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If you've known me for a while -- not even THAT long a while -- you've certainly heard me talk about this stuff before. But I'm putting some of it together here, in case it's useful to anybody to see it all in one place.
First: I think of depression as an external disease that comes in and attacks me. That's not the only way you can think of it. You can, realistically, think of depression as a thing that you are doing to yourself, or that it's just part of who you are. Philosophically, it can all come down to your definition of what the "self" is, and what "you" are. I mean, we are a combination of the physical expression of our genetics, plus the accumulation of our experiences, and my genetics plus experiences have left me with depression. So I COULD say that "that's just who I am", and that wouldn't be completely unrealistic.
It would, however, be completely unhelpful. Because it's ALSO realistic to make a distinction between "me" and "my disease". Depression is a disease in the same way that, say, fibromyalgia is. It's NOT just a different way of approaching the world, the way, say, Asperger's is. People have historically tried to romanticize depression, by trying to tie to to things like "an artistic temperament" or things like that. By saying that it has benefits like making people more poetic or introspective, or whatever.
I suppose people can learn things by going through horrible experiences. But that doesn't make going through horrible experiences a good thing. Victor Frankl and Elie Weisel both did wonderful, useful work based on their experiences in being in Auschwitz. But I would hope that nobody would argue in favor of the stark romantic beauty of Auschwitz because of that.
So it's far more USEFUL to think of depression as external to me. There's "me", my real, true, best self, and there's "depression", which is a force which blocks my full expression of my best self. My true best self excludes the depression.
I could choose to define myself to INCLUDE the depression, and state that, well, that's just who I am. But that would mean that I'm defining myself as a person who has no capacity to feel positive emotions and has no capacity to do useful work in the world. I CAN do that -- it IS congruent with reality -- but that's not who I want to be.
So I define "the depression" as separate from "me". That's ALSO congruent with reality. And THAT model opens up the door to the possibility that I can experience true "eudaimonia", the Greek philosophy term for a full, happy life.
Because depression directly removes your ability to experience important chunks of eudaimonia. You can't manage to do useful work that helps your family and your community, and you can't experience pleasure, and, while those aren't ALL of the parts of eudaimonia, they're certainly a really big chunk of it.
So, if I say that the depression is just who I am, I'm just a depressed person, then I've given up on any chance of getting what's good in life, and BEING what's good in life. But if I say that the depression is what's ATTACKING me, then I'm saying that I DO have a chance to have a good life -- and the depression is a hostile force that's keeping that away from me.
A second thing I've learned: there are a lot of different kinds of depression. You've got situational depression, where you're depressed because your life actually genuinely sucks. You've got depression which comes from your thought patterns. You've got depression that happens as a symptom of a more general, systemic disease, like thyroid problems, or fibromyalgia, or things like that. You've got depression that is a result of a more brain-specific disease, like bipolar or "traditional" clinical depression.
And you can very well have more than one at once. If you can't live the kind of life you deserve to because of, say, fibromyalgia, you could have depression directly from that, AND because your situation genuinely sucks, AND because you've started to believe that you somehow DESERVE this, so your thought processes have gotten messed up.
And it works in other directions, too. You could have brain-based biochemical depression, which means that you've been unable to take care of yourself as well as you deserve, so your external situation has deteriorated, and you've come to believe that you deserve that situation. Or the ongoing stress of a sucky external situation could have caused physical changes in your brain.
Honestly, it's not that a person MIGHT have more than one depression at once -- it's more that a person PROBABLY DOES have more than one depression at once.
Which is one reason why it's such a good idea to approach treatment with a multi-pronged holistic approach, looking it medicine, and cognitive behavioral therapy including meditation, and exercise in case it's metabolism-related, and taking care to go to nice places and spending time in nature in case it's related to your experience of the external world. And so forth, all sorts of things that are different for each person. Not all these things will help with all depressions, but the more of them you have the capacity to try, the more likely you are to hit the combination of things that are useful. That said, depression ALSO saps your ability to DO most of these things, so you're more likely going to have to pick and choose. Exercise OR spend a lot of time practicing mindfulness. Spend time in nature OR be extra-careful with diet... depression fights back and will try to adapt away from your treatment. And when -- WHEN, not IF -- you're not able to do all the things that might possibly help fight the depression, you have to be gentle with yourself and accept that that's simply the way it is. The depression will attempt to attack your self-image, and try to make you feel lesser for not being able to simultaneously attack it on every single possible front. Even though it's rationally obvious that you CAN'T do everything all at once, and that you'd never look down on someone ELSE for not doing everything all at once, the depression will try to make you feel small for not doing so yourself.
