Friday, 21 August 2015

What is Major Depressive Disorder? - Part 4

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In my last post, I hoped to bring to your mind the cumulative effect that the symptoms of Major Depressive Disorder have on the sufferer. Each and every day, for most of each day, he or she (from now on, I'll just say he) is battered by a multitude of mental and physical affects that just wear a person down. To the sufferer, there doesn't seem to be a reason for this, which serves to create frustration and confusion worsening the overall impact.

Whereas my last post tried to explain the effects from the view of an MDD sufferer, this post strives to be more objective. Consequently, while much of what follows is largely repetition, my aim is to comment on each symptom independently.

While Major Depressive Disorder seems to begin with mood - that is, after all, the first symptom described in the definition - it really begins with the brain. Neuroscience tells us that our brains have zones that regulate appetite, sleep, mood, pain, memory, and all other facets of our being. Some zones are special in that they are designed to monitor and regulate other zones, but all of them communicate with each other.

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We all have these zones. We all have a prefrontal cortex, the thinking part of the brain, and we all have a limbic system, the feeling part. The location of these areas of the brain tells us that the limbic system is the older of the two. As our prehistoric ancestors developed larger and more rational brains, the prefrontal cortex evolved to manage the limbic system, giving us an ability to balance emotion and rationality.

In some of us, however, the communication between these two zones is faulty. The prefrontal cortex, the thinking brain, doesn't regulate the limbic system, the feeling brain, in its designed way. In essence, thinking no longer regulates mood, mood regulates thinking. This fault in our brains is the behind-the-scenes of Major Depressive Disorder. It gives us an insight into why Mood is so dominant in the definition and in the sufferer's experience.

So, we begin with mood. Every day, for most of the day, the MDD sufferer feels sad. It's not feeling sad, in the traditional sense. Usually, when we talk of someone being sad, we can point to a cause and can reasonably expect him to regain an emotional balance over time. Sadness, then, tends to have both cause and closure.

For a depressed person, this is not the case. The sadness does not have any readily discernable cause, nor does it have any closure. It persists, and persists, and persists, no matter what is done to get out of it. Further, for many sufferers what they experience isn't truly sadness, it's numbness. There's an emptiness where there should be emotion. For others, an emotion is felt by its absence, not its presence. No matter the case, though, it's clearly more than what we commonly mean when we think of sad.

The definition of MDD presents an alternative affect of mood, the loss of the ability to perceive or experience joy. People can laugh and cry and celebrate all around the MDD sufferer, and he is indifferent to it. This indifference creates a disconnect, a distance between the depressed person and the world around him. Activities that were once enjoyed have lost their lustre. They have become uninteresting. And this lack of interest spreads throughout his world, infecting his job, relationships, and social connections.

In either circumstance, the first effort is to try to think a way out of the problem. But this doesn't work, because the connection between the thinking brain and the feeling brain is faulty. The sufferer doesn't know this. All that's known to him is that there's no reason to feel as he does. He'll try to fix things but can't.

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By themselves, these two primary symptoms are distressing. Consider all the joys the world brings to life: the laughter of children; the play of the wind on leaves and chimes; the warmth of a companion; the sharing of friendships. Now consider a life that is unable, for no apparent reason, to leave glumness behind or see this joy and participate in it. Consider how empty that life must seem. Consider how painful this must be.

You can see how, in these circumstances, the depressed person can experience a loss of energy, a reduction in vitality. If nothing brings him joy, if nothing breaks through the gloom, every small thing feels difficult and becomes draining. He is listless and unmotivated. He will feel guilty, wondering what is wrong with him. With guilt comes annoyance at himself for not being able to shake the mood off. Annoyance brings irritation and negative self-talk.

You can also appreciate how this depressed mood or inability to find joy can harm someone's thinking. Indecisiveness, confusion, irritability all seem to flow from the general ideas of "what's the point?", "it isn't going to make a difference", "it just doesn't matter". Moreover, because of increased fatigue, his thinking ability and his body have both slowed down. Plans can take an eternity to reach and another eternity to implement. In fact, so much energy is taken to plan or act, that neither reaches completion. He becomes paralyzed with his inability to plan or do. This too will foster guilt and shame.

His sleep suffers. On many occasions, sleep is denied him because his mind will not rest. He will consider, and reject, permutation after permutation, in an effort to think his way out of the problem. The racing thoughts will include denigration and shame. On other occasions, he sleeps non-stop, but he doesn't rest. The internal dialogue remains on a sub-conscious level infecting dreams. Either way, both the body and the mind are fatigued. With this fatigue will come increased impatience and irritability. He will lash out at friends, family and co-workers. His social relationships will suffer.

