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7 things to know about Major Depressive Disorder

7 things to know about Major Depressive Disorder

For most of my adult life, I’ve suffered from what I euphemistically have described as melancholy. And like most people, I mistakenly considered it to be a “mood” as opposed to a serious physiological issue.  If I just did X, then I’d feel better. 

When the issue began to seriously affect my life, I readily accepted “advice” that included “appreciate what you have”, “look on the bright side”, “try to reduce stress from your life”, “don’t sweat the small stuff”, etc.

However, that type of advice is about as relevant as telling someone who suffers from severe migraines or epilepsy that they can “cure it” by changing their attitude about it. 

Understanding what depression actually is

Depression isn’t caused by external events.  Not the type I’m talking about anyway.  Obviously if enough bad things happen to you, you can be pretty down.  But major depressive disorder is an event that occurs in the brain where your serotonin levels drop very low.  Because the symptom of it is simply being in an extremely “down mood”. Unfortunately, people who suffer this are inclined to try to just push themselves through it which only serves to exacerbate it.

In video game terms, if one’s mental well-being can be described as mana, then everything we do each day results in actions that give or take a bit of that mana.  A bad event, like a death or a divorce will take away a lot of mana.  What makes MDD so serious is that it is a largely random event that essentially drops your mana to near zero. Suddenly, those day to day events that might not be that big of a deal become potentially life threatening (or sanity threatening).

For example, some people talk about seasonal depressive disorder.  I think a better way to think of it is that during certain times of the year, the conditions result in a steady trickle of mana. For most people, this might be no big deal or maybe a mild case of be somber.  On the other hand, if you are unlucky enough to have an MDD event around this time, that steady mana trickle can take you to a very very dark place.

There is no cure, there is only management

Being an engineer, I tend to focus on solutions. The idea I couldn’t “solve” depression seemed ludicrous.  Throughout my 20s I had a mantra: “The cure for the blues is achievement.”  I made an ambitious bucket list to work towards by the time I was 40.

And so 40 hit and I had done everything I had hoped to do by then. My family life was wonderful. I had beautiful, wonderful wife of nearly 20 years. 3 healthy, happy children. A beautiful home. More money than I could ever need. My book had been published by Random House and was at every book store I went to. Good physical health. Lots of friends. Good support network. Awesome job.

But accomplishment has nothing to do with depression. Depression doesn’t care. It’s a physical disorder.  It’s like suggesting that someone with diabetes just needs to get a big promotion at work and suddenly they’ll be cured.

Depression doesn’t make people any more sensitive

Having talked to other people who are in a similar situation, one of the most frustrating aspects is that many people think that those with depression are just more sensitive or that you need to be careful what you say around them.   Again: Depression is NOT caused by external factors. 

Just as depression can’t be cured by good events, it can’t be caused by bad events. It is not caused by some relative saying something rude or getting a mean email or some Facebook argument. 

The only time external factors become an issue is right after an MDD event has occurred that has brought your mana down to zero. Then it matters and the onus is on us to understand that and manage it.

How to manage it

Once I began thinking of depression as a physical issue, I was able to start effectively researching ways of managing it.  Here are the techniques I’ve learned over the past 3 years (I’m 43 now, it was 40 when I finally accepted that there was no magic accomplishment bullet).

None of these things will “cure” it. This is simply managing it so that you don’t go into “negative mana”:

 

  1. Mindfulness.  This means focusing on the moment. MDD events tend to cause people to dwell on everything that they imagine is bad. “I’m wasting my life”, “I’m not living up to expectations”, “Why am I still alive? What’s the point?”, “Nothing is worth doing anymore”.  You can’t talk yourself out of these things at that moment. Instead, you just need to distract yourself and focus on the moment.  For me, that means something as simple as taking a peek at the conservatory in the house at the lizards and watching them do what lizards do (answer: Not much).

    Mindfulness does NOT mean: Going for a walk, exercising, reading a book, etc.  It means find something around and focus on it for a bit. The simpler the better.
  2. Deconditioning. Where I work, I have a standing policy on “brain times”. We only care about what accomplish in the bigger scheme of things. We don’t care if you’re accomplishing it at 2:30pm on a Wednesday. If you need to take a brain break (defined as: working from home and at 2:30pm you instead read a book or do something in your garden because you’ve had “an event” recently then do it).  

    Deconditioning is, by far, the hardest thing to do because MDD comes with “I’m not living up to other people’s expectations” and therefore it makes it even harder to force yourself to just not do something that requires mana even if it’s in the middle of a work day. 

