Tuesday, February 10, 2009

Defining Recovery

I ought to clarify. In my post, That's It! I Quit!, I talked about possibly quitting my meds. Several of you were sweet enough to worry about me and I wanted to thank you. I appreciate all the support I get from my readers. It means a lot to me to know I'm not alone. So I wanted you to know: I didn't quit my medicine. I'm still popping my pill each morning. I figure I should wait until we are in a more settled place or until I have a real medical reason to stop or until I'm better.

Which brings me to my most recent quandary: what does it mean to be better? When talking about a possibly chronic mood disorder, is there a point where the sufferer knows that they are through the worst and will reach a full recovery?

I honestly don't know.

For me, this whole depression "adventure" has been a series of ups and downs. It's not that I'm manic or anything like that, it's just that whenever the good times are rolling there's a part of me that wonders how long it will be before I get a stick in my wheels.

Maybe I feel that way because my depression really took off as postpartum depression (I had anxiously depressed phases in high school but nothing I really perceived as chronic until the third trimester of my first pregnancy). Feeling bad and crazy is hopelessly entangled with mothering because the two happened together. It takes a lot of effort for me to tease apart what is the depression and what are my instincts as a mother and, as an Latter-day Saint, what is inspiration from God. Maybe as long as I'm mommy-ing I'll struggle with this.

Or maybe I feel like my depression is always lurking because I had three babies in four years. That's a lot of stress--a lot of ups and downs--even for normal women. There are a lot of benefits to having kids close together (they are such good buddies!), but there's no doubt that it is also hard.

Or maybe the ups and downs are just the nature of the illness.

The first time I started antidepressants, when my oldest was four months old, I thought that my antidepressant was basically like a supplement. You know, my body didn't produce a certain substance so I would take a pill that would give my body more of that substance. Eventually, I thought, my body would take over and start producing the correct amounts on its own.

Turns out antidepressants aren't that straightforward. Nobody is exactly sure how they work. All the stuff about serotonin (or any other neurotransmitter) being more available in the brain is true, but no one knows exactly what the brain does with the extra stuff. And nobody really knows why some brains don't produce the correct amounts in the first place. We know there's a relationship between hormones and neurotransmitters and we know there's a relationship between general health and mental health, but we don't know the exact nature of those relationships.

It's popular to compare the use of medicine to treat mood disorders to using insulin to treat diabetes. I like the comparison a lot and use it myself when talking with others but a recent conversation with a clinically depressed friend made that comparison even clearer to me. When I told her I wanted to quit my meds she said she'd been there too but she figured it was like diabetes. "A diabetic can't just wake up one morning and decide their to quit taking insulin," she said. "It's not like their diabetes is going to go away just because they learned to manage it. It's an illness and it's chronic. Depression is the same thing."

That was quite a blow for me. I had always looked at this depression thing as something I was going to overcome. I guess it was ridiculous but I really thought that maybe one morning I could wake up and know that I would never have to deal with the crazies again. But it's not like that. You don't get better from clinical depression. All my therapy, all my medicine, all my thinking and writing, is only managing the symptoms. None of it is fighting the illness at it's source because we don't know the source. Or maybe we do. The source is me. It's who I am. It is my life. It is my existence--my body, my soul, my mind, my everything--that feeds my depression.

So what does all that mean for recovery? When you have a cold you wait it out and eventually the symptoms pass. You wake up one morning and know you're not going to be blowing your way through a whole box of Kleenex. Not so with depression. The symptoms will always be cycling around. How do you recover from something like that? What does it mean to "get better"?

Maybe it doesn't mean anything at all.


Coffinberry said...

I think you pegged on an important distinction in this post and the last about the difference between situational depression and chronic depression. One complicating factor is that situational depression can, over time, affect the structures of the endocrine and other regulatory systems affecting the brain and body, resulting in changes that may or may not be reversed.

However, when the primary underlying cause is situational (which was very much my case), resolving the situation (and the habits of response and coping learned during the situation) has a good chance of opening the door to eventual reversal of the physiological patterns.

We all are different, and the crosses we bear are unique to each of us.

Charlotte said...

On my darkest days, I pray and ask God why my brain is broken:) For me, while I definitely empathize with the depression, it's more about being overwhelmed by my emotions in general. My feelings just feel too much!! It is frustrating knowing that unless I medicate that, I will always be that way. And I swing back and forth between enjoying the calm that the medicine brings and enjoying the rush of feeling so much. Sigh.