A third point I'd like to make is about side effects. To a certain extent, many times, side effects are a result of too high a dosage. If you're on the right medication (and it has to be admitted that it's possible that the absolutely best medicine for you may not even exist yet -- perhaps the perfect match for you is one that is still being developed; that's why medical researchers are still working on developing new variations), then the first chunk of medication will go to relieving your symptoms. But too much will go on to do other things.
As an analogy -- let's say that you've got a big piece of flat ground, which is you. And there's a pit dug in it, which is the depression. And you want to fill that pit up with water until it's level with the rest of the ground, which will act as a sort of plug to relieve the depression. (I don't know why filling the pit with water counts as a cure -- this is just an analogy that came into my head, okay?)
If you don't have enough water, then you've made the pit shallower, but you haven't completely filled the hole. So more water -- more medication -- would have additional benefit. But if you have TOO MUCH water, it spills all over the place, and that water soaking the rest of the flat ground is the side effects.
If you've got the right medication, you're trying to just fill the hole as closely as possible without spilling over.
Kind of like blackjack -- get as close to 21 as you can without going over.
Now, if it's not the perfect med for you, then you may get side effects even before the hole is filled, or it might only be able to make the hole shallower but not completely go away, or whatever. You might be getting enough benefit that it's worth doing, but still have negative things.
For me, I've found what I think is an extremely good med for me, but my doctor and I make incredibly tiny tweaks. We find trackable differences when we make changes as small as 1%. I take 425 mg of lamactil three days a week, and 450 mg four days a week. That's an increase from when I took 425 four days a week and 450 three days a week. We increased by 25 mg a WEEK, and it made a difference. 3050 mg per week to 3075 a week -- about a 1% increase.
So: those are my personal opinions about fighting depression.
1. Think of it as an external hostile force that is attacking you. Believe that you are being unfairly and unjustly attacked by an insidious and evil foe. Get ANGRY at it. Energy is hard to come by when you're depressed, but anger -- righteous, just, honest, and fair anger -- may be one of the forms you can scrape up in order to try to get things started.
Understand that none of this is your fault. Rather, this is all the fault of the external power which is oppressing you. Understand that it's sneaky, and evil, and tenacious, and clever. Understand that this is not going to be an easy fight, because it's a real nasty foe. Understand that you're going to lose battles now and then, because depression is going to find your weak spots and hammer them. Understand that one of its favorite weapons is to try to confuse you about what IT is and what YOU are. It will mess you up, then try to convince you that it's YOUR fault. It's really good at that; be on the lookout for it, and be ready to fight back.
And, yes, it will sneak through sometimes and hit you anyway -- at which point it will try to follow up by convincing you that, because it managed to hit you, you are a failure and should just give up ... just understand that the sucker is slippery and mean and you will usually have been under attack for DAYS before you even realize that an attack is underway.
2. Take as many avenues toward fighting it as you can at once. That includes,
Not all those things are going to be useful for all depressions; not all those things are going to be POSSIBLE for all people. But the more of them one can manage, the more likely you are to hit the combination of things that is useful for your specific situation. Because you may well have more than one depression at once.
3. Medication is a really useful weapon to have in your arsenal. The voice in your head that's trying to convince you that using medication is scary, or it will change who you are, or it's a failure if you have to use it for the rest of your life? That's the depression, trying to prevent you from using an effective weapon against it. (It does that for all your weapons -- "exercise is too hard. Nutrition isn't going to help anyway. You don't want to be a downer and bring your friends down with you. You don't deserve to have a pleasurable experience, and you wouldn't enjoy it anyway.")
