Music.

Music has always played a vital role in my life, but I never knew just how important it was until I became depressed. I played saxophone in band from fifth grade all the way through my senior year of high school and I picked up my first guitar at age eleven and bass at age thirteen. Music was fun for me and I enjoyed a good beat and thought-provoking lyrics. However, when I became depressed, it was like a lifeline for me. Suddenly I had an entirely new set of emotions that I didn't know how to deal with or express. I couldn't even begin to describe how I felt, so I turned to the one thing that could. Music has a way of saying the things we can't seem to say ourselves.

I often found myself wondering why God let me feel so much pain. "My whole world is the pain inside me. The best I can do is just get through the day. When life before is only a memory I wonder why God lets me walk through this place" ("Beauty From Pain" by Superchick). Then I wondered if God even cared about my pain. "I fear you aren't listening because there are no words. Just the stillness and the hunger for a faith that assures" ("The Valley Song" by Jars of Clay). I would ask God to show me that He was still there. "Send me a sign, a hint, a whisper. Throw me a line 'cause I am listening. Come break the quiet. Breathe Your awakening. Bring me to life 'cause I am fading. Surround me with the rush of angels' wings" ("SMS (Shine)" by David Crowder Band). Then God would speak to me through the lyrics of "Times" by Tenth Avenue North: "In times of confusion and chaos and pain, I'm there in the sorrow under the weight of your same. I'm there through your heartache. I'm there in the storm. In my love I will keep you by my power alone. I don't care where you've fallen or where you have been. I'll never forsake you. My love never ends."

Even though I would hear God speak to me, I would still wonder if He really cared. I found myself asking God why over and over. "How long have I been in this storm? I'm so overwhelmed by the ocean's shapeless form. The water's getting harder to tread with these waves crashing over my head... I know you didn't bring me out here to drown, so why am I ten feet under and upside down? Barely surviving has become my purpose 'cause I'm so used to living underneath the surface" ("Storm" by Lifehouse). Then the words of "Need You Now (How Many Times)" by Plumb would play through my mind. "Oh, I get so tired of holding on. I can't let go. I can't move on. I want to believe there's beauty here. How many times have You heard me cry out 'God please take this'? And how many times have You given me strength to just keep breathing? Oh, I need You. God, I need You now." God always seemed to show up in those lyrics. He would make Himself known every time I cried out to Him. He never made the pain go away, but He would give me just enough strength to make it through that moment. 

Sometimes I would cut myself because I felt so much pain. The lyrics from Plumb in the song "Cut" rang true for me because it helped explain the pain and why I cut. "I do not want to be afraid. And I do not want to die inside just to breathe in. I'm tired of feeling so numb. Relief exists I find it when I am cut. I may seem crazy or painfully shy. And these scars wouldn't be so hidden if you would just look me in the eye. I feel alone here and cold here though I don't want to die, but the only anesthetic that makes me feel anything kills inside." That song helped me realize why I hid my scars (no one seemed to care... they wouldn't "look me in the eye") and it helped unlock the key to end the cutting.

Music never takes away the pain, but it explains it and makes it manageable. I don't know what I would do without it.

I drew this eye this morning. It's kind of ironic and symbolic for me because with depression, sometimes I can't cry, but need to do something with the pain. Drawing helps me release some of that pain, like crying would normally do. So, I drew a crying eye :)

Idle Hands Are The Devil's Playground.

Today I want to talk about the effects of not having a job (not just an occupation, but anything that occupies your time, i.e. volunteering, working, school, etc.) on people with depression. As some of you may know, I've been unemployed for the past nine months. Applying for jobs was a long, grueling process. I must have applied for over a hundred jobs, although I lost track after about 60. I had almost thirty interviews, but none of them got me a job. Feeling exasperated, I finally went to my counselor for advice on how to interview. He quickly figured out that it was a lack of confidence that was keeping me from getting a job. After an hour of roleplaying, I was interview-ready! Two days later, I interviewed and was hired on the spot to work at a local restaurant in the Gift Shop! Oh how I love having a purpose in life again. Something I can wake up and go do. Something that I know will benefit the world in some small way.

