I never thought I'd get over my depression
Knowing that your own head can betray you is a very scary thing, admits Aine O'Connor, but reaching out for help is vital in coping with the 'black dog'
When I wrote an article about my depression in 1994, some people thought I was deranged. Not because of the depression, but because I had written about it.
Others sent in their stories; they'd been fighting the black dog too and were glad to know at least that they weren't alone. Since then, attitudes have changed but many people still struggle.
I was young, I was loved; in theory I had everything going for me. But in April 1993, in a culmination of what that hawk-eyed genius hindsight would have seen coming for years, I could no longer hold my life together.
I was trapped in the most terrifying vortex of all the worst parts of myself and I had no idea how to stop it. I couldn't control my thoughts and I couldn't sleep, so there was no respite. I was in the vortex all day and all night. It is the worst place I have ever been.
Although I didn't know what it was, I had my first depressive episode when I was 15. Mentally, I felt like I was on the edge of an abyss; physically, my legs felt so heavy I could barely walk home from school.
In 1980s Ireland, depression wasn't discussed, partly because it was a mental illness but also because "getting on with it" was so valued that any suggestion you just couldn't was like some crazy Californian style of self-indulgence.
I hit all the normal teenage milestones but got used to ploughing through feelings and events that I should have stopped to deal with. The vortex that struck seemed sudden but had really been a long time brewing.
The complete loss of control over your thoughts and emotions is atrocious. But the place that comes next is almost worse. Diagnosed and medicated with some precursor to Prozac, I could perform as a human for a few hours every day.
I'd cry on the bus on the way home because a despair so deep makes you spring a leak. I had no idea how I was going to make it through the next 10 minutes, much less forever.
A psychiatrist changed my prescription to Lithium, though I was never diagnosed as bipolar. I was never exactly joyous but the absence of despair felt like an improvement. That was around the time I wrote the article.
Depression leaves in its wake a deep fear that it will come back. To know your own head can betray you is a very scary thing. My focus shifted when I got pregnant.
It is entirely feasible to stay on anti-depressants through pregnancy (though some are not advised during breastfeeding.) However, I hated the Lithium and felt that I was being managed rather than treated so I abandoned it all overnight.
It wasn't the wisest decision. Medication withdrawal should be gradual and going cold turkey left me very vulnerable.
My son's birth was difficult for us both and afterwards every feeling of self-loathing and unworthiness rose to the surface. It was so painful I couldn't articulate it to anyone.
I was married and had two children before I realised I wasn't where I – they – needed me to be. My fear was that this was as good as it got and I still couldn't enjoy it.
I began psychotherapy and thus began an odyssey. Over the years, I've made some bad calls on my mental health, mostly that I left it too long at various stages to get help.
But I've also made some good decisions: who I married, my friends, having children. You can be very unwell but still make good calls. I also have the great good luck of a loving family and good physical health.
I still struggle on occasion, but who doesn't? I've never been back in the vortex, I've never been anywhere near it. Sometimes I sense the spectre of the black dog but I don't fear him any more.
How I beat it
Almost everyone will go through depression at some stage in their lives but even dealing with the worst kind becomes a journey instead of a battle. Here's what I've learnt:
(1) The most serious threat to my equilibrium in recent years has come from stress. Everyone's limit is different but frequent feelings of being overwhelmed are a clue that "being down" has gone too far and it's time to get help. Other signs include an inability to feel good things, difficulty concentrating and a failure to think of one thing you would like to do even if you had the energy to do it.
(2) Appearance becomes too much to attend to, a word or thought gets stuck on a loop in your brain, company can feel overwhelming, you feel worthless and ashamed. Some people sleep a lot, some none at all.
(3) Insomnia becomes self-perpetuating and lack of sleep is a fast-track to insanity, so getting your sleep sorted has to be a priority. For myself, a sign that I'm having a problem sleeping is when none of the usual things such as lavender and avoiding caffeine work.
I fear insomnia and it can quickly get out of control, so I break the cycle with sleeping tablets, only ever half, only ever for a few nights. The respite from consciousness is worth the slight hangover.
(4) Anti-depressants can provide stability and help with anxiety. But they can also inhibit the libido and cause weight gain as well as becoming a monthly spend that racks up. Many anti-depressants also have quite serious withdrawal symptoms.
I had a really nasty experience coming off a very low dose of SSRI. Although I was careful to reduce the dosage in small amounts, I still suffered from vertigo, tinnitus and, incredibly, given what the medication was for – suicidal thoughts.
I have also spoken to people who find themselves trapped in a cycle. This is a really serious issue and an inadequately documented subject.
Every situation is different – and bipolar issues are different again – but while I believe anti-depressants have their uses, they're over-prescribed and I would be loath to use them again.
(5) Psychotherapy is vital, but unfortunately it's expensive, and, while many health insurance policies will cover hospital bills, which average around €15,000 a month, they won't cover outpatient therapy unless with a psychiatrist.
But it's some of the best money spent when you get the right therapist – and if you don't like the therapist, find a different one.
I learnt that I was a major contributing factor to my depression; I had bad mental habits that I needed to change. While some depression is chemical-based, a lot of it is putrefied emotion.
I had to learn to acknowledge, and stop, my own negativity, fear and tendency to self-sabotage. I'm still working on those, but therapy is when someone guides you towards honesty, not victimhood, and helps you take over the reins. It's good for you and those all around you.
(6) Mindfulness is brilliant as a method of moving forward. It's like an anchor and not only helps control negative thoughts but converts them into better ones.
You focus on this moment, cope, enjoy; don't think about it later or before. It makes things manageable but it also reveals fragments of beauty.
(7) Exercise really helps and, although it's the last thing a depressed person wants to do, you can start small, preferably in daylight.
(8) Whether chicken or egg, there is a definite link between addiction and depression. It's a double whammy of self-loathing and a chemical rollercoaster that leads to despair. These are not necessarily separate issues.
(9) I never had the option of paid sick leave, and perhaps not having it prolonged my plateau phase, but maybe time off would have prolonged my worst phase. The distraction of work, hobbies, people and volunteering is important after a certain point.
(10) I suggest it's best to tackle depression like any chronic illness and to speak of it as such.
Explain to an employer as if you were explaining arthritis or kidney trouble. I got ill, I got a diagnosis, I'm having treatment and I'm working towards getting well. Some days are going to be bad and for these I ask your understanding.
(11) When you're depressed, you worry it will come back. If you have children you worry, a lot, that they too will have it. Worry is a symptom of depression, so as you get better, it fades. And you will get better.