The comment policy for this post is different from my usual one. It’s at the end of the post. Content note: depression, obviously.
How — specifically, in a practical sense — do I live with the understanding that I have chronic recurrent mental illness?
I have chronic episodic depression, and probably will for the rest of my life. I’m getting better now, I’ve been better for a few months; but I accept that this is a chronic illness and I could get depressed again at any time. A few days ago, I wrote a piece about What All This Means: it was useful for me to write (a lot of my writing about depression is as much for myself as for anyone else), but it was a little philosophical, a little abstract and meta. So I’m writing this practical guide to how I plan to live as a currently healthy person who has a chronic recurring mental illness.
None of this is intended to tell anyone else with depression what’s right for them. This is entirely an account of what I think is right for me, written largely so that I can refer back to it later if I need to. If you find any of this useful, please take what you need and leave the rest.
Continuing to do self-care. I’m going to continue to eat a reasonably healthy diet, get enough sleep, drink enough water, exercise, spend time outside, spend time with other people (even if it’s just quiet time in cafes), meditate, do hobbies, limit my TV watching, write, take breaks from writing. I want to do those things anyway: I enjoy them and they make me happy and healthy. But I’m also doing this because when the next bad depressive episode hits, I want to be ready. Being in better health will make it easier to weather the storm — and if I’m already in the habits of doing self-care, it’ll be easier to stick with them when the next depression hits.
Asking people close to me to keep an eye on me. Depression lies, and one of the biggest lies it tells is, “You’re not depressed — this is just how the world is.” So I’m asking Ingrid, and my closest friends who see me pretty often, to let me know if they’re worried that my depression is coming back. In particular, I’m going to ask this of my friends who themselves deal with depression and know first-hand what it looks like.
When stressful or traumatic things happen, dial up my vigilance, and consider taking action. I know that hyper-vigilance about my mental health is itself not healthy. Trying to find the right balance — monitoring myself just enough but not too much — is going to be tricky. But I also know that my depressive episodes tend to be triggered by major stressful or traumatic events, usually when two or more happen at once.
So when life is ticking along reasonably well, I’m going to relax more. If I’m wondering whether a low, pessimistic mood is incipient depression or just human sadness; whether fogginess and difficulty focusing are coming from depression or whether I’m just coming down with a cold; whether a stretch of tired inactivity is depressed amotivation or just my body and brain needing a break — I’ll err on the side of, “I’m just tired and sick and sad.” I’ll keep doing self-care (see above), but if life or laziness interferes and I let it slide for a few days, I’ll cut myself slack.
But when life gets harder, I’ll get more vigilant. I’ll pay closer attention to my mental and emotional state. And if I am experiencing things that might or might not be depression, I’ll err on the side of assuming that it’s probably depression. I’ll get more rigorous about self-care; I’ll talk with my doctor about dialing my meds dosage back up; I’ll ask the people keeping an eye on me to keep a closer eye; I’ll look at getting back into talk therapy. Heck, if life gets seriously traumatic or I can see serious trauma coming, I’ll just get back into therapy, even if I don’t feel depressed. When my dad was dying in 2012, I got into therapy before he died — which meant that when the Armageddon of 2012 hit, I didn’t have to add “find a therapist” to my list of “shit I have to deal with when my life is already upside-down and my brain is hiding in a bunker and pulling the blankets over its head.”
Doing a mental health check-in routine. I want to avoid hyper-vigilance about my mental health, but I also want to avoid… well, avoidance. I don’t want to forget that I have chronic episodic depression, or go into denial about it. So I’m going to set up a regular check-in routine, probably once or twice a week, where I take stock of my mental health and see how I’m doing. Meditation may play a role in this. One of my meditation techniques is to focus my attention on my mental and emotional state, to just sit with my thoughts and feelings and observe them without trying to change them — so I’m going to start incorporating that technique into my meditation routine more often.
But when the next set of bad traumas hit, I want to have the meds already in my system. I don’t want to wait four to six weeks for them to kick in, and I don’t want to go through the crappy adjustment period. So I’m staying on them; at a lower dose, but very likely for life.
Finally, and very importantly:
Thinking of my next episode as “when” instead of “if.” I’ve had depressive episodes off and on throughout my adult life, maybe even starting in adolescence. They’ve mostly been off — I’ve been not-depressed more than I’ve been depressed — but they’ve been frequent enough that I have to assume this is a chronic condition. This means I’m likely to have them again. No — strike that. I’m almost certainly going to have them again.
So I can’t let myself think, “Oh, it’s been a few years since my last episode, maybe I’m all better now.” I can’t let up on my self-care and self-monitoring, and if the people I’ve asked to keep an eye on me say they’re worried, I have to listen. I can’t indulge in wishful thinking. I have to remember. I have chronic episodic depression. I need to act like it.
*****
That’s what I’m doing. What are you doing? Other people with mental illness that comes and goes — how do you cope?
Comment policy: If you yourself have depression or other mental illness, I welcome suggestions and perspectives on managing it as a chronic lifelong illness — but please frame them as what works for you, not as prescriptions for me or anyone else. If you don’t have mental illness, please don’t give advice of any kind. Thanks.
Wellbutrin_SR_tablets_150mg image by SergeSF, licensed under Creative Commons, found at Wikimedia Commons.
Depression varies a great deal from one person to the next, so what I say below isn’t intended as advice for anyone.
For me, having a regular supply of the right drugs is the only thing that makes an unmistakable improvement. By that I mean an improvement I am sure is a real improvement, and not due to anything else.
