First Day of School

I survived my official first day back Gettysburg in almost a year. I managed to make it through each of my three classes today without much trouble, but now I am extremely exhausted and ready to sleep for a while (especially since my anxiety kept me up much of last night, which is just how you want to start a new semester at college...) 

Awkward first day of school picture.

Today didn't suck. Parts of it did, but as a whole, today was okay. 

I felt a great amount of shame walking into and sitting through my stats class and Introduction to Brain & Behavior, mostly because I should have completed both of these courses last fall. It is really hard for me to come to terms with having to retake them, even though I know those medical withdrawals last fall were for my health and will be best for me in the long run. Most of the time I can't see the forest for the trees, especially when it comes to my future and my recovery. 

(I know most would think retaking these courses would give me an advantage because the majority of the material--at least for the first two months--will be review. This is not the case! I was active in my eating disorder last fall, which means my brain was not processing information to long term memory as effectively as usual, thus resulting in my not remembering much of what I learned last year. I am in for a frustrating semester with these two courses... So please, stop telling me they should be easy for me.)

On Monday and Wednesday afternoons, I'm taking this course called "Writing through Conflict," taught by Hugh Martin, a contemporary author (read more about him here). It'll be an interesting course, for sure, albeit a ton of work. I think the hardest part of the course for me will be handling the stress of its workload, as well as the memories the professor's presence brings to my mind--he reminds me of someone I'd much rather forget. 

Academically, I think this semester will be okay. It'll be an intellectual challenge, but I think the hardest part will be acting against this perpetual exhaustion I've been feeling to get myself to class, get myself out of my apartment, get myself to do my work.

The most difficult part of this semester, by far, is going to be dealing with the loneliness/aloneness I've felt since arrival. Don't get me wrong--I have friends here. At least, I think I still do. Little by little, I've been realizing the friends I still have here, although it's going to take time before I feel loved and cared for and supported here again. It's going to take time to build my relationships back up. I know that, logically. 

I can't help but feel I don't have someone I can turn to here when I'm having a bad day. I feel like I'm fighting the war all on my own, which is a hard thing to do when it seems each battle is never-ending. I feel I can't articulate my needs to people here. I feel I can't share my emotions here. I feel I'm walking on such eggshells here. I thought that was because of knowing if things get bad again, I going home and not coming back, but I'm realizing it's not. 

In a conversation with someone today, I was told, "Congratulations on beating eating disorders!" I was a bit taken aback by this statement at first, until I thought about it some more. 

I think there is this expectation of people--my friends, professors, acquaintances--that once I'm back, I'm better. That ten months at home is enough to "fix me" or "make me feel better." I don't think it's anything uncommon, but most people believe mental illnesses like depression, anxiety, and eating disorders can be cured, when in reality, I don't think they can. 

My Brain & Behavior professor gave an example from the media in class today when talking about depression and I think it applies well here. He said someone (I forget the name) rich and famous was being interviewed on the radio and was asked how he could be depressed when he was so well-off. This person responded with a question, inquiring how someone similarly well-to-do could have asthma or cancer or any other more socially acceptable illness. 

My professor was trying to illustrate the idea of mental illness being a result of an inconsistency in the body, but I think his analogy was slightly incomplete. Mental illness is more accurately depicted as a chronic condition--asthma or allergies, for example. It's not something you can treat once and then it will go away. (Wouldn't it be nice if it worked that way?!) 

Eating disorders, like depression and like anxiety, are something you learn to live in spite of (Most people say you learn to live with these conditions, but they suck the life from you, so I think it is more accurate to say live in spite of these conditions). I am learning to live in spite of my disorders. I am earning my education in spite of my disorders. I am back at Gettysburg and got through my first day of classes in spite of my disorders. 

Let that be enough.

Sometimes I forget I have depression...

Sometimes I forget I have depression.

Not because I've suddenly recovered from it or it's miraculously gone away, but because most of the time, I am so focused on the fact that I have and eating disorder and I need to recover from my eating disorder. I never really, truly think about recovering from my depression. 

When I think about recovery, I always think about it in terms of eating disorder recovery. I guess that's because it's so easily tangible, whereas depression recovery is not. With eating disorder recovery, I can see the recovery by seeing records of my following my meal plan, by being told by my doctor that I am in my weight range, by no longer being orthostatic or bradycardic. But with depression recovery, it seems like the only thing defining recovery is the ambiguous 'feeing better.' 

