Sorry for the break, there.  I took a writing hiatus, and then life got really busy.  I am going to try getting at least one of these written a month, more if I have topics that come to mind.

Today I want to talk a little bit about choosing to go off of a med, or meds.

Recently, after two and a half years of looking, I've landed a job, a good job, one that really fits me and my skills well.  For obvious reasons, this has helped my self-esteem, sense of self-worth, and general mood enormously.

For all of these reasons and more, after consideration, I chose to go off Abilify, which is the third drug in the cocktail I take.

The first point I want to make is that there are good reasons to try going off a med.  A major change in circumstance, as outlined above, is one of them.  Another is the inability to handle the side effects, or because it is causing other medical issues.

The main reason people seem to try going off their meds, though, is because they "feel better."  This is not a good reason to go off a med.  Chances are the reason you "feel better" is because the med is doing what it is supposed to be doing.  If feeling better does not come as part of an outside change or a breakthrough in therapy and world-view, the last thing you want to do is to try going off a med.

Let's say, though, that you have a good reason for trying to go off.  The first thing that needs to happen is a discussion with your prescribing doctor.  None of these medications are ones you want to stop cold turkey.  You need to create a plan for going off the medication, and your doctor needs to be a part of helping create that plan.  Certain anti-depressants can cause issues as serious as brain damage if withdrawn from improperly.

Additionally, you need to give your doctor the chance to say whether s/he feels it's a good idea that you go off the med.  You can agree to disagree, and insist, but you should at least hear your doctor out first, especially if s/he explains why s/he feels that way.

Finally, you need to monitor yourself very carefully when going off the med.  The minute you start to notice signs of depression, you need to be talking to your doctor again.  The solution might NOT be that you have to get back on the med, but then again, it might be.  And you have to be willing to acknowledge that possibility.

Taking myself off the Abilify has gone very successfully, but a) I'm in a stressful, but good place in my life right now, b) I talked with my doctor about it, and c) I was on 5 milligrams of it, as opposed to the thirty of Lexapro I take and the two hundred of Welbutrin, both of which I have no illusions that I can wean myself off.

I wouldn't want to discourage anyone from getting of a med if it's possible for him or her, but I would urge everyone who's on them to be incredibly careful in making that decision.

The Head Shrinker: Finding the Right Therapist, When and How

This may be the most true thing I say in this blog, ever: finding the right therapist is a gigantic pain in the ass, and it sucks.  However, while I've known a few remitting-relapsing depressives who are ridiculously high-functioning and who didn't feel the need for therapy, most depressives need it.

Truly, I feel like MOST people could use at least a little therapy.  It helps with self-awareness, which in turn aids how we treat and deal with other people.  But depressives?  Definitely.

As such, a few rules for finding the right therapist:

1. Do it when you're not depressed.  This is huge.  And not always possible.  But IF it is, if you can start looking at a time when you have the mental resources and the drive to do so, do it.  When you're depressed there's almost no way you will find the energy to try different therapists out, find one who actually clicks.  Not to mention, figuring out sliding scales, insurance, and other such issues when depressed can be near to/completely impossible.

A sub-rule to this is: Don't quit because you're "feeling better."  You're not going to magically decide you feel up to going back when you hit another depressive episode and don't want to get out of bed in the morning.  Therapy needs to be established as a regular thing in good periods, so that it carries out through bad periods.

2.  Look for professionalism.  Yes, this seems obvious, but let me tell you: not so much.  For one thing, the top two reasons therapists of all ilk lose their licenses are either breaking confidences or, yup, that oldie but goodie, sleeping with their patients.  Get recommendations, find out what reputation the doctor you are looking at has.  If you have the slightest inkling something is wrong, get out.

Small story:  I once had a therapist who fell asleep in a session.  I gave him the benefit of the doubt.  Everyone has a bad day, right?  Then he did it a second time.  I never returned.  Professionalism in therapy means that person is paying complete attention to you.  Make sure you feel that way.  If you don't, move on.

3.  Your therapist should be friendly, but not your friend.  Yes, you should be able to call your therapist in an emergency.  She should not, however, be the first person you think about calling no matter what happens.  What is more, she's not there to just support your feelings.  If you're being out of line or doing something stupid?  You want her to call you on that.  You WANT her to be that objective third-person view on your life, because without that, there's no way for YOU to learn things from her, and in turn, from yourself.

A corollary to this: your therapist should be able to say, "Hey, you need to put yourself in the hospital," and to press the issue if she feels it is necessary.

4.  There are a billion and five kinds of therapy, find the one that's going to work for you.  Talk therapy not working?  Have you tried art therapy?  Music therapy?  Cognitive behavioral therapy?  Those are the three that pop up right off the top of my head.  Any quality therapist, if you say, "Hey, I don't feel like I'm getting anywhere," will either, a) suggest a different tack to take, or b) suggest a different kind of therapy.  Listen and try new things.  You never know when you're going to hit that right one.

5.  If you feel like there are things you can't tell your therapist, you've got the wrong therapist.  I'm dead serious.  If you can't talk about that sex dream you had that's freaking you out, or something traumatic from your past, or your "guilty pleasures" with your therapist?  Find a new one.  A therapist can't help without seeing the things nobody else gets to.  That's the whole POINT of a therapist.  Feeling like you've got to hold back means you're holding yourself back from whatever your therapy goals are.  (And any decent therapist will create goals with you at the outset.  They don't have to be quantifiable, but they will be present.)

And this is huge: if at ANY point, you tell your therapist something and feel judged?  Run, don't walk.  A therapist's job is to take you as you are and help you to be the happiest and most comfortable you can be.  Tell your therapist you look at members of the same gender in a sexy way and they suggest religion?  Get the hell out.  Tell your therapist all you can do when you're at your worst is cry and watch football and they tell you you need more productive hobbies?  Pedal to the metal, my friend.  Yes, as I said above, it is a therapist's job to tell you when you might need to look at something differently, or interact with someone in a different fashion, etc.  It is NEVER their right to judge you, and if that happens?  Guess what?  You've got the wrong therapist.  Get thee a new one, anon.

Sparkle Motion, or, Just Keep Swimming: Exercise and Depression

With the exception of exercise addicts, nobody gets up in the morning and thinks, "Man, I can't wait to hit the gym."  Depressives even less so than the average person.  Which is why movement, any kind of movement, is pretty vital when it comes to handling depression.  Well, at least for me, and for a significant number of the other persons who suffer from depression I know.

Personally, I have three days to not do any kind of movement before I turn into a raging nutball.  Hormonal imbalance has nothing on three days of absolutely no working out for me.

That said, I'm too impatient and fidgety personality-wise to always do the same kind of workout.  In general, I think a lot of people need variety in their workout schedule.  If you're someone with depression, and you live in a cold place, if you can afford it, joining a gym with a wide variety of options is probably the best investment you can make in your mental health, aside from a therapist and possibly medication.

My personal workout schedule goes something like this:

Monday:  Usually swimming.  Aside from being a lot more gentle on a body that's seen its fair share of damage, swimming forces my mind to count.  Counting helps my brain slow down.  Swimming is generally a good alternative to meditation for people like me, who aren't great at consciously working to shut our brains down.  As such, swimming has a number of benefits: it's strengthening, it builds breath capacity, it's meditative, and it's exhausting, and almost always guarantees a good night's sleep for me.

Tuesday:  This usually becomes my abs-day.  Having some workout equipment at home, even if it's just a jump rope, or an exercise ball, is, in general, a good plan.  I keep both of those things, as well as an ab roller, and a hula hoop.  The hula hoop is great, because it works my abs while I zone out to an episode of Agents of Shield, or something like that, most weeks.  It allows my brain some free time, while my body works off some of the worst of my tension.

Wednesday:  I usually go walk with my sister in the winter.  In the warm months, my walks are outside, and I much prefer that, but since I can't walk outside for a significant portion of the year here, having my sister available to go pass the time on the treadmill is super helpful.  In general, if you can find a gym-buddy, it will help you to get to the gym, not only as a way to hang out, but because you're not the only person who knows you're supposed to go.  Sometimes peer pressure is a great thing.

Thursday:  Again, in the warm months, this is usually my bike ride day.  The bike KILLS me, but it's also pretty sweet, having that wind in my face, and it's a great all-over workout.  In the cold months, this might be another gym day.  About a year ago, when I was in taekwondo full time, Thursday was a tkd day.  If something programmatic like that appeals to you, that's another great option, because a) you're paying for it, and want to get the service, and b) people expect you to show up.  Also, forms are very meditative, it's a great way to slow down your brain.

Friday:  In the evenings, I go swing dancing.  Dance lessons/social dances provide fantastic cardio and when you're following, there's the plus of just letting go, of going where your lead takes you, which is meditative in its own way, as is following the beat of the music.  If you have a dance studio near you, the money to take a class, and any interest, I highly recommend this.  Not only is it good for you on several levels, it gets you out among people, which is another helpful aspect of it.

Saturday:  In the warm months I do long walks or bike rides early in the morning with Team & Training, which is an outfit that trains for endurance events.  I try to do one endurance event per year, at least.  Long-term goals, and just a little bit of that peer pressure I mentioned, help me to get through the every-day types of trainings, it might or not for you.   But any of the above options are good ones for Saturdays.

