Recognizing Depression

Medical science has created all manner of diagnostic tools over the years. There are blood tests that detect the slightest traces of hormones or other markers in the blood, and machines that provide images of our bones and internal organs. There are already so many tests doctors can preform to help make diagnoses, and they are developing more every day.

But there is no test for depression.

What they do instead is ask a bunch of questions and use the answers to point to it. They verify that the symptoms are present and then tell you that those symptoms are caused by a certain thing.

It is an inexact method with numerous flaws: the questions are subjective, the way doctors interpret the answers possibly more so. The questionnaire attempts to determine thoughts, feelings and behavior patterns that some people are better at recognizing. Each patient has a different baseline experience of “happy” and “sad,” their daily energy and attention level, how interested they are in doing things and how much joy they derive from what they do.

We understand that depression can be caused by–result in?–hormonal imbalances in the brain. Doctors prescribe medications that supposedly correct these imbalances, but there is no test to detect that they exist in the first place, or that the medication is correcting them. There are no CAT scans or MRIs that offer  physical proof of depression, a specific pattern one can point to and exclaim, “yes, there it is.”

This makes diagnosis–and treatment–difficult.

You’d think that after almost 20 years of living with depression (I consider myself living with it even when it’s in “remission”) I’d be an expert at recognizing it. And I am. I am quick to notice familiar patterns in my thoughts or moods, and “treat” them (when possible) with increased sleep and exercise, two things I know help ease my symptoms. So yes, I know how depression usually manifests in my life and I am quick to recognize it.

Except what if the symptoms I recognize as depression are just manifestations of who I am? I was diagnosed with clinical depression at 16 and I have been treated for it with a combination of therapy and medication for the majority of my adult life. I have never experience adult life without the specter of clinical depression lurking– I have no baseline “before” to compare the “after” to–and I’m starting to wonder if I even know what it really looks like anymore.

I have always wondered if my symptoms stem from depression, my nature or the stress of daily life (and my inability to cope with it). No human being is the same, we all sit at different places on the spectrum of “normal” (and one could write a book about how we determine “normal” and the damaging implications of that arbitrary categorization). Extreme cases of depression are easily recognized–I don’t wonder if someone with debilitating clinical depression is actually suffering from a disease–but for someone like me, who sits (with proper management) on the highly functioning side of the depression, it’s harder to determine what is the disease and what is just the person. Maybe, instead of falling on the highly functioning scale of depression, I actually fall on the lower functioning scale of “normal.”

One could argue that the two should not overlap, that suffering from–frequently or intermittently–the symptoms of depression and being clinically depressed are not the same. One is a serious mental illness, the other is… I’m not sure… some people’s natural disposition? The effect of an over-stressed life?

The distinction would matter less if the treatment were not the same. I have been taking medication for depression and ADD (another disorder that is diagnosed symptomatically) on and off since I was diagnosed in my teens. I can’t recall with real accuracy exactly how many of those years I was taking something, but I would be surprised if it were less than half. Was medication really necessary for all of that time? Is it necessary now?

There are times in my life that I can point to and say with absolute certainty that I NEEDED to be on medication. My freshman year of college I should have been on something and was not. My junior year in Spain I absolutely needed to be on something but the complication of living, and getting prescriptions filled, abroad made it impossible. My sophomore and senior years were much better, of course I was taking medication then.

There is no doubt in my mind that I had to take Zo.loft when I was pregnant with my daughter. I fought it and fought it but in the end my anxiety was crippling and I just couldn’t cope. I know now that I needed it, precisely because I fought going on it for so long.

Perhaps it is for the times when I can say with certainty that I needed to be taking medication that I question the times when I’m not as sure. Right now I am taking something, but do I need it? There is no doubt in my mind that this medication improves my quality of life, but is it necessary? My washing machine also improves my quality of life, and in this day and age–especially in this country–people would be appalled to learn that I do laundry by hand. There is an expectation that a washer and dryer will be available, if not in my home than at a laundromat. We simply do not live without that convenience anymore (but I have before, for a summer in Mexico where I washed most of my clothes in a concrete basin on the roof and hung them to dry).

Is my medication a metaphorical washing machine? Does it raise my quality of life to a level we expect, while remaining, strictly speaking, not necessary?

I will say that I do see my medication as a washing machine. It’s not, say, a dishwasher, which I have lived without for an entire decade. Sure I wished I had one, but I got by just fine without. It was mere inconvenience, its absence did not change the landscape of my days.

There have been times when I’ve been off my medication and functioning fine. The years I was trying to get pregnant I managed, despite the stress of trying to get pregnant and even secondary infertility. I was able to stay off medication for my second pregnancy and I was very grateful for that. There were a couple of years, in my mid-twenties when I didn’t take anything. So I know I can manage without medication, but I also know that I always end up back on it. And there were years when it wasn’t available and I suffered greatly for it.

Recently I tried to bring cut my daily intake from three pills to two. I thought I was doing fine and then after two weeks the thoughts started invading. I recognize depression as an attitude, a way of thinking, that is defeatist and devoid of hope. Everything seems unmanageable and I don’t see any way to make it better. I stop wanting to do things that usually bring me joy–or at least improve my mood. I cry a lot, for seemingly no reason. I am easily hurt by others and I feel like no body cares.

In the beginning, I recognize these thoughts and feelings for the lies that they are. I see through their false facade and I use self talk and cognitive behavioral therapy to impede the progress. But if I can’t quell the onslaught, it becomes harder and harder to recognize what is going on. Eventually I am drowning in darkness.

There are definitely triggers–stressful situations that make my depression more likely to emerge–but there are times when it comes on without provocation, when I’m taken by surprise. Those are the most unsettling.

I’m just starting the book Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down and Changed Who We Are by Katherine Sharpe. The author is my creative non-fiction professor. I don’t really believe in signs, but I do make note of meaningful happenstance and I know I can make this strange coincidence-I’m taking a class by woman who wrote a book about something I’m currently very interested in–meaningful in some way. In the introduction she writes:

This is a book about what it’s like to grow up on antidepressants. It attempts a faithful description of an activity that has become remarkably common–using antidepressants as a teenager or young adult–but still engenders intense, complicated, and often conflicted feelings, both in the young people who do it and the adults who are involved in their care. … Rightly or wrongly, antidepressants command powerful emotions; they can lead people to examine their deepest assumptions about themselves and the world.

Well, she’s definitely right about that.

I am experiencing a considerable amount of trepidation in reading this book. I’m scared that I’ll walk away with a changed attitude and that my actions will then have to reflect that change. I worry that my life will be harder, and less happy, at the other side. But I need to ask these questions, even if I can’t answer them. This is my life, and some choices require very careful consideration.

 What is your experience with depression, anxiety or mood disorders?

What are you thoughts of the prevalence of anti-depressants in America?