Depression

I'm dealing with depression at the moment. It's annoying that my brain chemistry can sneak up and go awry on me, but it happens, I've recognised it, I have to deal with it, and the more I know, the best chance I have of rebalancing my neurotransmitters.

So, what I know already: depression is a brain chemistry imbalance. It usually happens through a combination of events, sometimes combined with a definite trigger on top of them. It takes a while to set in, and a while again to clear. Unlike a broken leg, it can appear to have healed, even during its worst stages; someone with depression can act and appear perfectly normal until it becomes too stressful to keep up that sane appearance. And unlike most illnesses, it's not contagious, but does affect everyone around the sufferer. So now to research...

Symptoms include empty moods, feelings of sadness, anxiety, hopelessness, fatigue, loss of interest in hobbies/sex, difficulty concentrating, sleep problems, appetite changes, irritability, suicidal thoughts, physical symptoms. Tick.

Most of the sites I've visited have advocated treatment, usually in the form of drugs and counselling. These are probably sensible ways to deal with something this severe. Others suggest ECT, to which I have only one response: no f*ing way. Interestingly, nobody suggests removing the stress triggers that bring on depression, but maybe there's no bad in learning to cope with these being more important than the triggers themselves.

Of the chemicals available, SSRIs are popular: these maintain seratonin levels in the brain, keeping receiver neurons stimulated longer than is usually possible in a depressed brain. These take 3-4 weeks to take effect; they apparently need to be taken for 4-9 months before the chemistry balances itself out again; helpfully, most of the sideeffects are linked to the brain adjusting and disappear relatively quickly. I have tried SSRIs once in the past, and an unlisted but apparently common (at least amongst other SSRI users I have spoken -carefully- to) sideeffect is the "fizzing head" feeling, the main reason that I went cold turkey on the SSRI and swore never to use it again. I may reconsider, if I can find a convincing argument that this symptom is normal and unlikely to damage my brain; after all, I need it for my livelihood! Also interesting is the link between seratonin and carbohydrate metabolism; I haven't found much about this effect yet, but gaining weight may be a small price to pay for happiness.

Alternative treatments include St Johns Wort; this is quite common in places like Germany, but tends to be of most use in mild depression. If it's affecting my life, I'm not sure how mild this depression is.

Counselling can be useful for some people, but I'm not sure about me; I'd need an intelligent counsellor who can deal with quite a complex subject, and I'm not sure there are many of those around. CBT (Cognitive Behaviour Therapy), based around the idea of placing a regular structure on my life, could be very useful, as can regular exercise; these are things that I can put in place for myself now.

So, my getting-out-of-depression shopping list:

• Plan. Try to live a structured life; try regular bed and waking times; 10:30 to 7am seems like a good time to sleep; 7:30 to 4pm a good time to work. Allow for the odd deviation from this, but try to keep a general structure. Prepare for the normal, to allow for the unexpected, e.g. sort out the work wardrobe before each working week.
  
• Exercise. Make sure I get out running and to the gym several times a week.
  
• Identify and reduce stress. Always try to do things on the deltas: keep a list and plan of things to do, negotiate and organise work to be done, negotiate the normal boundaries of every relationship, plan to get out of trouble rather than worrying about it. Consider any changes that need to be made to my life (e.g. job or work pattern changes if needed). But be realistic about this, and remember to prioritise.
  
• Remember my own existence. Do things for myself sometimes. And don't hide from, but talk to the people who care about me.
  
• Consider using SSRIs and/or counselling. It's drastic, but if it's needed, it's needed.
  

And finally, for anyone reading this who cares about me: I will get better, I've done it before, but it will take time. Don't expect me to be suddenly well; there will be good days and bad days whilst I recover, but I am still fundamentally the me that you know and possibly love. It's not really relevant how I became ill, because it was never one thing that made me so, but a combination of many; what's important for me now is recovery. You are able to help me with the shopping list, but there is no obligation for you to; depression is a difficult illness to live near, and I won't think any less of you if you can't.