Choose Your Insanity, Part I

Untreated or Under-Treated Depression

Image may contain: house, sky, tree, outdoor and natureOver the past 19 years I have learned the consequences of untreated and under-treated depression. And, I have picked up a thing or two about the side-effects of antidepressants. Either can drive you mad.

The first sign that my 30 years of occasional melancholia was turning into clinical depression was in the summer of 1999. It started with what the doctor called, “cluster-headaches.” It was painful and came in cycles of repeated headaches followed by periods without them. The doctor prescribed sunglasses. (He probably gave me a medication, but the sunglasses are all I remember). It may be a cool look to wear shades, but imagine me in church on a Sunday morning leading worship and preaching with sunglasses on. Believe me, it makes eye-contact pointless when the congregation cannot see your eyes.

The second sign began in the fall of the same year. After multiple trips to the hospital and the doctor, it was determined I had Irritable Bowel Syndrome (IBS). The pain was severe and disabling. Nothing I was prescribed helped. I was asked to join a trial study for a medication that reportedly “was the best thing since toilet paper.” Because of some bleeding, I had to have a colonoscopy. Every medical person who was part of the trial study was interested. My procedure became the main attraction of the day with a regular stream of doctors and nurses coming in and out for a look. Hey, bottoms up! After no noticeable change, I was referred to yet another specialist who prescribed a medication that finally worked. But, with the pain gone, the true culprit appeared with a vengeance – depression.

A moderate to severe depressive disorder can have serious effects on your physical and mental health. Besides headaches and digestive issues, depression is often accompanied by back pain, stomachaches, chest pain, achy legs and arms, sleep problems (insomnia or hyposomnia), and weight gain or loss. It can make it harder to get over the flu or other seasonal illnesses, too. Studies have shown that people recovering from a stroke or heart attack and have comorbid depression are at double the risk of death than a person without depression. One study concluded that an “episode of clinical depression is as dangerous as smoking in causing heart disease and heart attacks.”

Depression also affects your brain. Sluggish thinking, difficulty concentrating, trouble remembering, problems making both minor and major decisions, and difficulty focusing are common. Recent studies have determined that untreated or under-treated depression can cause the brain to shrink. In most cases the brain will recover, but it can become permanent if the depression is left untreated over a long period of time. Magnetic resonance imaging (MRI) scanning has shown that depression is related to abnormalities in the memory center, conflict-resolution area, and the planning and executing parts of the brain.

My under-treated depression was partly my fault. I was inconsistent about going to a psychiatrist or a mental health counselor. After a while, I thought I could forego the travel and hassle of seeing a psychiatrist and let my family doctor prescribe my medications. One general practitioner gave me prescriptions covering a whole year. One annual appointment was really convenient for me, but not healthy.

Finding a counselor with whom I could stay engaged was difficult. On the second visit to the first therapist I tried, she told me that maybe God was finished with me. After my next visit, I was finished with her. Other times I used the miles I had to travel or the money I had to spend as an excuse. You see, I had yet to lose confidence in my ability to handle my own depression. It was not until after four hospitalizations and losing nearly everything in my life that I held dear, that I decided it was time to see a psychiatrist and go to counseling consistently. During that time, I had frequent, long and persistent episodes of suicidal ideations. The first lasted four and one-half years, the second and third one year each, and the fourth two years.

Untreated or under-treated depression carries a high risk of suicide. Thoughts can grow worse with time. My last round of suicidal ideations was so severe that it took every ounce of will I had to not jump in the swift river I walked beside or run and step in front of the train whose whistle I heard. Feelings of hopelessness, worthlessness, and visions of an aimless future gripped my soul. At one point, only the thought of spending an eternity in hell prevented me from completing suicide to escape the pain. Suicidal ideations can also express themselves in reckless behavior, risky situations, and dangerous circumstances.

Relationships can be damaged beyond repair. Family and friends can feel ostracized by your changed mood and behavior. Irritability, isolation, anger, lashing out at loved ones, and a disinterest in most things including sex do not make for healthy relationships. During my under-treated depression, my marriage ended and I became estranged from my children and grandchildren. God seemed far away.