When I was unemployed, I didn't have anything to occupy my time. I crocheted, sewed, read books, and watched TV, but didn't do anything concrete. And it did not help my depression at all. My problem was that depression makes it very difficult to want to have a reason to get up everyday. Everything within me said, "You're worthless. You have no purpose in life," and so I didn't desire something that would give my life more meaning. Don't get me wrong; I don't think that working is the thing you should put your hope in or something that will somehow take away the depression, but I do think it makes it harder to believe your life has no value when you have a job. A job isn't what defines you or what gives your life meaning. Instead, it is something that you can feel good about as a way to contribute to society and make the world just a little bit better.

In a study done by the American Journal of Community Psychology, scholars found that "of employed respondents not diagnosed with major depression at first interview, those who became unemployed had over twice the risk of increased depressive symptoms and of becoming clinically depressed than those who continued to be employed" (Dooley, Catalano, Wilson 745). That means that there is a correlation between being depressed and being unemployed. People who didn't even have depression were twice as likely to become clinically depressed when unemployed! Another study had unemployed blue-collar workers over 45 years of age fill out a questionnaire over a two year period and found that "prolonged unemployment or re-unemployment leads to depression [and] reduced hope... Being employed or retired leads to a reduction of depression" (Frese and Mohr 173-178). Ok, so it's clear that being unemployed leads to depression, but what do we do with this information?

I would suggest that the best thing to do for someone with depression is to make sure they're getting up and doing something at least every other day. One of the most important things that got me through the past nine months was my mother telling me to get up and go do something everyday. We would go for walks, go shopping, find an ice cream shop, or even just fill her gas tank. It was so important for me to keep moving and doing things, even if they seemed insignificant, to get me out of bed and into the world. She also had me apply for at least five jobs a week, which really helped me reach my goal of getting a job. So, if someone you know is depressed, you can help them by doing something with them--take them to a park or a baseball game, walk a dog with them or drive them around town--anything to get them up and out of their own little world of depression long enough to see that there's more to life than being depressed. You may experience some resistance, but keep trying. My mom never gave up on me even when I was stubborn and didn't want to get up. She just patiently coaxed me until I would go with her on an outing.

Another thing you can do for a friend or family member who is feeling depressed and is unemployed is to challenge them to apply for jobs everyday. Make applying for a job a full-time job (or at the very least, part-time). Set goals for them to apply for a certain number of jobs everyday or every week. Set concrete, attainable goals and give them some kind of reward in return (a candy bar is always very good incentive!). This will help them get a job, which will instill confidence and self-sufficiency within them and can make them feel less depressed. These small steps can really make a big difference in the life of someone with depression. That's all I got for now. More to come in my next post.

Dooley, David, Ralph Catalano, and Georjeanna Wilson. "Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study."American Journal of Community Psychology. 22.6 (1994): 745-765. Web. 16 Sep. 2013. <http://link.springer.com/article/10.1007/BF02521557>.

Frese, Michael, and Gisela Mohr. "Prolonged unemployment and depression in older workers: A longitudinal study of intervening variables."Social Science and Medicine. 25.2 (1987): 173-178. Web. 16 Sep. 2013. <http://www.sciencedirect.com/science/article/pii/0277953687903856>.

Yes, I did cite my sources. I miss college. Stop judging me.

Antidepressants.

Let me start this post off with a disclaimer: I am not a doctor, so when it comes to antidepressants, all I know is what I've researched over the last several hours or learned from my doctors over the years. I am not an expert and I might even get something wrong because, believe it or not, I'm not perfect :) Also, I try not to go too in-depth with any particular subject, but it can be a lot of information at once, so feel free to skip over some parts. Ok, antidepressants are grouped into several different classes of medications based on how they are thought to work. I say "thought to work" because we really don't know exactly how they work in the brain, but we know that they are often effective in treating depression, as well as a number of other conditions like anxiety, chronic pain, Obsessive Compulsive Disorder, sleep disorders, etc. I'm going to talk about the three most common types of antidepressants, although there are at least eight different classes of medications that classify as antidepressants.