Issues with weight and appetite seem obvious in these circumstances. By doing less, fewer calories are burned. Body fat and weight grow. Alternatively, there's no motivation or energy to cook, or eat, and weight plummets. In either circumstance, bouts of guilt at the weight gain or weight loss may cause binge eating or binge dieting to compensate. Both cause growth in negative self- image.

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The MDD sufferer loses all self-esteem. He is filled with guilt and shame and a growing sense of worthlessness. Unknowingly, everything around him that validates the guilt, justifies the shame, confirms his worthlessness, is absorbed, adding to the feeling. He feels guilt even if it isn't his fault. He feels shame even when there's nothing to be ashamed about. He feels worthless despite all evidence to the contrary. Increasingly, he engages in an internal dialogue of negative self-talk and external actions of self-abuse.

Negative thinking patterns have become the norm. A day, filled with both positive and negative events, seems to be nothing but a bad day. The depressed person does not see, cannot see, the positives. He also cannot feel positive emotions. He has become numb or, at best, feels the emotion by proxy, by its absence and through the eyes of others.

Practicing emotion by proxy allows the sufferer to don a mask or normality. He always wears this mask. No-one can see who he truly is because he is unworthy of compassion or empathy. In his eyes, if they saw the true him, they would see that he's a fake, that there's something wrong with him, and that he's undeserving. In addition, he remembers how he lashed out and is ashamed. He believes that he cannot be forgiven and convinces himself that this thought, is fact.

Isolation becomes commonplace. It takes too much effort to socialize. It's easier to just stay at home. But this generates its own guilt and shame adding to the sense of worthlessness. While alone, the guilt and shame, the inability to figure out what's causing all this, increases the volume and frequency of negative self-talk and self-abuse. The depressed person will try to shame himself into action, and shame himself again for not being able to act. In fact, everything becomes an occasion to shame himself. He will belittle himself in ways he would never belittle anyone else. He's worthless, he deserves it.

Consider how it must be to live in such a quagmire. To suffer without cause, to endure without respite. The definition of Major Depressive Disorder tells us that two weeks of this life is too much. Sadly, a typical episode of MDD lasts from six to nine MONTHS. If a person has had multiple bouts of MDD, without treatment or failed treatment, episodes can last YEARS. Consider that: at the bottom end of the typical depressive episode, six months, the sufferer is bombarded with this bleakness every day, for most of the day, for over 180 consecutive days, over 4,000 hours.

It's no wonder that the final symptom has such attraction. It offers an end to the suffering. Just as emotion is experienced by its absence, so suicide attracts, not because he wants to die, but because it will end the pain. It is the end of pain, not death, that is sought.

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The danger of Major Depressive Disorder lies in how each symptom acts in concert with the others to create a downward spiral into an existence filled with gloom, despondency, increasing emptiness, increasing numbness. Experiencing all of this, concurrently, takes its toll on the sufferer. The toll is both psychological and physical. The toll can be deadly.

The World Health Organization has stated that depression is the leading cause, worldwide, of living with a disability. The numbers tell us that one in five women, and one in ten men, will experience at least one depressive episode in their lives. The numbers also tell us that one episode, if untreated, will lead to another and that each subsequent episode will last longer and the fall will be deeper. The group at greatest risk? - unattached, older, white males.

All of this doom and gloom can seem to present a hopeless picture. However, not all who suffer will attempt suicide (yet the majority of those who attempt suicide do suffer). More importantly, there is a way out. My journey is proof of that. Beginning with the next post, I will present the other side of the equation: how the sufferer can find a way out.

Please refer to this page about medical advice.


Thursday, 20 August 2015

What is Major Depressive Disorder? - Part 3

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A short time ago I quoted the definition of Major Depressive Disorder (see here). When you read it, you see that the definition of MDD relies on two factors: (1) the simultaneous presence of multiple symptoms; and, (2) a duration of time over which these simultaneous symptoms are experienced nearly all day every day.

When you read the symptoms, you're probably struck by how vague they are: depressed mood (sadness) most of the day, nearly every day; diminished interest in pleasure most of the day, nearly every day; weight loss or weight gain of more than five percent in a month or a change in appetite nearly every day; insomnia or hypersomnia nearly every day causing psychomotor retardation (slowed down movements and thinking); fatigue nearly every day; feelings of worthlessness nearly every day; diminished ability to think or concentrate nearly every day; and recurrent thoughts of death or suicide.

But within that vagueness is a lurking danger. Notice the repetition of the phrases "most of the day" and "nearly every day". Notice the multiple mentions of slowed thinking and the multiple suggestions of slowed or reduced activity. Weight gain, or loss, is rapid and excessive. You either sleep too much or too little, again to an extreme degree - nearly every day.

