A woman who has major depressive disorder decides to go back onto her medication:

This is her story:

Today, I decided to go back on anti-depressants. This is a battle I’ve waged for years; do I really need them, do they really help, are the side effects worth it, am I just a loser who can’t deal with life’s vagaries.

Last weekend I drafted a post that contained the line, I feel like a bucket brimming with tears, and the slightest, inevitable tremble of the earth makes them overflow. It’s an inelegant metaphor, but worse, it’s a pretty clear symptom that things are not going well. It’s partly a bad birthday, partly the break-up, partly some harsh health news. It’s mostly, if I’m honest, cyclical, recurrent, my noonday demon.

“Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.”
— Andrew Solomon

This is a family tradition; at the cousins’ table at last weekend’s wedding, we raised a toast to Lexapro and discussed having a candy bowl of all our meds on the coffee table of the rental house we’ll share at the next wedding. It’s funny, but it isn’t. Undiagnosed and untreated depression, manifested as alcoholism and other self-destructive behavior, blackens the family history like soot after a fire. Not everyone, not all the time, but too many, too often.

For me, it begins with a lack of resilience. My normal ability to adapt diminishes and diminishes until I can’t remember that I ever had it. Then, despite the pride I take in being self-aware, I start to judge my good life unworthy and tell myself that my unhappiness, my deep profound malaise that rips the joy out of each moment and shows me only the glaring photo-negative of each happy event, is actually the only sane and measured response to a terrible world and my own failures to strive against the terribleness. That’s the most insidious part, for me; my beautiful brain turns against me, whispering that I am correct in my assessment of my own awfulness and that I deserve to feel bereft, that my sadness is borne from clearly seeing the world and my own bottom-rung place in it. That the life that stretches before me will always be this bleak and hopeless, and that it’s my fault, and that I’m forever lost.

I mostly retain enough self-awareness to know how first-world self-pitying this sounds to anyone but me, but knowing that doesn’t combat my secret belief that it’s true.

My first episode of depression hit me during my fourth year of college. I was living by myself, and working two jobs, and so sad and overwhelmed that I began skipping classes to sleep and sleep, until I got so far behind that I saw no option but to quit. The rueful backstory here is that my parents had already yanked me out of my beloved city and school once, for financial reasons, and I had fought bitterly to return to the life I thought was rightfully mine. And then I ruined it. No one, myself included, ever thought my actions might be aberrant because I was ill; I was just a failure who fucked it all up.

“…a part of depression is that it touches cognition. That you are having a breakdown does not mean that your life isn’t a mess. If there are issues you have successfully skirted or avoided for years, they come cropping back up and stare you full in the face, and one aspect of depression is a deep knowledge that the comforting doctors who assure you that your judgment is bad are wrong. You are in touch with the real terribleness of your life. You can accept rationally that later, after the medication sets in, you will be better able to deal with the terribleness, but you will not be free of it. When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better.”
— Andrew Solomon (The Noonday Demon: An Atlas of Depression)

I’ve tried and tried to write about the beginnings of this last trough, when my sister’s boyfriend was shot and nearly killed on our front porch in 2006. Well, I have succeeded in writing about it–the awful terror and despair of the days and weeks that surrounded the event, and my subsequent PTSD and years of broken sleep and terrible anger–but I’ve failed to write about it in a way that is useful. It’s simply too raw and ugly still, and there is no happy ending, only pain and permanent disability and broken hearts. The long-term effects led to my worst low ever, eventually, and to an appointment with a psychiatrist where I wept uncontrollably and confessed that I was afraid to leave my house and afraid to stay home alone and at the bitter end of my ability to conceal how bad things were. I was scared that I would die, that I was broken in a way that could never be put right.

Medicine was a revelation, a silver bullet that lifted me up and out in weeks. I’d gone so far as to get a prescription for anti-depressants before, but never taken them. Once I started, within six months I’d launched a new business, gotten a promotion, found a new place to live, and started dating again.

And then in January I quit. I felt good, I was falling in love, I was emphatically not a person who would be on meds for the rest of her life. I wanted to be the plucky heroine of my own story who’d had some lows and left them behind. I didn’t want my dates to see the pill bottles. I didn’t want to be damaged goods.

But I don’t want to be mired in black sadness and self-doubt any more either. I’ve met so many people lately who are doing amazing things with their lives, and I’ve lost so much time already. I write this to remind myself that I have more to offer the world than I’ve been able to give, that the drum of failure and hopelessness inside my head can change its beat. I get a flash every once in a while of what my life could mean, of what I could accomplish with the talents and abilities I have, and I need to hold on to those images and walk toward them. If I have to pause in my march each day to wash down some false pharmaceutical courage, it’s a small price to pay.