Sunday is my rest day.  You SHOULD have a rest day.  Two isn't the worst idea, either.  Your body needs the down time.  It's just that it really, really needs the activity as well.  Trust me, at first it might suck, but sooner or later you will start to realize that the irritability that comes along with depression is worse when you haven't done something in a while.  And it can be as little as jump roping for ten minutes, taking your dog for a walk around the block, or doing some yoga stretches.  Everyone's needs are different.

Our bodies, though, especially the bodies of depressed persons, need that activity.  And for the most part, our minds are perfectly willing to enact revenge when it's not engaged in.  Do your best to get up, and disallow at least that much of your mind's trickery.  Or, if it's a friend or family member struggling, be that friend who goes to the gym with her, comes over to do a workout, takes a walk, takes a dance class with her, whatever gets your loved one moving, be the person to make sure that happens.

It's Not a Happy Pill, It's an Anti-Depressant

In 2007, I went on anti-depressants.  This is notable, because I was diagnosed as needing to be on medication in 1999.

Why the eight-year hesitation?  A few things:

1.  Anti-depressants have a HUGE stigma to them.  The term "happy pills" in an of itself is an issue, it suggests that people who need--not want, NEED--to be on these kinds of medications are in fact just looking for an easy out.  It's as if we're somehow just going to our doctor instead of down the street to score some illegal substance that makes us feel better for a few hours.

To illustrate, here is a comment once directed at me by a family member.  A family member, who, by the way, is nominally in the health industry:  "Yeah, anti-depressants are great in the wake of, say, a tragedy.  I took some [when my father died] and they helped me to get through it.  But you can't live your life on a pill just to make everything easier."

In other words: stop being weak.  The rest of us are just fine without pills to help us get through the day.

2.  Anti-depressants come with side-effects.  One of the most common is significant weight gain, which isn't fun for anyone, but for a woman--and, in my case, a woman who already has societally-induced body dysmorphia--that can be devastating.

On one of them, I stopped sleeping.  On another, I was so nauseated that even basic toast wanted to come back up.

Additionally, they can have counter-indications.  I was on Prozac long enough that it started CAUSING suicidal ideation, rather than alleviating it.  They also cause long-term liver damage, which means they essentially shorten the lifespan of almost anyone on them.

To sum up: they are not fun and are terrible on your body.

3.  For me, I was terrified.  What if I went on them and they didn't work, and this was what life was like for the rest of it, a very possible seventy or more years?  More importantly, what if I went on them and they didn't work because there was nothing wrong with me other than being lazy and pessimistic and a bad person?

In the end, though, I had to try.  Because, honestly, things couldn't get worse, and the hope, however small, that they might get better was impossible to turn away from.  My medication history has been full of ups and downs.  It took several tries to find the right medication the first time, but I will never, not if I live to one million and three, forget the feeling I had when the right one--Lexapro, at that time--kicked in.

It wasn't sudden, it was slow, but there was one day when I got home from work and the gym, and wanted to do something that wasn't sleep.  I had the feeling tomorrow might be a pretty good day.  I felt like ticking a few things off my to-do list.  And I thought, "Huh, look at that.  There's a person in there."

And then I cried.  Because for the first time since I could remember, I could feel something that wasn't soul-numbing hopelessness.  Even if it was sadness that I'd waited so long to go on the meds, it was real, an emotion, not just a blanket of brain chemical malfunction.  And, as it turned out, when on meds that work, I'm actually pretty chill about a lot of things, even things that objectively suck.

Now, let me be clear: when I am on anti-depressants that work, not everything is easy.  Life is still life.  It is still stressful, and I still have to accept that I am not going to get a lot of things I want or wish for.  People can still be hurtful, and loss still occurs.

The difference is, my brain's default reaction to all of this is not, "What's the point?  Why should I bother with this anymore?" or, at the worst, "Everything and everyone would be so much better off if I just sat down with a bottle of pills and disappeared."

That's not a happy pill.  I've never taken any hardcore street drugs, but from what I have been told by people who have, it's a COMPLETELY different sensation.  What's more, it's ephemeral.  You come down from it.

Anti-depressants don't cause happiness.  They cause the brain to work the way it's supposed to.

Here's the truth: being on anti-depressants is a pain in the ass.  Forget all the stuff I mentioned above, okay?  Your body gets used to them.  And you slip back into depression.  And sometimes the best they can manage is to keep you from living in a haze of suicidal ideation.  Sometimes it takes years to find the right combo, because just having that much help makes it feel like they're working.  And, to some extent they are.

I have changed meds seven times since 2007.  Every time is a gamble.  And for years at a time, I have been willing to accept, "not actively suicidal" as "meds are working."

