Is this all there is?

May 25, 2009 8:37 AM

How do you know when you've recovered from depression?

It's been four years since I had what people used to call a nervous breakdown.
I guess in modern psych parlance that's a major depressive episode. I had to drop out
of my PhD program. I lost some friends (largely due to my own behavior). I've changed
(perhaps) irrevocably.

I'm still on meds, which I find necessary and don't feel bad about whatsoever. I've put my life back together, said to hell with the past, started a new diploma program in a radically different field and gotten happily married. I exercise, eat well and generally try to take care of myself.

But I still don't feel like my old self and I wonder if I ever will. This wouldn't
be a problem - expect that I like that old self a lot better than this self. I used to be
kind, sensitive, fairly confidant, impish, clever. Now I am closed off, cynical a bit dull-minded and feel terribly alienated from people. I hate talking about myself. I still don't truly enjoy the things that were so important to me four years ago (reading, mainly). My values have changed and I'm not sure that's for the better.

Recently I listened to Krista Tippet's conversation with Andrew Solomon (who wrote the wonderful book "The Noon Day Demon") in her audiobook "Speaking of Faith: The Soul in Depression." Discussing their own recoveries from depression, they agreed that
it feels like "you fall into your own life again." Andrew Solomon says, "I have the personality that is consistent with the personality I had when I was 10 and 20 and 25 and that then began to fall apart a little bit later on..."

And again on recovery:

"when the feeling comes back you think - 'Oh, this is a soul, this
is a spirit, this is something profound and alive which returned to me
after taking a leave of absence.'"

I don't feel these things, and I truly wish I did.

Hence my question(s): Hive mind, do you relate to what they are talking about here?
How did you know when you had recovered from depression?

Am I still depressed or is what I’m feeling only nostalgia and a normal part of aging?

posted by kitcat to health & fitness (17 comments total)

Just realized that I should mention - I'm 28 and female :)
posted by kitcat at 8:40 AM on May 25

There's is an inconsistency in what you're describing. First you write, "I've put my life back together, said to hell with the past, started a new diploma program in a radically different field and gotten happily married. I exercise, eat well and generally try to take care of myself."

But then, "I used to be kind, sensitive, fairly confidant, impish, clever. Now I am closed off, cynical a bit dull-minded and feel terribly alienated from people."

These two things don't seem to describe the same person.

Do you have your "life back together" or are you "dull-minded and ... terribly alienated?" Which is it?

Dealing with depression is a process, one which I suspect many people spend their entire lives mastering.

What is certain is that everyone is different, and that you should probably take the pronouncements by self-help gurus with a grain of proverbial salt.

Consult a professional. And keep at it.
posted by wfrgms at 8:47 AM on May 25 [2 favorites has favorites]

Hmm, this is a tough one. I had my first depressive episode when I was about seven, so for me, my personality has been shaped around those times. But when I am not depressed, or even on my good days when I am depressed, I do feel like myself. When I am ill, I feel like I am walking around underwater and on good days I am able to come up for air.

I wonder if you need your meds to be recalibrated? When was the last time that happened? Antidepressants can sometimes have a "poop-out" effect when they don't work as well anymore.
posted by sugarfish at 8:48 AM on May 25

Depression changes how you are, where you can't be sure if you are more who you are after the depression, a different person entirely or your 'old' self but layered with scars. It seems to me you are worried about being the third option, distanced from who you are because of your experience.

But I think one of the hardest parts of depression is the habit you form from it, the habit of being depressed. The experience you get changes how you perceive your own well-being so that being content is an almost strange occurrence, something to be fought for not something that just happens without effort. And I think that's may be more the issue here than anything else.

Realising your mental health has been and can be fragile easily leads to being overly protective of it, which could explain why you feel the way you do. I think I'm going to refrain from giving any real advice because I'm ill qualified to do so. Hope this helped in any way :)
posted by litleozy at 8:52 AM on May 25 [8 favorites has favorites]

How funny, I just discovered Andrew Solomon's interesting writing on depression via The Moth podcast yesterday.

My experience has been like his, being able to feel like myself again. But I too am unqualified to take this question on. I do wonder if you had been depressed such a long time when you were making choices and forming your personality that you now have, in some sense, a new self, one you have not experienced before. In that case perhaps you just need more time and to keep following the instincts and interests which draw you toward satisfaction.

But I also think it is worth talking to the pros about this. I would definitely bring it up with whoever prescribes your meds, because it does seem that they need fine-tuning from time to time. Perhaps, now that you are functioning so well, a change is in order. Or perhaps this is something to begin dealing with in talk therapy. I wonder if there are new issues emerging that had been previously masked by the severity of your depression.

