the space to be able to think without hurting.

Both of these drugs had the intent of allowing my mind, as it was, to not circumvent the work of therapy and fixing what generated my dips into depression. I was told that I could stay on them the rest of my life, or I could do the work and eventually come off of one, if not both, of them.

I chose the latter. I think probably at the time it’s because I had independence and control issues. But whatever my reasoning, it worked out to be the harder, but much better, choice. Because it forced me into the second part:

Therapy, and specifically Cognitive Behavioral Therapy. I had to spend a few years digging into my past to dissect and face all of the things that happened to me that caused my condition. Everything from abandonment issues, to physical, emotional and sexual abuse, to codependency issues, to bullying… I had to relive all that shit. It was not fun, to say the very least. But what it ultimately allowed me to do is face down those who had tormented me as a child and young teenager and realize, these people are NOT RIGHT. They weren’t correct about what they told me. They weren’t right in what they did to me. They had no power of me. They simply convinced me to keep myself down, because they convinced a child to think a certain way during those years when the brain and emotions and personality were developing.

I learned a fact that changed my life forever. If you’ve ever been to a circus with elephants, you see that those elephants are easily controlled and kept at bay with a simple rope tied to their foot, anchored with a stake in the ground. Now, an adult elephant can easily rip a stake from the ground with one tug. But it doesn’t, because as a baby, they chain the elephant’s foot to an anchor of metal and concrete. THe baby elephant struggles mightily at first, but eventually learns it is futile to struggle, so they GIVE UP. And that persists their entire lives. They are broken as children, so they don’t know as adults how powerful and strong they really are.

That’s us. And it didn’t sit well with me. I imagine it probably doesn’t sit well with you, either.

The second part of digging into my past was learning new ways to think to eliminate (or at least stem) the old ways of thinking. I did many exercises in retraining my brain’s neural pathways to go a different route. To that end, I HIGHLY recommend a book called The Power Of Habit by Charles Duhigg.

This book explains “the habit loop” and fundamentally how our brain builds neural pathways to eliminate the chore of active thinking. Ever have a friend move or start a new job, and accidentally drive to the old job or house out of habit? You just sorta “wake up” and realize holy crap, I went to the old place! That’s habit. And far more powerful… You didn’t even think about how to turn on the car, shift gears, apply the gas or breaks or turn signals, what any of the signs or lights meant on the road…. That’s how powerful habit is. That you can forget the individual patterns and behaviors of how to drive a freaking car.

Your emotions, self confidence, behaviors and other aspects of your life are the exact same. And if you want to change what’s happening now, you have to work your way backward to the root causes.

So, to that end, I do recommend medication. But much like having a broken foot, it’s a crutch until it heals, and then you MUST learn to walk on that foot and build strength and balance, or you’ll be on crutches your whole life. Depending on the severity of the injury, you may need a brace or some support for the rest of your days, so being on meds isn’t a bad thing if they’re required. Anything that gets you to a point where you’re not slogging through, day to day, draped in the horror of Depression is a good thing.

Long answer, but there you have it. I hope it helps.

Very sincerely and with much love,

Joe

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There was a followup conversation, and in it, some points were made that I wanted to share. They’re not quoted, but summarized for anyone who needs them:

1) YOU ARE WORTH THE WORK. You may not believe it right now. I may not be able to change your mind simply saying that. What will change your mind is the actual work. You start it, and at first, you feel it’s a waste of time. Resistance sets in and tells you to stop. It might even convince you. Do it anyway. A week goes by, a month goes by, three months go by… And you’ll see improvement. You will be shocked by it. Maybe it’s saying “no” to something not good for you, that you would have said “yes” to before. Maybe it’s fitness. Maybe it’s not saying negative things in your head about yourself. Something will happen and you’ll go “wow, that’s different.” AND THAT IS WHEN THINGS CHANGE. Much like a classic car with rust and carburetor problems and broken tail lights, but TONS of potential; As you begin improving, you will want to keep improving, until one day you look at the car and go “holy shit, this thing is BEAUTIFUL.” and you’ll take care of it and love it. That’s you. You’re that car.

2) You may be afraid of seeking treatment for fear of a diagnosis you don’t want to hear. The diagnosis is just putting words around what’s already going on with you. It’s happening. It’s better to know what it is than to wonder and suffer from an unknown enemy. I’ve always been a proponent of naming your fears, because once you know their names, they aren’t as scary. They say “sunlight is the best disinfectant.” It’s true. Shining light on dark things lets you see what they are, so you know how to deal with them. The way I figure it, if there’s a beast in a dark room that’s threatening to eat me, I’d rather see what it is, because then there’s at least a chance I can figure out how to kill it. If it’s going to eat me anyway, at least I’ll go down punching, and cause it some indigestion 🙂

To everyone reading this right now: I sincerely hope this helps you. And if you ever need someone to talk to, please don’t hesitate to email me. You are not alone. You’ve been here for me, I am here for you.