There was an instant and overwhelming response to our reader's story. One offer of support:
Re: your depressed reader, I've also had the experience of being turned down from a support group because I was too depressed. I've also been through treatment with antidepressants and therapy. I'm sure you will get hundreds of emails, with hundreds of suggestions, but nevertheless, here are mine.
One thing really jumped out at me in this letter: the author mentions drugs and therapy, but not more fundamental causes of depression, like sleep, diet, and exercise.
When I was chronically depressed, health professionals also never mentioned these things. I had to discover them on my own, over the course of nearly 20 years. Without knowing anything else about this person, I would highly recommend keeping strict sleeping and eating hours, never missing a meal, eating healthy food, avoiding anything that might disrupt sleep (caffeine, alcohol), seeing a doctor if a sleep disorder is suspected, and taking up an endurance sport. Personally, I cycle. I think the "endurance" part is important. More mild workouts haven't been as effective for me.
Another thing to note is all the recent brain research finding that we feel how we act, as much as we act how we feel. Plaster a smile on your face, and you will feel better, after you get over feeling stupid. Act like a happy person, and you are more likely to become one.
I know this all sounds cracked: forced smiling and cycling are going to succeed, where highly-trained medical professionals have failed. Right.
It's at least worth trying. I believe that at this date, with the recent failures of anti-depressants in clinical studies, and the continued failure of therapy in the same, these suggestions are actually better backed by the available evidence. In fact, our ancestors didn't spend their days sitting and eating refined sugars. We haven't evolved to tolerate such a life.
Another:
I just finishing your reader’s piece on feeling depressed and the idea of assisted suicide and I couldn’t help but feel both touched and sympathetic. I have been there, I think I know exactly how he feels. I have been through years of depression, mostly from multiple childhood issues (the details aren’t important) and probably also partly genetics (long history of depression in my family). I have tried therapy, medications, religion, monastic retreats, meditation, etc. Most of it didn’t help and the medications made it worse for me. Maybe I am wrong, but the only reason I can think that the therapist would stop seeing him is because he had given up on trying to help himself, and if he’s not willing to do that then no drug or therapist or group can do it for him.
And that sums up everything for how depression has been for me. It is not about hope. It is about purpose. I can’t control if I am going to be depressed or not, I can’t control what I feel (which is the saddest realization I have ever felt). But, you can control how you live and what you live for. What do I do this day? What do I create? What do I add to this world that makes it just a little bit higher quality a place?
Your feelings might influence and motivate your actions, but they don’t control them, and maybe I can’t not be depressed but I can live with some quality. I can spend a little bit each day drawing or sketching, keep a journal, learning martial arts or Tai Chi or yoga or meditation (it’s new age but really does help), take a continuing Ed class, or something. And, then you just do that every day for a little bit each day. Once you do that, you try a part-time job, do that for six months, and then (only once you’re ready) you try full-time and you get an apartment and you begin to respect yourself for taking care of yourself.
Some people say faith helps; it didn’t for me (I lost mine a long time ago). What finally helped me was to feel I was doing something of value. For myself I tried all of those things I just mentioned. Got to a point where I was doing ok and then tried a long-term goal. Mine included joining the military; and I think the only time in my adult life where I have not been seriously depressed was deployed in Iraq in a war zone.
And that is why I say it is ultimately not about how you feel or the depression or anxiety. It is based on the purpose you choose in this life. That I know add some small quality to this world and am trying to make things a little bit better. What I do now to deal with depression is to practice a little meditation every day and also a little Tai Chi, and although I do have long-term goals I focus more on how I live each day. It’s a cliché, but it works. Not perfectly. The depression does not go away (at least for me it hasn’t), but it does get better, as long as you keep trying.
Another:
There is certainly something going on in his brain, and that makes this problem physical, not spiritual. It also makes it temporary, not permanent. He must remember that physical problems often have physical solutions. The brain is the physical seat of all sensation and thoughts – experience. But it is an organ just like any other organ. It too is susceptible to disease, and these diseases can many times be treated.
Organic disease can manifest as depression through some sort of inflammatory process in the brain. Just because his depression is anti-depressant-refractory does not mean it is treatment-refractory. He might explore Lyme Disease, hypothyroidism, heavy metal poisoning, or other medical disorders that can often manifest as depression. These could certainly help explain why anti-depressants have not worked for him.
Even if it turns out to be a primary psychiatric illness, there are still treatments it appears he has not explored. Vagus nerve stimulation and deep brain stimulation are possibilities. Electro-convulsive therapy is much more evolved now than it used to be. Even though it is clearly very painful for him to be him, he needs to know that somewhere, somehow, there's a solution out there in the physical world that will make life tolerable. He can find it.
There is still hope. If this person can remember any time in his life when he felt happy, even for an instant, then it is possible to feel that way again. He might have to rack his brain to find such a moment, but if he can, he can habituate himself to remember that moment over and over again, and to remember, most importantly, that it's possible to experience the world in that way once more. He has, at least in most senses, the same brain he had then, the same brain he had when he felt that way. Even more importantly, there are people who love him and who will fight for him to get that moment back. His mother.
Disclaimer: I am a patient, not a professional. I do have an inflammatory brain illness: Lyme Disease encephalopathy. The fact that Lyme Disease is so common in the northeast and quite curable at early stages belies the seriousness of the disease. Once it gets to an advanced stage undetected it is, quite honestly, dangerous. It is no accident that it often gets confused with serious diseases such as MS, ALS, Alzheimer's and syphilis. While it may not be able to kill you directly, it will make you want to die. (I've written to you before about that, and you posted it.)
But I too know what it is like to live without hope. I spent decades trying to get rid of this illness, since I was a child. I made it through secondary education and into college not being able to think very well. I suffered from diminished awareness, depression, social anxiety, and a multitude of other cognitive and psychiatric issues. Eventually I couldn't even breathe correctly. It was impossible for me to conceive that there was a solution out there, and so I very much though the only solution was death.
My father finally suggested it was Lyme Disease, and my blood tests came back positive. Treating for it took years; killing off the spirochete once it has advanced to this stage happens only very, very, slowly. Nonetheless, my health has improved dramatically since I wrote that post to you, and I feel immensely better now that I can think, feel, and breathe again. I am immersed in reality, and can comprehend what goes around me much more clearly. I am finally better.
I am returning to school in the fall, at the age of 28, to finish my last semester. Now my life begins again. Know hope.
The Dish 