Pregnant With Depression, Ctd

Andrew Solomon has a fascinating piece on the subject:

While the drugs are risky, depression during pregnancy is at least as problematical. Animal studies show that stressed mammalian mothers are likely to have offspring with poor neurodevelopment. Pregnant women experiencing depression or anxiety are under greater stress and may have altered neurobiology themselves, which could affect fetal development via changes in the uterine environment. Indeed, untreated depression during pregnancy is associated with increased miscarriage rates, preterm birth, and low birth weight—some of the very risks associated with maternal use of S.S.R.I.s. Depressed mothers are at increased risk for preeclampsia. Recent research has shown that the fetus of a depressed, expectant mother has alterations in the microstructure of the right amygdala. There is even some evidence that mothers who are extremely stressed during their first trimesters may be more likely to have children who later develop schizophrenia. …

At the same time, it is important not to blame mothers for their children’s neurological challenges. The shadow of the “refrigerator mother,” who was said to cause autism, falls long across this research. It may be counterproductive to tell women under stresses they cannot avoid that they are damaging their children by being unhappy—or by being treated for their distress. Blaming some women for injuring their children by taking antidepressants and others for injuring their children because they are depressed creates a no-win situation that is itself depressing.

There is no universal right answer here, and, under those circumstances, quoting the studies may seem counterproductive. But women need the leeway to make their own choices—to look, as one does in many areas of health care, at two unsatisfactory options and select between them, and to do so with as much information as possible.

Previous Dish on the subject here.

Suicide Leaves Behind Nothing, Ctd

by Dish Staff

A few more readers share their stories:

A close friend – also a funny, intelligent, well-liked guy – killed himself four years ago. One of his (and my) best friends said at his memorial:

Bob was one of the smartest people I ever met. He never did anything without thinking all the way through. I hate his last decision and I don’t agree with it, but I have to believe that he did the right thing – for Bob.

This was a revelation for me. I think when we speak about suicide as a failure of ego, or the end of a losing battle, or a selfish choice, etc. we do a dishonor to the dead. Bob did a thing he chose to do: suicide is a conscious act. In denying the logic of that act we deny the dead the very last agency they had.

I know there are biochemical reasons for depression and in that sense we can say a suicidal person lacks volition, but this seems even harsher to me:

not only can a depressive not control their emotions or thoughts, they can’t control their behavior. Perhaps they can’t, but how does it help them to remind them of the fact? Are they zombies? If they were “fighting” depression, is this how they’d want to be remembered: the depression “won?” A suicidal person is making a choice, and it’s usually not a choice about us, the survivors.

In circumstances where someone seizes the reins of their own death deliberately, publicly, and without the stain of depression – living wills, advance directives, hospice care, denying care, assisted suicide – we don’t beat our chests about their selfishness. Indeed we rarely use the word “suicide,” and often speak about their “brave choices.” People usually disagree about these choices as well, but they seldom deny that the person making them has the appropriate agency to do so. The difference is striking.

Another reader quotes John Tabin:

Those who’ve never been suicidal may not realize how hollow the insistence that “there’s always hope” can sound.  The very essence of depression is the absence of hope.

In my own experience, it’s worse than that.  It’s the conviction that hope itself is poisonous.  That it’s a lie you have to burn your insides to tell yourself.  That it’s every bit as big a lie as hopelessness.

On a different note, another thing people don’t understand about severe depression is that it’s a physical experience.  Aside from the lack of energy, which seems to be universal, the physical aspect is different for different people.  For some people I’ve known, depression physically hurts.  For me, it takes the form of a hollowness in the stomach.  At my worst, in the bout that eventually led to my diagnosis, I could not eat at all.  The very idea of food made me sick.  I ended up in the hospital with an IV, having all sorts of tests done, and losing 20% of my body weight.  It was months before I could eat any but the blandest of foods.

Severe depression is both mentally and physically exhausting.  You just have nothing left for anybody.  No intelligence, no humor, no counsel, no sympathy, no love, no hate, no words, no nothing.  Those things belong to persons, and you have no personhood left.  You are an empty sieve.

Whenever I hear people say suicide is the most selfish act a person can take, I just shake my head.  By the time a “person” has reached the point of realizing — not “thinking,” because that’s not how they experience it —realizing existence is meaningless hurt for which the only solution is nonexistence and they can no longer stand the pain, they have no personhood left.  There’s only the most tiny and shriveled remnants of a self in there: a desiccated pea in an empty cavern.

