human, being

Depression is not my fault

Since I was a teenager, I’ve endured a winter season of depression, often so severe that I contemplate suicide at the deep end, or at best, have a hard time getting out of bed in the morning. Over the years I’ve tried a number of remedies: drugs, herbs and supplements, light therapy, talk therapy, yoga, meditation, exercise, low-carb diets, high-carb diets, and just accepting that some days are going to be worse than others and being OK with that. Usually, it’s a combination of all of these things that works best for keeping me going from late November through March.

My affliction is called seasonal affective disorder, or SAD. The theory is that a lack of sunlight, due to living at northern elevations, sets brain chemistry askew. Melatonin production takes precedent, causing sleepiness, and usurping the receptors usually used by serotonin, norepinephrine and dopamine. Sometimes, the opposite happens with too much sunlight. For me, this is also true. By August, I tend to be overly energetic, need less sleep, make erratic decisions. Some people think that depression like mine is a slow-cycling form of Bipolar Disorder, or Bipolar II.

This condition has affected my life in many ways. My relationships in the past have suffered greatly in the winter, as I withdraw, get incredibly angry and have so little energy–both physical and psychic–that I drop out of everything. My work performance slows. My sex drive disappears. Everything in the world–and in me–is gloomy and wrong. I start slowing down in late September, and by March, I start feeling better. The change to and from Daylight Savings Time seems to be the start and stop of the worst of it.

This season has been worse than the past several. I believe this is the case because of the stress of Steve’s unemployment, my mother’s on-again, off-again cancer diagnosis, and my health issues attributed to the Mirena IUD, which I had removed with great relief in mid-October. Stress is cumulative, and by late November, I was feeling more depressed than I usually am in February–typically my darkest month.

In the past, I’ve had zero luck with antidepressants. They’ve either given me horrible side-effects (Cymbalta was the worst, which made me want to pick my skin off) or flattened me out so much that I couldn’t be creative, which is key to my line of work as a writer (Prozac and Paxil are the worst here). In 2007, I had talked to my doctor about taking Wellbutrin, but decided instead to give more light therapy, fish oil and talk therapy a try.I felt good last year, better than I had before.

This year, however, those techniques had no effect on my level of depression, so I decided to try Wellbutrin.

The problem with antidepressants, in general, in treating SAD is that it takes up to 12 weeks to feel relief, and I need treatment for about 16 to 20 weeks. Then, it’s not like you can just stop taking the drugs cold turkey without absolutely ruining your life. Given that by June, I’m pretty level and by August, I’m a bit manic, I can’t stay on the drugs year-round. That means a lot of going on and going off, with all of the side effects associated with that process. Anyone who has attempted to come off of Paxil knows what I’m talking about (the hallucinations I had were enough for me to consider committing myself for a few days).

The literature says Wellbutrin is a good drug for SAD for a couple of reasons. First, it’s relatively quick to get up to therapeutic levels; many people feel better within a week, and most feel better within three weeks. It’s rather easy to titrate off the drug as well. Second, Wellbutrin boosts dopamine and noreprinephrine, the two brain chemicals that are responsible for energy, motivation and desire. So, rather than flattening you out and killing your sex drive, the drug reportedly gives you a lot more energy and boosts your sex drive. In fact, many people take both Wellbutrin and an SSRI like Prozac, because the former counteracts some of the bad side effects of the latter.

I was a tough decision for me to take the drug. I don’t like the stigma that comes with being on “mental illness” medication. I don’t like the idea that I can’t just fix myself using alternative therapies. I don’t like taking yet another drug (I also take a daily thyroid pill and allergy pill, plus a handful of vitamins and supplements). All of this means admitting that I have a problem, and as perfectionist, I don’t like problems.

It also means acknowledging, finally, that this isn’t a problem I can control or fix out of sheer willpower. I have a strong family history of mental illness–panic attacks and anxiety in my birthmother, schizophrenia in two of three uncles and a maternal great-grandmother, manic depression in my maternal grandfather. Obviously, my family history is working against me.

Depression is part of my life. And it’s probably time that, instead of fighting it, I accept it. That which we resist, persists, right? And , honestly, if I’m OK supplementing my body with Synthroid because my thyroid doesn’t on its own produce enough hormone, why is it any different that I need to give my body help in slowing the uptake of two brain chemicals because that process isn’t working properly. I’ve blamed myself for this problem–this physical malfunction of my body–forever, as if I personally wasn’t smart enough or strong enough to fix it with sheer willpower. I’m now recognizing this stance as pure ridiculousness. It’s like my car has an electrical problem so it doesn’t start on some days, and I’m blaming myself and refusing to fix it using reliable means as punishment for having a bad computer. I recognize that I’ve taken this position of denial partially out of fear of being socially ostracized, of my employers not understanding, of people thinking less of me.

But right now, after three weeks of Wellbutrin, I’m amazed at how good I feel. I feel, well, normal. The little stressors are rolling off my back easier. How much of my life have I wasted out of pure stubbornness? How many relationships with friends, lovers, family, have I damaged because I couldn’t accept the truth? Instead of beating myself up on what I’ve lost for the past 26 years—I had my first “bad season” in 8th grade, age 13—I am going to look at today, and the coming days, from the perspective of what I can hold on to or even gain. Rumination is fruitless, because I am where I am for a reason.

The first week on the 150 mg, extended release version of generic Wellbutrin was hell because of the headaches. I did some research and found that the generic version–which, contrary to popular belief needs to be similar to but not an exact copy of the original–has some major side effects, including headache. I asked my doctor to rewrite my prescription as “dispense as written,” then decided to tolerate the headaches after learning that the name brand isn’t covered by my health insurance and would set me back almost $200 each month. Wow.

I’m feeling pretty good now. The headaches have stopped. My sex drive, which has been pretty depressed as well for the past few months, is near normal. A good thing–my appetite is supressed, and when I do eat, I feel fuller faster. I’ve read that Wellbutrin is being tested as a weight loss drug, because it does suppress appetite and improves motivation. We’ll see how that affects me, because I usually put on 10 to 15 pounds over the winter because I crave sugar so much (a sign of dopamine deprivation) and lack self-control. One odd side-effect that’s potentially dangerous: alcohol has a much stronger effect on me. The other night, I had my typical two glasses of wine at a night-long party, and I was still drunk the next morning. I usually only get light buzz from two glasses of wine. The hangover lasted two days. I tried having just one drink the other night and it made me drunk to the point of slurring–as if I’d had a few Long Island Iced Teas. So, no more drinking for me. Steve gets a permanent designated driver.

The headaches have gone away, but the insomnia that’s also related to Wellbutrin is getting worse. Last night, I was wide awake at 3:30 am. Fine on a weekend night (I slept until 11 am), but on a work night, not so much. I’ll have to come up with a new routine, perhaps adding in Benadryl to help me sleep and going to bed earlier. Hopefully my new motivation to exercise–usually unheard of this time of year for me–will also help wear me out a little. The steam room also makes me sleepy, so that’s a bonus.

Every year for the past five years, since my marriage ended, I’ve looked for a new way to “fix the problem.” Maybe my new desire to accept the cycle of depression and mania as part of who I am is the change I need that will make life smoother from here on out. And in terms of the stigma, the only way it will go away is if people like me, who have been ashamed of their body’s malfunctions, take back their power and lose the shame.

Depression is not my fault.


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