When I woke up on the morning of Jan. 15, 2011, I felt like someone had beaten my head with a pipe overnight.
Either that, or they had driven a nail into my skull about two inches up from my hairline on the centre line – then wiggled it to maximize the pain. I initially thought I had a concussion.
This is what I consider to be the kickoff point of a battle with severe depression that continues to this day.
I’m writing this as an act of therapy for myself, to inform others and to provide some resources for help. I don’t think people who haven’t experienced severe depression know what’s going on in the life of the afflicted person, so consider this a primer.
Parts of this will be scary, so be forewarned. With that caveat, here’s much of my story.
The storm hits
One analogy I’ve used to describe severe depression is that it’s like a thunderstorm going on inside your head.
My brain was being buffeted by forces I could feel but not understand, and it was affecting my whole body. I was whimpering, wobbling and largely drained of energy. I could function at a basic life-support level, but that was about it.
I called in sick on Monday, Jan. 17. I tried to do things that day. I tried to read one technical document but the words were a blur and I couldn’t understand anything. This really alarmed me.
On Tuesday, Jan. 18, I went to see my family doctor.
It’s worth noting that I’ve had the same doctor since I moved to Toronto in 2000. As a result, I was dealing with someone who knows me, my contemporary medical history and who has seen me in a mentally healthy state.
The upshot was he wanted me to take a week or two off.
I told my senior producer at CTVNews.ca that I was in no shape to work. I thought maybe I’d be back by Jan. 31, as a planning guess. Wrongo.
Things continued to slide, but my notes indicate that on Sunday, Jan. 23, I felt relatively normal. That didn’t last long.
On Tuesday, Jan. 25, I went to St. Lawrence Market. I felt lousy. How lousy? One alarmed individual asked me, “Are you okay?!?!” My grim reply? “No. No I’m not.”
The next day, I was back at the doctor’s office.
Now, to meet a diagnosis for severe depression (aka clinical depression, aka major depressive disorder), you need to have experienced five of the following nine criteria for at least two weeks:
This is taken from PsychCentral.com:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
I believe I batted eight out of nine. I told CTV any return was pushed back until at least Feb. 7.
So I’ve been diagnosed. But here’s a little-known fact: You can still have brief periods of relative normality within the depression.
I phoned a good friend in Saskatchewan who’s had his own battles with depression and told him the news.
“My doctor told me today that I have severe depression, but as I’m talking to you, I don’t feel all that depressed.”
His answer? “Well, you don’t, not all the time.”
The crashes and other bad things
To give you an example, a few times in the early going, I woke up, felt not bad, and thought to myself, “Maybe today’s going to be a good day.”
Then the crash would come.
What’s a crash?
The way I’ve described one to people is that it’s the best preview you’ll likely get of the very last moments of your life. You know you’re about to die, but you aren’t angry or scared or filled with regrets. In fact, you don’t feel anything at all. In some cases, you may even be welcoming death’s embrace.
Crashes could last for hours. If you were to peek in my bedroom during one, you would have seen someone who appeared to be in a conscious coma. My eyes would be open, but I couldn’t move my limbs, and I didn’t react to any stimuli. I just felt numb and lost.
The way I felt a crash coming on is the same plunging feeling you get when a roller coaster starts its descent. But this roller coaster ride would end with you being submerged underneath icy cold, black water – and you had no idea when you would emerge, if ever. Another dismaying fact is that you’d come to know what was about to happen, but you felt powerless to stop it.
Another example of how debilitating depression can be is this: Trying to shovel a bit of snow for even a few minutes would leave me exhausted and crying.
It’s worth noting that in some ways, I’m a relatively tough guy. I ripped my knee up with a chainsaw in 1985 while working in oilfield surveying back in my home province of Alberta. I walked out of the bush with my shirt tied around my knee before going to the hospital for 80 stitches. Lots of pain, but no tears then. Hit myself in the leg with a five-pound, razor-sharp logger sports axe in 1979 during a visit to the UBC forestry school. I was joking in the immediate aftermath and was pogoing to the B-52s that night on my stitched-up leg.
But, being unable to effectively shovel a few centimetres of snow left me standing on the street motionless, blubbering and feeling useless.
I was losing weight at the rate of five pounds per week. I wasn’t trying to diet.
