Thursday, August 21, 2014

About untreated depression

I had untreated depression for most of my life.  The vast majority in fact.  Memories from before a certain point are hazy so I can't put a definite start date on it.  I do know that the questions about "the last two weeks" as compared to "usual" always threw me because for me depression was the default setting.  There was no other usual.

Though on account of having two types of depression (yes, it comes in flavors) sometimes it was worse.  I had two settings for much of my life: depressed, and bouts of really, really, really fucking depressed.

It took, I'd say, five to ten years to realize I had depression.  It took another three to get anyone to take me seriously enough to get attempts at treatment.  All failed.  I got ping ponged between doctors, put on all manner of medication, and none did shit.

What I was like when depressed is, I think, best described by the time it took me two hours to brush my teeth.  The actual tooth brushing took two minutes.  That's well within the margin of error of the two hour figure.  I just kept on stalling out.  There are too many steps, you see.

First I had to get up, mustering up the will and drive to do that took quite a while.  Then I had to walk to the bathroom.  Once in the bathroom I had to put the toothbrush together.  (Electric toothbrushes commonly have removable ends.  One of the many uses of this is that you can have multiple people use the same expensive part because the part that goes in the mouth is different for everyone.  The down side is that you have to put it together and take it apart every time you use it.)

That took a while.  Not the doing, mind you, the getting the will to do it.

Then I had to open the tooth paste.  Took what felt like forever to start doing that.

Then I had to put toothpaste on the brush.  Guess.  Seriously, if you're not seeing a pattern yet something is wrong.

Then I had to actually pick up the toothbrush and brush my teeth.

When that was over I happened to glance at my watch and realized that two hours had passed between when I decided to get up to brush my teeth and the moment I was done.

Again, the actually brushing took two minutes.  (I know because the brush had a built in timer.)  None of the other tasks took longer than you'd expect.  So that's basically two hours spent doing nothing because I lacked the will to do anything and had to build up for every step.

Or there's the fact that I watched The Shawshank Redemption untold times for hours on end because I couldn't muster the will to stand up, cross the room, and change what was in the DVD player.  (I started being depressed before DVDs existed, for what its worth.)  Even getting together enough giving of a damn to pick up the remote and press play so it wouldn't be stuck on the title screen was hard, but it was better than it being stuck on the title screen.  That was way better than in the earlier days when hours might be spent staring at a wall in my room.  (My room has pretty boring walls.)

The point here is that depression isn't just about when you feel incredibly soul crushingly sad for no reason.  It isn't just when you feel like it's everything you can do to keep your head above water while no one gives a shit and you're worthless and so forth.

It isn't just the fact that it can (though will not always) turn you into an asshole who pushes everyone away when what you really need is to let people in.

It isn't just anything, people are too complex for an illness to manifest in just one way and depression is too complex of an illness for that as well.

It can also be apathy, it can be smothering anxiety, it can be a lack of drive, and any number of other things that simply make you stop.  Just stop.  Not "stop and ... " but stop.

It can make it so that the ones who need help most are least able to seek it.

And when there was a break in my not-actually-treating-my-depression "treatment" I simply wasn't able to get back to it.  I drifted.

And then I had no insurance.

And then I had insurance for about six months.

And then I had no insurance.

And then years passed.

And then fortune smiled upon me.  A few nervous breakdowns and a panic attack or two later (depression is comorbid with so much shit) I had a good psychologist who set me up with a good psychiatrist and for quite a while no treatments worked.

So, you know, same old shit.

But finally we found a medication that worked.

Which gave me total insomnia.  The symptoms of sleep deprivation are remarkably similar to depression.  So it was kind of a wash there.

Lots of shit, a concussion, being forced to try out a cheaper medication that didn't work, and so forth later and now I'm on a working antidepressant and the insomnia it causes is dealt with via a prescription sleep aid.

The only medication found that works for me in 15 years of (on and off) looking for one?  It wasn't even put on the market until ten years ago and even then it was explicitly supposed to NOT BE USED unless you'd exhausted all other options.  Do you know what it takes to rule out even one medication?

Most antidepressants work like this:
Doctor: We're going to start you on a low dose so take Xmg a day for a month."
*month passes*
Doctor: Ok, that isn't working, lets up the dosage a bit, lets try Ymg a day.  It'll take a while to build up in your system so we'll check back in a month.
*month passes*
Doctor: It's still not working but we did start you on the lowest dose so take Zmg for the next month.
*month passes, having reached the end of the alphabet the doctor moves on to Cyrillic, when Ya (that's the one that looks like a backward Latin alphabet R, by the way) is reached it's decided to try new things*
Doctor: Sometimes this medication needs a little help from another.  There's been a lot of research into promising synergistic effects.  So let's see if it works along with ξmg of medication ا.  See me in a month

(That's an Alif, by the way, the font is kind of wanting.)

AND SO ON.

Antidepressants work slowly and sometimes it takes a high dose for it to start working.  The dose of the medication I'm on that does work?  Six times the starting dose.  Assuming that I remember the starting dose correctly, it might actually be twelve times the starting dose.

And all of this skips over an important fact.  The medication?  Expensive as fuck.  If I weren't on my current insurance (which ends at the state line and involved jumping through hoops for ages, hoops that I wasn't able to make myself jump through for the longest time) I'd never be able to afford it.

Which means that until I got said insurance (which is ridiculously good for prescription drugs and crap for many other things) even if I, and my doctor, had known the exact medication and dosage that would treat my depression it would have been impossible to actually get my depression treated.

All these things and more are why I get pissed off at people who act like it's easy to get treatment for depression.  It fucking isn't.

I don't know what's made the latest round of, "Let's blame the person with a mental illness for not getting it treated when it would be hard to treat anyway and the mental illness itself makes it harder to get treatment in the first place," people come out, but it's pissing me off.

If the reason it's come up is Robin Williams then I'm doubly pissed off, if it isn't then I'm merely singularly pissed off.

4 comments:

  1. I've had occasions where I sat in the drained bathtub for an hour because I couldn't manage to make myself get up and reach a towel. It sucks. I wish I had something better to say than just "I sympathize".

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  2. Thank you for talking about this. People should know this stuff. It is really frustrating that people will spout off on every old thing without ever considering what it means for the people involved. I hope never to be one of those people.

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  3. There's an essay in the paper this weekend - a first person story about why some people, with the author as an example, are reluctant to take medication for depression. Which is another barrier on top of the "inability to do things" and "money" and "some meds don't work" hurdles that you mention here.
    http://www.theglobeandmail.com/life/health-and-fitness/health/why-were-afraid-of-antidepressants-even-when-we-take-them/article20179002/

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  4. It's just as bad in the UK with one exception: the NHS will supply drugs. You don't have to be able to pay for them or have insurance. It's a huge difference but it's the only one.

    The rest of it: the trying and failing and upping and changing and trying to cope with no energy to do anything - all that is the same.

    It sucks.

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