Selective Serotonin Reuptake Inhibitors (SSRIs) are a type of antidepressant that are thought to work by preventing the reuptake of serotonin by the presynaptic neuron, which causes the synapses of the brain to have more serotonin in them. Basically it prevents serotonin from being cycled back into the presynaptic neuron so it is instead used by the brain. Serotonin, along with norepinephrine and dopamine, is a neurotransmitter that causes feelings of well-being and happiness. When someone is depressed, their brain tends to have lower levels of these three neurotransmitters, causing a chemical imbalance. The goal of antidepressants is to re-balance one or more of those chemicals in the brain. SSRIs balance out the levels of serotonin alone. The specific medications in this class of antidepressant include Celexa, Lexapro/Cipralex, Paxil/Seroxat, Prozac, Luvox, and Zoloft/Lustral.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), on the other hand, balance the levels of both serotonin and norepinephrine in the brain. They work similarly to SSRIs, only with both serotonin and norepinephrine. SNRIs prevent the reuptake of norepinephrine and serotonin, causing higher levels of these neurotransmitters in the brain. The medications in this class include Pristiq, Cymbalta, Ixel/Savella, and Effexor.

Finally, we have the Tricyclic Antidepressants (TCAs). TCAs were discovered in the 1950s, and were widely used in the decades to follow, but have mostly been replaced by the use of other types of antidepressants because they have more dangerous side effects and can be more lethal in the event of an overdose than other newer medications such as SSRIs and SNRIs. However, TCAs are still more effective in treating more severe, treatment-resistant forms of depression than newer classes of antidepressants. They are also not considered to be addictive, which is preferable when taken for an extended period of time. The list of TCAs is so lengthy that I will not mention all of them, but a few well-known medications within this class are Elavil/Endep/Tryptomer, Imiprex/Elepsin, and Depressin/Vagran.

As you may have already gathered, all antidepressant medications come with their own set of side effects, some more severe than others. One major problem with antidepressants is that on occasion they can have the opposite affect on the body, causing worsening depression and very severe suicidal thoughts or actions. That is why patients have to be monitored closely when starting a new antidepressant, because it is hard to tell on your own if you are more suicidal than you were previously, and people looking in from the outside can usually tell that something is wrong before you can. Other side effects include weight loss or weight gain, sleepiness or fatigue, diarrhea or constipation, headaches, dizziness, insomnia, nausea, decreased sex drive, dry mouth, tremors, etc.

Along with having possible adverse side effects, antidepressants are also known for taking a long time to build up in your system and begin to take effect. It typically takes four to six weeks before you know if an antidepressant is actually helping because it takes that long for your body to get used to the medication. Because of this, it can be a long and grueling process to find a medication that is right for you. In addition to the delayed effects when starting an antidepressant, it can also be difficult to switch over to another medication because you often have to ween off of antidepressants. Stopping cold-turkey can cause major problems, so it's best to listen to the doctor when they tell you to cut the pills in half for a week before completely stopping them. It also takes time to find out how much of an antidepressant you need to reach therapeutic levels. Your doctor will work with you to continue to increase the dose until you reach a level that is appropriate for you. As you can probably imagine, during this process of weening and beginning a new antidepressant, you may experience more severe symptoms of depression when you have weened off your old one, but haven't yet reached therapeutic levels of the new one. This is why people often complain about having to switch antidepressants.

For some reason, my depression is a treatment-resistant form of depression and most antidepressants are ineffective in adequately treating my symptoms. Typically they begin to work for a while when I first start taking them, but over time the effectiveness decreases until I have to increase the dose, and then the same thing happens. My doctor increases the dose until I have reached the maximum safe dose of one particular antidepressant before moving on to another one. I have tried 13 different antidepressants over the last seven years and none of them have been effective for longer than a few weeks. Like I said, it can be a very frustrating process. Hopefully I'll find one soon that works for me and when I start Dialectical Behavior Therapy, the two will complement each other just enough to be effective. By the way, I should mention one last thing before I finish: antidepressants alone are often not enough to be effective; typically a doctor prescribes medication but also recommends some kind of other therapy that will also help relieve symptoms of depression. I hope this overview has been helpful in addressing the basics of antidepressants.

