R U OK?

[megpie71]

It's R U OK Day here in Australia. It's a national day dedicated to raising awareness of mental health issues.

So hi, I'm Meg, and at the moment, I'm not OK.

I have chronic endogenous clinical depression. Chronic means this is long-term, it isn't something that's going away any time soon. Endogenous means there's no readily apparent "reason" for why I'm depressed. Clinical depression is the name of the mental illness I have, and as the previous two sentences point out, I don't just have this illness one day a year. It's for life, not just for today.

At the moment, I'm having one of my periodic "black" times. I'm dealing with a depressive attack, which means I'm displaying all the symptoms of depression. I'm feeling vulnerable, self-critical, guilty about long-past offences, unable to be cheerful, unable to find happiness, worthless, useless, hopeless, and I have recurrent thoughts about how I (and the world at large) would be better off if I were dead. Or in other words, I'm depressed. Again.

I've been feeling more or less this way for most of the past two weeks, and I'll probably continue feeling this way for at least another week and a half. I'm not doing much by way of housework, and I'm having to struggle to keep up with my university commitments. I have a lot less energy than I used to have, and while I'm feeling tired all the time, I'm also not sleeping well (I'm dreaming a lot more, and my sleep is a lot more physically restless than it used to be - I woke up this morning with my covers all pulled loose, which is a pretty good indication that there are problems). I'm irritable, and the person I'm most irritated with is myself.

How do I know all of this? I know it because I've been dealing with the depression since I first started going through puberty (my first real feeling of dealing with suicidal impulses was back when I was about ten or eleven, and it just kept going from there). I'm in my forties now, and I'll probably be dealing with this until I die. So I've learned to deal with it.

I've tried multiple anti-depressants. They don't work for me. Or actually, that's probably mis-stating things. Anti-depressants don't work to deal with the sort of depressive episode I'm dealing with now - they're not for acute short-term treatment, because even the most rapid-acting of them take about a couple of weeks to build up to levels where they're going to be effective. The other side of it is that for me, taking antidepressants on a long-term basis is analogous to walking around on crutches all the time just in case I happen to break my ankle again. The effects of antidepressants - the loss of libido, the anorgasmia, the feeling of losing about half my emotional range (yeah, I don't feel as far down... but I lose all the up, too), the mental fogging that comes with doses strong enough to actually stop the depression in its tracks - all of those are a bit too high a price to be paying for the dubious privilege of not being depressed for the year or so it takes my brain to figure out how to be depressed anyway.

I'm also a bit sceptical about anti-depressants in general as well, mostly because we don't know how they actually work to treat depression. By which I mean: we don't know how reduced serotonin or norepinephrine levels, or strange dopamine levels, or odd amounts of endorphins at the neuron level affects things to make depression visible at the cognitive and emotional levels. It's in the bit of neuropsychology which could best be described as "Step Two: ????". There's also no diagnostic tests available to check neurotransmitter levels in the brain - instead, they have to be guessed at from behavioural and self-reported cues. Which means that the medication-go-round with mental health issues is mostly a case of "well, try this and see whether it works", and if it does work, well, that probably meant your levels of whichever neurotransmitter that one was supposed to be targeting were out of whack. Or something. Probably something.

So at present, I'm back to the tried-and-true strategy which got me through from early puberty until I was about thirty: I just bulldoze through it. Because here's the crucial bit: I've been living with depression since I was fairly young. So I'm used to it. I've accepted it's part of my life. I am going to have days where I'm going to wake up and think "oh damn, I'm not dead. Now what?". I am going to have whole weeks where the most I want to do is sit in a corner and cry. I am going to have months where fun just isn't on the agenda, because I don't know how to have fun. I'm going to be living a life where if someone tells me "just cheer up", I'm likely to shoot back with "how?", and actually get a certain amount of sadistic enjoyment out of watching as they flounder. I'm going to be living a life where the "think positive" types are going to receive a quick rundown of just how useless trying to think about the positives in the middle of a depressive storm is - as I've said elsewhere, I've tried it, and what happens is I wind up absolutely positive that the world would be a better place if I wasn't part of it.

So I get up in the morning, think "oh fuck, still not dead," and carry on. I have routines set up. I have an alarm which goes off at 8.30am every morning to remind me to get dressed, and to take my thyroid meds. I set myself limits on what I'm expected to achieve each day, and those limits are low - they're set for what I can achieve in the middle of the worst of the depression. I'm prepared for the days where I don't want to do anything, and where all I want to do is hide, and I give myself permission to take days where all I'm doing is sitting and watching a DVD, because any other form of intellectual or physical effort feels like too much.

It's like the weather. The storm will pass. I'll feel fucking rotten while it's doing that, and any obstacle is going to seem impassable, but it will pass.

So yeah. I'm Meg, and at the moment, I'm not OK. But I'll probably be OK in a couple of weeks. So that's OK.