There are a lot of other little things, which I hope help some, but I don’t really feel confident about any of them. In many cases, I suspect that rather than those things making me feel less depressed, instead, when I feel less depressed for other reasons, I do those things.
You say that you eat reasonably healthy, but how do you know what that is? That’s the problem I’m having. Or that I fixate on far too much. I’m obsessed with eating well, but every thing is bad for you according to someone. Don’t eat gluten, or any grains, or night shades, or this or that until all I’m eating is chicken. Then I read up about arsenic that’s in chicken….
I’ve had 5 mercury fillings replaced in the hopes that that will help and it may well be helping, but it’s early days (I notice the metalic taste is less common but could be just wishful thinking). I’ve tried ssri drugs when I was younger, and they either made no difference or made me worse. I’m too scared to try any others. All hopes are currently rest on the mercury thing. I’m working on my music trying to keep my mind off it, although I don’t really feel music anymore. One thing is for sure it’s better if I can force myself to do something. Doing something is usually not as bad as I think it’s going to be.
For me, a big part has been accepting that I need my meds long-term as in probably forever. The cycle of recovering, lowering dosages until I am med free then inevitably crashing into yet another depressive episode has happened far too often for a supposedly intelligent person. I guess I look at it now like insulin and diabetes – yes, I will feel better when taking the insulin but that’s not a valid reason to stop taking it.
I don’t know what to say. I read your work here and enjoy your Facebook page discussions. I’m glad to see you’ve got a plan and I hope it bears fruit for you. You deserve as much wellness as you can find or make.
This article…it left me feeling exhausted and hopeless that I’ll ever be able to do even half the things you’re talking about. (Or an equivalent set of things that would work for me…or even have the energy and brainpower to come up with a plan)
I have major depression with dysthymia in between episodes. I don’t remember a time where I even had dreams or things I enjoy. Well, I do remember, but it’s like looking at a photo album that belongs to someone else.
I’ve begun to suspect that I have fibromyalgia as well, but getting treatment has been challenging. I hurt all the time and am never not tired. My brain doesn’t work anymore.
I joke that my dogs’ names are Xanax and Prozac. They keep me going and, often, the only joy I find is in brief moments witnessing their antics or just snuggling with them.
I take an anti-depressant, which keeps the floor just above rock bottom. I try to eat well. Sometimes I do yoga or meditation, but I have a hard time putting time into anything that isn’t my job since my energy is limited and I’m scared to lose my job. And also have trouble convincing myself I’m worthy of it.
I’m just so weary.
This is perfect timing for me, too. I’ve had recurrent low-level depression for the last several/many years, and have only recently started to really try to take control of it all the time rather than just one day realizing I’ve been in a funk for weeks and not being sure how to dig my way out. The last couple of months have been great, but recently of those “Oh hello bad feelings, there you are, wondered where you’d been” times started to creep on. The difference was, this time I noticed it was happening and went into full-fledged survival mode right at the beginning as a protective action rather than wait until it was a reactive “can’t do anything else” response. It’s helped a lot, I think. I feel like I’ve been riding the wave of it on the top and am almost over it, rather than sinking down. I’ve almost entirely cut out being active on the internet, am trying to be very cautious about what I eat and record it all (because letting my food choices go to heck is part of that spiral), I’m scheduling in a little indulgent me time every day, just trying to treat myself very nicely and, well, selfishly. But since I’m doing it on purpose and proactively, it’s not the “leave me alone I can’t handle anything” mode I usually end up in.
The hardest part of that kind of self-care has been trying to re-train my friends, sort of opposite of what you described of using your friends as a barometer. I have a couple who are acutely tuned to when I start to spiral down, and it was almost impossible to convince them that what I was doing was to try and stave off the descent rather than being in the midst of it. (“No, I’m ok, HONEST, I’m withdrawing ahead of time.”) I know it was out of love, but I was already on the cusp of running out of spoons and trying to reassure them took a little more than I had to give. Hopefully next time it will go more smoothly, if this turns out to be a good strategy. But yeah, it feels like I need a poster that says “ETERNAL VIGILANCE”.
These are some things that work for me:
* Being on the right meds with the right dosage. I had some weird experiences before the dosage was corrected. Fortunately it only took one time.
* Being able to openly discuss with family and friends. My immediate family (wife/kids) are completely aware. We can discuss it seriously, and they also know that I will joke about it (yes, probably in bad taste, but that’s how I cope). I’m not sure how many others of my family are aware, but I’ve made no secret about it when there are visits. Same with friends. I have a good friend I work with that I’ve shared many of my tales with, which I’ve found to be extremely helpful. I guess just being able to discuss it openly. I don’t worry about what others will think of me.
* Accepting who and what I am. I’m not perfect, I make (many) mistakes, and will continue to do so. This has helped me in my job, and especially with relationships (social, family, professional). When I look in the mirror I’m happy with the person that I see.
* I put my energy into the things important to me: family, job, reading, other hobbies, etc. I also know there are going to be bad days, but I won’t allow them to consume me.
One of the common things between the article and the comments I noticed is having people look out for you. This doesn’t always work for me, but often just seeing other people care is important.
Unfortunately, there is no magical cure.
Simply knowing the depression is cyclical, that if I wait it will get better for a while, has helped me a lot. Recognizing that a depressive episode is in progress, and learning to not trust my analyses of the future (reminding myself that I’m probably wearing shit-colored glasses) is also valuable.