Depressed? I'm not depressed. If I was depressed, where was the “black cloud”, the pain, the inability to get out of bed that I had heard about? Degrees of depression never occurred to me. Life just seemed like a lot of work, visions of swimming through gelatin, my worldview was kind of flat. Surely I could mind–over–matter that.
For a time after my diagnosis, I tried every non-pharmacological treatment for depression I could think of. It didn’t help. I had resisted resorting to prescribed antidepressants because I thought my depression was specifically due to the onset of my Spinocerebellar Ataxia and recent retirement, and consequently, not responsive to pharmacologic treatment. I still slept well (neither too much or too little), hadn't gained or lost weight, maintained a healthy appetite and didn't feel like biting anyone's head off–too often. But, focusing on people who were worse off and how fortunate I was not to be: in pain, terminal, single, financially strapped, friendless, childless, etc....didn't seem to matter.
I also had a bias against antidepressants. I believe they are overused in this culture on people who aren't happy 24-7, rather than being reserved for people experiencing a genuine depression. I think I also had a fear of dependency and that was part of my aversion too. "Oh for Gawd sake," a friend chided, "it's not as if you're on heroin!"
I had breakfast with another friend who was prescribed antidepressants after her heart attack and it helped get her life back in balance (not my kind of balance). She thought I was showing signs of depression and should consider treatment. I had been thinking about it for awhile and her input was another outside perspective. In retrospect, combining antidepressants with counseling might have been more efficient, but my "can do" attitude, usually an asset, became a (uh) handicap. Maybe just one regimen would help me snap out of it. So I told Earl (who had been waiting to hear it from me) that I thought I needed some kind of intervention, thanked my friends, and called my neurologist.
Usually responsive, I didn't hear back from her. Did I really email her or just think I did? I spend so much time in my head, that's a common occurrence. Just as I was about to call, in came her email response. My correspondence had been sent to her spam folder. As she said, "The very last thing I wanted to tell you was that you were being dumped into my junk mail–that seemed like just too apt a metaphor for life for someone struggling with depression.....but I know that your sense of humor remains intact, even if it has been strained lately." So, I looked around for my missing sense of humor, started a course of a selective serotonin re-uptake inhibitor (SSRI) antidepressants and waited.
“Outing” my depression and treatment plan rather than to deny it to family and friends helped. Even though they may have wanted to, no one said, "Well, duh!" Just as situational depression can be subtle and the onset gradual, so is the treatment effect. I had been warned that response can take time and that an SSRI isn’t an amphetamine. But, I wanted to be better instantly and eagerly watched for any sign of improvement. I was like a pot of water on the stove. Jeez, I wasn’t used to being emotional and it was so ...depressing! Before the Ataxia, I didn't like being "handled". Now, people thought I was fragile and treated me accordingly. I probably was, but that really pissed me off.
So, am I better after a treatment course of SSRIs? After a while, life seemed less like work, more like a manageable effort. I aimed for a balance of my cheerful and cranky sides. I didn't have visions of swimming in gelatin anymore. A mobility scooter helped me enlarge a world that was progressively getting smaller. Those were my major benchmarks, so I began the tapering process off antidepressants rather than just abruptly stopping treatment. But, my Ataxia will always be evident and progressive, so it's not likely that I will ever need to plan a celebration party. The occasional private "Pity Party" is more likely (previous post). My good days are more frequent than my bad days. Yeah, I'd say better–not great, but better.
The lesson: Even situational depression is not a "snap out of it" thing.