A Season of Melancholy

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My death will most likely be by suicide. That was the thought ruminating through my mind as I walked along the sidewalk in front of my building on a cool, sunny day in October. I looked up toward my third-floor apartment, surveying the distance from the balcony to the ground. During the eighteen months I’d lived in the building, I’d never once looked over the balcony to assess how many feet I’d fall if I jumped, or where I’d land if I took that leap. 
“Not far enough to break a bone,” I whispered, as I wiped a tear from my cheek. I’d hoped my sunglasses would hide the tears in my eyes, but they couldn’t hide the ones streaming down my face.
I turned left on Kenner Avenue, and hobbled along the road toward Woodmont Park. Going for a walk on a pretty day was a last ditch effort to pull myself out of my depressed mood. My instinct was to remain in bed all day, in a dark room, with the covers pulled over my head, but I’d dealt with episodes of clinical depression enough times to know I had to leave my room. I knew it was the mental illness feeding me unreasonable messages. My depression had come to life, haunting me like an evil spirit. I knew as soon as I adjusted my medication, the sadness would go away. I reminded myself of another depressive episode a few years ago. I struggled for six weeks before seeking medical attention. All it took was three days of an increased dose of an antidepressant to lift me out of the darkness. Why had I waited so long? Maybe it was pride, shame, or simply the fact I thought I could will myself out of the depression if I tried hard enough.
This time I knew what I did wrong. I ran out of refills for one of my prescriptions and didn’t have enough pills to get by until my next doctor’s appointment. My doctor was out of town. I felt fine at first. My mood was stable. Certainly I could manage for one week without a mood stabilizer. I had all the other drugs I take to treat my condition. One pill wouldn’t matter, or so I thought. The second mistake I made was failing to account for the change of season. Under the best of circumstances, people with no diagnosed mental illness might be subject to a seasonal depression. For a person with bipolar disorder and a history of major depression, a change in season usually requires an adjustment in dose of the drug cocktail that maintains stability during the spring and summer months. The third contributing factor to my downfall was a dispute with my supervisor at work regarding a new policy and procedure. I saw a flaw in the system and was too vocal about how much I disapproved of the new plan. It doesn’t take much of a stress-inducing stimulus to send me into an emotional tailspin. The three culminating factors were the perfect storm of events to precipitate a downward spiral in mood.
With each passing day, I felt as though a little piece of me was dying. I clung desperately to the life raft keeping me from being sucked into a dark abyss, but my sanity was slowly slipping away. The first red flag that something was wrong was I completely lost interest in writing, a hobby I’d enjoyed so much in recent months that I could sit for hours at my computer, typing, creating all sorts of scenarios for the protagonist of my novel, while I laughed, hoping to entertain my readers as much as I was entertained writing each chapter. I wanted to be good at something. I thought I’d finally found my niche. I believed I had a talent and was creating a marketable product. I imagined my story playing out on the big screen. Wow, wouldn’t that be something! A pharmacist with no formal training in journalism, creative writing, or experience in the publishing industry actually writing a successful novel. Maybe I’d become a screenwriter. My novel would be optioned for movie rights and become a summer blockbuster hit. I read a few pages of what I’d written and realized my hopefulness in becoming a published author was grandiose manic thinking, not reality. 
I hated what I’d written. I hated the main character of the novel, which in turn meant I hated myself, as she was based on a younger version of me. The other characters I had created were no longer the lively, fictional friends and family I’d spent countless hours developing. Why had I even tried? So many hours wasted on a project I was now embarrassed for anyone to read. The negative thoughts kept cycling through my head in a continuous loop, feeding my depression.
Intellectually, I knew the dark thoughts were a symptom of an illness. Emotionally, I could not separate the two worlds. By day five of no medicine, I could no longer stand the pain. I called the cross-covering physician and got the refill I needed. 
“You know better,” the doctor said at our next scheduled appointment. “There is always somebody on call. Do you need any more refills?”
We carefully reviewed each drug on the list of the plethora of meds I take to regulate my mood disorder.
“Do you feel like you need to be admitted?” he asked.
“No, I’ll be more comfortable at home,” I said.
“Do you own a gun?”
I realized the doctor was reading from a familiar script, a prepared list of questions to ask suicidal patients.
“No, no gun. I wouldn’t know how to use it if I had one.”
“Do you have a plan?”
“No plan,” I replied.
I never had a plan to commit suicide. I simply did not have the will to live. I wanted someone or something else to end my life. I work in a hospital and have seen too many suicide attempts go wrong. I felt like a failure in every other aspect of my life. I was convinced my suicide attempt would be a failure as well. I wasn’t afraid of dying. I was afraid of living.
He continued to ask questions. I calmly answered them. I gathered my prescriptions and scheduled a follow-up appointment.
A week later, I returned to the clinic for an emergency appointment. I’d grown increasingly restless and noticeably agitated.
“I think I’m having a mixed episode,” I said. “Usually things roll right off, but everything and everybody is annoying me. I’m not sleeping. The dark thoughts are gone, but I’m incredibly nervous.”
I was experiencing symptoms of both mania and depression. It wasn’t the good, euphoric mania, or the hopeless, debilitating depression. My mood was somewhere in between, a roller coaster ride of emotions. I had to get off the ride.
“I’m glad you called. You did the right thing,” the doctor said. “Don’t worry. You’ve gotten off track before and we’ve always gotten you back on course. You’ll be fine.”
Another increase in doses. Another follow-up appointment in two weeks.
That evening I sorted the pills into a days-of-the-week medicine organizer. “Is this what my life has come down to?” I cried, as I counted six pills into each pocket. Remembering how far I’d fallen by not taking just one of these pills scared me. Drugs are very powerful and mysterious things. For whatever reason, this cocktail worked for me, and it’s what I had to take to treat my illness.
