How I Survived Severe Depression
Shubhrata Prakash, an officer with the Indian Revenue Service currently on sabbatical in Bangkok, went through a very long episode of depression. At the end, she was inspired to write a book The D Word: A Survivor’s Guide to Depression that not only became therapeutic but grew into a handbook on depression.
1. Would you consider depression a mental illness?
Depression IS a mental illness, which also has physical dimensions. Unfortunately, most people who have not had a close encounter with it think that depression is sadness. This is also because of the colloquial use of the word ‘depression’ to denote sadness.
To differentiate the illness from temporary sadness, the term Major Depressive Disorder (MDD) is used technically by mental health professionals. It has been classified as a mood disorder. The fact of MDD being a real illness has been established by research, which has reported changes in brain chemistry and its physical structure to be coexistent with the outward symptoms of MDD. There are changes in some neural pathways relating to reward perception and memory formation which may be reasons for the negative thinking cycles found during depression. (Studies by Russo and Nestler; by Rolls, Feng et al)
2. What efforts are underway to improve the treatment of depression?
There is a lot of research going on even as we discuss depression here. With advancement in technology, it is possible to functionally map the brain. Gene research is proving fruitful with identifying genetic markers for depression. Research in bio-chemistry is trying to synthesize better drugs with more efficacy in depression treatment. Alternative physiological therapies like repeated- Transcranial Magnetic Stimulation (r-TMS) are being tried out empirically for relief from depression.
One can certainly hope for a day when all the research would result in tailor-made drugs and therapy for each individual affected by depression. The ultimate success in this enterprise would be when the expression of the depression gene is prevented altogether.
3. What treatment did you have to undergo to treat your depression?
I was put on a course of anti-depressants. My medication protocol escalated over a period of time from a simple SSRI to multiple drugs. I also underwent psychotherapy in the form of Inter-Personal Therapy (IPT) and Cognitive Behavioral Therapy (CBT).
4. Do you think you could have prevented the onset of your depression in any way?
It is not possible for anyone to prevent depression from happening just as it is not possible to ward off unseen germs and viruses which cause physical diseases. The exact cause of depression is not known yet. However, changes in the brain have been found associated with depression. There is the genetic programming which may predispose someone to depression. Hormonal imbalance can also trigger depression. Hence, prevention of onset of depression is not possible, according to my understanding.
Once a depressive episode is over and depression is in remission, it may be possible to prevent a relapse. The coping strategies learnt during psychotherapy, and the fact that the depression sufferer may be alert and looking out for symptoms of recurring depression, may help. However, if the depression triggers are stronger than the possible prevention efforts, it may not be possible to prevent a relapse either.
5. It is not uncommon for depressed individuals to have thoughts about suicide? Did such thoughts ever cross your mind? How did you avert them?
Unfortunately, the answer is yes. The urge to end the agony of living with the pain of depression is too strong. Fortunately, I have had a very strong support system within my family. My husband and my parents have been my biggest support. Every time I felt that life is not worth living, I would imagine never seeing my beloved children again…never seeing my husband again…not being around to see what my children grew up to be. I would imagine my family struggling to live without me. And for what? Just a lie that depression told me that “life is not worth living”!
So, I changed my thoughts. I imagined living a life with my family in which I was better and my usual self. On days when I couldn’t “live”, I contented myself with just “existing”. On days when I could, I “lived”.
6. What were some of the strategies you used to help yourself during depression?
I went through a very long depressive episode, during which time I tried many different things to help myself. Unfortunately, when it comes to chronic depression, there is no silver bullet for slaying the monster. So, something would work for a few days, and then I had to reinvent my strategy when the earlier one stopped working.
If I were to choose a few of the more successful strategies that worked for me, I would list out these:
- Reading up as much as I could about my condition. It kept me informed and alert.
- Knowing my limitations. There is only so much you can fight. You have to figure out when to fight, and when to just beat a wise retreat. Depression is a very tough opponent to beat.
