This letter is written for all those who are suffering from depression. I hope it gives you the hope and encouragement that you can improve and gradually get control of your depression. I am slowly winning the battle. I hope you can too.
My fall into depression started 17 years ago (1978). The first episode was diagnosed as an anxiety reaction. It developed into depression. I expect it was a result of an event in my personal life. I got over it but it took 4 years, a year off work (in which I did volunteer, and later paid work, with blind students), and a reduction in job responsibilities. Medications were poor in those days, so nothing much worked to help me. What followed was 8-10 good years. I thought that I had fully recovered.
About seven years ago I began a gradual descent into a major depression. I did not recognize the signs, and neither did my family doctor. The first indication was an irritable bowel syndrome. Then lots of bladder problems with frequent urination and tendency towards incontinence. I had an enlarged prostate gland and so, at age 54, I had prostate laser surgery. In hindsight, at least half the problem was my nerves. But I did benefit from the surgery.
Again, with the 20/20 vision of hindsight, I know that I was sliding into depression. Low energy and increasing fatigue came next. This led to a gradual drop-off in my activity level both at work and in recreation. Over a period of 4 years, I was doing less and less recreationally and with hobbies. I could get through the work day, but eventually I had to go home at noon for a short nap. Gradually, I could no longer attend evening meetings as a volunteer board member, and I could not attend cultural and musical functions, or family parties with my wife.
I used to be a high energy guy. I once built a huge addition on my home, working 8 hours at work, then return home to work 6 hours on my house. I loved it! Now, I had very little energy, and had to drop almost all my activities of boating, carpentry, photography, working on my summer cottage, and dining out with friends.
By 1992 I was a wreck. I awoke early each day, and the singing of the birds was like torture. I was hypersensitive to noise, and when my kids played their stereo or the TV, I had to request that they to turn the volume down. Needless to say, I was not a fun person to live with. Anxiety began to take over, and I worried about all sorts of silly things. I nearly drove my family nuts. My psychiatrist did not believe in antidepressant medications, and would only use very old medications that did me no good. For sleep, she suggested over the counter sleeping meds.
My wife probably saved my life. I was at the point of crying, not sleeping, no energy, low concentration, high anxiety, and generally non-functional. I thought I was going crazy, and I told her so. She had the foresight to take me to the hospital. They kept me all day and sent me home. No beds available in the psych ward. She took me back each day for three days. She stomped and persisted and threatened and finally they let me in to the hospital. I stayed 4 weeks, and it was a wise decision. It was a decision that I could not have made alone. It is wise to have another make the decision for you because you are likely not thinking rationally.
On Day One I hated the place. "This is a dump. Let's go home," said I. But I stayed. My wife went home and cried. By Day Two I loved the place. Finally, someone understood my problem, and what I was going through. More importantly, they insisted they could help me. I was so relieved. But I kept asking the doctor if I was in the right place. Everyone else seemed to have lots of energy. I was a zombie. She told me they were mostly patients suffering from schizophrenia.
The nurses and my doctor were very kind and gentle to me. Each nursing shift I had a primary nurse that was instructed to have at least one conversation with me, up to one hour if I could manage it. At first I couldn't. The doctor started me on Zoloft (50 mg) with gradual increase to 150 mg. I also took 2 mg of Clonazepam for sleeping. Finally, I got some sleep. I had lost 20 pounds, and gradually my appetite returned, but it took many months. My anxiety was very bad, and I could barely walk a half-block. Once I thought I would pass out on the sidewalk. My medication was being increased too quickly, and my blood pressure had dropped. "Relax," said my doctor. "Mother nature has a way of handling this." "How?" I asked. "You faint," she replied. I didn't see the humour in her comment.
I was encouraged to go home at weekends, first just for a few hours, then gradually one overnight trip. Finally, after 4 weeks I went home to stay. I was still very shaky, but I survived. I began to walk, and could get around the block. I was able to read now, but only light material, and only for short periods. I rested a lot.
The next three years were both wonderful and terrible. Wonderful because I got back to work. Terrible because I had two relapses. I was off work for three months, then returned half time for December, 1992. In January, 1993 I returned full time. Although my productivity was low at first, I gradually picked up. I was still on Zoloft, but gradually phased it out by April, 1993. BIG MISTAKE! It proved to be too soon. But my psychiatrist had retired, and my GP thought it would be OK. Summer was coming. I had a good summer and seemed to be getting back to normal.
I felt so good, my wife and I decided to sell our family home (now empty nesters), and purchase a townhouse. ANOTHER BIG MISTAKE! This proved to be a very stressful event after 25 years in the house. We did this over the late summer, and made the physical move in October. By December I was crying again. The doctor put me back on Zoloft. but I was really falling fast. I begged him to refer me to a psychiatrist, and in January,1994 I got lucky and was taken on by a doctor at the UBC Hospital Psychiatric Out-Patient Department. Happily, this new doctor knew the illness of depression well, and ordered me off work for six months. It turned into eight months. He switched me to Prozac and later Paxil. They didn't do much for me. But I stayed on Clonazepam. It worked for sleep and helped control my anxiety, which was still a serious problem.