I guess depression recovery can be measured by how much more I am leaving my house, how much less I am isolating, how many times I reach out to friends, but none of that seems to signify recovery to me. My depression is this all-consuming feeling of drowning, of being suffocated in this endless pool of hopelessness and pain. It is like being in a cave full of only darkness, where there are absolutely no exits anywhere. It's continual grieving for something that you never knew existed. 

Depression is not so much behavioral as an eating disorder--more mental and emotional, but it is so much more complicated than that. All that depression is becomes so mangled and tangled up inside of my head and interwoven into my life that operationally defining it is not something I can do. I know people have done it--professionals--but defining and explaining it for me, as someone who experiences its intricacies and quirks day in and day out, nothing seems adequate. 

It wasn't until recently I actually noticed I've been completely forgetting about my depression. I obviously know it exists... It crosses my mind every night when I take my antidepressants that, "Hey, Sarah, you have depression and if you stop taking these drugs, you'll soon feel like shit." But other than that, it's hardly ever a thought. 

A little over a week ago, I spent my part of my night/early morning in the emergency room because for the first time in months, I had selfharmed and I was worried I may have gone a little too far. A friend decided I needed to go to the hospital, whether I wanted to or not--I was definitely on the side of not, and so we went. I spent that early morning and the days following trying to figure out exactly what had happened, what had triggered me to do what I did that night. And no matter how much I thought about it, I was not able to quite discern what happened (usually it is fairly simple to see a causal relationship with my behaviors). 

It's slowly come to me that I used selfharm as a way to cope with the overwhemingness of the depression that I was feeling inside of myself that night. Nothing happened to trigger it, just like nothing ever happens to trigger it. It just is, sudden and suffocating. 

I guess lately that I've just been tuning out my depression, focusing on the tangible aspects of my eating disorder recovery, seeing everything I was feeling as an effect of no longer using eating disorder behaviors, and ignoring the fact I have a dual diagnosis of an eating disorder AND depression. 

I've realized I can't treat one and just ignore the other. Recovery does not happen on it's own, and although eating disorders and depression can share similar symptomology, they are not the same illness. I have to work on recovering from both. So now it's time to focus on both maintaining the progress I've made in my ED recovery and learning how to manage and live with my depression. 

Because even though I sometimes forget about it, I do have depression and it does highly impact the qualitiy of my life. 

I Got In A Fight Last Week...

I got into a fight. On Twitter. It sounds so lame and immature... But someone needed to say the things that I did, and honestly, I regret nothing.

One night last week, I was scrolling through my Twitter feed, when I can across a tweet claiming that the cure for depression is "a weekend of nature, sit[ting] under a tree and watch[ing] the water cascade over a cliff." As someone who has struggled with diagnosed clinical depression for a very long time, I was offended by this tweet. My response to it was: "Depression is a disease and chemical imbalance in one's brain, not an emotion. Stop #mentalhealthstigma & belittling the problem!" (Let's take a minute and think about how hard it is to tell someone facts and why they're wrong in 140 characters...) The replies I received were less than informed, and in some cases down right mean. I think my favorites were the ones that told me I was "brainwashed" and "Perhaps the chemical imbalance in your brain is a RESULT of you negative thinking/attitude" and "#YourHashtagsMeanAsMuchAsYourDegree #Nothing."

Depression is a serious mental illness that affects 5-8 percent adults in the United States each year. Less than half of these people will get help for their disease. This is a problem. Stigma and misinformed people are a problem. So let's look at some myths (and some arguments) that I came across in my Twitter fight.

Myth #1: Depression is not a disease.
The dictionary defines disease as "a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury." By this definition, depression must be a disease because brain scans have shown decreased activity in certain areas of the brain in depression patients, higher levels of stress hormones, and various genetic and biological causes that cause symptoms impacting one's thoughts, feelings, behavior, mood, and physical health. For some, depression is a life-long condition in which periods of wellness alternate with recurrences of illness. Depression is a leading cause of disability worldwide and represents a global public health challenge. According to the World Health Organization, it is the forth-leading contributor to Global Burden of Disease, and by 2020, depression is projected to be the second-leading cause.

There is no doubt, then, that depression is an illness.