There are lots of meds out there. All of them will have SOME degree of effectiveness. EVERYTHING has some degree of effectiveness. Heck, CRYSTAL HEALING will give slight symptomatic relief for a week or two. The placebo effect is very strong with initial response to depression, but it doesn't last long. So track your medications carefully, and make sure that they have a genuine, ongoing benefit. Consider checking a "depression inventory checklist" weekly to get an actual record of how you feel. The "PHQ-9" is short, free, public domain, and about as good as any other one, so use that one. Because one of the things that depression does is mess with your memory of how you USED to feel, it's going to be very difficult to track whether you're getting better or not, unless you take snapshots at regular intervals.
If the benefit goes away after two weeks or so, switch treatments. There are lots of meds out there; some of them will work better than others.
Now, this next one, a lot of people will disagree with me. So, think about it, and if you decide I'm completely off of my gourd, that's fine. But here's what I think:
When you find a med that works, slowly built up the dose until you either are making no more improvements, or until you start having side effects. If you have side effects, back down the dosage a little, until the side effects subside. But stay at the maximum dosage you tolerate comfortably.
This is a deeply weird and uncomfortable idea for most people, and if it doesn't work for you, that's fine. We all want to be "better". We want to be "healthy", by which we mean that our body maintains itself, BY itself, as well as it possibly can. If we rely on medication, we want to minimize that reliance.
And, for that matter, we're very aware that a whole lot of the American medical system is profit-driven, and that pharmaceutical companies are always pushing us to take drugs we probably don't need.
So this idea of use the MOST medicine you can instead of the LEAST goes completely against our instincts for at least two reasons: one, it sounds like we're buying directly into a line of patter being fed us by people who are more interested in their bottom lines than our well-being, and two and perhaps even more importantly, because we think of "more medicine" = "more sick", and "less medicine" = "less sick". And we want to be less sick, so we want to use less medicine.
So, if you come to an opposite conclusion than I did, I'm comfortable with that. Still, I ask you to at least roll the idea around in your mind for a bit.
First: I think of depression as an external disease that comes in and attacks me. That's not the only way you can think of it. You can, realistically, think of depression as a thing that you are doing to yourself, or that it's just part of who you are. Philosophically, it can all come down to your definition of what the "self" is, and what "you" are. I mean, we are a combination of the physical expression of our genetics, plus the accumulation of our experiences, and my genetics plus experiences have left me with depression. So I COULD say that "that's just who I am", and that wouldn't be completely unrealistic.
It would, however, be completely unhelpful. Because it's ALSO realistic to make a distinction between "me" and "my disease". Depression is a disease in the same way that, say, fibromyalgia is. It's NOT just a different way of approaching the world, the way, say, Asperger's is. People have historically tried to romanticize depression, by trying to tie to to things like "an artistic temperament" or things like that. By saying that it has benefits like making people more poetic or introspective, or whatever.
I suppose people can learn things by going through horrible experiences. But that doesn't make going through horrible experiences a good thing. Victor Frankl and Elie Weisel both did wonderful, useful work based on their experiences in being in Auschwitz. But I would hope that nobody would argue in favor of the stark romantic beauty of Auschwitz because of that.
So it's far more USEFUL to think of depression as external to me. There's "me", my real, true, best self, and there's "depression", which is a force which blocks my full expression of my best self. My true best self excludes the depression.
I could choose to define myself to INCLUDE the depression, and state that, well, that's just who I am. But that would mean that I'm defining myself as a person who has no capacity to feel positive emotions and has no capacity to do useful work in the world. I CAN do that -- it IS congruent with reality -- but that's not who I want to be.
So I define "the depression" as separate from "me". That's ALSO congruent with reality. And THAT model opens up the door to the possibility that I can experience true "eudaimonia", the Greek philosophy term for a full, happy life.
Because depression directly removes your ability to experience important chunks of eudaimonia. You can't manage to do useful work that helps your family and your community, and you can't experience pleasure, and, while those aren't ALL of the parts of eudaimonia, they're certainly a really big chunk of it.
