07 June 2009


Anhedonia: Loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences. Anhedonia is a core clinical feature of depression, schizophrenia, and some other mental illnesses.

At the beginning of May, I suffered a small setback, and, for a few weeks, experienced a bout of depression. It was my own fault. I mail order my medications—much more economical—and let one of them lapse before I got around to calling in a refill. In part, I did it deliberately, as an experiment, to see what would happen. It wasn't exactly reckless; I wasn't going cold turkey. But although I know at this point that I am a lifer, so to speak, with regards to psychoactive medication, occasionally I get curious to see what life might be like without.

The experiment was a failure. It was about two weeks, just enough time for the medication to leave my system. And then, I was mildly depressed. In the scheme of what I have experienced regarding depression, it was nothing, really; more an annoying cold than a flu, but it was uncomfortable nonetheless.

By this point in my life, for better or for worse, I am a pro in dealing with this, so I recognized more or less immediately what was going on. Even though I have been through this many times, it is always humbling when the scales fall from my eyes. I have engaged in mindfulness practices long enough now that I know very quickly when I am depressed. My thought patterns move into a very specific, negative groove. And though I know this is depression speaking, and not me, I still believe the awful things I tell myself, with all my heart. It is special kind of madness to hold these contradictory states of mind simultaneously.

I recognize depression in other people immediately. I can feel it, energetically, but the physical signs are also unmistakable. There is the tell tale way you hold your jaw, the tightening of the throat, the strained quality of your voice. Even if you wanted to, it is very difficult to smile, as gravity conspires to pull all your facial muscles downward.

When I am depressed, I have great difficulty connecting with other people in any meaningful way, so I tend to avoid social interaction. Depressives can be insufferable company, and I am always afraid of spreading my poison.

If you have suffered from clinical depression, you will never again use the word depressed casually, as in, “I am so depressed about this lousy weather we're having.” You can be sad, or disappointed, or frustrated about the weather, but depression is something else entirely.

Anhedonia, the loss of the capacity to experience pleasure, is a good place to start. When you are depressed, your emotions take on tangible weight, and the world lays heavily upon you. You feel like you are walking against the current. Your world view is very dark. You feel hopelessly pessimistic. You cry easily, and not necessarily for good reason.

Concentration is poor. For me, it is like my head is filled with white noise, or static interference. I have a limited attention span, and trouble retaining information. I give myself a break from reading the newspaper, as it will go in one ear and out the other; the shallow Style section is about the right level of reading comprehension at these times.

Anxiety is another part of the equation. That is, feeling irrationally worried about things over which you have no control. Do you remember the opening scene of Sex, Lies, and Videotape, where Andie MacDowell speaks with her therapist about how worried she is about garbage?

That about sums it up. (And I really did used to worry about garbage.)

I spent the first half of my life feeling this way, more or less constantly. I imagine it began in adolescence, as it often does, and there is a hereditary component. For some people, depression is situational. If you have suffered a great loss, or been dealing with a stressful situation, you may find yourself depressed. If you are lucky, it will lift of its own accord. If not, you can seek treatment, and eventually wean yourself from medication. But some people, who are predisposed toward depression, have the misfortune of getting stuck in this state for long periods of time.

When I finally figured this out about myself, in my late 20s, after the requisite spate of denial, I spent a good deal of time being angry with myself for not having known. I thought I was smart, and relatively self-aware, so how could I not have known something so fundamental about myself? But when you are depressed, you literally cannot see the forest for the trees.

It wasn't until I accepted the fact that I was depressed, and began to take medication, that I began to see things clearly, probably for the first time in my life.

The only thing I can compare it to is when I learned that I needed glasses. I was in college, and having trouble seeing what a professor was writing on the board. I asked a friend sitting next to me to help me interpret what was written, and he looked at me, perplexed—we weren't that far from the board—and handed me his glasses. And although they weren't the right prescription for me, I put them on, and things immediately became clearer. And then I made an appointment to see an eye doctor.

