In my first blog post, I had mentioned that bipolar disorder is a mental illness that has episodes of highs and lows. The lows in the disorder are episodes of depression. Depression is a term that most of my readers will be familiar with. I understand that it is one of the most prevalent mental illnesses.
There are different kinds of depression such as manic depression (which was the term used for bipolar disorder earlier), post-partum depression and seasonal depression. In my post, I will be talking about depression associated with bipolar disorder.
The first time I faced depression was in 2017, right after my manic episode. In case of bipolar disorder, the low usually occurs after a high or manic episode. One of the reasons for clinical depression is the chemical imbalance that occurs in the brain. In my case, in addition to the physiological reason, other reasons were that I was forced to quit my job (where I was doing extremely well) and the realisation that I have this condition. Therefore, there are other factors like your circumstances, life occurrences, over and above the physiological factors that lead to depression.
Manifestations of Depression
When I faced depression for the first time in 2017, it was one of the worst things that had ever hit me. I was suffering from extremely low levels of energy and low self-esteem. I was not even able to get up and brush my teeth. I had no interest in anything around me, and was extremely dull. I was also having low self-esteem and feeling worthless. This was especially due to the fact that I had to stop working abruptly and I ended up comparing myself with my peers. I was having a very high appetite and was eating a lot more than usual. There were moments when I used to just sit and cry without any reason.
These symptoms are not unique to a person suffering from bipolar disorder, but to anyone suffering from depression. Low levels of energy, exhaustion, lack of interest in activities for a prolonged period of time are common symptoms of depression. Further, lack of sleep or excessive sleeping, low appetite or excessive appetite are also signs of depression. In some extreme cases of depression, one can even have suicidal thoughts. For a situation to be diagnosed as depression, these symptoms need to exist for a week or so. In my opinion, if you have any of these symptoms then it is always advisable to consult a psychiatrist and seek advice. It is always better to err on the side of caution.
Dealing with Depression
Dealing with depression was a giant that neither me, nor any of my family members were used to. Food is something that used to uplift my mood. So Srini (my husband) and his mother used to ensure that I get to eat the food that I always wanted. Also, we used to go and visit family and friends when I felt up to it, and that used to cheer me up. These visits usually ended up in me lying down in our relatives’ house and not engaging in any of the discussions.
One thing that my psychiatrist advised was to do some physical exercise every day. Even if it is walking for 10 odd minutes, he had asked me to do it. It is said that exercise generates endorphins in the body, that uplifts the mood. It took me a while to start doing it, but then, after maybe three months or so, I slowly started working out. Also, he advised me to never be alone, and to always be amidst family or friends, so that you are part of conversations, even though only sub-consciously. This again was more strictly implemented by Srini and his mother.
While food and social interaction was making me feel better, I was not getting better. This distinction between “feeling better” and “getting better” is critical. I came across this in the book, Feeling Good by David D. Burns (that I had referred to in my second post, https://www.thewholesomeliving.in/post/fear-of-failure). Feeling better is temporary and getting better is working towards a more permanent solution. Our aim should be to adopt methods that will not just make us feel better, but also help us get better.
The turning point in the recovery process was the therapy that I started in 2018. The therapy really gave me a sense of direction, and put my thinking into perspective. My self-esteem was still driven by my work and I was still feeling horrible that I am not at the same level as my peers, and was forced to quit because of my illness. My therapist told me to reduce the emphasis that I provide to work in my life, and told me that my work does not define me. Slowly, I shifted my focus from work, and started cooking, gardening and paying attention to other aspects of my life. The therapist had drawn a schedule for me, and asked me to do at least 50% of it. I slowly started seeing changes in my self-confidence. Things were getting better, and I had a good run until September, 2019. In 2019, I faced two back to back manic episodes which fortunately did not affect me as much as my episode in 2017.
I recovered from the manic episodes, and then in the beginning of 2020 depression hit me again. In addition to the chemical imbalance in the brain, shifting to a new city and coping with a new job also contributed to the relapse. While I couldn’t join my new job, I can say that seven months into this year I am 70-80% out of my depressive phase.