I improved slowly with the doctor's help, and the support of my family, but I really needed a good anti-depressant. By September, 1994, I tried again to return to work. I lasted only 9 days. I was full of anxiety again. Back I went onto Long Term Disability Leave. I had succeeded in working all of 1993, but 1994 was proving to be a washout.
AND NOW FOR THE GOOD NEWS! In December, 1994, my wife spotted an ad in the paper asking for volunteers to be a participant in a research study at UBC Hospital. I joined and was administered the medication Ipsaprione. This drug is not yet on the market, but it has many good features. I had no side effects from it, and it helped my a great deal over a period of six months. However, when I tried to phase out Clonazepam, I started to slip again. My doctor switched me to Effexor, and I have now been on that medication for 11 weeks. It seems to be very good for me. It has been the quickest acting, and I can now see light at the end of this horrible black tunnel that is called depression. I take 75 mg of Effexor daily (split twice per day at 37.5 mg) and still take 1.5 mg of Clonazepam for sleep.
My anxiety has almost disappeared. My energy level is still low, but improving. My activity level is still low but improving. My sleep is gradually improving, but I suffer ups and downs in this area. I have been able to resume many activities with my wife, and I am now able to attend evening dramatic productions and musicals. While I get tired during the day, I can get through with an afternoon nap. I still have a long way to go, but I now feel confident that I will recover to at least 80% of my former functioning. 100% may not be realistic. I am very glad of the Effexor and I am convinced that a good medication is required to get a sufferer out of the hole of depression.
Also at UBC I joined a group concentrating on cognitive and group therapy. This group ran for five months, one day per week for two hours. The group was led by a superb doctor who followed the book Ten Days to Self-Esteem by David Burns. The doctor also challenged us to face our negative thoughts, and to examine closely our relationship with the key person in our lives. The book is a write-in style handbook and we had lots of homework each week. It proved a good way to develop skills in learning to use the tools of cognitive therapy. The research on cognitive therapy is good, and it provides one more way that a sufferer may learn to control depression.
I also try to exercise regularly. I joined a fitness club, but find it easy to overdo it. If I do, then I suffer nausea afterwards. I have found walking to be the best for me. Getting out into the light is also part of this strategy, and my doctor at UBC recommended that I get out every day into natural light. Experts recommend exercise and natural light as a way of controlling depression.
I also joined a support group run by the Mood Disorders Association of BC. This has been a source of great support. We number 25 persons, and we get together six times per month. We meet two evening meetings per month, and every Sunday afternoon for recreation (bowling, billiards) or just for coffee and lots of laughs. We are good to each other and keep an eye out for those needing encouragement. We phone each other regularly, and have had several parties where we invited spouses and friends to attend. One of the relatives jokingly referred to us as the "Prozac People," but recently I have been telling the waitress at the coffee shop that we are the National Bowling Team. She seems to be convinced.
We must be very successful because we keep attracting more and more members. Support groups are very valuable, especially for the person who lives alone and has no support at home. We share knowledge about the illness, and information about medications. This way we broaden our knowledge about the depression and manic-depression, and share advice that we are getting from our doctors. I believe that information and knowledge is the key to combating this horrible illness. I highly recommend a good support group.
After leaving the UBC drug research program, I was very fortunate to be accepted into the practice of one of Vancouver's leading psychiatrists. He is a kind and gentle man with a vast array of experience with the treatment of depression. He has continued the 75 mg on Effexor, and may bump me up a bit on dosage. He also increased my dosage of Clonazepam to 1.5 mg - I had previously been at 1 mg. We both hope that I can soon reduce the Clonazepam which may be adding to my drowsiness during the day. Finding a knowledgeable psychiatrist is essential, and not easy to do. Many sufferers are still seeing only their general practitioner, and many of those are not familiar with the newer medications, nor have they the experience and expertise to effectively assist the sufferer with depression. We have noticed that when newcomers join our support group, they often are not getting good advice. One must be persistent in getting to the right doctor.
One additional comment must be made about the sufferer's relationship with family and loved ones. Persons with depression are frequently irritable, and difficult to live with. I certainly was! Compound this with the likelihood that the family members do not understand the illness, and are confused by the sufferer's behaviour. Depression is a frightening illness, and the whole family suffers. One of the worst things the family member can do is tell the sufferer to "Just get on with it!" or "Pull up your socks and get going." It is essential that the family learn about the illness. The Mood Disorders Association of BC (MDA) has good video tapes that can be purchased. Each support group (chapter of MDA) has copies that can be borrowed. There is lots of good reading material in libraries, books by experts in the field, and now this information on the Internet. The sufferer should suggest in the strongest terms that family members attend some sessions with the doctor in order to learn about depression.
In closing, I offer you the hope and encouragement that you too can get out of the hole and see the light at the end of the tunnel. Find a good doctor, get on a good medication, learn some cognitive therapy, get some exercise and join a good support group. You too will be a winner.
Best wishes, Roger
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.