In short, your mind and your body are slowing down, day by day by day, as they become deeper enmeshed in a depressed state. You are listless. Every small task or decision seems like a mountain to climb. Everything is a challenge; something as simple as getting out of bed can be overwhelming. You're indecisive, unsure of what to do and, if you do something, you're sure that somehow you'll screw it up and then you beat yourself up for not completing the task perfectly.

You don't understand why you're paralyzed by such simple things. You believe that there's nothing wrong with you and you try to work and think your way through it. And when this doesn't work - and it can't because you're body and mind are slowed - the negative self-talk begins. You talk to yourself in ways that you'd never talk to anyone else, heaping vile abuse on yourself. In time, you come to loathe yourself, deeming yourself to be worthless.

You start to isolate. In the beginning, you do this so you don't "bum out" friends or family. You feel guilty about this. In time, you just don't care; after all, no-one wants to be with someone so worthless anyway.

So you close into yourself. You feel more and more empty, more and more numb. And you tire. And you lose hope.


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Therein lies the danger. Experiencing all of these things, each and every day, practically the entirety of each and every day, is exhausting in ways that only those who have suffered depressive episodes can comprehend. Each day is both a mental and physical struggle. You struggle to think, to decide, You struggle to sleep or stay awake. Some days you don't eat, you can't eat, and others you binge on comfort foods, eating more than you should because you have not eaten for a while. The struggle robs your life of all joy, fatigues you to the point where you cannot get any rest. And the numbness consumes.

Sadness is too inadequate a word to describe this state. Depression, another word, is also inadequate. Tell someone you have cancer, and they will nod and sympathize and express regrets. Tell someone you are depressed, and they'll ask for the reasons why, tell you to "get over it already", tell you about their deprerssion and why it's really no big deal. And inside you both agree and disagree and a new bout of self-abuse begins.

This is your life, 24 X 7. You loathe yourself. You are empty. You have lost all hope. You are in constant pain. You see no way out of the pain. Thoughts of suicide creep in. And with the constant pain, the exhaustion, the numbness, the never-ending despair, it seems to offer a solution.

So re-read the definition.  Read between the lines. Take the words to an extreme. See the depths before you. Dwell on them. And then you might have an inkling of what it means to live with Major Depressive Disorder. Maybe then you'll appreciate just how deadly it is.

Please refer to this page about medical advice.



Wednesday, 19 August 2015

What is Major Depressive Disorder? - Part 2

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In my last post (see here), I quoted the definition of Major Depressive Disorder. My plan was, and remains, to discuss this definition by commenting on its two key elements: the multiplicity of symptoms and the duration of them. My research had been completed, my notes were ready, my plan was in place, and yet - nothing. Why this nothing?

Simply put, my inactivity is caused by the lingering effects of my MDD. Even though I have recovered significantly over this past year, I continue to experience symptoms of Major Depressive Disorder - depressed mood, diminished interest, fatigue, feelings of worthlessness and guilt, and diminished ability to think or concentrate. Admittedly, the impact of these symptoms is less pronounced than they were a year ago, but they continue to make themselves known. They are a reminder that my recovery, while both positive and uplifting, is incomplete. My journey to recovery continues.

So, even though my preparations for the follow-up posts were complete, the actual task of writing the final text proved to be elusive. My thoughts were scattered, my interest was iffy, and feelings of inadequacy popped up.

Additionally, I have an anniversary of sorts coming up. It has been almost a year since my suicide attempt. While I believe that my writing has helped me to exorcise that demon, I do know that the depth of my depressive episode causes me be consciously cautious in considering plans for the future. I have no doubt that there is also a subconscious effect.

I'm not, however, the same person that I was nearly twelve months ago. My self-improvement efforts, my research, my active involvement in therapy, my self-work at home, my writing, my medication, and my new-found hope, have worked together to give me the tools I need to cope. Moreover, I now have a willingness to accept my limitations and seek help before it is too late. I know where I was last year and I know that it's a place I never want to revisit.

My acceptance isn't restricted to recognizing my limitations. It extends to how I view Major Depressive Disorder. I know longer see myself as depressed. That word doesn't fully convey what I, and millions of others, go through. It has a commonality of meaning that trivializes the pain and incapacity that we live with. I now accept that I live with a disability, Major Depressive Disorder, and that this disability means that I will, from time to time, undergo depressive episodes. I am not my illness, but I accept that it is, as it has been since my teenage years, a component of my life.

By accepting this fact, and by applying the tools I've acquired, I'm a more balanced person than I was last year.

And I am better for it.

Please refer to this page about medical advice.