David's Inferno (25 page)

Just askin'.

The real problem is that there's no quantifiable way to measure depression. Which makes life kind of difficult for traditional data-driven researchers. A psychiatrist can make his own before-and-after observations. And he can ask you the same questions before and after you start or stop a medication. Scientists are also beginning to be able to measure the amount of certain chemicals in your brain that may indicate neurotransmitter level and functioning.

It's just not the same as with other drugs.

We know what will
probably
happen if we take an aspirin, smoke tobacco or marijuana, have a glass of wine, or a cup of double espresso. However, we don't know with anywhere near 100% certainty whether a specific prescription mind med will alleviate our symptoms; fix what ails us; have significant side effects (including death); or work for a day, month, year, or lifetime. There's an overload of facts, figures, and anecdotal evidence out there.

You can measure whether a blood pressure medication is lowering your blood pressure. You can measure whether a cholesterol medication is lowering your cholesterol levels. You can even measure whether a cancer treatment is reducing a tumor or the number of cancer cells in your blood.

Even with other immeasurable or “subjective” medications there are at least some reasonably reliable indicators. Inhalers do or don't help you breathe better. Sleep medications either put you to sleep or they don't. Pain medications either relieve the pain or they don't. There may be questions about the placebo effect even with these drugs. But, tell that to anyone who's gasping for breath until they take a shot of their inhaler.

Whatever you decide to do, it is really helpful to have one or more professionals go along for the ride. Maybe if your depression is situational, your psychological immune system can manage to remain intact—the exposed inner “skin” slowly scarring over while your neurons and/or esoteric energetic patterns find other ways to get the job done. As your life improves or at least evens out over time, your moods may improve or even out accordingly.

In cases of clinical mental illness, however, the neural patterns are usually so out of kilter that changes in external circumstances have minimal effect. That's when it's probably time to call a professional.

By professional, I mean anyone who has a lot of experience working closely with people suffering from big-time depression or mania. It could be a psychiatrist, psychologist, chiropractor, homeopath … even a psychic or priest. Or any combination of the above. As long as they are open to discussing any possible treatment you're curious about without making you feel like an idiot; as long as they answer your phone calls when you're desperate, or at least call you the next morning; and as long as you feel that they are truly committed to your healing … partners, I daresay, in the process.

Fortunately, everyone's become a little more open-minded. Nobody ever told me that prescription meds were the devil's work. A few people suggested that natural remedies were better, but even my most rabid vegan, natural-remedy-adherent therapists and friends acknowledged that sometimes medications might be necessary … at least temporarily. By the same token, no conventional medical professional ever gave me a hard time about having some needles stuck in me from time to time.

Still, it can feel weird to tell your psychiatrist that you're also taking mega B vitamins, SAM-e, tryptophan, and doing full-spectrum light therapy. It can make you squirm to tell your homeopath that you've decided to go back on your meds, just when
she or he is convinced they finally figured out the right remedy for you.

I'm a big fan of putting your cards on the table. Their opinions and prejudices aren't your problem. By the same token, they don't have to agree with what you're doing. They just need to do their best to understand where you're coming from and explain the potential risks and rewards as best they can. And you owe it to them to provide as much information as you can before they prescribe anything, natural or otherwise.

I don't know, for example, if combining acupuncture, herbs, deep tissue massage, and prescription drugs helped trigger my breakdown. For all I know, the combination kept it from being more severe. I have no regrets. But I know that, at times, by not coming clean, I missed an opportunity to work more openly and closely with my psychiatrist, in a way that might have been helpful to both of us.

The important point is that most professionals—conventional or alternative—don't have a whole lot of experience in how
other
therapies might interact with theirs. An herb or pressure point over here is likely to affect a gland or neurotransmitter over there. And vice versa. Same is true for massage, meditation, prayer, illegal drugs, and SSRIs. We're still in uncharted waters here … and it's best if we admit it.

Bottom line: It's a miracle that any one treatment can help more than one person. We're dealing with more synapses in our brains than we can imagine. Our thoughts, feelings, words, actions, and biology emerge from our distinctly individual history, physiology, genetics, environment, culture, race, color, and creed, as well as our astrological sign, karma, past lives, energetic body, and a host of other factors that aren't quite so apparent to the naked eye. (You may not believe in those last few. That's fine. I think that means you're an empiricist.)