Beginning to take medication for depression was a similar revelation. The results were not so immediate, or as quick as getting fitted with a pair of glasses, but slowly, and consistently, my world view began to change.

I literally began to see myself differently. Prior to being treated for depression, I perceived myself as someone who could afford to lose ten pounds. After treatment, when I looked in the mirror, I realized my weight was absolutely fine, and had always been. I had previously thought my facial features were not proportionate; my nose too big, my chin too small. But again, when I reexamined myself through this new prism, I realized there was nothing wrong with my face.

Simple tasks, that had always been effortful for me, became effortless. I had not known that it was not normal to have trouble getting out of bed in the morning. Now, I would wake in the morning, and hop right up. Just like that! Who knew?

(I don't mean to sound like a PSA, but if any of this sounds familiar to you, you should get yourself to a qualified psychiatrist ASAP. A psychiatrist, as opposed to a GP, because they are better versed in the nuances of depression and anxiety disorders, and are better qualified to give you the right medication for your particular condition.)

While we have come a long way, there is still stigma attached to mental illness, and I am occasionally shocked at the way people, even some medical professionals, think it is a matter of pulling oneself up by the bootstraps.

I once saw a dermatologist for a consultation, and as she scanned my chart and noticed the medications I was taking, she shook her head and said, with astonishing ignorance ,“I don't know what it is, I see so many people taking these drugs lately. I guess the drug companies must have really good marketing reps on this.” She then scanned me from head to toe, and I could see the thoughts running through her mind: You are an attractive, slim, well-dressed woman, she thought. And after thinking these things to herself, she said to me, aloud, “What do you have to be depressed about?”

I was speechless, as I, a layperson, tried to explain to this doctor, somewhat awkwardly, that this was the point of depression; and you don't necessarily have good reason. I never went back to see her again.

I even find my own psychiatrist's view of depression somewhat limited. When I first went to see her, I explained to her that while medication was an essential part of my treatment plan, I did many other things to manage my condition, including mindfulness practices like yoga and meditation, acupuncture, body work, and other energetic modalities. She looked at me, smiled insincerely and handed me my scrips, as if to say, “That's nice dear. You take your pills and run along now.” But she is a good mixologist, so to speak, and she takes my health insurance, so I stay on her client roster.

I was not at my best for most of the month of May. But I knew it was just a matter of being patient, and giving my body time for my medication to return to the right therapeutic level. Slowly, but surely, as the month progressed, I felt things improving. One day, about a week ago, David asked me how I was feeling, and after thinking for a moment, I responded, “Well, I'm not feeling depressed anymore, just a mild twinge of anxiety. It's nothing I can't handle.”

And then I laughed, because I realized I had made a joke at my own expense. Depressives have no sense of humor, and humor is a sign of joy. Once I was aware of it, these moments of grace came flooding back, intermittently but with increasing consistently, and the thrill of experiencing joy once again, was enough to make me giddy.

I would love to live my life without psychoactive medication, but at this point in time, it is not in the cards for me. After much soul searching, and rigorous asana practice, I've come to accept that I could stand on my head for hours a day—and at this point, I can do this, for quite some time, with good alignment—but without medication, it would not be enough. Perhaps someday I will find the energetic modality that once and for all rebalances my chakras. But until then, I will happily take my drugs.

I no longer consider the medication a sign of weakness, but one of strength. This is the difference between how a depressive sees the world as opposed to someone who is not suffering from depression. Once I accepted this as an essential fact about myself, it was a supreme act of surrender, an acknowledgment that there are things which I cannot control. I see it now the way I do adjustments, and props, in my yoga classes; as enhancements. Just as I would never tell a student who could not touch the ground in uttanasana not to use blocks, I would never tell myself, or someone else in my condition, to struggle unnecessarily when help is readily available.

These drugs are a fucking miracle. They changed my life. And while depression is as old as humanity itself, I thank God every day that I no longer have to live that way. And that it is why I am not shy about talking about this; because nobody, in this day and age, needs to live this way.

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