I'm lucky right now.  I'm on the one-two-three punch of Welbutrin, Lexapro, and Abilify and it WORKS.  It works in the way where, when I have free time, I actually want to read or write or watch some television, instead of sleep.  It works where I can do things like plan ahead: go to the grocery store with an actual list, and come home and make meals for the week.  It sounds simple.  It's not.  It's the difference between a life that is just made up of days of forcing myself out of bed and to do every little thing that has to be done until I can get back in bed, and days where my life is actually happening, and I'm an active participant in it.  And because they actually work, instead of just providing base-stabilization, it's the first time since 2011, which was the last time I was on a combo that fully worked, that I can remember who I'm like as a person underneath the depression.

Right now, my insurance is refusing to support the Abilify, which means I'm going to have to appeal and try and figure out another way if they still refuse, since it is $830/month, which is, you know, outside my ability to afford.  I'm still underemployed, and still have been for over two years.  My rabbit has an ear infection that will not go away, and my dog vomited directly where I sleep on my bed while I was dancing Friday night.  And you know what?  It's all okay.  I'll find a way to afford the drug, because I need it, and I have always figured out ways before.  My rabbit is almost nine years old and this is her first ear infection, which is a near miracle.  The puking forced me to clean my mattress, which really needed it.  And I'm in the process of interviewing for a job I might get.  If I don't, well, back to the drawing board.

I cannot emphasize enough: these drugs aren't happy pills.  They do not blind me to the things that I'd rather NOT happen in my life.  They don't give me moments of ecstasy.  They allow me to COPE and to live my life without the constant specter of suicide.

If you or someone you know is avoiding medication because of stigma or fear, I cannot stress enough that neither of those are good enough reasons to continue being miserable.  Please, please try, or get them to try, talking to a prescribing doctor.  Maybe meds aren't for you.  But maybe they are.  And maybe underneath how terrible everything is, there's a person, screaming that zie just needs a little help, just a shove in the right direction.  Get yourself, or try to help the person you love get that shove.

"It's like...": Talking About Depression Through Similes and Metaphors

As someone who was on Prozac for two years, the thing I still think of immediately upon hearing the word is the commercials they used to have, with a cartoon person under a cloud that followed her around.  I remember thinking, "Yeah...no, it's not like that."

It's not that the single-person-rain cloud is a terrible metaphor, but it's really not a great one, either.  For one thing, we use that particular metaphor to refer to people who bring drama or other things we don't like to a situation, regardless of whether that person is actually mentally ill.  It's specificity, therefore, leaves much to be desired, and  more than that, it lumps those of us who are actively fighting against that "cloud" with persons who embrace it.  Another thing is, while we all might find Pigpen from "Peanuts" cute, we also all think he could go and find himself a bar of soap and some water.  In other words, when we see artistic representations where only one person is being affected by something, we tend to put the onus of dealing with it on that person without much consideration for what that means.

Obviously, metaphors and similes are contextual.  Not every one is going to apply in every situation.  But, here are a few solid and decently transferable ones.

1.  The broken arm:  I cannot take credit for this one, it comes from a friend whose brother is on the Autism spectrum.  Hir mom once told hir that if hir brother had a broken arm, nobody would expect him to pitch a baseball game with that arm.  But because nobody could SEE the Autism out front, people often expected life skills of him that were the equivalent of asking a kid in a cast to pitch that ball.

Depression is the same way.  No, you can't see it.  That doesn't make it less real than a broken arm and it certainly does not make it less debilitating or limiting.  Some people with depression CAN do everything persons without can.  Others cannot, plain and simple.  And even the ones who can?  Are struggling at least ten times as much as a person with normal brain chemistry to complete the same exact task.

2:  The minefield:  Also not mine.  I wish I could remember who I picked this up from.  Living with depression is like walking through a minefield every day, except that only the person with depression knows there are mines.  She spends all day avoiding them, and if she gets to the other side of the field, everybody acts like it's not a big deal, no accomplishment, nothing to give her a shoulder squeeze about and say, "Hey, well done."

HOWEVER, if she accidentally trigger one of those mines, it's huge and ugly, there's a good chance others get hurt and everyone blames her.  She didn't actually SET the mines, she just couldn't avoid one.  Whether she couldn't see it, or it wasn't possible to jump over, or whatever, the triggering was not intentional.  But she gets in trouble for it, all the same, when every other day, hurtling and running and desperately trying to cross that damn field, everyone takes her actions for granted.

3.  The monster:  This one is mine.  Every day I get up and I'm being attacked--think of this in physical terms.  The attacker is up to the person creating the metaphor.  Mine is amorphous and monstrous.

But I'm being attacked.  And I'm struggling against my attacker, throwing kicks and punches, screaming for help, trying all kinds of things, waving my hands.  It's not just that nobody hears me--although many people don't--it's that people hear and walk by anyway.  In my head, I'm always on a busy street, and people know what's happening, but they still walk on by.

