I have been dealing with depression for the past 5 years. By taking medication every morning (venlafaxine), I am able to function as “normal”- whatever that means. Many people who are fortunate enough to not have to deal with this diseased condition have no idea what types of thoughts those with depression are going through during every episode. I used to be one of those fortunate individuals. I knew what depression was in theory, just another piece of knowledge: retracting alone with sad feelings and loneliness. However, now I see that my understanding had been very superficial and had been taken from a third-person’s perspective. As always, we can never know the inside of someone’s mind and correctly assumed its contents without first having experienced the same situation.
I remember the day I mentally collapsed and got trapped in the deep, dark, circling thoughts. It was the first week of September. I admit that I had been stressed because of struggles to get funded as a principal investigator of my laboratory and from big changes I had made in my research directions. I was not satisfied by my performance and frustrated by innocent, harmless comments. Although the comments were made with supportive intentions, they were very harmful to me at that time. That day, I had an internal review committee for my grant proposal. Three of my colleagues were the members assigned to read my grant proposal, and to provide their feedback. I was nervous. I knew there was weakness and prematurity in the proposal. I should have skipped one round and waited for some more data. However, my funds at that time would soon be expired. I did not have any confidence that skipping would be a better decision and whether waiting would help improve my proposal. In the end, I could not make that decision. All the weaknesses I had hidden by pretending that they did not exist were revealed and torn through. I had known that this would happen, but I had also held on to the hope that it would not come to be. But of course, all my colleagues are good scientists, and they saw the weaknesses of my proposal. I tried to play it cool since I had known that this would happen.
That night, something changed in my mind. I experienced a very strong feeling of embarrassment. Rage to the situation. Hopelessness towards the future. Confusion, and a sense of being lost amidst my life and research directions. These sentiments all melded together and circled endlessly around in my mind. I have always been good at falling asleep. So, I could still fall asleep that night. However, I woke up around 4 AM with a very strong feeling that I wanted to vanish. In my mind, I kept thinking in a loop: “I want to die. I want to die. But I don’t want my family to be sad. I want to disappear. I want to disappear without anyone noticing. I cannot disappear because my kids will be sad. I want to vanish from everyone’s mind as if I had never existed.”
In addition to this crazy circling of thoughts in my mind, my behavior clearly changed. It was obvious to my wife. I curled in on myself fully covered under a blanket in bed. I might have cried. I am usually a morning person, but it was very difficult to come out from the bed. In the beginning, I tried to hide my change from my kids, although I could not hide it from my wife. However, this did not last. I could not leave from the bed as usual. Even when I did, I would soon roll into a couch and take up a self-hugging position, fully covered under a blanket. After everyone left for school or work around 10AM, I felt a bit better and started preparing myself for work. Clearly something was wrong. But I could not ask help. I did not feel that I entitled to ask for help. I had no self-esteem. No recognizable value. I just wanted to vanish.
For a week or two, nothing changed. Maybe it got worse. I could not express my feelings to anyone. I was not sure what was happening to me. All I knew was a strong sense of uselessness and insignificance directed towards myself. I came to my office everyday, although I stayed in the office so as to not go out to see anyone. Occasionally, someone would come to see me in the office. Then, I would pretend was alright as usual. However, inside my office, what I would do was just search online for words such as ‘vanish’, ‘want to die’ and ‘depression’. I was not sure if I was depressed. I had doubts about my mental state but did not fully accept what I was feeling. Again, I could not tell anyone because I thought I had no value and thus, no right to ask for any help.
I was not sure what to do. I knew something was wrong. I needed help but could not take any action. My wife started to get worried. She made suggestions, but I could not make any decisions. Now I know why: one of the main symptoms of depression is the blocking out of any decision-making abilities. Asking for help always requires one’s ability to make a decision. My wife was the one who found a Japanese psychotherapist nearby, made an appointment, and took me there. In the first session, I cried. Just cried nonstop. I could not control my emotions at all. It was a very strange, strong feeling I had never experienced. I took three sessions with that psychotherapist and decided to change to a psychologist who knew the academic environment instead. Nothing was wrong with the previous therapist, and I really appreciated her help with taking me out from my small, dark cubicle. Importantly, I could express my feelings with my mother language. But it was not easy for me to explain my academic situation.
I started seeing the new psychologist every week. I often cried in these sessions. He provided me with various perspectives and reminded me to consider the situation surrounding myself with these views. I fully understood what he said but I could not take it at face value. I was too miserable to believe his words. Then, I cried. Sometimes, I felt better after the session, but the next morning, I was back to struggling in bed. Mornings were always difficult. Starting from around 4AM and lasting until around 10AM, all that would circle in my mind was: “I want to die, disappear, and vanish”. I just waited until this feeling left. Afternoons and nights were alright for me, I would hope that it was getting better. But the next morning was a repetition of the same thing again.
I fortunately did not need to take a sick leave. I had a few classes to teach during the fall semester. I thought it would be impossible. But the psychologist told me that the knowledge had never disappeared, and that I should be alright. Indeed, I was able to run the class, although I got exhausted after that. Then, what became clear to me was that there were certain tasks I was able to do, and other tasks that had been fully compromised. I could react, but not act. Reaction and action. My reaction was not compromised at all. If someone asked something I knew, I could react. Interestingly, teaching in a class was a reaction to me. On the other hand, I could not make any decisions, choices, or selections. Even small ones. I could not answer questions like “what do you think?” or “which one do you like?”. When I tried to answer those, my heart began to beat violently, and my hands would sweat. My brain would be frozen in fog. I realized that Action and Reaction are two completely different activities. In our normal life, we do both flawlessly and without special awareness. In depression, one activity is completely blocked- at least for me.
The sessions with the psychologist clearly helped me a lot. However, it was not sufficient for my situation, which involved genetic backgrounds and stress levels. One of my family members had suffered with depression; another grant deadline was also nearing. My psychologist suggested several times that taking medication could be one option. I was hesitant. I probably thought that I could deal with depression without it. Or, I did not want to accept that I was depressed. I am not sure about that anymore. He explained that taking antidepressants was similar to taking insulin for diabetic patients or like wearing eyeglasses for nearsightedness. Depression is a condition in the brain. No doubt about it. Although its etiology is not fully understood, reduction of serotonin levels is suggested as a part of its mechanism. Sometimes, some people need some extra support to maintain its levels to function properly. By that time, I had told some close friends and colleagues about my condition. One friend who had one family member dealing with it, also suggested taking medication. I finally decided to take medication six months after everything had first started.
Medication for depression is interesting. It is usually expected to function 2-3 weeks after the starting date. With no immediate effects. During these 2-3 weeks, some side-effects like diarrhea, palpitations, and sudden sweating may occur. You have no idea if your medication is suitable for you until you try it. I was told usually only one third of the population experience beneficial effects to any one type of drug. If you do not feel any benefits, you switch to another one and wait for another 2-3 weeks. I went to see a doctor in a walk-in clinic to have a prescription. A funny realization that occurred to me was, until that moment, I had never thought to see a doctor because I had never thought that I was sick.
Simply put, I was lucky. My medication worked as expected. I felt a bit for the first 2 weeks. Then, I remember one day, I suddenly felt a feeling of clarity. Something I had not felt for at least 6 months. I do not deny that I had some placebo effects. But the effect was obvious, as demonstrated by the search history of my internet browser. Before that moment, I was constantly searching up words like ‘depression’, ‘suicidal’ and ‘disappear’. It had stopped. I started listening to music and feeling motivated. I regained my ability to concentrate without constant distractions. The next month, I completed three grant proposals and submitted them. That had never happened in my previous career. Then, two out of three were successfully funded. Where had my hopelessness come from after all? It had just been my perspective.
I took the medication for 6 months. I felt good and was not keen to renew my prescription, because I had to go to see a doctor again. I was exercising and meditating regularly. I thought I was fully recovered. I stopped taking it. After 5 months, around November, the daylight hours began to get shorter, I was back to a state of depression. I started taking the medication and felt better after a while, then stopped once more. I stupidly repeated this cycle two more times. Why? When you are taking medication, you feel fine. Then, it starts to get annoying. You feel very awkward about the fact that just one pill changes your personality. Of course, the change is not drastic, but you are in a better mood. Your timidness and shyness disappear. You feel that your life is much easier than used to be at the annoying level. Which one is the real one?
My psychologist gave me a lot of great advice. His story of insulin and eyeglasses really helped me make my decision in regard to taking medication. He also added, when I asked how I would know it was time to stop taking it, “who would ask to stop taking something that they need?”. Now, I accept this view. I need it like insulin for diabetes or like eyeglasses for nearsightedness. By now, I know how depression happens to me. I have prepared myself not to be swallowed by it. Yet at times I still fail to resist against it. Failed twice, in fact. I decided to keep taking the medication. The weather is one trigger. From fall to winter is the most dangerous time. I sense air pressure changes. The fluctuation of air pressure is the worst stimulation. Mental stress is another one, particularly when I become too concerned about that which I cannot control, such as comments from grant/journal reviewers as well as my own reputation. Once you learn to let go of these inhibitions and concerns, your life will be back in your hands. For some individuals like me, medication helps for that. You are in control of your own actions, and you are not dictated by the reaction of those around you. Amazingly, in the end, life is simply all about your own perspective.
Acknowledgment: I thank Vera Lynn for English editing.
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