So, if I say that the depression is just who I am, I'm just a depressed person, then I've given up on any chance of getting what's good in life, and BEING what's good in life. But if I say that the depression is what's ATTACKING me, then I'm saying that I DO have a chance to have a good life -- and the depression is a hostile force that's keeping that away from me.
A second thing I've learned: there are a lot of different kinds of depression. You've got situational depression, where you're depressed because your life actually genuinely sucks. You've got depression which comes from your thought patterns. You've got depression that happens as a symptom of a more general, systemic disease, like thyroid problems, or fibromyalgia, or things like that. You've got depression that is a result of a more brain-specific disease, like bipolar or "traditional" clinical depression.
And you can very well have more than one at once. If you can't live the kind of life you deserve to because of, say, fibromyalgia, you could have depression directly from that, AND because your situation genuinely sucks, AND because you've started to believe that you somehow DESERVE this, so your thought processes have gotten messed up.
And it works in other directions, too. You could have brain-based biochemical depression, which means that you've been unable to take care of yourself as well as you deserve, so your external situation has deteriorated, and you've come to believe that you deserve that situation. Or the ongoing stress of a sucky external situation could have caused physical changes in your brain.
Honestly, it's not that a person MIGHT have more than one depression at once -- it's more that a person PROBABLY DOES have more than one depression at once.
Which is one reason why it's such a good idea to approach treatment with a multi-pronged holistic approach, looking it medicine, and cognitive behavioral therapy including meditation, and exercise in case it's metabolism-related, and taking care to go to nice places and spending time in nature in case it's related to your experience of the external world. And so forth, all sorts of things that are different for each person. Not all these things will help with all depressions, but the more of them you have the capacity to try, the more likely you are to hit the combination of things that are useful. That said, depression ALSO saps your ability to DO most of these things, so you're more likely going to have to pick and choose. Exercise OR spend a lot of time practicing mindfulness. Spend time in nature OR be extra-careful with diet... depression fights back and will try to adapt away from your treatment. And when -- WHEN, not IF -- you're not able to do all the things that might possibly help fight the depression, you have to be gentle with yourself and accept that that's simply the way it is. The depression will attempt to attack your self-image, and try to make you feel lesser for not being able to simultaneously attack it on every single possible front. Even though it's rationally obvious that you CAN'T do everything all at once, and that you'd never look down on someone ELSE for not doing everything all at once, the depression will try to make you feel small for not doing so yourself.
A third point I'd like to make is about side effects. To a certain extent, many times, side effects are a result of too high a dosage. If you're on the right medication (and it has to be admitted that it's possible that the absolutely best medicine for you may not even exist yet -- perhaps the perfect match for you is one that is still being developed; that's why medical researchers are still working on developing new variations), then the first chunk of medication will go to relieving your symptoms. But too much will go on to do other things.
As an analogy -- let's say that you've got a big piece of flat ground, which is you. And there's a pit dug in it, which is the depression. And you want to fill that pit up with water until it's level with the rest of the ground, which will act as a sort of plug to relieve the depression. (I don't know why filling the pit with water counts as a cure -- this is just an analogy that came into my head, okay?)
If you don't have enough water, then you've made the pit shallower, but you haven't completely filled the hole. So more water -- more medication -- would have additional benefit. But if you have TOO MUCH water, it spills all over the place, and that water soaking the rest of the flat ground is the side effects.
If you've got the right medication, you're trying to just fill the hole as closely as possible without spilling over.
Kind of like blackjack -- get as close to 21 as you can without going over.
Now, if it's not the perfect med for you, then you may get side effects even before the hole is filled, or it might only be able to make the hole shallower but not completely go away, or whatever. You might be getting enough benefit that it's worth doing, but still have negative things.
For me, I've found what I think is an extremely good med for me, but my doctor and I make incredibly tiny tweaks. We find trackable differences when we make changes as small as 1%. I take 425 mg of lamactil three days a week, and 450 mg four days a week. That's an increase from when I took 425 four days a week and 450 three days a week. We increased by 25 mg a WEEK, and it made a difference. 3050 mg per week to 3075 a week -- about a 1% increase.
So: those are my personal opinions about fighting depression.
