The first time I became chronically depressed as an adult was shortly after my nineteenth birthday. One morning I found myself unable to get up. There was a large block of lead resting on my body. When I reached out, all I could feel of the world, or myself, was lead.
Aside from a longstanding bitter struggle with my sexuality and my fraught relations with my mother (and even more fraught relations with my father), there were many legitimate reasons for me to have been scared of that particular day, and the many similar days which were sure to follow it. My waking hours were stretched between volunteering for an almost cult-like youth organisation that exacerbated my sense of alienation rather than providing the sense of belonging it promised, working excessive hours as an A-levels tutor at a factory-like ‘agency’ where I was bullied and exploited, by my employer, and studying a hyper-competitive degree in a subject for which I had absolutely no passion or interest, but chose only because I thought law was just what clever people were meant to study.
Though entirely within my own power to alter, these soul-sapping demands on my time seemed like immutable, permanent facts of life (didn’t everyone have to work? Didn’t everyone hate their boss? Wouldn’t I be a bad person if I didn’t ‘give back’ by volunteering?) But the longer I forced myself through days that felt like fires after frying pans after volcanoes, the bigger my block of lead grew, and the harder it was to see the sources of my anguish with any sort of perspective or objectivity. And receiving fewer clear messages from my increasingly shut-down and neglected feelings, my ‘problem-solving brain’, began to turn inward to my vast internal storage vaults of painful thoughts and memories, running-riot to find anything it could use to piece together an explanation for just how unbearably awful I was feeling. And because this terrible feeling was so increasingly disproportionate to ‘real-life’ circumstances, my cerebral problem-solving machine had to conjure up larger-than-life explanations for its suffering, so it started to put together some spectacularly dark and intellectually complex formulations to ‘explain’ the depression, thus only perpetuating it.
I was too afraid of my trigger-happy mother to tell her about my affliction, but she found out from my brother, and soon I was being driven to the same psychiatrist that had treated my father, who had suffered a manic-depressive episode shortly after I was born. The psychiatrist diagnosed me with Generalised Anxiety Disorder and prescribed Escitalopram, an SSRI. I desperately wanted to believe that this was the magic pill it had been promised as, the one that would blast away the leaden block above my bed.
Plane ticket to South Africa
And after a very touch-and-go fortnight of agitation and uncertainty, one morning I found myself fully awake and standing upright on the floor beside my bed, completely unaware of having performed any cognitive processes to get myself from my familiar position of leaden prostration to an unfamiliar position of dignified readiness for the day. And then, in the space of just over a month, I transformed from feeling barely alive after twelve hours of sleep to springing out of bed after just four, from sharing my evenings with sitcoms on a laptop screen to going out until the early hours of the morning with whatever chums I could rustle up (or discover at my favourite nightspots). My savings were soon depleted, but I managed to obtain a substantial amount of credit by charming a bank-clerk. I made a last-minute decision to run my first ever half-marathon. I made similarly impulsive choices to move out of my mother’s house into a friend’s parents’ guestroom, leave my job with a 2000-word no-holds-barred resignation letter, and book a last-minute plane ticket to South Africa to be a counsellor on the same month-long summer camp at which I had been a volunteer the previous year.
This last decision set me up for my medically induced state of hypomania to tick over into a full-blown manic-depressive episode when I was least able to cope with such an eventuality. One night halfway through the camp, I suddenly found myself having lost the ability to sleep. Or eat. Or think about anything in a vaguely proportionate, rational or optimistic way. I had no way of guessing what was happening to me, because as far as I was aware the ‘magic pill’ that I was still taking had ‘fixed’ me. So I thought that when everything ‘flipped’ again, and so suddenly, this was just my ‘wake-up call’ into the truth of the world’s inescapable and all-consuming terror.
Many lessons could be taken away from the sequence of events that lead up to my first major nervous breakdown, as well as what followed. But one of the most important is how my psychiatrist could have been more willing to consider the possible sources of even deep-rooted and seemingly chronic states of depression in very real, identifiable circumstances which the patient had lost the ability to relay himself because of the pervasiveness of the impaired state of mind which had taken hold. Before prescribing anti-depressants, it is worth considering whether there might be structurally embedded elements of a patient’s life, such as a ‘wrong’ job or a toxic relationship, that are causing him or her the chronic stress that is at the very least significantly contributing to the impairment. Additionally, rather than assessing a situation of chronic depression in isolation, it is necessary to carefully ascertain any history of significant mood swings, and if these have been present, to prescribe anti-depressants with caution, and not without corresponding stabilising medication. Even if there is no obvious history of mood swings, patients who are prescribed anti-depressants should be monitored closely because of the possibility of such medication inadvertently triggering latent bipolar tendencies and catalysing an initial hypomanic episode.