Myth #2: Depression is a disease.
This is intentionally contradicting the point I just made. Depression is a disease, but it is not a straightforward medical disease. Confused? So was I, don't worry. Dr. John Grohol explains it in this way:

Diseases are manifestations of a problem with some physical organ or component within the body. And while the brain is also an organ, it is one of the least understood and easily the most complex organ within the body. Researchers and doctors refer to a diseased organ when something is clearly wrong with it (via a CAT scan or X-ray or laboratory test). But with our brains, we have no test to say, “Hey, there’s something clearly wrong here!”

One could make the argument, as many have, that because brain scans show abnormalities in certain biochemical levels within the brain when they suffer from depression or the like, this “proves” that depression is a disease. Unfortunately, research hasn’t gotten quite that far yet. The brain scans show us something, that much is true. But whether the scans show the cause or the result of depression has yet to be determined. And more tellingly, there is a body of research that shows similar changes in brain neurochemistry when people are doing all sorts of activities (such as reading, playing a video game, etc).

Depression is not a pure medical disease in the traditional sense, but a mental illness or mental disorder. It is complex in that reflects its basis in psychological, social, and biological roots. While it has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure.

Dr. Azadeh Aalai relates it in this way:

Psychiatrists oftentimes use the parallel of the diabetic who takes insulin to treat his condition; so, too, must the depressive take his or her meds, they claim. This is a wildly inaccurate parallel for a number of reasons. Firstly, one can definitively diagnose and validate diabetes as a medical condition. One can also identify with certainty the underlying medical reasons behind the diabetic’s condition. Lastly, one can also identify with certainty the extent to which the disease can be controlled/treated with the administration of insulin (in the case of type I diabetes in particular). There is no definitive blood test or otherwise physical examination that can determine a depression diagnosis. In fact, contrary to the entire medical paradigm, the symptoms of the illness actually serve as the basis of the diagnosis in the case of depression. Moreover, there is not a clear intervention, medical or otherwise, that can be implemented for a depressed individual that will work in all cases.

Summary: Depression is a mental disorder or mental illness--not a disease purely in medical sense, but it is still a disorder.

Myth #3: Depression is a product of your environment.
This one made me laugh a little bit. The boy who said this was clearly confused because he gave an example of a kid being depressed because his parents were fighting. First of all, that is not clinical depression--that's sadness. The two are not synonymous, but I will get to that later. Second of all, all mental illnesses are biopsychosocial in nature.

The first component is biology, which includes both the biochemical makeup of the brain, as well as inherited genes. Neurochemistry, especially neurotransmitters like serotonin, has been shown to correlate with depression, but the brain is so complex, that much is left undetermined for certain. Lately, research has started to show a genetic predisposition to mental illnesses like depression, but none of this determines if an individual will be affected. Having a relative with depression only increases your risk for getting depression by 10-15 percent. Correlation does not equal causation. The second component of this model is psychological, which includes a person's personality, how he or she was raised to deal with stress, how he or she deals with emotions, and other aspects. The final component of this model is social, which includes relationships and how we interact and communicate with others.

The biopsychosocial model is the most widely accepted model in all of psychology because it states that mental illness cannot be caused by biological or psychological or social factors alone--it takes a combination of all three to bring about any mental illness.

Myth #4: Depression is a choice.
Depression is not something that a person chooses to have! Seriously. A person with depression does not want to feel the way that he or she feels. It is not something that can be willed away any more than cancer or diabetes can. Research has shown depression correlates with chemical changes in the body, which cannot be overcome simply by a change in thinking. Depression is a medical condition that arises from errors in brain chemistry, function, and structure due to biological, psychological, and environmental factors.

Myth #5: Depression is just sadness/laziness/weakness. 
False. Equating depression with any of these things is like saying a common cold is the same as pneumonia.
Depression is not just ordinary sadness, grief, or laziness. Again, to quote Dr. John Grohol:

Depression is overwhelming feelings of sadness and hopelessness, every day, for no reason whatsoever. Most people with depression have little or no motivation, nor energy and have serious problems sleeping. And it’s just not for one day — it’s for weeks or months on end, with no end in sight.

Depression is not a sign of weakness--it can strike anyone at anytime. It does not discriminate against gender, race, age, sexuality, religion, culture, or any other factor. Someone with depression is not just feeling sorry for him or herself. Some of the most prominent and accomplished individuals have suffered from some form of depression, including:  Alexander the Great, Napoleon Bonaparte, Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, abolitionist John Brown, Robert E. Lee, Florence Nightingale, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan, Barbara Bush, Ludwig von Beethoven and Michelangelo.