The thing is, at the end of every day, the monster resolves itself into me.  Because, as one of my friend with depression once said, "The problem is, my brain is trying to kill me."

I agree, to a certain extent.  But really, my brain is trying to do the maximum amount of harm UNTIL it can kill me.  Which means that, yes, the monster I'm fighting?  Me, and only me.

This is a short post, because I don't want to muddle this issue, it's too important.  Verbal and visual representation of mental illness in a positive way is sorely lacking, and if I can inject just a little bit of it into the common rhetoric, I will be pleased.

To sum up: things to avoid are more broad metaphors and similes--pick something specific, like a broken arm, like a physical attack, a minefield.  Avoid metaphors and similes that are used for sadness, because sadness is different.  Use descriptive terms and EXPLAIN why the two are good comparisons.

And please, if anyone has other good metaphors/similes, leave them in the comments.

ETA:  A comment was left with the World Health Organization's video on depression.  This metaphor did not work for me, because it needed a LOT of narrative explanation, which I try to avoid, and because it's based on a dog, which is something I have positive associations with.  That said, it might work for others, so I am glad to have the resource.  Thanks, Jay!

The Honey-Do List: or, some basic DOs

I apologize for this being a week late.  My sister was doing her first half-Iron distance triathalon last week, and for those of you who aren't familiar, spectating that kind of event is an endurance test in and of itself.

In any case, as promised, the flip-side of my last blog post: or, what TO do as the friend/family member of someone suffering from severe clinical depression.  Sticking to the five number format, since it worked well last time and I like symmetry.

5.  Take care of yourself.  I'm willing to bet this seems self-evident, but only from the outside looking in.  It is incredibly easy to lose sight of self-care when being a support system for someone who is spiraling.  Self-care is a lot of things.  It is eating right, it is sleeping enough, it is physical activity, but most significantly, in this situation, it is the ability to say no, to look to others for help.

I had two friends once, and one was a depressive.  She was a self-harmer, and I'm pretty sure she had borderline personality disorder.  The other friend was someone who had never really dealt with self-harm and the threatened potential of something worse.  Both women were young at the time, and the support-friend got to the point where she was the ONLY support for the self-harming friend.

Support-friend wasn't sleeping enough, was very worn down and at one point, I asked, "When Other Friend asks you to come over or if she can stay with you, do you feel like you can say no?"

And after a long moment, she shook her head, "No."

Trying to get help while depressed is hard.  It sucks.  It often doesn't work quickly, so it seems like all the effort was pointless.  If you allow yourself to become the sole support system for someone who is depressed, that person may very well take advantage (knowingly or unknowingly) and use your support until YOU are the one whose health is suffering.

Learn to say, "No, I cannot help you right now," and to put yourself first.  Realistically, unless you are taking care of yourself, making sure that you are steady and grounded, you're not able to help us anyway, you're just creating an enabling loop.

4.  Encourage us to get help and to KEEP AT the things that are helpful.  This, obviously, ties in with the last one.  Here's the thing about depression: when we're in a depression cycle, we have neither the energy nor the mental strength to seek out aid on our own.  We don't believe it will help.  Many of us have been and been and been to professionals to no real advancement or change.

We still need it.  Not only because professionals are the best suited to know when we need to be put in a hospital and make that choice dispassionately, but because they are paid to take care of us, and therefore are an essential part of the support system.

When we're doing well, we often tell ourselves (and others), "Oh, I don't need that right now."

When we're doing well is EXACTLY when we need to be working on it.  It's when we have the best ability to do so.  Chances are, though, that we won't unless encouraged.

What's more is, we probably won't stick with it unless we see support from our friends and family.  Asking a person who is depressed what she's getting out of her therapy sessions?  An absolute no.  Saying, "Hey, I really think you're doing better at __________ since you've been in therapy,"?  Go for it.

This is the same (maybe even more so) for meds.  A lot of people seem to think psych meds are the same as say, cold meds, where once you start feeling better, you can get off of them and your body will take care of the rest.  That's not how it works.  These meds are more like something you would take for an auto-immune condition, or something else chronic.

A lot of people DO get off their meds when they start feeling better and then spiral back because the improvement stemmed from the meds fixing the problem.  Psych meds are often a lifelong deal for people with depression.  Being meds positive is a HUGE help, since there's already a stigma on mental illness and using meds for them.  Not to mention, every one of these meds comes with a barrel of possible side effects and the probability of long-term liver or kidney damage.