Meds and exercise
Clearly I wasn’t pulling out of this on my own, so on Feb. 1, my doctor started me on a medication called Cymbalta.
It is known as a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI).
Serotonin is a neurotransmitter that affects mood. Norepinephrine affects energy level. The SNRI works by preventing neurons from absorbing those two neurotransmitters, thus boosting their concentration in the brain and easing depressive symptoms.
If you want a full-meal-deal explanation of how these medications work, I can highly recommend The 10 Best-Ever Depression Management Techniques, by Margaret Wehrenberg (more on this later. Here’s a PsychCentral.com review).
An SNRI* drug works almost stealthily. It takes between two and six weeks before you start feeling its benefits.
* SSRI drugs (Selective Serotin Reuptake Inhibitors) include brand name antidepressants such as Prozac and Zoloft.
But something else that undoubtedly helped was exercise.
A quote from the Wehrenberg book: “Exercise is probably the single-most effective depression-defeater you can do. It is the best way of overcoming lethargy – as long as you do it.”
It’s also a natural way to boost serotonin, helps fight stress and is just a good thing for the brain and the rest of your body.
I asked my doctor how seriously I should take working out while depressed. He told me this: “You should treat it as an absolute imperative.”
After that, I tried to go to the gym almost daily. Sometimes I couldn’t do very much, but I figured I’ll at least get on the elliptical trainer, even if it’s for five minutes.
Sometimes I had sags before working out. To conceptualize sags, think of a thunderbolt hitting my head, or a single thunderclap booming inside and then echoing. It’s enough to disrupt me for a short period of time. You could also think of it like a cellphone losing its signal or an invisible wave passing through one’s head.
There were times I would be motionless in the locker room for 10 minutes. I’d pull on my gym shoes, but couldn’t lace them up. I’d just sit with my elbows on my knees, my head in my hands and wait for the storm to pass. That was more like a mini-crash. But sags would be a constant part of my life in this period.
I morbidly kept track of them, and for months on end, I would experience about six to 12 sags per waking hour.
By mid-February, the meds started to kick in. I was telling a psychotherapist made available through my employer’s employee assistance plan that I could feel some of the old Bill bubbling up underneath.
Thoughts of death
Unfortunately, it wasn’t long before I would experience the first of two major episodes of suicidal ideation.
For background, I took the Wehrenberg book to the first group support meeting for depressives that I attended in mid-February. I displayed the book, and some attendees reacted like it was kryptonite. Seems they liked to talk about being depressed more than they liked to talk about how to recover.
However, the facilitator liked it, and she asked me to prepare a review. That task would normally take a few hours. I stretched the work over the next several weeks. I basically worked five to 10 minutes on, two hours off.
On March 22, I went to my second, and last, meeting. I tried to give a verbal summary of the report – and bombed. One guy cut loose with a loud yawn, and my head exploded.
The facilitator, different from the first, mildly suggested that the offending yawner didn’t mean it as an editorial statement, but I would have none of that. It didn’t make me feel any better when I saw him yawning at other people. In retrospect, he may have been just tired.
Unlike other times when I’ve felt put down in such a manner, when I woke up the next morning, I told myself the following: “All I do is bore people. I should just kill myself.”
Sound crazy to you? It is, but news flash: Depression is a mental illness. You aren’t thinking straight.
For example, if I perceive you as broadly hinting that my so-so book review is boring, my internal response is to think I should kill myself? That makes no sense.
Fleeting thoughts of death and killing myself were a constant companion, but for the most part, they weren’t serious. Think of them more as flies buzzing, with me mentally swatting them away. But when I filled out a questionnaire the first time I saw the psychotherapist, my response to the one about whether I had thoughts of killing myself was ‘most of the time.’
One statistic I’ve seen is that 3.4 per cent of those diagnosed with severe depression successfully commit suicide.
I never actually tried to harm myself. But streetcars scared me (oddly enough, not subways), and so did bridges over traffic. In the latter’s case, I just thought it would be so easy to step in front of a moving streetcar, and in the former, there was something terribly seductive above the combination of height and moving traffic (remember the roller coaster?).
About two weeks later, the bomb really dropped.