Congratulations on keeping going over what must have been a pretty long hard road. Doing what you've done for yourself would be remarkable work for anyone, let alone someone who's not feeling quite fantastic yet. That is so impressive that you were able to make those changes - something to feel good about in itself. I feel sure that your desire to feel more fully 'yourself' will be realized as well, because you clearly have the tools to find and work on problems effectively. So, do enlist your professional support team to assist you in that work.

And give yourself time! Don't be too anxious that this hasn't happened yet. Full recovery can take a long time. Do notice when you look around at some moments and say "hey, I feel pretty good." those moments are big clues to follow.
posted by Miko at 9:02 AM on May 25

I'm sorry to say that your description reads more like someone suffering from depression and becoming resigned to it than like someone who has recovered. Is your post representative of how you've been feeling for a while or do you think you're just in a momentary dip? As suggested upthread, this would probably be a good thing to talk to your therapist/doctor about and see if it's time for a change in your medication. I'm sorry you're going though this and I wish you improved health going forward.
posted by Maisie at 9:11 AM on May 25

This morning on NPR I heard an interviewee say that we're good at curing, but not at healing. That is to say: the root of the matter might have been "fixed" but the violation you feel, and the hurt that's happened because of it, isn't as readily addressed in western modern medicine. I think it's really true. I'm going through some really serious health issues and while I have faith that the medical solution will be found, the process of feeling my body break down, the kinds of life changes I have to make (and choose to make) as a result of it feels a bit like grief. Grieving the innocence of 'before' -- before I knew better, before I knew what it's like to figure out a chronic health issue, before I knew other people's stories that pour out in their efforts to empathize, before I had to decide on activities depending on pain/meds/exhaustion/doctor appointments, before I had to think about any of this.

Sometimes we expect ourselves to return to normal. I don't really think that's possible, nor, when you really think about it, desirable. I like being able to empathise with folks that are going through a really hard time -- I don't shoot out sunshine out my arse and am able to talk about hard stuff without just wishing it to go away. Some of that is normal aging. But some of that is being confronted with things well before most of my peers had to think about them.

So I don't think you'll ever be the same. You had to make huge changes. You had to prioritize. You had to face really hard things and have hard conversations with people. You've seen the fallibility of the human body, the strength and weakness of human bonds, and the truth of the people around you. You probably don't have time for drama. Or for people being cruel. "life is too short" and all that. I feel it too!

But I think there's something else going on here. And I think talking it out might really help you. Not just more meds, but really letting yourself think about that process and where you are now. In so many ways it seems like you've got some things "cured" but you're not really healed. Spend some time thinking about these things, journaling, or talking to a great counselor/therapist. And definitely consider retweaking the meds.
posted by barnone at 9:25 AM on May 25 [6 favorites has favorites]

Thank you, all. This helps. barnone, can you tell me which NPR show that was so I can maybe find it podcasted?

Please feel free to keep posting. I'd like for this to be helpful to anyone who is wondering what recovery might feel like. Also, please don't hesitate to admit (if it's true for you) that your experience matches that of Krista Tippet and Andrew Solomon. I understand that you may be reluctant to say, as if you were some kind of authority, THIS is what recovery feels like. Trust that it may be helpful to share your experience.

Thanks again.
posted by kitcat at 10:01 AM on May 25

As I read the header I immediately formulated a glib response--"When you realize at 11:30 AM that the thought of being depressed or worrying about being depressed has not occurred this morning ". I can't agree with Maise that your post sounds as if you are depressed. It does sound as if you are somewhat anxious about being depressed--which is entirely understandable given an episode with major depression. Anxiety and depression are very similar on a neuro-chemical level and can be easily confused and confusing. The following is not always true but if you are depressed about being anxious or anxious about being depressed you are probably anxious not depressed. You may well be able to tweak or supplement your medication to remove some of that "dull-minded" feeling. I hope you are seeing a good psychiatrist for meds--some physicians, including psychiatrists, treat meds like a sledge hammer rather that scalpel. Dosage is extremely important. Either to little or to much can be a problem.
BTW, I absolutely love "Speaking of Faith" and have a long distance crush (even at age 67) on Krista Tippet. She may well be one of the best interviewers on Public Radio. She has fascinating guests and some incredibly intellectually rigorous conversations--while being very warm and impecably gracious.
As a mental health professional, and a person who has experienced intermittent depression, I am not a great believer in our ability to accurately recollect how we used to feel--the important thing is how you feel/think today and the quality of your day to day life. Our memories are to often clouded by the experiences of the present and our hopes/fears about the future.
Congratulations on continuing to effectively managing your depression and please do not hesitate to pursue those things bring you confidence, hope and bit of zest.
posted by rmhsinc at 10:21 AM on May 25 [1 favorite has favorites]

I -- ex-depressive -- agree with Tippet and Solomon there, for what that's worth.

