Treatment Resistant Clinical Depression
Is There a Silver Lining?
My first episode of severe depression struck when I was in my final semester of graduate school and lasted five months. The day before, a Saturday, had been productive and relaxing, giving no signs of psychic peril.
When I awoke the next morning and swung my feet to the floor, the small dorm room tilted and spun. An unfamiliar combination of anxiety and dread spread its tentacles through my chest and stomach.
I remained seated on the edge of my bed for 15 minutes, trying to get my bearings, and then lurched toward the door six feet away.
I felt the need to keep moving, so I spilled into the hall of the nearly deserted dormitory. Panicky, I paced from one end to the other for several hours.
I was struck with clinical depression seven or eight times over the coming three decades. All except the most recent lasted between four and six months.
Five years later, when the second one struck, I at least knew what I was facing and quickly got to a psychiatrist. He diagnosed me with clinical agitated depression and started me on medication, one of the new SSRIs.
I eventually recovered and naively assumed I was cured. Not so. It came back again and again.
Over the last three decades I have taken a glut of medications, some of which seemed helpful, at least for a while. I have taken several SSRIs, SNRIs, a seldom used MAO inhibitor, and potentiating antipsychotics such as Tegretol, with other meds like Abilify, Namenda, and Lithium thrown in here and there.
Several times I have needed time off from work. I have been hospitalized four times, twice for suicidal ideation. I have seen several therapists, but to no apparent avail.
Ten years ago, I had 12 rounds of electroconvulsive therapy (ECT), which poked holes in my memory but left the depression untouched.
The severity of clinical depression is not like feeling down or out of sorts, and is isolating. Friends and caring people have asked what it feels like to be afflicted, but I have never known how to characterize it.
Severe depression, at least the kind I have had, is a different realm of experience from ordinary life and its attendant emotions. It is not like feeling sad or having the blues, just more intense. I can best describe my depression as a severe pain in the brain. The best analogy I can think of is to imagine the brain as a broken leg shattered into shards of bone and gristle.
So, I didn’t talk much about anything during times of depression, and I didn’t like being around people. I felt best curled up in bed under a blanket that covered all of me except my nostrils.
After my first attack, I did considerable research into the causes and treatment of my malady. During the last 40 years we have heard about the chemical imbalance theory of depression, but are still unsure what this means. And although we have made modest progress in coming up with new treatments, we still rely on medications that have been with us for at least several decades.
For decades I was convinced that my depressions were purely chemical. They came on fast, incapacitated me, and left abruptly.
It seems odd to me now, but for most of my life I have been incurious about the psychological factors that could be contributing to my illness.
My last depression was the most intense and at eleven months the longest. On many days I spent as much time as I could under the bedroom covers. Every day for several months, I kept myself away from the kitchen knives because I knew I could avail myself of them the next day. Suicide deferred one day at a time.
Since recovering from this bout nine years ago, I have finally looked at the psychological aspects of my depression. These begin with such an analytically dominant approach to life and relationships that my emotions have been stunted. It was very odd to realize after my 60th birthday that for so many years I had thought about feelings, read about them, studied them in others, and confused all this with actually feeling them.
During the next several years, I changed. It was not a matter of a single transforming event but an evolution over time marked with small bursts of insight and “ah hah” moments. It did not happen fast.
A friend once diagnosed me with the disorder of over-analyticity. I discovered that underneath this lay shame, not so much from my childhood but rather from my actions in early adulthood. Over the years, I adopted a common defense against shame — emotional numbness. I knew virtues like compassion, forgiveness, and acceptance were desirable, and as a minister and counselor I spread the word. But I did not experience them.
It was not until I passed 60 that I fully realized something was wrong with me. When challenged to feel an emotion or account for my behavior, I fought, froze, or fled.
My subsequent evolution has flowed from three motivations.
First, my wife was unhappy with me and encouraged me to be more.
Second, I was unhappy with myself; I felt false.
Third, I sensed strongly that without change, my next episode of depression would drag me under for good.
In the midst of my last depression and before my recent “journey,” I changed psychiatrists. The woman I was seeing was unsure what to try next. I found a new doctor, a bio-psychiatrist, who was an expert in treating recurrent, treatment-resistant depression.
After I told the new physician my story, she nodded and said, “We will make you better.” And we did. But this was only the chemical part.
I am not the only person who has noticed my evolution. My wife has also noticed, and today we have a good marriage. Friends remark on the change, as have several casual acquaintances.
It’s nothing exotic or original. I have found vulnerability, non-judgmentalism, and humility, which have opened the door to emotions like sadness, contentedness, and compassion.
How people change varies from person to person. I have spent much of my life thinking that the first step was to acquire knowledge and inspiration; after this I could put the action part into play. This didn’t work. Lots of inspiration, no action.
So I flipped the sequence, instead beginning with action. What did help is practice. This means that to feel compassion for others, I needed to practice it even when I didn’t feel compassionate. I did my best to conjure up compassionate feelings, even when I didn’t even like the person. It sounds pointless, but it worked. After several months at it, I began to feel compassion, sadness, fear, and love.
I let other people know what I was doing and asked for help. I meditated.
This “fake it till you make it” strategy required me to slow down, arrest my habitual analyzing, and allow silence and space for my left brain to come online. It was not a speedy process. However, the explicit pairing of intentionality and action eventually molded a different person, who now feels compassion as a motivation for being and doing.
This seemingly simple process takes advantage of our brain’s capacity to forge fresh neural pathways in a manner that can eventually change personality and character.
This has meant gradually shedding my reflexive analyticity and self-protective aversion to feelings, and an evolution toward authenticity. I don’t know what self-authenticity is. Justice William Douglas once said of pornography that while he couldn’t define it, he knew it when he saw it.
I can’t define authenticity, but do recognize it in action. For me, it is an ability to feel, to claim what I feel, and to behave commensurately. I don’t always do this skillfully or right out of the gate. It can be a messy, confusing, and challenging business. But messy can be good.
So, here I am at age 71, feeling chagrinned that I have been so slow at all this. I don’t know whether I am done with these depressions. But at the same time I don’t feel all used up, and I have hope for the future.