My Story (Part Three).

I felt some hope when I left the hospital after my first suicide attempt, like something had changed somehow. But things only continued to go downhill after that. I was soon diagnosed with psychosis resulting from the depression becoming so severe for so long (For those of you that don't know what psychosis is, it's a severe mental disorder in which thoughts and emotions are so impaired that contact is lost with external reality. It comes in the form of delusions about reality and also hallucinations, which came in the form of seeing, hearing, or smelling things.). This brought with it a whole new set of symptoms. I began to hear voices and see things that weren't there. I had dissociative episodes where I would try to harm myself, usually by cutting my wrist, and not remember what had just happened or why my wrist was bleeding.  This was all in addition to the terrible agony I felt deep within my chest. Sometimes I even felt a physical pain in my chest because the emotional pain was so great. 

Two weeks after my first attempted suicide, I found myself back in my car again taking too many of the same pills that had threatened to take my life the first time. This second attempt was also followed by an image of my brother, which prompted me to call the police so they could bring me to the hospital where I was given that same charcoal that I had been forced to drink only fourteen days earlier. By the time I got out of the hospital this time, I knew it was time to try something more drastic than counseling or medication. I went online and started looking up treatment programs for depression. After searching for several hours to no avail, God prompted me to search for an intensive outpatient program in a small town in Colorado that I had been to in ninth grade with my church youth group. 

Sure enough, I found a two week long program meant for people with persistent and severe mental illnesses. I showed my mom their website and we both agreed that it was the perfect option for me. Over the next few weeks, God allowed all the pieces to fall into place and on the Sunday after Thanksgiving, I was on a plane headed out to Colorado. Those two weeks in that program changed me forever. I found healing, rejuvenation, and strength in a Christ-centered atmosphere and was excited to return home with my newly acquired knowledge of how to cope with extreme emotions. I was ready to face the world once again through the power of Christ in me. 

My only mistake was believing that God had somehow completely "healed" my depression so that I wouldn't have to take medication or go to counseling anymore. I stopped both of these things and found myself back to square one within a matter of months. I was asked to leave school again, this time for a full year instead of just one semester. I was devastated and confused. I thought God had healed me from this terrible pain and I couldn't understand why He would allow it to return full force. Over time, I would realize that depression is a life-long battle and that the depression had much more to teach me about life before it would retreat into the background again.

Since that time, I have found a great counselor that is teaching me a lot and helping me sort through all my emotions in a healthy way. I have also started Dialectical Behavior Therapy, which will teach me how to cope with suicidal thoughts and thoughts of wanting to self-injure. I now know that while God's plan may not be to completely get rid of my depression in this life, He is going to teach me how to manage it and live a full life in the midst of the pain and struggle. And who knows, maybe someday I'll even be able to help someone else who is going through something similar. I may not know what the future holds, but I know the One who holds the future.

My Story (Part Two).

Close to the end of my sophomore year of college, my school asked me to take a break from the world of academia and come back when I could manage my symptoms a little better. By this time, I was completely isolating, speaking only when spoken to and never going outside unless absolutely necessary. I also had developed anxiety by this time (anxiety and depression can often go hand in hand) and found myself having panic attacks a few times a week as well. I remember the feelings of sheer terror when a panic attack would come on. It left me unable to move or breathe for what seemed like hours, but in reality was only a few minutes. Then, as quickly as it had come on, it would leave me, shaking and crying on the floor. I was afraid to go out for fear that I might have a panic attack when I was in public. The anxiety and depression I felt completely controlled my life. I wish I could say it suddenly got better, but I can't. Over time and with the right medication, my anxiety attacks slowly became less frequent until they stopped completely, but my depression remained. I felt utterly hopeless and alone, so I turned to creating things in order to get by. 