Apart from being the same person (after a fashion) that I was at 10, the really stunning thing is that I cannot figure out what the hell the problem was. I can't identify with my old depressed self; I can't conceive of why I could not 'snap out of it.' Depression no longer appears logical.

I mourn the lost years but I don't feel permanently damaged.

I am amazed to find myself with little to offer people who are currently depressed. I am genuinely no longer walking among them and am a little shocked at how little understanding I can muster up. I still get unhappy, of course, but it's not a feeling comparable to bona-fide depression, and my happiness is not blunted or doubted. I can no more slip into a depressive state now than I could slip into any other illness.

Keep at it -- your recovery -- because it's nice being alive, even after years and years where it wasn't.
posted by kmennie at 10:35 AM on May 25

In my therapist opinion, life may not ever feel exactly the same as it used to, especially because of the influence of the antidepressant, which--for many, many people--tends to have a desensitizing effect. A lot of people just don't feel as much when they are on the medication, and for a lot of people that's really good when they're slipping back into being depressed, but for a lot of people that's very difficult in the day-to-day living part. Artists sometimes feel blocked, people who are used to having strong feelings may feel like they don't really know themselves anymore. But not being depressed and suicidal every moment sure is an improvement. I think that it can help to be working on the medication titration with your prescribing doctor, maybe trying other types or different doses.

In my former-depressed-person opinion, I kind of think of it as an experience that changes people permanently, but not necessarily for the worse. I don't know that people just flip right back to 'who they were before' really... I think people come out the other side. I sometimes have difficulty with small relapses into depression, but I acknowledge all of the great things I feel too, like listening to a great song in the car with the windows down, having a really great day at work, celebrating an anniversary and what that means to me, hugging someone I love or snuggling with a cat. I concentrate on those good things and my experiences of them, keep myself mindful of the goodness and positive things. That's what lets me know I'm doing ok--not necessarily that I'm done with depression, so to speak, but that I'm ok right now. I try not to think about the next time I'm going to feel badly, I think about whatever good I feel right now, even the tiny things.
posted by so_gracefully at 11:32 AM on May 25

A major depression permanently alters your mental landscape. If you are waiting to get back to your old self, understand that that may never happen. Sometimes if you bend a piece of steel it can't be bent back to its original shape. That isn't a bad thing. It's just a thing that happens to be true. Try to accept yourself as you are now.
posted by RussHy at 11:42 AM on May 25

I recognize how you feel, including the disconnect between feeling reasonably successful and fulfilled, and feeling a strong sense that the warm, open part of one's personality has somehow been lost. My experience has some things in common with yours, and some not (I've mostly been in lots of talk therapy, due partly to physical problems with antidepressants), and I know there are many dissimilarities I don't see because I don't know you/am not your doctor, but for what it's worth, I feel strongly that my sadness is due to the effort of "doing better." I've worked really hard to build a healthy life that will support me, and to act in productive ways and consider the emotional consequences of all that I do, and that's made me rely much more than I once did on planned, rigid, conscious thought, which in turn has made me cynical and mentally absent. I suspect that this will equalize more with time -my old personality will return to some degree and mix into what I've learned- and that I'm really just not out of the woods yet.

This post is obviously testimony rather than advice and I apologize for that, but I thought it might be vaguely helpful.
posted by thesmallmachine at 12:26 PM on May 25

I hate to be the unsatisfying answer guy but I imagine that the It's-Over experience is different for different people. Sort of like how people respond differently to antidepressants. Some get nothing or worse, some kind of feel better, and for some it's a magic pill and bang, they get their life back 100%. So the people's experiences you read about who suddenly feel that wonderful return to pre-depression self once it runs its course, that may or may not be how it goes for you. Maybe there are diminishing returns the longer chronic depression goes on. Things may, as one of Jack Nicholson's characters said, be "as good as it gets". I agree with the commenter who said to accept yourself as you are (and not doing so may be related to some of the alienation). But it doesn't mean you can't keep looking for ways to improve. Maybe it can be a self challenge. "How much can I improve my outlook on life?" The good thing is that you can keep doing that forever. Sounds pollyanna to these depressed ears, but maybe you can give it a go.