    I still struggle with this a lot and I own my own company. Yet, middle of the afternoon on a Tuesday I will force myself to read through a contract or some proposal or status report or some other thing that sucks the life out of me simply because it’s a work day in the afternoon. But I’m getting much better at simply rescheduling things so that I either spend that time doing something I enjoy (like writing code) or something unrelated (reading a book, playing with the dog, whatever).
  3. Drugs. There’s no way around this. SSRIs and related drugs are a life saver. Find ones that work for you and stick to them. Yea, it sucks to have to take something every day forever (until they do find a cure). But I already take a multivitamin.
  4. People. How you deal with people in this situation depends on if you’re an introvert or an extrovert. I’m an extrovert so I tend to enjoy being around people most of the time. I gain mana from socializing. But introverts lose mana from socializing.  So if you’ve had an event, deal with the people issue appropriately. You don’t go flying with a severe ear infection and you shouldn’t go present at a company meeting if you’re an introvert and you’ve recently had a MDD event (reschedule! Yes, DO IT).
  5. The right job. People say “Life is short” and proceed to live as if they’re immortal.  I had a financial advisor friend who joked that if I quit “messing around” I could be worth 9 to 10 figures instead of “merely” 8.  That gets back to the obvious: Having money has very little affect on MDD. MDD doesn’t care.  Epilepsy doesn’t go away if you have a lot of money either.   Instead, the right job means having a job that provides as many “mana generating” opportunities as possible with the fewest number of “mana absorbers” present.

    Where I work, we have an in-house fitness trainer, a nutritionist and (again, since hitting 40) it is forbidden to have anything resembling “crunch”. If someone is working a lot of hours, they’re asked if they’re doing it because they enjoy what they’re working on versus because they have some sense of obligation.  If it’s the latter, it’s discouraged and we can discuss the underlying issues.  A big part of this is employee retention.  Working with people you know and care about for many years is extremely helpful. 

    Having an environment where people feel there’s a lot of flexibility to learn and do new things over your career (tired of concept art? How about game design? Or how about cinematics? There’s time to learn).  At the same time, it also means having a lower stress environment where people are less likely to have anxiety or not get along as a result.
  6. Diet and Exercise.  These aren’t cures. But holy cow, making sure I am not eating crap can go a long way.  I love my mochas in the morning (they really help me) but I’ve moved away from fast food and the other garbage I used to ingest and just feel better. Poor diet is more like a drip drip drip to mana.  Similarly, it’s not so much that exercise will make you happy as much as inactivity is a constant drip drip drip to mana.
  7. Accepting what it is. Last but not least is accepting what MDD is. It’s a physical issue that has no simple cure. It is not some weakness in character. It is not a failure on your part to appreciate what you have.  It’s just as physical as epilepsy or diabetes or some other physical ailment.
    The only difference between MDD and any other ailment is that the symptoms of an MDD event come in the form misery that, if unmanaged, becomes utter despair that can be very dangerous.

 

I hope this helps others. It has taken me some years to get to this point.  Until recently, I’ve really not talked about this outside my family and a few very close friends.  But I’ve come to the conclusion that there are a lot of people out there facing these same challenges.

Most people who know me know me to be a pretty happy person. That’s because I am a happy person much of the time. Just like people can be very healthy until they have the flu, I am happy until I have an MDD event that requires me to have some care in how I manage it.

127,091 views 39 replies
Reply #26 Top

Curiously...ALL the best commedians suffer/suffered chronic depression....

Kinda makes you wonder...;)

Reply #27 Top

I suffer from major depressive disorder and I was recently doing pretty bad and I kind of feel like ranting and getting something off my chest in a somewhat anonymous way.  I have mentioned this a few times, but I also have worked in mental health for the last decade most recently at a state hospital.  It's taken it's toll on me.  I've seen some serious shit, from suicides to brutal assaults, but I have always been able to handle it.  What I couldn't take is working for a place that clearly didn't care for it's patients or it's workers.  Over the last year, we had developed a state board of nursing certified program to train new hires to work on the hospital units.  Most people who start working at the hospital have little to no experience working in a setting like this, and know very little about mental illness.  Well, we had a new interim superintendent start, and he changed our 5 week training into a 3 day training.  It caused chaos, it may have even attributed to a patient's death.  I was in charge of training these new employees, and I was never consulted about any of the changes.  They continued to change the length and content on a weekly basis, never once consulting me and with little to no warning.  On top of this, they wanted me to work double shifts everyday.  I quit.  I had to.  I have a new job, working with adults with intellectual disabilities, and I am a lot happier.  What I want people to get from this is, don't take shit from a job or people in your life.  Life is too short to be around or work for assholes.  