Unfortunately, there is no one-size-fits-all therapy to treat bipolar disorder. What works for a while doesn’t last forever. Fine tuning the drugs and doses is a careful balancing act. Increasing the dose of an antidepressant can tip me over into a manic phase. Adjusting the dose of a drug used to treat manic symptoms can send me crashing and burning into another depression. The mood stabilizers tend to dull my senses. I’m unable to think clearly, a feeling I hate because I feel numb and my creativity vanishes. Some of the drugs used to treat bipolar disorder cause weight gain, a side effect that makes my self-esteem sink even lower. The chemical happiness I’m supposed to feel is sometimes countered by the horrible side effects of the drugs used to manage the illness.
My condition continued to deteriorate over the next few weeks. My doctor decided a change in antidepressant therapy was indicated and I agreed. I took a week off work to safely change medication without the risk of compromising my job performance due to impaired cognitive function. The plan was to taper off the antidepressant, Effexor, and begin the drug, Wellbutrin, as soon as the Effexor cleared my system. With no antidepressant on board, I completely bottomed out. I went to the next scheduled appointment with my psychiatrist feeling like I was walking in slow motion. Every step took a monumental effort. I walked down the hall of the clinical to a water fountain and suddenly the thought of walking any further was exhausting. My doctor had to pick me up off the floor and escort me to his office. 
I started taking the antidepressant Wellbutrin and felt completely normal within a matter of days. I was able to return to work, thinking clearly and feeling optimistic I’d finally worked my way out of this depressive episode. The good outcome didn’t last. A slight dose increase of Wellbutrin suddenly caused a drastic change in my mood, behavior, and thoughts. My emotions were out of my control. Within a span of twelve hours, my mood changed from stable to having an abnormal preoccupation with suicide.
“I know why people kill themselves in hotel rooms,” I thought, as if I’d had a brilliant light bulb moment. “That way somebody will find the body. I need to check into a hotel.”
I started a mental checklist of what I needed to pack for the trip from which I would never return. I knew I was in trouble. I knew I needed help. If I was not a pharmacist and not aware an increase in suicidal thoughts or actions is a serious adverse side effect of antidepressants, I might have acted on that impulse. I knew it was the drug creating the suicidal thoughts. I was more scared than I’ve ever been in my life. I sought medical attention immediately.
Finding the right combination of antidepressants, anti-psychotics, and mood stabilizers to control my illness is not the biggest challenge in coping with a mental illness. It’s the social stigma and shame that goes along with the words bipolar disorder. My illness has wreaked havoc in my life, a self-destructive tornado, leaving a trail of fractured relationships, lost jobs, and interpersonal and professional conflict in its wake. The depressions have been so debilitating, simple self-care measures like brushing my hair or taking a shower became overwhelming tasks I cannot perform because they were too hard. The depression could be seen in my face and heard in my tone of voice. Sometimes I feel like I am trapped in a prison of my mind and the only way to escape is by death. 
Mental illness is a struggle and can be life-threatening, yet I don’t think people realize just how dangerous a mental illness can be if left untreated. Many people do not seek help because they are too ashamed to do so. Actress Catherine Zeta-Jones put a public face on mental illness in 2011 when she announced she checked herself into a facility to seek treatment for bipolar type II disorder. I was comforted by the news, relieved this beautiful, talented woman was brave enough to reveal she struggles with manic-depressive illness. I share the same diagnosis, yet for me, bipolar type II disorder is not as glamorous. I feel like a modern day leper. I’ve felt threatened, harassed, and discriminated against because I have a mental illness. Whether this perception is real or imagined, the feelings are the same and those feelings worsen my condition.
Approximately 5.7 million people in the United States, or 2.6 percent of the adult population, are affected by bipolar disorder. Over two-thirds of the people diagnosed with bipolar disorder have at least one close relative with the illness, or unipolar depression, suggesting the disease may be hereditary. Mental illness is an illness, just like any other medical condition. It deserves treatment and respect. We need to educate our society on that fact.
“Something that we, as psychiatrists, are very concerned about is the added suffering due to the stigma our patients face in society. Privacy of health information is still critical for many reasons, and it is especially important in mental health settings. It's always hard for people to talk about personal problems with someone, and if they're worried about a paper trail, it's even more difficult. We know that about half of the people with depression who would benefit from treatment just won't come in because they don't want any record. It is totally illogical, especially when you realize that some of them will die by suicide. Stigma kills and we fight it all the time,” says my psychiatrist, an Associate Professor in Psychiatry at Vanderbilt University Medical Center.
“We know that depression in bipolar disorder is extremely dangerous and is much too often a deadly illness, but we also know that our treatments do work, and we are developing new and better treatment options all the time. The only reason why someone won't get better is if they give up. There has never been a point in offering treatment where I have actually given up.”
The beautiful prose written in Lord Macaulay’s essay describing the deep melancholy that took possession of eighteenth century writer Samuel Johnson is the most accurate description of clinical depression I’ve ever read. 
“The light from heaven shone on him indeed, but not in a direct line, or with its own pure splendor. The rays had to struggle through a disturbing medium; they reached him refracted, dulled and discolored by the thick gloom which had settled on his soul, and though they might be sufficiently clear to guide him, they were too dim to cheer him.”
When I read those words, I thought, “Finally, someone gets it. Somebody understands”.
The most disappointing thing about my recent depressive episode is how it affected my writing. I have not revisited my book project. I planned to write as long as the hobby was fun and when it stopped being enjoyable, I would put it aside until I found pleasure in writing again. There is no deadline. Writing is not my livelihood. For now, my project is dormant, but like flowers in the spring, hopefully it will bloom again.


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