On April 3, I decided for whatever reason to Google “workplace depression.” One result was a link to a Globe and Mail article on two prominent suicides – MP David Batters and fired Toronto deejay Martin Streek.
The article didn’t bother me at the time. About five hours later, I decided to step out and catch the last period of the Leafs-Bruins game at a local watering hole (the Wehrenberg book recommends that you not sit at home and rot by yourself. For the record, I had a club soda at the bar).
While watching the game, for whatever reason, thoughts of Batters’ and Streek’s deaths popped into my mind. Not only that, I told myself that I’d be joining them.
Before that exceedingly chilling notion, I thought about taking a post-game walk south down Bathurst Street then back up Niagara Street for exercise. But then I started fearing that if I did, I would keep going and walk out into the dark, cold waters of Lake Ontario until you couldn’t see me any more. Problems solved! No pain, no fuss, no muss.
This particular suicidal ideation thought became an unstoppable loop. I had a little voice in my head cooing me into taking that walk.
Fortunately, the sane part of my brain was telling me: “What the fuck? Stop thinking that! Are you crazy?!?!”
It lasted for about 15 minutes. Be interesting to know if anyone around me suspected what was going on in my head. I finally calmed myself down. When I got home, I phoned a crisis line for the first time ever. Had to wait for 25 minutes. Got the wrong person when I did get through.
A bored-sounding individual answered. I started out by saying, “I have severe depression …”
She interrupted with the following deadpan observation: “Oh, that’s not fun.”
Again, my head exploded. I wasn’t phoning to make idle chitchat. I was phoning because I just experienced something horrifying and needed help.
Obviously I lived, but I could see someone in a worse state not surviving an encounter like that. I voiced my displeasure to the service’s executive director the next day.
When I talked to my doctor next, I described what happened at the bar and asked, “How seriously should I take that?” Ashen-faced, he said, “Very seriously.” As in, if you can’t get the thoughts under control on your own, call 911 or get to a hospital ASAP, preferably CAMH. Its location at College St. W. and Spadina Ave. has an emergency room that’s geared to psychiatric cases.
- CAMH – 416-535-8501, ext 6885
- Gerstein Mobile Crisis – 416-929-5200
- St. Elizabeth Mobile Crisis – 416-498-0043
- Distress Centre of Toronto – 416-408-4357 (HELP)
- Telehealth Ontario – 1-866-797-0000
CAMH recommends you just come to its hospital. Its telephone number directs you to Telehealth. A CAMH employee also told me that emergency wards have psychiatric residents on duty 24/7.
The psychotherapist registered her alarm this way: “You saw yourself doing it and everything …” she said, her voice trailing.
I never had an attack that bad again. On Easter weekend, I went for a walk in High Park. Emerging onto the Queensway, I walked eastward. The sight of the pedestrian bridge over the Gardiner Expressway and Lake Shore Boulevard at Roncesvalles Avenue made my blood run cold.
Near the Victoria Day weekend, I went on another walk down through High Park. This time, I bounded out onto the middle of the pedestrian bridge. “You don’t scare me any more!” my inner voice triumphantly told the bridge.
To this day, however, stories about depressed people committing suicide leave me shivering.
Return to work
On May 24, I showed up for work for the first day since Jan. 14. The plan was to have me gradually build up my hours at work, with a goal of having me working full-time by mid-July.
Working a 40-hour week didn’t prove to be sustainable. Since late October, I’ve been working a 32-hour week, but I’m hoping to bump that up in the near future.
October was a significant month in another sense. I got put on a new medication called Abilify, which is meant to be taken in addition to one’s main antidepressant and is meant for people whose symptoms aren’t being fully resolved — and I had felt like I’d plateaued. I’d have to say it helped.
In an Oct. 15 note to self, I wrote that I felt relaxed, happy and sociable. Those are three self-descriptors you don’t use very much when you’re in the grips of severe depression.
The path to recovery, however, is not unbroken. I experienced a setback that started in late October and continued throughout November. By mid-December, things had stabilized, and I felt I was on the upswing in mid-January.
As I write this, I don’t feel 100 per cent, but I do feel pretty good.
Remember the thunderstorm analogy? The main storm is over. I would liken my remaining symptoms to the echoing rumbles of the departing storm. But fortunately, I’m seeing a lot of blue skies these days.