I avoided meds for SEVEN YEARS for lots of reasons, but definitely among them was the idea that taking them made me weak, that "now we just prescribe a pill for everything" and I didn't really need them.  I needed them.  I still need them.  And I still hate that I need them.  The last thing I need is people making me feel like I'm weak/stupid/bad for taking them.

Finally, we also need to be encouraged to build up community.  Whether this is through support groups, or hobbies where we meet other people, the more community we have, the more help YOU have when things get bad.  Community is essential.  If there's a way to help us create some, even if it's just having a few dinner parties and trying to introduce us to people you think might make good friends?  In the long run, that's going to be better for everyone involved.  You will have people to turn to for support and support for us can be diffused among a larger group of persons.

3.  Aid in good habits.  This is a little like four, but slightly different in that this is talking day-to-day behaviors.  So, for example, depression tends to breed a lot of "side effect" conditions, such as eating disorders, insomnia, agoraphobia, etc.

For example, let's say your friend's problem is agoraphobia, in the sense that she refuses to leave her hosue.  Create a standing "date night." This is important: be the one to drive, to pick the place and be ready to have to do the work of basically dragging her with you over protests. But do it.  Make sure she gets out of the house, even if it's only for an hour.

If the problem is compulsive overeating?  Do activities that don't involve food or at least involve healthy foods.

Help us to live in clean and safe environments.  Maybe this means coming over on a Saturday and making us sort out our closets with you, if you're good at that kind of thing.  Maybe this means helping us to find a cleaning company, if financially viable.

Get us to exercise.  Physical movement helps with the depression, even if we don't want to do it.  If the weather's nice, get us to take a walk around our neighborhood.  Or maybe find a yoga workout online that can be done inside, together.  Just something to get our blood flowing.

Like I said last week, do not do these things FOR us, do them WITH us.  And if you cannot get us to leave our house/help with tiny things/etc.?  Call our doctor.  Let a professional handle the situation.

2.  Listen.  Listening is hard.  It's hard to just take in a flood of "I hate my life," and not try to help, not try to make us see where there's a flaw in our "logic," but here's the thing: you can't help, not in the big picture of actually clearing up the depression, and our logic is flawed because our brain is misfiring.  No amount of arguing is going to change that.  Chances are we KNOW our logic is flawed and it doesn't matter, because we cannot emotionally feel that.

There's a comic of one person having a panic attack, and another person says, "Calm down," and then the person panicking says, "It worked!"  When put into stark relief that way, we can all see how ridiculous a comment like that is, when someone's brain is telling her to panic.  It's the same with depression.  You can tell us to "cheer up," or "think positively," or that the "past does not define the future," or that "hope exists," and you're basically just talking to yourself.  And probably making us feel like you weren't listening or you are dismissing the way we feel.

But listening to us, listening and just saying, "man, that sucks," or, "can I hug you?" or "I'm here," any of those things, it may not make it BETTER for us, but it doesn't make it worse and it does remind us that there is someone out there who cares enough to just let us be who we are, mental illness and all.

It's not fun for the person listening, believe me, I get it, I've been that person more than once.  And it feels helpless and sometimes really eye-rolly.  But to the person to whom you're listening?  It feels like, for once, someone is actually HEARING us, and we don't get a lot of that.

1.  Be persistent/annoying.  My best friend texts me every day.  Every single one.  Without fail.   And most of the time I'm kind of like "yeah, I'm here, yeah."  But on those days where I'm holding onto things with broken fingernails and the skin of my teeth?  That grounding moment is huge.  It says, "Hey, there's someone out there who would be really upset if you did what you want to do right now."

Bug us.  Sometimes, we're probably going to be dicks about it, wanting to be left alone to ruminate, let the depression marinate.  It is very seductive in that manner.  Be that third wheel.  Disrupt our date, bring pizza we didn't ask for, and a board game.

Try to do it in a way the person in question handles well.  I'm best at text and email, so that's what most of my friends do.  They'll call in a pinch, but I don't like being on the phone, so they try and avoid that.  Other people like that voice connection, or, if you're near, maybe they'd sometimes prefer actual face to face.  You have to determine what works best for you and your loved one.

I recently saw an article about how people disappear in times of grieving to "give the mourner space."  Except that, in most cases, what the mourner needs most is a community of support, rather than "space."  Depressives are the same way.  We put off vibes that we want to be left alone, and maybe some of us even really do, but we shouldn't be.  We need to have people showing they care, making sure we're responsive, and generally just pecking at us until our brain lets up and we settle into a remission phase.

Some Basic Don'ts

I know, I'm supposed to balance the Dont's with the Dos.  But, a) Don'ts with depression are easier, and more universal, and b) relax, next week's edition is on the Dos.  I've got to maintain a little mystery, right?  Keep you coming back for more?  Or something.