Careers can become a casualty of moderate to severe depression. Accumulating sick days, unproductive efforts, lack of energy, and diminished concentration is not a recipe for a good employee. Both of my careers – pastoral ministry and counseling – were lost and are now unrecoverable. Students can lose interest in or find it difficult to study. Class attendance can be sporadic and assignments are late if they get turned in at all. Aimlessly sitting around thinking about your symptoms, sadness, and misery can interfere with decision-making and make matters worse.

Substance and/or alcohol abuse, addiction, and self-injurious behaviors are possible.

Yes, untreated or under-treated depression can put you into a sad and worsening state of affairs. Psychotic breaks from reality, catatonic features, catalepsy, posturing, echolalia or echopraxia, anorexia, obesity, and leaden paralysis are possible.

Is there any hope? There is always hope. Proper treatment can go a long way toward restoring a new normal. However, that “new normal” can come with its own challenges and its own brand of insanity.

Come back next week for a look at the common side-effects of anti-depressant medications and the issues they cause.

NOT A CHANCE!

Image result for no chanceWithin the past couple of weeks someone asked if one could function normally and have severe depression. I responded with an emphatic “No!” There is no way one can go about his/her day without “a change from previous functioning” if they have a major depressive disorder. Even a person with dysthymia or a mild-to-moderate depressive disorder will have some impairment. However, severe depression is in a different league all together. In no way am I trying to minimize depression in whatever form it may take, but by definition severe depression severely interrupts one’s routine. According to the Diagnostic Criteria from the DSM, severe depression is marked by “several symptoms in excess of those required to make the diagnosis, and symptoms markedly interfere with occupational functioning or with usual social activities or relationships with others.” In order to meet the criteria of a major depression diagnosis, one must have at least five of the nine symptoms for a minimum of two weeks and have a change from previous functioning. Severe depression requires eight or all nine symptoms to be present. A depressive disorder is not to be equated with sadness, grief, or a “terrible, horrible, no good, very bad day.”

Four years ago this month I wrote the following attempt at a poem.

Ode to Despair

What can you say when there are no words to express                                    The pain, the sadness, and the foreboding hopelessness.                  Statements, remarks, and speeches reverberate like a round                       That goes on and on without end in meaningless sound.

“Due despair and agony on me, deep dark depression,                          Excessive misery,” is an all too common sad expression                                  For the weary and worn who go through life damaged,                           Hidden, misunderstood, in anguish, wounds un-bandaged.

“Who can deliver me from this body of death?” I shout,                                   But only an echo returns with scorns and mocks all about.                        “There is no help for him in God,” I hear as trouble multiplies,              Gloomy and cheerless, I want not to live and am afraid to die.

“It is enough! Now LORD, take my life,” I earnestly pray.                             “What are you doing here?” the LORD whispers in the fray.               “Forsaken, torn down, killed all the day through,” I reply.                              GOD listens with compassion HIS grace ready to supply.

Strong winds tear at mountains and break rocks into slivers.         Earthquakes alter the contour of the land and courses of rivers.                   Fire purges the grass from the field and fells the trees.                                    But, the LORD passes by gently and speaks to my needs.

As you can infer, I was severely depressed. As a Christian I could not end the poem in absolute despair, so I included a stanza of hope. To be truthful, it was not how I felt at the time. Death, I thought, would be a relief.

I had all the symptoms – depressed mood, diminished interest in activities, weight gain, hypersomnia, psychomotor agitation, fatigue, diminished ability to concentrate, and recurrent thoughts of death with suicidal ideations – of a major depressive disorder. To put it succinctly, I was a mess. Depression had been hounding me for a year as I spiraled downward into a bottomless free-fall. And, for the next eighteen months I trudged through a morass of thick, endless darkness with no hope of escape. Normal functioning? That was an unknown cloud in cuckoo-land. Severe depression destroyed everything I spent my life building and it very nearly destroyed me, too.

Thank the good LORD I have been in partial remission for over two years. Although I have accepted the fact that I will never be “normal” again, I find that life is well worth living. I have hope, fulfillment, happiness, and contentment. If you can function normally, thank God, address whatever is troubling you, and march on toward health and wholeness. On the other hand, if you are falling and cannot seem to right yourself, there is hope. Reach out to a professional who will help you begin to heal.

The peace, mercy, and grace of our LORD be with you. Amen!

*image from 123RF.com