In addition to the medicines, I would also attribute it to the regular therapy that I took from my therapist. While the overall therapy was similar to the one I received in Delhi (i.e., directional), the difference I experienced in this case, was the attention to detail by my therapist. He analysed the behavioural and mood changes I face during depression, and made me aware of it.
There is a very effective form of therapy called Cognitive Behavioural Therapy (CBT) to deal with depression. The therapist was/is using CBT methods to address my depression. CBT is essentially being cognizant of your thoughts, and using actions to change your thoughts. For instance, a very simple example would be, if the thought in your mind is that I do not want to get out of bed and exercise, then you negate that thought by maybe just getting out of the bed and taking a walk for 10 mins. It is not a very easy process, and will require a lot of time and patience for someone who is facing depression. But what I have felt is that it has made me more aware of my thoughts, and has not let the thoughts overrule my mind.
Another important factor which I cannot over-emphasise on is the importance of making a small chart of the different things that you would put under these various buckets: (i) physical needs; (ii) emotional needs; (iii) spiritual needs; and (iv) social needs. Last but not the least a list of your main support system. So personally for me, in the first bucket would be good food, maybe dancing, shopping etc., and in the second bucket would be journaling, speaking to my family etc. I think even if you are not facing depression, this list would be a good mental health hygiene tip to follow.
So in my journey, therapy played a very important role in dealing and recovering from depression. In addition to therapy, physical exercise (even if it is for 10 mins) always helps to keep you afloat. Further, I would say one should have a basic schedule in place, that is the few things they would not compromise on in any case; such as taking a shower, a short exercise, spending some time watching t.v. or talking to family. For a normal person, these might seem very silly, but for someone facing depression these are very hard to do. Therefore, getting to cross these small tasks will give them confidence to move ahead.
Common Misconceptions about Depression
We need to understand that being depressed and sad are two different things. Depression is a prolonged phase of dullness, lack of energy, lack/increased appetite, lack/increased sleep, excessive emotional turbulence etc. Depression is a mental health illness which needs to be addressed. In this connection, I am not in full agreement of using the word “depressed” too loosely. In my view to say that “the food is so depressing” or the “weather is so depressing” is an expression of thought trivialising the trauma faced by a person suffering from depression. Having said that, I am not sure if I am being too sensitive about this or if it is a reasonable expectation?
Another aspect is that a person who is being depressed is not “being lazy”. He or she is not involved in day to day activities not out of choice, but out of a physiological condition. Such stigmatising statements only intensifies the depression. As a family member, friend or colleague one should not judge or make any conclusions about the person and offer help to the person.
Thirdly, depression is not “in the mind”, so please don’t offer advice like “it is all in the mind”, ‘be strong, you can fight it” and you can deal with it using your will power. Further, we need to understand that depression can hit anyone irrespective of the economic or social status in the society. I think we are aware of this because there are a lot of celebrities who have faced depression in their life. In this connection, I have heard people saying he or she has everything they need in their life, then why are they depressed or sad. As mentioned above, depression is a physiological condition and a mental health illness, so it cannot be overcome with the “power of the mind”.
Parting Thoughts
I think the first step before seeking medical help, is acceptance that you have a mental health illness. To be absolutely honest, it has been three years since I have got diagnosed and I have still not completely accepted my mental health condition. It is not an easy process, but it is an essential process. I would like to give a very special shout out to all my family and friends out there who have constantly supported me in my journey. Whenever I face self-doubt or lack of clarity, I reach out to them and they have always been there for me. You know who you are, and I am so grateful to have you in my life.
Therefore, if and when you face any uneasiness similar to the ones discussed in this post for a long period of time, do seek help. Being in denial is not going to help you out of the situation.
Please go meet a psychiatrist or a therapist[1]. It is important that you get the intervention that is needed. I cannot stress the importance played by medicines and therapy in my life. I completely understand that there is a lot of stigma attached to all this, and even in me coming out and discussing about my mental health condition. But after writing my posts, I started noticing that there are a lot more people who are open and keen to discuss mental health than I thought. Hence for the sake of one’s own mental well-being, we should ignore the stigma and seek the help that we need.
[1] While a psychiatrist will prescribe medicines, a therapist will not.