Myth #6: Depression is just a phase and if ignored, it will go away. 
This is false. Depression is a medical condition that requires treatment and support. In fact, many times symptoms of depression will get worse if left untreated. One of the most effective treatments of depression is through behavioral activation. This is the idea that in order to decrease depressive symptoms, one must act opposite to them--activate one's behavior--in order for them to decrease (which will not be instantaneous).

Myth #7: Antidepressants work no better than a placebo and have dangerous side effects.
This one I had to do some extensive research on and the jury is still out on it, not just in my brain, but in the scientific community. Talking about antidepressants, Dr. Azadeh Aalai wrote:

The standard the FDA requires for psychiatric meds to be approved and sold to consumers is not a high one: only two independent studies that yield significant results in favor of drugs is required, regardless of how many trials may be required to render such findings. In other words, “so long as research eventually yields evidence of efficacy, the failures would remain off the books. This is why antidepressants have been approved even though so many studies have shown them to be ineffective” (Greenberg, 2010, p. 216). Moreover, research suggests that the reduction of depressive symptoms seen with antidepressant use may be more indicative of a placebo effect than the merits of the drug itself. For instance, some sources contend that up to 80% of the effectiveness of antidepressants is due to placebo effects (see Greenberg, 2010). This comes at a high cost, given the documented (and not so documented) side effects—chief among them that in some cases, ironically, use of antidepressants actually increases suicidal ideation (particularly among adolescents).

A study done by Harvard in 2005 more deeply probed the risks of antidepressants, as did a study at the University of Colorado. Multiple studies have shown the effectiveness of antidepressants over the use of a placebo. People will analyze these studies inside and outside and upside down, but the speculation that antidepressants are no more effective than a placebo has not yet been evidenced in research, and like all medications, psychiatric medications come with their risks and side effects. However, if the medications are taken properly, under supervision of a trained medical doctor, the risks are generally minimal.

Myth #8: School shootings are caused by antidepressants, proving they do more harm than good. 
So. I don't even know what to do with this one. To me, it is a clear case of people assuming that correlation is the same as causation. I did a Google search of school shootings and antidepressants and found not a single credible source in the first few pages of results. To make sure that I was not missing anything, I did a search of PsychInfo, which gave me no results. There has been no research done in the academic community which states a definitive link. I read a statistic (and only one statistic, and not from a valid, peer-reviewed source) that stated 90 percent of school shootings could be linked to antidepressants. Since Newtown, there have been 44 school shootings in the United States, as of February. An estimated 31 million Americans are on antidepressants. That is a very small percentage, even if all those involved in the school shootings were taking antidepressants. Correlation does not imply causation. A link between two things, is not always causal, and in this case, assuming that cause is not only incorrect, but irresponsible AND it continues to promote stigma that keeps people from getting help!

Myth #9: The only way to treat depression is through the use of antidepressants. 
Treating depression is not as simple as just taking a pill. Medication alone is not enough and is generally most effective in addition to psychotherapy. Cognitive Behavioral Therapy (CBT) has been shown to be particularly effective in the treatment of depression. Lifestyle changes such as balanced nutrition, regular exercise, and adequate sleep have been shown to help as well as things like mindfulness, meditation, and yoga.

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Resources and References:
http://www.nimh.nih.gov/health/topics/depression/index.shtml
http://psychcentral.com/lib/an-introduction-to-depression/000650
http://www.nami.org/Template.cfm?Section=depression
http://www.nytimes.com/health/guides/disease/major-depression/overview.html
http://www.huffingtonpost.ca/2013/11/13/depression-myths-_n_4268047.html
http://psychcentral.com/lib/what-is-depression-if-not-a-mental-illness/000896?all=1
http://www.psychologytoday.com/blog/evil-deeds/200809/is-depression-disease
http://psychcentral.com/blog/archives/2009/10/18/7-myths-of-depression/
http://www.psychologytoday.com/blog/the-first-impression/201302/5-myths-about-depression
http://www.healthcentral.com/depression/just-diagnosed-822-143_3.html
http://psychcentral.com/blog/archives/2009/10/18/7-myths-of-depression/
http://www.healthline.com/health-slideshow/9-myths-depression#1
http://www.hpb.gov.sg/HOPPortal/health-article/10202