Last week I took a giant step into a new frontier. After a lifetime of navigating a volatile mood, and a decade or so of very deliberate efforts to manage it, I decided to start a pharmaceutical anti-depressant.
I'm not gonna lie ... despite years of counselling others that taking meds isn't a failure ... that it creates the space to do the hard work of healing ... that it may make things a little lighter and more manageable ... that it's not a life sentence ... despite all of that, I still struggled with the decision. As a naturopathic doctor, this seemed like a last resort, and I struggled with feeling like somehow I was a failure for not being able to fix myself in a more natural way. I was afraid of side effects (most significantly the possibility of weight gain, which surprised me ... I've never lived with weight as a motivator, but this came burbling up when I pondered the meds), and was focusing more on them than on the possibility that they might help.
I have never been terribly even-keeled (ask my parents!) ... I feel deeply, and I generally celebrate my ups and downs as the rainbow of being human. For years I have practiced all the things I would recommend to a patient. I am a voracious exerciser, and have always felt better when I make it a daily priority. I eat well. I drink minimally. I don't smoke or do other drugs (though I have dabbled with edible marijuana recently as part of my explorations). I make sure to get the sleep I need (which in my case is a lot) and usually sleep deeply. I mostly enjoy my paid work, I volunteer, I have many hobbies. I have a spiritual community. I have a partner that loves and supports me. I have kids in whom I revel. My life has meaning and purpose. I am surrounded by powerful circles of loving and supportive family and friends. I've worked with therapists and practiced skills of mindfulness, gratitude, acceptance and cognitive-behavioural therapy. I've woven in evidence-based natural health products.
However, a series of events over the past year tipped the scales and left me lower than I ever remember being; even when circumstances improved, I couldn't climb out of the hole. A combination of more intense anxiety and depression punctuated by dark thoughts of not existing have forced me to take greater notice. The things I have always done for balance aren't balancing me anymore. My motivation has tanked. Exercise no longer helps - not only am I not driven to do it, I feel worse when I do - I feel weak and my body hurts all the time. I am exhausted constantly, not wanting to get out of bed. I resent my responsibilities and commitments - even those I willingly make. I am deeply affected by all the terrible things happening in the world and feel incapable of making a positive difference. I know my life is blessed - I can identify every wonderful thing. But I feel so little joy or genuine appreciation for it. It all seems unmanageable and heavy and dark, and in many ways, I feel guilty for having such abundance when so many others suffer. I feel like an ineffective teacher, doctor, parent, partner, child, friend. I am never doing enough and I don't have any more to give.
For a time, I wondered if this is due to age: my body not having the same energy as it once did; injuries taking longer to heal; maybe a bit of a midlife crisis. But I always imagined myself doing triathlons until I was 80 ... there is no good reason to feel this way at 40. I'm okay with slowing down, and I appreciate the concept of making transitions in life, but this feels like a particularly needless, abrupt, and unpleasant one. A colleague suggested that I learn from the stoics - embrace getting older with grace ... though when I watched the lecture he sent me, it only suggested doing all the things I am currently practicing.
Both my medical and naturopathic doctors ran a litany of tests. Did I have an autoimmune disease? A thyroid issue? "Adrenal fatigue"? We even did a sleep study to make sure my sleep was all I thought it was (that was an experience I never want to repeat!). All came back pristine - a good thing, but still leaves me without answers - the only thing left to check is Lyme, which is entirely possible given my lifestyle. When I suggested to both my MD and ND that I might be depressed, they questioned it ... saying I didn't "look" depressed.
Isn't that the thing though? A person struggling with depression doesn't always fit the classic profile of a low-affect, poor-hygiene slug dragging themselves (or not) through the day. I don't always want to get out of bed, but I pull myself up. I don't feel like exercising, but I arrive at my appointments by bike. I dread going to work, but I show up and invest in my patients, my students and my research. I make my family healthy dinners; I send birthday cards; I reach out to friends; I plan vacations; I shower (occasionally). How many stories have we heard lately of people committing suicide when no one knew they were struggling? I suspect most people see me as a capable, confident, energetic, strong person. I'm aware of my persona. I strive to be authentic, but it's tough to let on when things are hard. The effort of maintaining this identity makes everything infinitely harder. I am exhausted. (And let me comment on our cultural obsession with being "fine" ... such an internal debate every time I am asked how I am ... I want to be "great!" ... I'm not ... but that's the expected response, so as not to be a downer, or to burden the person asking. But it feels like such a lie.)
My MD wrote a prescription for an anti-depressant at my request. I wasn't sure if I was going to take it, planning to give the combination of a new therapist and a new supplement regime (along with being kind to myself) a few weeks to see if I felt better. However, I reacted to a relatively minor incident last week in a way that let me (and my loved ones) know that I am really having a hard time keeping a grip on things. My partner and my best friend both urged me to give the meds a try ... telling me all the things that I tell my patients (see above). My therapist agreed. A dear friend was staying with me the night that I walked to fill the prescription. She too has struggled with her mood for many years, and I have at times played a central role in supporting her journey. It seemed very symbolic that she was with me as I took my first dose. Despite weeks of doubting and second-guessing and self-judging, I felt hopeful. I know it will take a few weeks for my serotonin levels to rise to a degree that I notice an objective change, but in the meantime, I'm aware of a reassuring placebo effect. I connected with some of my dearest friends over that week - as it happens - and was deeply reminded that they have my back.
I still struggle with the idea of pathologizing human emotion. I truly believe that the terrible things in this world are worthy of our despair - but that awareness ideally motivates instead of buries. I don't want this medication to numb my compassion for others' struggles - I've been assured that this won't happen. I have always had high standards - for myself and others - and I don't want to stop caring. But I'm also aware that the weight I've been feeling has been interfering with my ability to act and to experience joy. That's not how I want to live. (And it's definitely not what I want to model for my kids.)
My goal is to be lighter. To be mindful of suffering, and find a way to release some resistance. Compassion for others shouldn't be mutually exclusive with my own sense of joy and gratitude. Striving for excellence is not opposed to extending kindness to myself. Someone once told me that nothing worth having is upstream - that blew my mind, because all my life I have worked so hard and taken things so seriously. Perhaps it's time to go with the flow a little more - at least as an experiment.
I will continue to practice acceptance of my emotions, even when they are difficult. I embrace sadness; anger; joy. Fear and disappointment are harder, but I will practice acceptance and curiosity about that too. I find solace and healing in the gifts of Thoreau, Emerson, Brown, Brach, Kabat-Zinn and others. I believe this is the ultimate solution to my suffering - embracing and loving my imperfect humanity with kindness, compassion and a sense of humour. And extending that loving kindness to others. This will likely be my life's lesson. In the meantime, I'm hoping sertraline will help make it all a little lighter.