- Being very regular with my psychotherapy sessions and doing all the hard work required to make therapy work for me.
- Exploring safe complementary and alternative medicine options that were compatible with my medication, like massage, yoga and mindfulness.
- Expressing myself creatively through writing and painting.
7. Your five tips to manage depression
- Acceptance of the diagnosis. The earlier one comes to term with the fact that one has a mental illness, the easier it is to fight and overcome.
- Seeking and using help. Seek out medical and therapeutic help. Seek out help and support from family, friends and colleagues – anyone who is understanding and empathetic. And then, use that help - be regular with medication and therapy.
- Being wise to the distortion in thoughts that depression causes. Therapies like CBT help in doing that.
- Working out stress reduction strategies. Depression lowers stress tolerance. There will always be stressful situations and patronising people around. You need to have your combat strategies in place.
- Taking one day at a time. During the darkest days of depression, you just have to hold on to the hope that one day it will get better, and all you have to do is get through today.
8. Why did you feel the need to write a book? Do you feel writing about your depression has been therapeutic for you?
There are many reasons behind my writing a book on depression. One was the lack of information in the Indian domain when I was looking for ways to help myself through the hopeless days of depression. So, my writing was a way of sharing the knowledge I had gathered during this process. Another was the hope of bringing hope to a large number of sufferers like myself, who could benefit from some of the strategies I used for helping myself. Yet another reason was the abysmal lack of awareness in the population in general (including me before my brush with depression), which gives rise to a lot of social stigma.
Writing ‘The D Word’ was definitely not cathartic. Writing this book has been very therapeutic, and has helped me in lots of ways. Writing has always been a passion for me and this has been a very fruitful way of channelizing that passion. At many places in the book, counselling others was also self-counselling. I have read and re-read my book many times. The book has helped in reinstating my pre-depression self-worth which was eroded by the cognitive impairment brought on by depression.
9. What unique offerings/insights does your book, The D Word: A Survivor's Guide to Depression, provide to readers?
The D Word is just a sincere and humble effort to bring hope to depression sufferers and their families, and awareness about depression to society. The book is structured in two parts. In one part of the book, I have tried to describe what depression is, what its causes are, what treatment options are available in India, what changes in thought processes occur, how persons suffering from MDD can help themselves, and some advice and guidance for their caregivers and families. In the other part, I have journaled my own tryst with depression, and have also tried to bust some myths about MDD and mental health issues.
10. Would you like to add something more to what you have written in the book?
Yes, I would like to take my readers a little further along time than the point at which my book ended. Now, eight months later, my depression is in remission. Sometimes I do undergo sudden dips in my mood, which are the remnants of depression. But my ‘bad and very bad’ days are finally a thing of the past. My brain has got re-rewired somehow. I am living a drug-free and fulfilling life, which has included doing a lot of follow-up work on the editing etc of the book. I am still on leave from work, but I am not on leave from being a mother anymore. I am now a full-time mother to my children, who are showing great growth in their own lives because of my becoming well.
My therapy sessions came to a logical conclusion a couple of months back. My body finally started moving, and I have spent a lot of time on swimming and yoga. Mindfulness meditation is now a daily routine, just like sleeping and eating. My sleeping rhythm is almost back to normal. I have lost 12 kgs of weight after I became drug-free, and my BMI is inching back to the healthy range. The black cloud hovering over my head has finally dissipated. I cannot predict a relapse, but…such is life!
Dear fellow sufferers, it does get better. If I could get better, so could you. I do not know the hows and whys of my getting well, but just getting there is worth holding onto hope.
(Shubhrata Prakash is an officer with the Indian Revenue Service. She has a Bachelor’s degree in Mathematics from St. Stephen’s College, Delhi, and an MBA from Xavier Institute of Management, Bhubaneswar. Before joining the Civil services, she has worked briefly in advertising with Lintas and Leo Burnett. Shubhrata is the author of a collection of poems titled “Ink On Water”.)