A Way Out

     One memorable year I contracted both dysentery and hepatitis A, two diseases so distressing I shall spare you a recitation of their symptoms. Yet if some malevolent god should offer a choice between one of them and another bout of depression, I think I’d go with the dysentery. It’s the most painful, but it’s over quicker.
     Fear not. I am not about to inflict upon you my tale of woe. I’m writing this to let my fellow depressives know that there is – there may be – a way out.
     Alcoholics have clubs they can go to. So do cocaine addicts, overeaters, sex addicts and neurotics. So do musicians and artists – though their clubs are usually called bars. But depression by its nature keeps people apart. There’s no club. And if there were, I wouldn’t want to go to the meetings.
     I’m also writing this because my experience confirms the scientific theory that depression can be caused by biochemical imbalances in the brain caused by stress. And, for the record, I suffered through my first episode before I knew the scientific theory, so it could not have influenced me then.
     The theory goes that depression can be caused by deficiencies in neurotransmitters, such as serotonin or norepinephrine – substances that are released, and then reabsorbed, each time a synapse fires. Norepinephrine – also known as adrenaline – triggers the “fight or flight” reflex.
     But when mammals are subjected to prolonged stress, the brain may respond by shutting down receptors for the neurotransmitters – in effect, “turning down the volume” biochemically. When the stresses are removed, the body and brain feel an insufficiency, because they have turned themselves down to survive the stress.
     The theory has been confirmed by studies on lab rats, and it helps explain why people with dreadful childhoods may become depressed later in life – after the stresses have been removed – and why combat veterans may suffer long after they are safe from war.
     I worked with torture victims inside U.S. immigration prisons for several years in the 1980s, and when I was not doing that I worked as a freelance writer and city editor for daily newspapers – high-stress occupations all.
     In the late 1990s, years after I left the prisons, I suffered a prolonged depression so bad I could not get up off my couch. I felt then, and I felt just a few weeks ago, just like my fellow melancholic, Dr. Samuel Johnson, felt when he said, “I would consent to have a limb amputated to recover my spirits.”
     The strange thing is that the great stresses in my life had been removed when I fell into depression. It did not lift until I went to a doctor and he prescribed me a selective-serotonin reuptake inhibitor.
     These drugs do not add neurotransmitters directly to your body. They delay the body’s readsorption of serotonin, or norepinephrine, after the synapses release them. So the level slowly rises, and the worst aspects of the depression lift – if you’re lucky.
     I am not pushing drugs. That’s why I’m not naming the drug I took long ago and started taking again this month after it happened again. This time – 10 years after I quit the drug the first time – the disease whacked me after a disastrous three-week trip to California.
     I drove 3,000 miles to reclaim my house from renters who had stolen everything in it, and even tried to sell the water heater. I worked 14-hour days rehabilitating the place for two weeks, then drove 3,000 miles home and was ecstatic to arrive home in Vermont.
     But when the stress was removed, I crashed into a black hole and could not climb out.
     Once again, I could not get off the couch. My personality changed. I became paranoid, insanely distrustful and morose. I wanted to call a good friend in California who had been through depression too, but I did not because I thought he would not want to talk to me and would hang up – even though I knew that thought was nonsense.
     I became Black Bob. I knew there was a Normal Bob somewhere, but he was not answering the phone.
     I resisted the chemical as long as I could, for no reason that I can remember. Less than a week after taking it again, the depression started to lift. I am again becoming what passes for Normal Bob – whether that’s good, bad or indifferent, no one can tell, including me.
     I know the drug doesn’t work for everyone. I know that drug companies shamelessly have pushed it for off-label uses, pushed it to children, pushed it to anyone, including household pets, from whom the drug companies can make a buck. And sometimes the drug apparently makes things worse.
     But depression is a horrible thing – worse than dysentery – and dysentery is no fun at all.
     Depression causes suicides and murders and untold misery. It ruins lives and wreck careers. It seems interminable. It appears that there is no way out.
     I’m not telling my story to push drugs. I’m telling it because it might help one depressed person somewhere.
     If you don’t trust me – and why should you? – you might try reading “Touched With Fire: Manic Depressive Illness and the Artistic Temperament,” by Kay Redfield Jamison; or “The Noonday Demon: An Atlas of Depression,” by Andrew Solomon; or “Listening to Prozac,” by Peter Kramer.
     If you’ve never suffered from depression and want to know what it’s like, William Styron’s “Darkness Visible” pretty much sums it up. If you have suffered from it, there’s no need to read that one. You don’t need to know what it’s like – you want a way out of it – alive.

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