Again, I really cannot speak for all persons with depression.  This is more about me and all the people I've known with the condition than the world at large.  But pronouns are tricky and not always as varied as I might desire.

I am going to do five of these, since that's a nice, round number.

5.  Do not take it personally if I don't seem terribly present.

As I've talked about in this note, depressives are taught early--and later internalize--that our tendency to be "sad" means we are self-involved.  This often creates a defense mechanism which turns us into people who automatically de-prioritize ourselves.  As such, when we are at all, even just a little bit able to be, chances are we're going to be the best person in your life for listening, empathizing, and trying to support you.

If you notice we've stopped really paying attention, say, we're nodding our heads but not responding the way we normally might, chances are a few things are happening.  Depression robs people of the ability to concentrate.  It might be taking us all our energy just to focus.  It's also possible that we don't have the energy to care at that time.  This is NOT personal.  It's not even close to personal.

We have stopped caring about OURSELVES.  We have stopped caring about everything that previously made us happy.  In my case, when I get to this point, if I COULD care about anything, it would be what's going on with my friends and family.  But I'm so far beyond that, it's generally all I can manage just to be physically listening/hearing.

You don't have to stop talking.  Just be compassionate if the response you usually get is unavailable.  And don't get mad because we can't be the person you need right at that moment.  At least in my case, I'm trying as hard as my little heart can manage.  Also, getting mad isn't going to get you what you need or want.  In my case, it's going to mean I withdraw emotionally from you long term, because I have learned you have no ability to consider my emotions, and because the last thing I have the ability to do at that moment is say, "Hey, I need you to realize I'm having a hard time right now and that doesn't mean I don't care about you."

4.  Do not let us disappear.

This is a hard one.  Especially if the depressive you know and are trying to be there for is an introvert.  Because that person NEEDS time alone to even have a chance of functioning in the rest of her life.

If the person is an extrovert, don't mess around: make sure that person is going out with you, even if you have to provide rides, or set up hanging out at her house with some friends.  This latter is a good way to handle an introvert if you cannot get her to come out: take food to her place.  It allows her the safety of her surroundings, and means that she's eating.  Depression can cause emotional over-eating, but it can also cause a complete lack of interest in food, ESPECIALLY if it has to be made.

I am someone who's really awesomesauce at making myself eat when depressed and last night I had a bowl of cereal and an apple for dinner because I couldn't rustle up the mental energy to actually figure out a meal plan and enact it.

A sub-tip to number four is, if you get to her house and basic things, such as taking out the trash, laundry, etc., need to be done, help.  DO NOT do it for her.  Unless you physically cannot drag her out of bed--in which case, call someone stronger than you, put her in your car, and take her to the nearest hospital--have her participate in some way.  It can be small.  You can have her sit down and sort the laundry.  Or walk with you to the curb with the trash cans.  Anything.  But force her to take part in her own life.  I am not saying this is easy.  She might be a total crab-ass at you.  Or say terrible things.  Or cry hysterically.

Get her some water or Gatorade, and make her participate in her own life anyway.

At the VERY least, call or text and check in with her.  Suicide happens, in my experience, when people reach a crucial clusterfuck nebula of two points: the sense that things are hopeless, cannot get better, and things will always be this terrible and painful, and that the world, even the people in it who love us, is better off without us, and things will be easier for everyone that way.

This is possibly the most important point of this post: nobody can stop another person from committing suicide.  At the end of the day, it is the person who takes that step's choice.  That said, letting a person know you care day in and day out, even if it's just by saying "hi, thinking of you," can go a long way toward slowing or even halting the cycle of "nobody needs me" thoughts.

If you can--and being the friend to someone suffering from depression is grueling, so if this means too much mental and emotional energy on your part, just don't--occasionally find a reason WHY you care about that person to mention.  It doesn't have to be epic.

A friend recently told me she needs me to hang on because she learns things from me.  That's an A++ reason.  Any reason that's real will help.  It won't FIX anything, but it will help.

3.  Do not expect miracles from medication and therapy.

Speaking of fixing...

In some people, these steps do cause miracles.  And if that happens to someone you love, be thankful, because miracles are rare and precious.  But if what you get out of that person is instead two days out of the week that are better than they were before?  Or the ability to communicate frustration where she could not before?  Take that and run.  And be proud when those moments happen.  Let the person KNOW you are proud, not only for the progress, but for being willing to get help, to try different things, when, frankly, it's one of the hardest things.

On Thursday, I went to my prescribing doc.  He really wishes I would go to the hospital, because I have hit the space where I genuinely have no capacity to believe life will get better than it is right now, and I have no interest in continuing on in this space.  Or, as I said to my therapist when she asked me if I planned on doing another triathalon, "The thought of being alive long enough to do that is depressing."

