You are all on notice.

[xiphias]

Too many of my friends are in emotional pain. Now, some emotional pain is because of genuine loss, because people are in bad situations, because of real, external things that cause people to be in pain.

There's not a hell of a lot I can do about that, except be a shoulder to cry on, and to listen, and to express sympathy. And I want to do that for you.

But there are also a lot of people I love who are in emotional pain because of depression, and other internal effects that people carry with them.

I have decided that depression is my enemy. I hate it. I've started to make a good dent on killing it in my own brain, and I am now getting sick and tired of this evil enemy attacking my friends, too.

Depression, you are my enemy. I HATE you, and I hate to see you fucking with my friends. And so, I am YOUR enemy, too.

So, people I love -- when I see Depression attacking you, I'm going to get mad, and I'm going to start pushing you to take care of yourself and to destroy it.

If you are sad and upset because of grief and loss, that's not depression. If you are sad and upset because of loved ones who have died, that's not depression. If you are sad and upset because your life actually does, genuinely, suck, that's not depression.

But if the worm of depression is eating away your mind from inside? That's what I declare war upon.

Now, I don't care HOW you fight it, so long as it works. For some of you, taking B12 vitamins will work, because your brains just aren't producing enough of those B-complex vitamins, but, if you take supplements, your brain will be able to use them to make the seratonin and other neurotransmitters you need. If that works for you, that's fantastic.

Some of you will be able to control your depression through exercise. Your brain will be able to use the endorphins and other chemicals released in exercise to synthesize the chemicals it needs.

For some of you, that won't work. Some of you will need antidepressants. For some of you, selective seratonin reuptake inhibitors will work -- you make enough seratonin, but other parts of your brain that don't really need it are slurping it up before it can do its job. For some of you, those won't work, either. There are several classes of antidepressants. If one doesn't work on you, try another one.

Talk therapy might work for some of you. For others of you, it will do fuck-all. At least, before you're on drugs that help. Once your brain DOES have the chemicals it needs, THEN talk therapy will be useful, because, at that point, your brain will physically have the structures to be CAPABLE of not being depressed. At THAT point, you can start to learn how to not be depressed. But you physically CAN'T learn how to not be depressed when, in your brain, that whole part is just plain missing.

Being depressed isn't your fault. It's a physical disability. It is your brain physically not producing the chemicals that non-depressed brains have. In order to NOT be depressed, those chemicals need to be there, some way or another.

And it is just about impossible to get out of depression on your own. Those chemicals which are lacking? Those are the chemicals which would allow you to do things about getting out of depression -- and they're not there.

I have a wife who pushed me into treatment. And pushed me into different treatments, one after the other, until we found one that worked.

So, that's it. I want these motherf-ckling depressions OUT OF your motherf-cking brains. And I'm going to be yelling at each one of you to DO something about it, and if that thing isn't working, to DO SOMETHING ELSE, until you kill the depression.

Unless you don't want me to -- feel free to tell me NOT to do that. I'm not your parent. There are a couple people on my f-list that I AM in some sense responsible for, and you don't get to opt out of this (temima, I'm looking at you) -- but the rest of you can.

I just hate depression. I hate that it attacks my friends.

Comments

[(Anonymous)]

You haven't mentioned the theory I subscribe to, which is that some people learn self-destructive behaviors and patterns of thinking. Over time, these patterns, or other factors, like abuse or bad life situations, can mess up people's emotional response systems. Looking back on my family situation growing up, I'm not at all surprised at how I am now.

It doesn't help that people who get depressed often don't have people who can act as a support network, because they withdraw, or have personality traits which keep people from liking them. And I don't blame others for this -- I don't like spending time with other people who are discouragingly depressed either.

I'm not sure what to do about my issues. My mood has been ok recently, especially since I've found various ways to keep busy, but I still have very little motivation in life and few friends.

I've tried antidepressants and they don't do much except blunting my emotions. Talk therapy has been an utter waste, but I'm convinced it's because most therapists aren't very good at what they do. I don't understand what's supposed to happen in therapy, but whatever it is, it hasn't happened for me.

If you have any suggestions, I'd love to hear them.

[xiphias.livejournal.com]

The right antidepressant at the right dosage does not blunt emotions. Emotional blunting is a side-effect that means that you're on the wrong drug, or the wrong dosage. It's something that must be mentioned to a clinician -- it means that whatever you're on isn't working.

In general, I think that most people with clinical depression need a combination of three things: drugs, talk therapy, and behavior modification. I believe that the drugs have to come first, and once those are stable, you can go on to the other things.

I think that talk therapy won't work if there is clinical depression in the way, and that that is probably as much of a bar as incompetent therapists. That said, there ARE a lot of incompetent therapists -- but there are also some competent ones. You just have to be willing to go through a lot of ones who AREN'T a match before you find one who is. If after two or three sessions, nothing useful is happening, it's time to find someone else.

Family background fucks people up tons, too. But, personally, I think that long-lasting, chronic depression coming from being fucked up by family can be treated the same way as the sort that I have. I don't KNOW that, of course. But I think that, basically, being fucked up by family physicially breaks your brain, and that it then needs the drugs to survive.

I suppose I could also speculate that fucked-up families are ones where the parents have broken brains themselves, and they go ahead and genetically pass those along to their children, along with the fucked-up-ness itself.