1. Think of it as an external hostile force that is attacking you. Believe that you are being unfairly and unjustly attacked by an insidious and evil foe. Get ANGRY at it. Energy is hard to come by when you're depressed, but anger -- righteous, just, honest, and fair anger -- may be one of the forms you can scrape up in order to try to get things started.
Understand that none of this is your fault. Rather, this is all the fault of the external power which is oppressing you. Understand that it's sneaky, and evil, and tenacious, and clever. Understand that this is not going to be an easy fight, because it's a real nasty foe. Understand that you're going to lose battles now and then, because depression is going to find your weak spots and hammer them. Understand that one of its favorite weapons is to try to confuse you about what IT is and what YOU are. It will mess you up, then try to convince you that it's YOUR fault. It's really good at that; be on the lookout for it, and be ready to fight back.
And, yes, it will sneak through sometimes and hit you anyway -- at which point it will try to follow up by convincing you that, because it managed to hit you, you are a failure and should just give up ... just understand that the sucker is slippery and mean and you will usually have been under attack for DAYS before you even realize that an attack is underway.
2. Take as many avenues toward fighting it as you can at once. That includes,
- cognitive behavioral therapy, dialectical behavioral therapy, mindfulness, meditation, and/or prayer
- exercise
- nutrition
- talk therapy
- maintaining social contact with friends and family
- finding spots of beauty and pleasure to experience
- medication
Not all those things are going to be useful for all depressions; not all those things are going to be POSSIBLE for all people. But the more of them one can manage, the more likely you are to hit the combination of things that is useful for your specific situation. Because you may well have more than one depression at once.
3. Medication is a really useful weapon to have in your arsenal. The voice in your head that's trying to convince you that using medication is scary, or it will change who you are, or it's a failure if you have to use it for the rest of your life? That's the depression, trying to prevent you from using an effective weapon against it. (It does that for all your weapons -- "exercise is too hard. Nutrition isn't going to help anyway. You don't want to be a downer and bring your friends down with you. You don't deserve to have a pleasurable experience, and you wouldn't enjoy it anyway.")
There are lots of meds out there. All of them will have SOME degree of effectiveness. EVERYTHING has some degree of effectiveness. Heck, CRYSTAL HEALING will give slight symptomatic relief for a week or two. The placebo effect is very strong with initial response to depression, but it doesn't last long. So track your medications carefully, and make sure that they have a genuine, ongoing benefit. Consider checking a "depression inventory checklist" weekly to get an actual record of how you feel. The "PHQ-9" is short, free, public domain, and about as good as any other one, so use that one. Because one of the things that depression does is mess with your memory of how you USED to feel, it's going to be very difficult to track whether you're getting better or not, unless you take snapshots at regular intervals.
If the benefit goes away after two weeks or so, switch treatments. There are lots of meds out there; some of them will work better than others.
Now, this next one, a lot of people will disagree with me. So, think about it, and if you decide I'm completely off of my gourd, that's fine. But here's what I think:
When you find a med that works, slowly built up the dose until you either are making no more improvements, or until you start having side effects. If you have side effects, back down the dosage a little, until the side effects subside. But stay at the maximum dosage you tolerate comfortably.
This is a deeply weird and uncomfortable idea for most people, and if it doesn't work for you, that's fine. We all want to be "better". We want to be "healthy", by which we mean that our body maintains itself, BY itself, as well as it possibly can. If we rely on medication, we want to minimize that reliance.
And, for that matter, we're very aware that a whole lot of the American medical system is profit-driven, and that pharmaceutical companies are always pushing us to take drugs we probably don't need.
So this idea of use the MOST medicine you can instead of the LEAST goes completely against our instincts for at least two reasons: one, it sounds like we're buying directly into a line of patter being fed us by people who are more interested in their bottom lines than our well-being, and two and perhaps even more importantly, because we think of "more medicine" = "more sick", and "less medicine" = "less sick". And we want to be less sick, so we want to use less medicine.
So, if you come to an opposite conclusion than I did, I'm comfortable with that. Still, I ask you to at least roll the idea around in your mind for a bit.