I'm right where you are, wondering if it's really over, if this is it, or if some of this is just habit now, but knowing I don't feel like I once did, and wanting to again. It's been so long that I can't even remember what it felt like to feel other than this, except I remember how it was when it was much worse. So is this me now? I know there are some specific things I can try, such as more therapy, perhaps some promising new med, and maybe most helpfully some brain retraining with cognitive-behavioral exercises.

In your case, dull-minded may be a feature of both the depression and the meds. I know it was/is for me, before, during, and after years of medication. Maybe that's tweakable via meds at least to some degree now whether or not it ever pops back completely. It could be that a certain level of lessened mental acuity will persist for the long haul. I miss my sharpness but have adjusted as best I can. Not enjoying reading could be part of the classic telltale sign from the depression pamphlet at the doctor's office, "you no longer find pleasure in things you once enjoyed." So despite what sounds like a fairly successful treatment regimen, the underlying depression may still be active in that way.

However, closed off, cynical, and alienated may be feelings you can work on and improve. Cynicism is a great candidate for CBT. Negative self talk can be countered with awareness, analysis, counterlogic, and practice. Reportedly it has gotten very good results statistically. I know it helped me some. Closed off and alienated might be countered by deliberate interaction with people and release of fear of judgment by them. Maybe both of those could benefit from some CBT too. I know what it's like to be told to pull yourself up by your bootstraps when somebody has stolen your bootstraps, but if you can put one foot in front of the other, you can make attempts at these things. Sustaining them over time and not regressing is usually the issue for me.

I hope the tupperware top of your depression pops back out to its original shape. I'm having a party if mine ever does. The party snacks will be candies that look like my least favorite anti-depressants and oh how I will laugh, LAUGH AT YOU, depression. A HA HA, I will say.
posted by kookoobirdz at 1:18 PM on May 25 [3 favorites has favorites]

It was Diane Rehm interviewing Abraham Verghese on his new novel. But he's written a lot about medicine and being a physician and had some interesting things to say. It wasn't all relevant to this topic -- but it was one line that really resonated for me this morning. If nothing else, his book looks good!
posted by barnone at 3:46 PM on May 25

I have a long history of anxiety and depression. I've made a lot of progress in the past few years but because my issues started when I was quite young, I can't identify very much with the personality I had when I was 10 or 15 or even 20. For me, getting better feels like becoming more "whole", for lack of a better term - less consumed by the bad things that have happened in my life, and more capable of holding my own in the world.

Some of the changes you describe could just be the result of ongoing personal growth and in and choosing to spend your energy on different things. Perhaps you don't read for fun as much these days because you're doing tons of reading for your degree. Perhaps you're less outgoing because you're in a happy marriage and you don't have as much need to make new bonds with people. I find it easier to focus on whether I'm happy with my life compared to my current goals than in trying to compare myself with who I used to be.

That's not to say that nothing is wrong. It sounds like you are dissatisfied with some aspects of how you feel, so a checkup is warranted. While you're figuring that out, be gentle in your assessment of your current self. You've accomplished a lot. There could be more elements of your "old self" in your personality than you see right at this moment.
posted by rhiannon at 3:55 PM on May 25

This is a fascinating question.

I've struggled with depression since I was 14 (I'm 42 now). In one sense, you'll never go back to being your "old self." Dealing with depression and its effects is a transformative experience. You don't come out of it the same as when you went in.

Having said that, there came a time, maybe five or six years ago when I felt like the "old me" was back. The world was brighter, I felt more optimistic, and less alienated. For many years, it felt like there was a "clamp" on my head that prevented me from thinking clearly. That went away, too. My creativity and intellectual curiousity are back, and I'm working on projects that I wish I could have started seventeen years ago.

I would recommend being gentle with yourself and not comparing your present situation to what you've read in books. It takes time to recover from a major depressive episode, and four years is not that long. After my big crash, it felt like I had to learn how to deal with the entire world all over again. Depression is a bastard. It crawls into every corner of your existence and poisons the whole thing. You have to get in there and scrub it out of all those corners.

It took a lot of work to get from my lowest pit of depression (age 25-26) to now. The right combination of meds, a lot of therapy, and a bunch of personal effort. One of the best pieces of advice I ever got from a therapist was, "be a scientist with yourself." She meant to find out what really works to make you feel better. Find out what makes you feel better, and repeat as necessary. For me these things included exercise, dancing, meditation, and photography. Depression is a multi-modal condition, and it requires a multi-modal response. Whether it be physiological, pharmacological, behavioral, cognitive, interpersonal, nutritional, or otherwise, every little bit helps.
posted by oozy rat in a sanitary zoo at 7:06 PM on May 25 [2 favorites has favorites]