Reply #28 Top

*hats off

 

Keep up the great work Sir Xia.

Reply #29 Top

I have suffered with major depression for close to 40 years, though I wasn't properly diagnosed until around 18 years ago, shortly after my younger brother died of a suicide.  The impact of that manifested in both physical and increased mental illness... something I'd had for quite some time but didn't realise it.  When the doctor who diagnosed me asked a series of questions and related my answers to chronic depression, I finally understood why I felt so low at times and like I'd lost control.

It took the death of my brother, its impact on me and my becoming quite ill before I sought help.  Prior to that I was a typical hard-headed male who didn't need help... like I was tough enough to fight it through and come out the other side a winner.  Oh how wrong I was!  If only I had swallowed my male pride and admitted to needing professional help beforehand, then perhaps I may have coped better when he passed. In fact, had I gotten myself properly diagnosed sooner, I may have recognised his symptoms and been able to help him.  I will never know that now, but it's a regret I hope nobody else ever has to live with, knowing the devastation it brought to myself and family members.

I don't know what triggered my depression - whether it was being hospitalised for 3 years with multiple injuries and the associated pain; or my 1st wife abandoning me to raise two small children alone; or the work colleague who blindsided me with a kick to the face because he resented my position being over his; none of the above - but if you or anyone you love or care about begins to exhibit signs of depression and/or abnormal behaviour, please get yourself or them the necessary help to lead as normal lives as you or they possibly can.

I still have occasional days where I feel so melancholy I start crying for little or no reason at all, and there's nothing I can do to stop it, but for the most part I am back in control and I am able to manage my illness with medication and a positive attitude.... acting the fool and sharing crazy jokes and humour with others.

Reply #30 Top

Quoting Kamamura_CZ, reply 25

As a person who has been diagnosed with depression and took medication for a few years, I will share my notes on depression. 

 

- I personally believe that it's a result of a deeply unsatisfactory life our industrial and post-industrial society forces upon us. I mean, we are designed to run through forest, pick berries and hunt animals, to mate and experience both thrill and fear to which physical response is the right thing (fight or flight, etc.) All our hormonal systems are build around this, but our way of life has over-conditioned us, our fears are immaterial, like economic crisis, or loss of job, or a disease that may or may not worsen, and running away is not a useful response. We burst in anger, but can't fight because social repercussions would follow, we became shy and unsure, because we are compared with artificially created perfection of the media world we cannot compete with. We are like motors, and the driver is constantly pressing the gas pedal while holding down the hand brake.  All this, gradually, day by day, over the year, twists and breaks our mental balance. But I still believes it starts in the head with subtle things that few people even realize by the time. 

- I believe like second type diabetes or arthritis, depression is a physical manifestation of an unnatural state that lasts for a long time, a chronic problem. Like a person who eats too much simple sugars, gains weight, and suddenly, his insulin receptors become resistant and he has a serious problems that cannot be solved just by eating less alone. Once serious depression manifests in states where you are completely overwhelmed and sliding down the spiral, you can no longer solve it in your head, you need medication and help as soon as possible, and the quicker you realize it, the better. There is also the danger of destroying the relations with people around, because even the most sympathetic friends and family members may give up on someone who is grim and silent and sad all the time. The medication can sort of wall off the problem for a while - it does not go away, but at least you have a moment of respite and a chance to do something. However, there is a question of what to do.

- Never tell a person with acute depression to try to exercise. It just doesn't work - it's good long term to stay healthy and to get those endorphine boosts when done regularly, but if you have an acute episode, it will make things only worse. The only thing to do during acute depression is to start medication and find something to cling to before they kick in (usually took about two weeks for me).

- I don't pretend to have solved the problem, but for me personally, I have found a way to stabilize it. I have identified a circular patterns of thinking revolving around despair, death, lack of perspective for humanity, self-loathing, and so on that work like a motor that starts and accelerates the problem, and I just no longer go that way. When I catch myself going in this direction, I force myself to stop, and that's it. It's still there as a cloud on a horizon, but I don't suffer those crippling, debilitating episodes anymore.  

- Personally, I find a great comfort in the works of Friedrich Nietzsche who in my opinion went through states of severe depression and supposedly suffered from schizophrenia later in his life too and ultimately deteriorated both physically and mentally, but before that happened, he experienced moments of unique and absolute clarity few can ever aspire to. Just one famous quote that (for me) summarizes it all:

"When you look stare into the abyss long enough, you will find that the abyss is staring back at you."