So -- my suggestions are to find a COMPETENT doctor or other clinician -- RN, prescribing physician's assistant, whatever -- who is specifically trained in depression and wants to attack it with every weapon in the arsenal -- talk therapy, behavior modification, drugs, vitamins, exercise, Tibetian chanting, balancing your four humors -- EVERYTHING -- and will keep trying different things until they find what works for you.

To KNOW that this isn't your fault, any more than a clubfoot or color-blindness would be your fault. And to not give up.

[(Anonymous)]

I'm not convinced that it isn't my fault, since I often make bad decisions which make me feel emotionally worse (staying up all night, procrastinating, avoiding social contact, etc). And it doesn't matter whose fault it is if there's still no way of improving the situation.

[xiphias.livejournal.com]

Of course you're not convinced that it isn't your fault.

That is the most evil and pernicious thing that depression does: it convinces you that you did this to yourself. That IT'S not there -- YOU'RE doing it. It is an evil, evil disease, and this is precisely why I hate it so much -- because not only does it destroy you, it convinces you that you did it to yourself. It tells you that it's all your fault -- that you deserve it, that you are doing it, that if only you were a better person, this wouldn't be happening, that this is simply a case of you being lazy, or weak, and that if you were stronger, better, smarter, wiser, or just generally a good person, you wouldn't be doing this.

It's all lies.

It's all lies the depression tells you.

The depression lies to you, and tells you that it's your fault, and it gets inside your brain, and twists things around, and it makes you believe it.

It's not true. It's not at all true. But the depression fucks with you until you believe it anyway.

And that's why it's evil.

Staying up all night? Procrastinating? Avoiding social contact?

Those aren't causes of depression: they're results. They'e symptoms. Those are things the DISEASE does, not you. It just twists your mind around to convince you that it's you, and not it.

And there are ways of improving the situation. But you need help to get better. You can't do it alone, and you don't HAVE to be able to do it alone. Depression will try to tell you that you have to do it alone. It is lying to you. You need help -- friends, a support network, a good, competent doctor or other clinician, and, almost certainly, drugs.

[(Anonymous)]

I don't really like philosphy, so I feel uncomfortable saying this, but I have trouble believing that everyone who procrastinates or is socially isolated has a problem with their brain chemistry which requires drugs. My entire family is bad at getting things done and never did much socially, so I'm not surprised that I picked up the same patterns.

Everyone, depressed or not, should have a support network. The problem is getting one.

Another problem is finding an effective therapist. It's easy to say that if I just took some drugs it would allow therapy to start working, but if nothing is accomplished in a therapy session besides me complaining until time runs out even when I'm having a good day, I don't see what would ever happen.

Can anyone describe what exactly goes on in effective, productive therapy, where they ended up changing for the better? I know the obvious, vague stuff, about exploring your feelings and motivations and coming up with strategies and stuff. I feel like I do that all the time on my own, without any results, while I *didn't* discover anything in therapy and certainly never came up with any strategies. So I'd like to know the *details* of what happened in therapy and how it helped.

[xiphias.livejournal.com]

I'm sorry for not responding to this sooner: I was out all weekend.

I think your first point is right: clinical depression is ONE thing that can result in procrastination and social isolation, but is far from the ONLY thing that could.

Now, MY question, about the REST of your family, is, "are they generally content being loners and taking their time getting things done?" There's nothing wrong with being a loner, there's nothing wrong with being laid-back. If they're content with their lives, if it works with them, then there's no problem.

If it causes pain, then it IS a problem. And it sounds like it causes pain for you. Does it cause pain for the rest of your family, too?

I'd say that, for ME, at least, "productive" therapy is when the therapist and I can set specific, concrete goals for the time between then and our next meeting, things that I can work on, track, and come back and report how it worked out.

For instance, perhaps I could make a goal of "spend two hours working on my resume, and apply to three jobs per day." Or "go to the gym twice a week." Or something like that. Something concrete and measurable, some goal.

If I DON'T make that goal, then we look at WHY, at what happened emotionally or to my energy level, or what, that kept me from doing it. Without throwing blame around, doing our best to NOT have me feel guilty about it, but giving us a chance to look at what happened instead of what we intended to happen, figure out whatever that thing was, and start to come up with ways to work around it.

For me, anyway, useful therapy isn't about "how did I get this way," but rather about "what do I do from here".

Other people have different needs. There are people who have genuine traumas that they need to deal with -- in effect, they're dealing with so much emotional scar tissue that it's getting in the way. There are people who have irrational responses to situations, which they need to work through and understand in order to defeat.

But me, what I need is concrete plans and measuarable goals.

That is merely what works for me -- you may need something different.

But, as you can see, for ME, since I need measurable goals that I can attempt to do and then talk about what made it succeed or fail, I ALSO need drugs to allow me to have the chance to have it work. If I have so much emotional shit going on that I physically cannot get out of bed (I've been going through my LJ and tagging old entries, and I'm reading about how bad stuff used to be), then it's obvious that I cannot learn anything useful about why I didn't get to the gym twice this week -- I didn't get to the gym because I couldn't get out of bed. That's not useful.

So, for ME, I need drugs to get me to the point where I have a chance to do something, then therapy to help figure out things to do, and to discuss and analyze why I was or was not able to do them.