That's why so many different people are convinced there are so many different “best” ways to treat major depression.

Some people insist natural remedies are better. Others say only pharmaceuticals have been proven effective.

Some people think alternative treatments are weird. Others think that electrical stimulation of deep areas in your brain is weird.

Some people think you'll get fired if your boss finds out. Others figure your boss will get sued if she or he fires you.

Some people think seeing a psychiatrist is a sign of weakness. Others think it takes courage.

Some people think medications are too expensive. Others think it's worth begging and borrowing if you have to.

And, just when you think you've found a treatment that works, winter comes … there's less sun … so you start producing less vitamin D which somehow affects your serotonin levels. So maybe you take a vitamin D supplement and feel a little better. And then you have a massage and feel a lot better. And then you wake up with your mind racing down roads that are best left untaken, so you roll over and take a .5 mg tablet of Klonopin and doze off for an hour, but when you wake up an hour later you're still agitated, so you do an intense workout to calm down. Which leads, after breakfast, to a surprisingly pleasant early-morning nap, only to wake up wired again, so you take a little calcium-magnesium and call your psychiatrist who suggests that instead of taking 60 mg of Cymbalta every day, you do 60 mg one day and 30 mg the next.

And then, just when you think you've got things in balance again, you get fired or divorced or start to have unrelated angina, or break a leg so you can't work out, which confuses your neurotransmitter systems in a whole different way.

That fictional scenario might make you question the possibility of
ever
stringing together more than a few blessed moments of sanity. But, lest I scare anybody who is currently on a similar roller coaster, I've been good—really good—for
years
with only a very few very brief relapses.

There are countless treatments for this disease, many of which I have had the pleasure of experiencing. I'm as tempted as the next
“expert” to offer an opinion on what someone is doing or taking. But, I know that what helped me could have an equal and opposite effect for someone else … or even for me the next time.

Fixed opinions are luxuries that I, and I daresay most depressives, can ill afford. We may ask you what you know about depression and meds. We may want to hear about your experiences or those of your friends. We may ask for your suggestions. But ultimately, what we really need is as much support as possible, regardless of our choices.

E
VERY MOMENT
of intimacy is its own little miracle. Whether with casual strangers, long-term friends, or family. Whether it manifests as a random act of kindness, simple acceptance, gentle humor, light touch, heartfelt hug, or passionate romance, love has a kind of energy that accepts no substitutes. Even if there were no prescription drugs, no supplements, no acupuncture needles, no homeopathic remedies, and no meditation practices, the most powerful remedy of all is still swirling around. Unfortunately, when you're that involuted, it usually feels just out of reach … even in the midst of orgasm, which releases more than enough serotonin, dopamine, acetylcholine, and norepinephrine to perk up most human brains.

I recently heard a story about a doctor who uses sophisticated brain scans to diagnose and treat illness. Early in his career, a friend of his who had just fallen “madly” in love stopped by his clinic for a visit. Curious, the doctor did a scan and, when he read it, it looked exactly like the brain of someone on cocaine …

From the epicenter of my personal psychotic universe, I was surrounded by many people who—knowingly or not—provided some form of support. I see them radiating out in Dantean spheres from
an inner one that only Wendy could occupy to outer orbits of those who saw me so infrequently that I figured they never suspected there was anything wrong. Wrong.

Masking the symptoms of mental instability—or making them seem like not such a big deal—is the depressive's version of an Olympic event. It takes an extraordinary amount of energy to manufacture manifestations that will seem relatively normal to the people around you. I figured I usually earned at least a bronze medal. But it appears even in that I may have been deluded. A few years later after “outing” myself in a local paper, I received a letter—a real, handwritten letter—from someone I've known for almost thirty years but, except for the occasional party or chance meeting downtown, rarely saw. She wrote:

She's right. We are all connected. But … but … but … what do you say when you see someone who's clearly fallen into an emotional sinkhole? You want to help, but how? Everything you say seems to disappear into a bottomless pit. Trying to cheer him up seems somehow insensitive. Too much empathy can make you pretty damn sad yourself … which can, in turn, make him feel even worse. After all, if you feel someone's pain, that's twice as much pain, right?