It’s not selfish at all.  Not in any sense in which we use the word, anyway.

Read the whole thread on depression and suicide here.

Suicide Leaves Behind Nothing, Ctd

by Dish Staff

The thread on Robin Williams’ death morphs into our long-running thread on suicide:

Elizabeth Nolan Brown’s post reminded me of the thoughtful and informative comic on depression by Hyperbole and a Half. It’s in two parts – One and Two. I just re-read it all, and making it a little more heartbreaking this week is that the movie she is looking for in Part One stars Robin Williams …

Another reader opens up:

First, I want to make it clear I’m not writing this for sympathy or attention. A lot of people have been posting on social media this week about their own personal struggles with depression and suicide. I’m not ready to go public like that, but in the wake of Robin William’s suicide, I wanted to share something anonymously with your readers.

Yesterday I showed up at my therapist’s office with my “suicide kit”:

a bottle of 20 OxyContin, a bottle of 100 Tramadol, a bottle of aspirin (to thin the blood and facilitate drug absorption) and a half-dozen straight razor blades. I’ve had variations of this kit since a botched suicide attempt in my teens. If I had to give a reason why I’ve kept this thing around, the closest I could articulate it would be “escape hatch”. There’s a history of depression and manic-depression on both sides of my family tree, and I saw how it ground away at them, especially my mother. I did not want to die like that – alone, bitter, medicated, stripped of personality and hope.

So here I am at 50, no immediate family, just filed for divorce because my husband of 18 years found something perkier out yonder, and I’d be lying if I didn’t tell you I haven’t been eye-balling that kit every single day for the last three months because holy shit do I ever want to fucking escape.

And then Robin Williams hangs himself on a doorknob, evidently after hacking away at his wrists first, and suddenly it seems like half the people I know are confessing to suicidal thoughts or struggles with depression. Last week I was not so depressed that I could not hear it, could not absorb it, could not register the fact that I am not alone in feeling this way.

I’m not adequate enough of a writer to describe to you how important this is to someone like me, but know that it is important. Important enough to make me close and throw away an escape hatch I’ve held open for 33 years. And that’s why I’m writing. In case one of your readers out there also struggles with depression, also has their own “escape hatch”, can also hear, absorb and register that they are not alone in this. Because you’re not. I’m here. We’re here. Know this. And if you can, let others know it too.

Another reader:

Of course the ongoing Robin Williams discussion hits a cord with anyone who has felt what deep depression feels like. I feel blessed that I have had limited experience with it personally, except when I had my twins 10 year ago and suffered a despair – post partum – that I could not explain or get rid of without medication for a while. As those who have felt this inexplicable emptiness know, there is no amount of external stimulus, love, support or encouragement that can really heal this.

But that depression was NOTHING compared to what was a nearly suicidal reaction after being on Wellbutrin earlier this year. I was in a lethargic funk and feeling down about all sorts of things, and my doctor said if fatigue was a problem, perhaps bupropion could help. For about a month I thought it was helping, and then I woke up one morning and wanted to end it all. It was the scariest feeling I’ve ever had. The only thing I could muster was the will to look up my symptoms and it appeared I was having a paradoxical reaction to the medication that was supposed to help lift me out of the blues.

The idea of moving out of bed, of even getting to the toilet seemed beyond me. I cried, screamed and scared myself all day. Thankfully I felt sure it was a strange reaction to the medication and despite the pharmacist telling me I should taper, that was not going to happen. I stopped taking it immediately and about two days later I felt better.

But to think that feeling I had is something people with severe, suicidal depression grapple with every day, I can totally see why some battles end the way Robin’s did. I cannot even explain the feeling, other than to say I came close to calling 911 and checking myself into a mental hospital, and I do not have a history of major mental illness. I felt like a hopeless prisoner in my own mind, from which there was no escape, relief or balm but time.

Some people deal with that every day. We should have compassion and mercy and not question the “what ifs” – because unless you’ve felt that pit of despair, you just don’t know. So in the talk of seeking medication help as part of the fight against depression, that is well and good for many, but people should also be aware that the cure can make things even worse for some people. The brain’s chemistry remains such a frustrating mystery, so it’s impossible to tell for whom this will be the case. The warning labels say these things but I never thought that would be me.

Thanks for listening.