PERSONAL EXPERIENCE:

The Big 'D': Or the Dreary Despair of Depression

"…the dark withdrawal of the person…"

Depression. I had always thought the word was too mild to describe the actual miasma and angst, the dark withdrawal of the person into a personal oblivion. Of course, upon reflection, just as there are different stages of cystic fibrosis (cf), there are different levels of depression. Indeed, the insidious onslaught of depression can be so mild as to be overlooked or explained away easily. Usually it is when the full despair of depression is obvious that treatment is sought or thrust upon oneself.

When you have a serious disease like cystic fibrosis (or cancer or AIDS, etc.), it may be too easy to explain away depression. Just the thought of coping with a life-long illness is enough to depress even the most optimistic of people. Inevitably cystic fibrosis causes some part of the depression, but seldom the whole reason for the feelings of despair. Interestingly, studies have shown that people with cf are no more inclined to depression than the average. Other studies have shown that depression may be genetic and inherited. In the USA, my home, sales of anti-depression medications are sky-high. Why? Do we need better definitions for the different types of depression? Or, does modern life have a predisposition to depress us?

In my case, as with so many others, the beginning of my depression was a minor chord of my daily life. I was becoming increasingly unhappy with my work. Where my job once provided challenge, stimulation, and great personal reward, it now brought frustration, irritation and a mix of anger and feelings of being abused. At one point I thought nothing of putting in excess of forty hours a week into my job. My job defined me. I was recognized as being truly excellent in my field. I loved my work so much that it often came before my marriage! Somewhere, somehow, I began to lose interest. Even now, with hindsight, I can't pinpoint when the whole cycle began, but begin it did. A slow inner turmoil that became a hellish descent into personal oblivion.

"…I recoiled from friends and family alike."

The disillusionment started insidiously. As I became more disenchanted with work, I also began to deteriorate in other ways. I neglected my health woefully. I failed to take daily medications and didn't go to clinic. I recoiled from friends and family alike. I was always too busy for luncheons or visits. I never answered the telephone. Personal hygiene slipped. Why bother grooming when I wasn't going anywhere and certainly didn't feel good about myself. I started cocooning myself. Wrapped myself into myself, falling into a vortex of subconscious me.

Throughout my life, I always suffered from insomnia. Over the years, I learned how to cope and adjust without reliance on medication. It wasn't very easy at times, but years of coping left me able to adjust. Then the depression started. It became increasingly more difficult to sleep. Worse, without the interest of my work, there was nothing to occupy my sleepless nights. I was never a fan of television, and listening to music was too passive an activity for me to enjoy. I started reading - something I had always enjoyed. However, instead of the books I normally found interesting, I started reading fiction. Everything from murder mysteries to love stories. My favorites quickly became the medical and forensics murder mysteries. I would read all night, falling asleep at around eight in the morning just when the rest of the world was beginning a new day. This new pattern quickly kept me from functioning in the normal 9 to 5 workday routine. I stopped eating lunch, and often dinner. I avoided friends and evening social functions. My new routine was to read about two books a night and sleep all day. But, hey, I was sleeping, which was very comforting.

"Depression is an intensely personal trip."

After about six months of this behavior, my bed became my castle. I was loath to leave it for any reason. At this point, I was eating irregularly. I kept snack foods and candy by my bedside, which became my meals. Unless I absolutely had too, I wouldn't leave my bed. It was at this point that my husband became very worried. An insidious part of depression is that there is very little someone else can do for you to help you recover. You are largely responsible for yourself. My husband pleaded with me to get help. He found the first psychiatrist I consulted. However, there was precious little he could do on a day-to-day basis to help me. Depression is an intensely personal trip. Indeed, in some ways my husband contributed to my feelings of despair. Out of frustration, we would have bitter arguments. Sex became nonexistent. I think to save himself, he began to ignore my situation. He tried to act as if nothing untoward was happening. This playacting let me also pretend that I wasn't 'that' badly off.

Needless to say, I lost my job. I used the too handy excuse of cf and being sick to hang on as long as possible. Nonetheless, the job loss was greeted with relief. Oh how I had come to truly loathe the job. Surprisingly, I still have no yearning for work of any kind. Friends predicted that I would soon become bored without a job. To date that hasn't happened. Another symptom of depression? Probably.

About this time, there were several attempts at new starts, usually at my husband's behest. An exploration into new job possibilities and new hobbies. However, about the same time, our personal finances became drained. My husband took the burden of additional work and tried to come up with innovative financial reforms. This new situation drew me deeper into the chaos of depression and I became filled with guilt and self-loathing. Instead of moving forward and looking optimistically into the future - as my old self would have - I fell deeper into the black pit.

"…I wanted the nothingness of sleep."

It is often said that until you truly hit bottom you can't come up. I had been prescribed a benzodiazapam for another malady. In the past, at times of stress, I noted that if I took a pill or two more than prescribed, I would feel rested and able to sleep. With the full cloak of depression surrounding me, I wanted the nothingness of sleep. I took nearly 100 tablets over three days. I nearly died - no exaggeration. Later, when dealing with the withdrawal of such a massive overdose, I would wish I had died. To this day, I still don't know if my real intention was suicide. All I noted, felt and desired was the calm nothingness of sleep.

It was my cf physician who took control of the situation. I had gone to see her in an effort to treat the withdrawal symptoms of the overdose. She was a wise practitioner. Whilst treating me just enough to lessen the symptoms a little, she pushed me into seeing a psychiatric specialist. Calling every day, she was relentless. Only my husband was more determined. I suffered a hellish three weeks of withdrawal symptoms that I swear is worse than death itself. Even now, I'm having great difficulty trying to describe that horrendous period. I couldn't stop shaking, I couldn't sleep. I felt like I was crawling out of my body. I saw things, I couldn't see things. It was hell on earth.

"The talk therapy was invaluable."

At this time, I wish I could offer a fairy tale ending to my saga. I can't. I saw a psychiatrist for a year (all that we could afford given the stupid USA health-lack-of-care system) and was prescribed anti-depression medication. Actually, the first prescribed medication didn't work at all, however one needs six weeks to determine this. I'm not at all certain the second medication helped either. The talk therapy was invaluable.

Although cf was not a major factor in my depression, it played its part. I've always been extremely fearful - not of dying, but of death itself. Interestingly, I've always had this 'knowledge' that I wouldn't die of cf. From whence it sprang or originated beats me. I simply feel sure that cf won't cause my demise. It didn't help that a year ago; I started being monitored for breast cancer. Both of my parents died of cancer. My mother's breast cancer metastasized after ten years remission and she succumbed to lung cancer. My fearful big 'C' is not CF, but Cancer. As an atheist, my fear of death didn't have the solace of an afterlife existence that many (most) religions promise. No heaven, no hell, just nonexistence. It was the actual fear of losing my being, essence, which frightened me. Try getting over a fear of death. Trust me, it will easily lead to depression!

Two years have passed since my diagnosis with depression. I am still depressed, although I am a bit more able to handle it and certainly recognize the need for treatment. I made some life changes that have helped enormously and others are in the works. Yet, I can't claim to be cured. Perhaps there is no cure for depression. I am a bit more productive, but really just a little bit. I remain unemployed. I have started to care for myself, but not as well as I used to. For instance, my hair is uncut and gone is my usual perm - and I don't really care what I look like. I am barely keeping up with household chores (don't peer too closely at my home!), trying to eat regularly, and try to keep in touch with family and friends. Every day is a struggle. I now appreciate what depression truly is and the agony of manic depressive days. Although my case was diagnosed as 'mild depression', I experienced and continue to experience days of highs followed by some low spots. Sort of like living with cf!

"…fear of death was definitely a concern."

What, if anything, did cf have to do with my depression. Considerable therapy showed that I was angry with co-workers who didn't know of or appreciate my health sacrifices. I recall one incident of severe illness when I experienced little empathy from co-workers (and friends, too, if truth be told). Nobody asked that I sacrifice health, but I guess I was feeling unappreciated and, well, used. And, another 'weird' aspect was that people would constantly dismiss me with 'you have a mild case'. NO! Of course, I wasn't depressed about my health because that was fairly good for someone with cf. Rather it was the lack of thought or acknowledgment that I still did have some health problems and issues. Just prior to the start of my depression, I lost many close and good friends to cf. Death or, rather, a fear of death was definitely a concern. Overall, while cf played a part in my depression, it wasn't a starring role.

What can I say about depression except to take it seriously, get appropriate treatment, and don't beat yourself up over it? Perhaps most importantly, learn to live with it. Even if that means living at less than your ideal. If you can afford it, I highly recommend talk therapy in addition to anti-depressives. You don't have to see a psychiatrist necessarily. I needed one because another illness I suffer from requires medication that the newer anti-depressives work against. I was, therefore, severely limited in choice of medication. There are good social workers out there. One of the best that I encountered was assigned to my cf clinic. She was truly a jewel. However, her time was severely limited by other aspects of her clinic work. Psychologists are another excellent resource for help. However, just like finding a good cf doctor can be difficult, the same is true for professionals involved in psychotherapy. I saw one counselor for six completely wasted months. If, like me, you can't afford to pay for care without the aid of insurance, getting help is very, very difficult. The psychiatrist I saw for about a year tried to get me into a subsidized mental health care facility only to find a three-year waiting list! When I overdosed on the benzodiazapam, I waited 10 hours at a hospital emergency room for mental health professionals to assess me! Today, I called the psychiatrist noted by my insurance carrier and I can't get an office visit scheduled until August! Even the very real and dangerous symptoms of the overdose didn't hurry up necessary care.

"…I have no fairy tale ending."

As I said earlier, I have no fairy tale ending. I'm currently not on any anti-depressives because of my problem with another disease and its medication. I'm also not seeing anyone professionally. My insurance will pay for about 6 mental health doctor visits per year. I am waiting until near the end of this year to combine 6 visits from year 2002 with that of 6 visits from early 2003, and hopefully make some significant progress in combating my depression.

Depression is a very lonely experience filled with dark alleys, haunting nightmares and crooked realities. When you suffer depression, dark grey days are hopeful. Dark black days are way too common. And, bright sunny days so rare that this atheist thinks for a moment, maybe there is a heaven.

Sonia Emilio
USA