 

Agree totally.  This expresses well both my experience and my understanding of the world we have created for ourselves as well.  One minor disagreement:  I don't think ostio arthritis results from the cognitive dissonance inherit in living in 'modern' societies.  Rheumatoid, probably yes.  All in all - excellent description.

Reply #31 Top

I am posting in this thread so I can uncheck the "subscribe" button to see if that works. The e-mails this forum sends me have no clickable links -- not even the thread title. They're underlined and blue, but not links. I will check this thread once or twice more in case Brad can tell me anyone I can forward the email to as a bug report.

Reply #32 Top

It is somewhat unsettling that I sort of think I might be in this MDD category may have been slipping into for a long time (how do you boil a frog....).  It has seemed worse this last couple of years and I simply thought it was the fact that I turn 50 this year and saw it coming.  I am not sure how this gets diagnosed and by whom, but I do worry about labels.

 

Reply #33 Top

Quoting My, reply 32
I am not sure how this gets diagnosed and by whom, but I do worry about labels.

It may take more than a couple of visits to a health professional with experience in this field, but you would be assessed using a number of questions and observations during your visits.... and don't worry about the labels. 

Seriously, they only hurt when you try to peel them off... cos they stick to your body hair and rip it out in clumps upon removal.

Me, well I wear my lunatic label with pride, so there's no thought given to its removal.. :-" :grin:

Reply #34 Top

Quoting My, reply 32
but I do worry about labels

I worry about the 'labels' they put on you in hospital....a wrist tag is fine...but also having an ankle tag makes you wonder whether there's an expectancy you/they might be losing body parts.....

Reply #35 Top

Quoting Jafo, reply 34


Quoting My Views and Muse, reply 32but I do worry about labels

I worry about the 'labels' they put on you in hospital....a wrist tag is fine...but also having an ankle tag makes you wonder whether there's an expectancy you/they might be losing body parts.....

Nah, it's not the ones around yer ankled ya gotta worry about.... nah, it the ones they put on yer big toe you've gotta worry about.  :-"

Reply #36 Top

Quoting Jafo, reply 34


Quoting My Views and Muse, reply 32but I do worry about labels

I worry about the 'labels' they put on you in hospital....a wrist tag is fine...but also having an ankle tag makes you wonder whether there's an expectancy you/they might be losing body parts.....

Or maybe losing all you body parts... toe tag?   Oh, and every label is a libel, yes?

Reply #37 Top

I bookmarked this and read it and reread it. This is a great post and I want to thank you for sharing it. It's huge. It's often easy (for me) to talk about what's bugging me or getting me down but I never mention the depression that comes with it. Like mentioned in this thread, you worry about labels and what people will think...even your friends and family. I've been estranged for years from most of the people that know that I battle depression.

The reason I am adding to this thread is that I think (at least for me) there are levels of depression. The older I get the wiser I get. It becomes easier to see when and where I am the one responsible for what ever current depression I may be in. It doesn't make it any less painful or any easier to deal with, but there is some comfort when you can put your finger on the cause or the root. The hard part is getting your head out of that thick, dense fog to see well enough that you can see how you might have helped create it or add to it. I hope that makes sense.

What is harder is what I am going through now (and have been for some months). So, I'm not so far gone that I think anyone is in my head and I need a new tinfoil hat but it's a hell of a coincidence that this post came about when it did (for me).

Cause I have found myself in a depression that is just scary. It's scary (if this makes any sense at all) because I can be depressed and be okay with it..it's familiar...it's a ride I have been on before and I know it has an end and I will come out in one piece and move on. But this one is  so deep and seems so endless. And it's one where I feel helpless to do anything about it. I've learned to deal with depression over the years by making compromises and accepting certain facts. (You might say we have a deal, depression and me...that is until now. ) I'm off the reservation in the sense that it's just never been this bad and I have never felt like I don't have a chance of snapping out of it or that I just didn't have the strength. What drives this depression is out of my control (or so it feels) and I don't know HOW to get control of it. I'm strapped in. I've never been on THIS particular ride before and it's not only scary but overwhelming.

I won't go into a big mess of detail. I just wanted to say thanks for this post. I'll be keeping it bookmarked and going over it as much as I need to. It helps to keep me grounded a little bit and I apreciate what it must have taken for you to share it with the rest of us. Thanks, again.

Reply #38 Top

@PoSmedley  Thank you.  Your post inspires me!

Reply #39 Top

With the recent suicide of Robin Williams I thought this topic might be timely.