It was so therapeutic for me to crochet a hat or sew a quilt and it became like an act of worship for me. Until this point, I had never really turned to God for help in dealing with the depression. Sure, I went to a Christian school, attended chapel three times a week and went to church on Sunday. I was a Biblical and Theological Studies major, so most of my classes felt like a church sermon every week, but I wasn't really doing anything to strengthen my relationship with God. I know that is why God put such a drive within me to create. I made a living off of the things I would make and then sell during those long months when I was not in school. Ceramics, crocheting, and sewing became my way of expressing who I was and what I was feeling and so I just kept creating. Soon, I felt the depression begin to lift ever so slightly. I went back to school that spring and began classes again. I did well that semester and felt that the depression no longer controlled me. It was still there, but it was in the background just enough so that I could see the other things in front of me instead of always looking through the filter of depression. 

However, it returned that summer. I'm still not entirely sure why, but it may have been because I didn't keep up with going to counseling throughout that summer because my counselor worked at my school and she was only available during the school year. I began to feel myself slipping away again. Like the real me was being sucked into some vortex of depression that was slowly eating away at my soul. The pain was worse than it had ever been and I felt no hope at all anymore. I got to a point where I couldn't even think about the future because the idea of living another minute in this cruel new existence terrified me. Pretty soon I felt that I could not take it anymore and I did the one thing I had been fantasizing about for years. I attempted to take my life.

However, after I had downed a bottle of pills an image came into my head. It is an image that I know could have only come from God and it is one that still haunts me to this day. The image was of my twin brother crying out in agony--an agony that was far worse than the one I was currently experiencing. He was in an unbearable amount of pain and it was because of me. I had decided to take my life and he had just found out that his twin sister had been erased from existence forever. This image was almost too much to handle and it instantly called me to action. I called a friend and told him what I had done--that I had taken a bottle of pills and I needed help. He called the police for me and an ambulance came, picked me up, and took me to the hospital, where I had to drink an entire cup of liquid charcoal in order to absorb the medication before it was absorbed into my system. After staying in the hospital for several days, I finally got to go home and I gave my brother the biggest hug he had ever gotten. More to come in my next post...

My Story (Part One).

I was thirteen years old when I first started to experience symptoms of depression. They came on slowly, so much so that I didn't even notice that anything was wrong for a while. My world slowly began to fade to gray. Colors seemed just a bit dimmer, lines and edges blurred ever so slightly, and voices and sounds seemed sort of muffled. It was as if a cloud had settled over me. I had no idea at the time that this cloud would remain with me for as long as it has. 

By the time I was fifteen, I had begun to isolate myself from my friends and family. I would go to school, but I wouldn't talk to anyone, sometimes for the entire day. Then I would go home and go straight to my room, where I finished my homework, then crawled into bed and slept. I would sleep all evening and through the night, only to wake up and do it all over again. It was around this time that I began to have thoughts of wanting to die. I felt so depressed all the time and I began to wonder what it would be like to simply stop existing. I didn't know at the time that what I was experiencing were suicidal thoughts, but I knew that I didn't like them and I wished they would go away. So, I talked to my youth pastor about the things I was experiencing and after listening to my story, he said to me, "Heather, I think you have major depression." You would think those words would be a crushing blow, but I felt strangely comforted by them; there was finally an explanation for the way I was feeling. Taking my youth pastor's advice, I talked to my mom and went to see my doctor. 

Sure enough, my doctor said I had major depression and prescribed some antidepressants along with recommending that I start seeing a counselor. This news was slightly less reassuring than what my youth pastor had said. The idea of going to talk to a complete stranger about my deepest, darkest thoughts terrified me. Nevertheless, I obeyed my doctor's orders and scheduled some appointments with a counselor. I went to counseling on and off throughout high school and took my antidepressants as prescribed, but did not experience much relief from my symptoms. In fact, the depression slowly got worse and worse until my sophomore year of college. But that story will be saved for my next post.