Depression
Depression is the most common form of mental illness. Millions upon millions of people suffer from it.
First, we must distinguish between bipolar depression and unipolar depression, which is what most people have. Bipolar depression is far less frequent, but exponentially more severe. People with unipolar depression are more or less depressed all the time—but the risk of suicide is much lower. I have no personal experience with unipolar depression, but I have many friends who do, so I think I can speak with authority on it.
Depression is characterized by feeling like shit, weight loss, sleeping much more than is necessary, losing interest in things you like to do, and having low self-esteem. You feel unworthy. Often, this is accompanied by substance abuse, which—guess what—only makes it worse. Self-medicating your depression with alcohol or anything else is never a good idea. Short-term gain, long-term pain.
I don’t have the cure for depression, but I can tell you what helps, if only momentarily:
1. Move a muscle, change a thought. Go out for a walk. Go out for a drive. Go work in the garden. Go to the batting cages. Go for a run. Go play tennis. Do something with your hands. Don’t: sit on the couch and watch TV or doomscroll social media. I like to say that the inside of my head is a bad neighborhood, and I don’t want to go in there without a shotgun and a flashlight. So I don’t go in there. I do stuff. But when you are depressed, the last thing you want to do is to do stuff. You have to force yourself to do it. Working with your hands is especially helpful. If you are the type of person who likes to work on cars, or likes to make things out of wood, this is the best way to get out of your head for a few hours. I hate getting my hands dirty, so gardening is not for me, but many people extol the virtues of gardening. The best thing you can do for your mind.
2. Avoid isolation. When you are depressed, you don’t want to talk to anyone. This is the exact moment that you should be lighting up your phone, talking to as many people as possible. Talk to them about how you are depressed. If you talk to ten people, you are bound to get two or three good ideas. But again—it will get you out of your head. Here’s one for you—call someone else and ask how they are doing. Call someone you know who is going through some shit and try to be of assistance. Nothing will get you out of your head faster than helping someone else. Also, you might realize that your problems are not as bad as you thought, compared with those of some of your friends. You might call up a guy who is going through a really hellish divorce. You can help him out, and you can help yourself out in the process. I make a lot of phone calls on any given day. I am really not that social—I am doing it for my mental health.
3. Take medication, if necessary. I don’t have a lot of experience with antidepressants—took Prozac for a while and found it to be a bit stimulative, which wasn’t what I was looking for. Also, antidepressants take a while to build up in your system, so it’s not a break-glass-in-case-of-emergency kind of drug. Some people resort to short-term fixes, like Valium and Xanax, and while those provide some temporary relief, they are not a long-term solution, and they can cause chemical dependency. Anyway, the goal of any psychiatric medications is to get off them eventually—you shouldn’t be a lifetime user of Prozac or Wellbutrin. But they do help. Note: if you are suffering from bipolar depression, the SSRIs are to be avoided, as they can trigger a manic episode.
4. Don’t stop, don’t give up. Don’t call in sick to work because you are depressed. Put on your pants and get in your car and go. Depression is a real disability, but you have to fight through it, which is the message that I want to get across here: keep fighting, keep pushing. Don’t let the monsters win. If you spend a day laying on the couch, it is not going to help, and it is going to make things worse. The worst depression I ever had lasted about four months when I was at Lehman Brothers. I lost 42 pounds. I never, not once, called in sick to work.
5. This, too, shall pass. The way you are feeling right now is not the way you are going to be feeling forever, though it sure feels like it. You think that you are going to feel like shit for the rest of your life. You won’t. It will pass. It might take a while, but it will pass. It probably won’t pass if you don’t take care of yourself, if you don’t do the things in this list. It probably won’t pass if you don’t want it to pass. That’s the thing about depression—people get used to living with it. They get used to feeling like shit, it becomes familiar, it becomes comfortable, and they don’t do anything about it. Do you want to get better? Then take action to get better. There might be someone reading this who thinks that I don’t know what real depression is, the kind of depression where you’re curled up in the fetal position on the floor, crying. Yes, I do. I’ve been there. And there is a good chance I’ll be back there again. I survived it, so can you.
I will tell you what helps a lot—sunlight. Myrtle Beach gets 230 days of sunlight a year. New York gets 115. I totally underestimated the impact that sunlight has on my mental health until I moved to South Carolina. Seattle gets 88 days of sunlight a year, and to compound it, in the winter, the sun doesn’t come up until 9 and sets at 3. Remember, Washington is at about 48 degrees north latitude, so the days are very short in the winter. Nothing but darkness and rain. I lived in Washington my first two years out of college, and it was brutal. When I was in the Coast Guard, I took a trip to Kodiak, Alaska in late November. 22 hours of darkness. The Coast Guard had a big suicide problem in Kodiak for a number of years. They call it Seasonal Affective Disorder, and it’s a real thing. Though you can be depressed even in Arizona or Southern California.
Remember: nobody is at fault for being depressed. It is a matter of brain chemistry. Some people have it, some people don’t. There shouldn’t be any social stigma whatsoever, but there still is, a little. Having said all that, we all have a role to play in our own recovery. I don’t know about you, but I don’t want to spend 30% of my life depressed. I want to be happy, joyous, and free. I am happy, joyous, and free about 2% of the time. How do I know when I am happy, joyous, and free? When I am having singalongs in my car and I just don’t care. Most of the time I am worried about one thing or another. I am actually suffering from very, very mild depression at the moment, which is common for me after I have a book come out and there is a letdown after the initial flurry of sales. Another book that doesn’t make the bestseller list—I am still a failure, or so I think. But I’ll snap out of it eventually, and go back to feverishly working on some new project. I’ve been through this a bunch of times before.
Depression is not a choice. But it is also not not a choice. Pop psychology will tell you that it just hits you—whammo—and you have no role to play in your recovery. But there are things you can do.
P.S. If you like WGGTB, please tell someone about it.
most clinical depression is chronic, like most adult diseases. we get the wrong idea when we are little kids or have little kids. we think illnesses are like strep throat or middle ear infections: take the meds 5-10 days and you're done.
adult diseases like high blood pressure, diabetes, cardiovasular disease, are chronic and require chronic treatment. if you have a single episode of clinical depression you might get off antidepressants and stay off them. once you've had 3 episodes, accept that it's chronic and stay on the meds that helped you. 2 episodes: depends on how severe, how quick in onset, how dangerous, personal preference.
sometimes i tell people that part of my job as a psychiatrist is telling if they're depressed [clinically] or just miserable. don't mistake situational suffering for clinical depression. the former might trigger the latter, however, so it might take a professional to really tell the difference.
unipolar depression is more likely accompanied by diminished or disturbed sleep, while bipolar depression often has excessive sleep. bipolar mixed states - excess energy usually in the form of irritability, agitation, raciness, and diminished sleep accompanied by depressed mood, is really uncomfortable and really dangerous. this is the state that is most likely to lead to suicide.
if you can exercise yourself to a better mood, good for you. but there's no shame in getting checked out by someone who understands these things. getting checked out doesn't commit you to meds or treatment of any kind. so don't make a big deal of getting checked out if you're suffering. maybe you're just miserable.
This is good stuff - practical, helpful, and written with your usual clarity and style.