My first bout with major depression struck when I was 12 years old. It happened so fast, I didn’t know what hit me. During my first year in junior high school, my family moved to a nearby city that had a better school system. Prior to the move I’d been a healthy, confident kid with lots of friends, but a couple of months into the school year, I lost sight of who I was. I stopped eating, no longer spent time with friends and couldn’t feel joy. I wasn’t capable of articulating what I was feeling so I couldn’t ask for help. This was in 1974 and it wasn’t common, like it is today, for kids to be diagnosed with depression.
William Styron, author of the book Darkness Visible, believed that if there were a single word for depression, it would be something like brainstorm, meaning not some burst of intellectual inspiration, but “a veritable howling tempest in the brain.”
When I read Styron’s book, twenty-five years after I experienced my first brainstorm, I was taken back to that inexplicable nightmare. All my memories from those early years are dark, cold and wet. When I experience depression today I see the same dark clouds. I live in Southern California, where we have very few cloudy days, but if I’m depressed I don’t see the cheery sunshine or feel its warmth.
WHAT IS DEPRESSION?
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
My diagnosis for Bipolar II came years after I was diagnosed with depression, probably because I enjoyed my mania, and never would have complained to a doctor about it. Except for some impulsive trips to Turkey to see a Turkish boyfriend, who would break my heart when I was in college, and some promiscuity in my twenties, there were no negative consequences. I loved flying high from mania, and just thought I was having super-intense adrenaline rushes. Without them I never would have gotten through college or graduate school. My mania allowed me to overcome my fear and low self-esteem.
I recently read the book Liar, by Rob Roberge, whose descriptions of mania resonated with me:
“It feels like my brain could juggle chain saws right now…”
“I feel like I’d electrocute anyone who shook my hand.”
“…like I could stand on the road and hear ants eating, if I tried hard enough.”
But as I’ve gotten older, my mania scares me because I feel more desperate. I’m afraid I’ll make plans to travel somewhere that I’m not physically well enough to go through with. I’m afraid I’ll apply for a job I’m not healthy enough to perform, or spend all my money on a new car because I don’t plan to live long enough to need any savings. Perhaps the most dangerous aspect of my mania is that it tells me I can live without my feeding tube, the small amounts of food I can eat and my medications. If I stop the tube and food, or even reduce them, within a few days I start to feel like I have the flu, so I try to remind myself of that in those moments.
These days when I’m feeling manic I try to bounce ideas off my husband before doing anything foolish, but secrecy is a big part of my mania, so I have to really be careful. So far I haven’t done anything that has gotten me in trouble, but there’s still time!
WHAT IS BIPOLAR DISORDER?
Definition from the National Institute of Mental Health
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
- Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
- Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
- Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.
Signs and Symptoms
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.
RESOURCES FOR HELP
Depression and Bipolar Support Alliance – http://www.dbsalliance.org/
Families for Depression Awareness – familyaware.org.
Mayo Clinic – mayoclinic.com.
National Institute of Mental Health – nimh.nih.gov.
National Mental Health Information Center – http://www.samsha.gov.
FOR ADDICTION, DRUG AND ALCOHOL ABUSE: