It’s been a little while since I’ve gotten into a difficult topic, so I’m giving it a shot again. This time, I’m going to get into my experience with depression. While not specifically gender related, it is something that I’m dealing with as I’m on my gender journey. As with previous posts, I’m not pretending to be an expert on this topic, but will be writing about the things I’ve learned and experienced. Other peoples’ experiences may be different.
First, let’s get into what depression is (and is not). The National Institutes for Mental Health define depression (the medical terms are “major depressive disorder” and “clinical depression”) as a:
…common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Some symptoms which are common with depression are:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
The first time I read this list, I was wondering who’s been spying inside my head! I had so many of these symptoms. But even then, I wasn’t ready to deal with my depression. To do so, I had to admit that I was depressed, which I couldn’t do, even with the evidence staring me in the face. As I mentioned in another post, it took my PCP telling me that he thought I might be dealing with depression to get me to admit it to myself. I mentioned that I had an appointment with my psychiatrist the next day – I had been considering cancelling that appointment because I wasn’t sure what to talk to him about!
So what was I experiencing? Irritability, fatigue and difficulty sleeping for years, but with my gender realization, I added the feelings of hopelessness, worthlessness and helplessness, loss of appetite, and aches/cramps. Most troubling were the thoughts of death. I wasn’t suicidal, but it occurred to me on a regular basis that I was causing my loved ones pain because of my gender issues (guilt), and that their lives would have been better if I’d never been born. Even when I was having those thoughts, I recognized them as irrational and untrue, but even still, I couldn’t shake the thoughts.
Admittedly, in hindsight, how I dealt with this wasn’t the best way. At first, I denied the idea that I might be depressed (even with evidence in black in white right in front of me). I couldn’t be depressed – “these are just side effects of my gender struggles.” Then came rationalization – “who wouldn’t feel these things when they were struggling with changing their very perception of themselves?” Bargaining – “as soon as I figure myself out, these other things will go away!” Are some of these stages sounding familiar? They’re part of the Five Stages of Grief. Guess what comes after bargaining? Depression and Acceptance! I accepted that I was experiencing depression and got help.
The first help I got was from a friend, and he didn’t even know it (nor did I) when he gave it to me. Shortly after I had come out to myself, he related to me his experiences after someone very close to him died; how he felt and how it affected him, both in his personal and professional life. He was fortunate to get a wake-up call before permanent damage happened, and got help for himself. He told me about therapy and medications, how they worked, how it was a long and slow process, but also how he was able to get himself out of the depression and off the medications. His openness and honesty planted the seed of “it can happen to anybody”; it took a few months for that tree to bear fruit.
The next help was therapy, although I wasn’t aware that we were treating depression. My therapist gave me a safe space to share my fears and dark thoughts without judgement. She helped me to examine them for what they really were – in some cases, just uncertainty about the future; in others, real concerns; others still, harmful thinking. We worked to find ways to live with the uncertainty, address the concerns, and change the harmful thoughts. By the second session with her, she had encouraged me to find and set an appointment with a psychiatrist, although under the premise of “helping with dysphoria.” More than likely, she recognized what I really needed was help with depression, but also recognized I wasn’t ready to hear/accept that, and she hoped I would get that diagnosis from the doctor.
The third help was my PCP. He addressed all my physical concerns that I brought to him, and when they persisted, he didn’t mince words – “do you have a psychiatrist?”. Me: “well, yes, actually, I have an appointment tomorrow. But I was thinking about cancelling it.” Him: “Don’t! I think you need to talk to him about possibly being depressed.” I was in the right place at that time to hear what my PCP was saying and accept that help.
Obviously, the next help I got was from my psychiatrist. Since I had the benefit of these other people’s experiences and diagnoses, the visit with the psychiatrist was pretty straightforward. He asked me what I was there for, and I told him “well, my PCP thinks I might have depression.” Him: “what do you think?” Me: “I think I probably do.” We talked for over an hour, with him asking questions to probe my thoughts and feelings to make sure that I really am dealing with depression. At the end, he agreed with the PCP’s diagnosis, and prescribed an anti-depressant. I’ve been on it long enough for it to take effect, and while it’s hard for me to say my mood is different (because it doesn’t feel “different”), I look back and realize that I have not had as many of the symptoms of depression since starting this medication. That’s not to say that it “fixed” me, because some of the symptoms do come back occasionally; but when they do, they don’t last as long, and don’t hurt as badly.
I’m not going to get into the specifics of what I’m taking, but suffice to say that it’s a common anti-depressant. I’m fortunate that my insurance covers it 100% (yay for insurance companies recognizing that mental health is important!). It’s the same one my friend took. My friend described the effects of the medication as “it didn’t take away the problems, but it made them affect me less so that I could deal with them instead of reacting to them”. My psychiatrist described the medication as akin to the “red pill” from The Matrix: if you take it, you may see things for how they really are, which could be good or bad; he’s seen marriages dissolve because the person taking the medication finally deals with the unhealthy behaviors which were keeping them stymied in the relationship. Yikes!
Anxiety is a close relation to depression. NIMH gives some of the symptoms of Generalized Anxiety Disorder as:
- Restlessness or feeling wound-up or on edge
- Being easily fatigued
- Difficulty concentrating or having their minds go blank
- Muscle tension
- Difficulty controlling the worry
- Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
Sound familiar? It shares many symptoms with depression. For me, the difference between anxiety and depression centers around two of the symptoms: restlessness or feeling wound-up or on edge, and, muscle tension. I guess I kind of intuitively know the difference when I’m experiencing anxiety and call it what it is.
I’ve identified anxiety as part of my life, and have even tracked it in my journal (as far as the anxiety relates to my feelings about my own gender). For me, the good news is that it hasn’t reached a point where I fall into the category of an Anxiety Disorder. It gets even better because the anti-depressant I’m on also serves as an anti-anxiety medication. As my psychiatrist put it “I don’t see any reason to treat your anxiety separately, because I see the depression as the root problem, and the medicine will tend to lower your anxiety anyways.”
What depression is not
As I’ve said before, in western cultures, mental health is largely misunderstood and often ignored. Those with mental conditions are often stigmatized. So let’s go over some things that depression (and many mental disorders) are not:
- Depression is not weakness. A person with depression isn’t so because they weren’t mentally strong enough.
- Depression is not sadness; it is not a mood; it is not the “blues”. Those are emotions which are largely influenced by circumstances. You can usually identify a cause for feeling sad; but depression can happen for no reason.
- Depression is not a choice. It is a medical condition. It is no more of a choice than having a broken bone or a kidney stone.
How to help a person with depression
This is a tough one, because for me, I wasn’t ready to receive help until I’d suffered for a while. For me the biggest things that helped were the support of my spouse (showing me I was loved, even when I felt unlovable), and finding out that people close to me had dealt with depression (and had emerged from it). I was more receptive to my PCP’s suggestion when he made it. Here’s a good article which describes ways you can be supportive as well as ways you might be able to start a conversation with someone you feel may be suffering from depression. Many of the things in the article are things those around me did, and it does help.
Something to be careful to not do is use words/language which implies a choice or an ability to change mood. Telling a person with depression to “snap out of it”, or to “get over it” isn’t helpful, any more than telling a person with a broken leg to “walk it off”.
I’m still on my journey through depression, but I have lots of support as I work through it. If you feel like you might have something similar, please reach out for help. And if you are having suicidal thoughts, please don’t wait – get help now!
Until next time,