I won't go to the hospital because I cannot afford it, either financially or time-wise, and because all it would mean is a bigger mess when I come out the other side.  Additionally, I have a bunny who just got an ear infection, and I'm the only person who can take care of her the way she needs.  My bunnies are actually my last line of defense.  I remind myself regularly that nobody is going to take an almost nine year old and almost seven year old bunny and really pay attention to them and love them if I'm not around.

So, instead, my doc doubled my dosage.  If this doesn't work, the next step is putting me on a THIRD anti-depressant, co-currently.  Being honest, I sincerely doubt any of this will even take the edge off.  Changing meds hasn't worked the last two times we've done it.  I don't think it will now.  I don't think going to therapy is doing anything, because I've reached the point where there's nothing more to say: something I straight up told my therapist this week.  And that's the disease.  It tells me, in no unclear manner, that nothing I do will help, that things will always be like this.

And I believe it, because I have no other choice.  But I go to therapy and doctors because I know its the right thing to do.  If you know a depressive who constantly goes and does the work, at her worst, she's not doing it because she believes it will change anything.  She's doing it because she's supposed to.  Hug her and tell her she's doing a great job and you're proud of her for keeping it up, even when it seems hopeless.   Because, trust me: it does.

2.  Do not let us go silent.

This is another hard one.  For me, talking, really talking, when I'm like this, is a chore.  I'm tired of hearing my own voice in my head.  I don't have anything new to say.  I don't want to pretend to be happy.  Silence is my best option.

Which is why, once a week or so, it's important that someone find a way to get me to talk, even if I am saying the exact same thing.  Things haven't gotten better for me in two years.  They're unlikely to anytime in the foreseeable future.  I'm not going to have a lot that's new and interesting to say.

Ask leading questions and listen anyway.

It's like this: I may be tired of hearing my voice in my head, but that's not going to shut it up.  And a lot of the poisonous shit it says?  Is just plain better getting released.  When someone overdoses, we pump her stomach, because "better out than in."  Depression is the experience of constantly overdosing on hopelessness without any affirmative action on one's own part.  Someone's gotta go in and make us bring it all up every once in a while, because just like the drugs, if not as immediately, it will kill us.

1.  Do not, do not, do NOT, EVER, say the words "things could be worse," or "just cheer up," or any variation thereof.

I actually get that for some people this helps.  Those people are not chemical depressives.

Have you ever broken a limb, or had a bad flu, or cut yourself deep enough to need stitches?  Out of curiosity, did thinking positive thoughts about getting better hasten your healing process?  Because, if it did, you might have either mutant or angelic powers, and you should consider a career in televangelism, or something.

I can think all the positive thoughts I want.  Realistic ones, even.  Ones like, "I write well and research like a boss and have a really interesting professional and academic background: someone has to hire me sooner or later."  Or, "Lots of people meet life partners much later in life, things are just taking their time."  I can repeat them in front of the mirror every morning.  I can use them as a meditation, whatever.  My BRAIN does not believe them.  Because my brain does not function correctly.  Much like a broken arm, the essential function of my brain is in a state of disrepair and works on a basis of limited functionality.  The difference is, fixing a broken arm is a decently exact science at this time.  Fixing my brain?  Not so much.

As far as the "things could be worse" approach, let me quote something I saw on tumblr, the font of all true wisdom.  (That is a lie.)

"In breaking news, the person in the worst situation on planet earth was finally found and THAT person is allowed to be sad.  No sads for anyone else, though, ever."

Like I said, I realize that for non-clinical depressives, this sometimes helps.  I've met people who find it useful to think about the fact that they could, say, not have a home, or be going hungry, or be physically ill.  And I envy the crap out of those people.  Man, if I could make myself better by thinking about all the things that could be worse?  I'd be the world's happiest chickadee.

For a moment, though, let's take it for granted that I don't actually want to be so miserable all the time that I would rather be dead.  And from there, let's take the logical step that if it were that easy for me to feel better, I'd have already fixed the problem.  I talk in this note about how, not only is using this approach unhelpful, it's DANGEROUS.  It tends to cause a guilty reaction, which will not only make me stop talking--see point number two, this is NOT a good thing, it doesn't mean I feel better, it means I've been made to feel like my pain does not matter--but will stay with me, and very possibly trigger a cycle of even worse feelings of worthlessness than are usually an issue.

A sub-suggestion here is, "things will get better"?  Also not helpful.  I cannot convince myself of this.  You telling me it?  Feels dismissive, even if it is not intended to be.  And again, it makes me feel foolish for not being able to make my brain believe it, makes me feel like I should stop talking, like I should go away.  Away away.

So what DO you say to a person who's depressed?  *grins slyly*  Come back next week, mes amis.