And streetcars and bridges don’t intimidate me.
Recovering from depression is frustrating. In some ways, I liken my situation to that of hockey player Sidney Crosby, who is suffering from concussions and has only played eight games since Jan. 5, 2011. As of Feb. 6, Crosby still wasn’t ready to play.
I asked my doctor recently about a prognosis and he just threw up his hands in a “who knows” gesture. I’m getting the impression that severe depression fully clears up when it clears up.
Wehrenberg cites a 2004 study that claims only about one-third of depression patients achieve full remission.
The nature of the illness also makes recovery hard, she said: “Lethargy, hopelessness, pessimism, bad thinking habits, lifestyles that reinforce the depression, and refractory negative mood all interfere with useful interventions. … Therapy for symptom management requires moving clients out of lethargy and into action, taking charge of cognitive habits, instilling hope, changing lifestyle, and reducing negative mood. Those are hard to accomplish on one’s own.”
I’ve definitely had some help.
I have a great family doctor. The Bell Media doctor has been a fine resource, as has been a second doctor who works as a GP psychotherapist. She’s the one who turned me on to Abilify. Besides that, I had the professional services of a psychotherapist for about 18 sessions.
In that sense, the professional support has been there.
The support group didn’t help me very much. Maybe I should have given it more of a chance, but again, I found people more willing to talk about how lousy they feel rather than how to feel less lousy.
My Saskatchewan friend was a rock. My mom not only phoned me regularly, she sent me an azalea – which I then killed through ineptitude. As I regained social function, one former boss/friend invited me out to the occasional lunch.
In talking with a veteran Toronto journalist who has suffered from depression, I asked if she found the people who are most supportive are those who have experienced depression themselves. She agreed with that assessment.
On Feb. 9, 2011 (the first Bell “Let’s Talk” day; I’m a Bell Media employee now), I outed myself on Facebook as having severe depression. Many of my “friends” said nothing.
One person who I know from real life even penned a blog post to a dead Twitter acquaintance he’d never met, but wouldn’t say, “Hey man, sorry to hear to you’re sick” to me. What would he have written had I ended up killing myself?
Focus on the living, not the dead.
What can one say? It shows the depth of stigma attached to having a mental illness.
If I could make one plea, it’s that you respond in the kindest way you’re capable of if you learn a friend, acquaintance, co-worker or family member has developed depression or some other mental illness.
As one example, some friends didn’t retract their offer of a cottage visit after I told them I was recovering from depression (I said that at worst, I’ll sleep a lot).
But while kindness is great, you’ll have work to do if you ever develop severe depression.
In my case, besides taking meds, exercising and doing talk therapy, I did some self-directed cognitive behavioural therapy through an online service called MoodGYM.
A psychiatrist recently recommended some brain-building smartphone-based games as a way to speed my recovery and get my brain working better (I’ve thought of this severe depression incident as a brain heart attack).
Besides Wehrenberg, another book that has been important to me is is The Mindful Way Through Depression, by Mark Williams, John Teasdale, Jon Kabat-Zinn and Toronto’s own Zindel Segal.
It teaches Mindfulness-Based Cognitive Therapy, a blend of Eastern techniques such as meditation and yoga with more traditional Western psychiatric practices.
For me, one of the most self-destructive mental habits associated with this depressive episode is rumination, where a negative thought or memory gets stuck in one’s mind.
If you’re of a certain age, you might remember push-button radio tuners in cars. If the inside of my forehead was my mind’s screen, every button led to a scene that served no purpose other than replay a horrible incident that would drive my mood down further.
Very simply put, MBCT gives you the tools to help you change the channel to something more positive – and Wehrenberg said the way to recover from and prevent depression is to build positive neural pathways through the brain (I have negative neural superhighways).
I hope to take a course in MBCT from the Centre for Addictions and Mental Health this spring.
I also hope to go fishing in northern Saskatchewan, wander on the Prairies, enjoy the Euro 2012 soccer tournament and pig out on Greek food during the Taste of the Danforth in August.
It’s good to be alive.
And to those who helped me through this difficult time or simply showed me kindess along the way, a very sincere thanks. You have no idea how much it was appreciated.
Some anonymous individual saw fit to attack me over this post. You can find my response at Dear Anonymous Critic.