A Survivor’s Guide to Depression: Passage Two – Grey Tide

In the Company of Millions

SSRIs are the most widely prescribed antidepressants in many countries. with sales of $14.3 billion in 2019, expected to reach $15.98 Bn by 2023.

Depression is a notoriously expensive disease, costing society $210 billion per year, according to new data published in the Journal of Clinical Psychiatry. Depression is an epidemic with approximately one in six Americans on antidepressants,  and more than a quarter of those long-term users,

It’s not reassuring to know I have lots of company.

The Grey Tide Wanes and Waxes

Thanks to pharmaceuticals, I’ve had remarkable runs of freedom from serious or lengthy depressive episodes – passages I refer to as ‘donating my brain to science.’

For the past ninety-five days – for the first time in nearly thirty years – I’ve been taking no medication for depression. Stopped cold. Since I hate most kinds of drugs, this was liberation. A few situational episodes of feeling defeated rolled in, but that’s part of the challenge of this passage in my life. For most of these days, my spirit has been doing well. I fancied that my brain had rebooted, free from chemical interference. Of course, as with all experiments, one has to wait for the other shoe to fall.

I used to think of it as ‘the abyss,’ a chaos of black despair. I’ve renamed it ‘the black tide’ and I’m now swimming in the grey part of that tide. My shine’s gone dim. I hunger to be back the sun, fully engaged with all the strange and wonderful and confounding ideas and people and events that life serves up. I’m looking at all sorts of alternatives to return to stable ground.

It amazes me how little science can tell us about brain function. Psychiatrists and psychologists have evidence only of trends in effectiveness and possible side-effects, not that any individual will have these experiences or if, in fact, any given drug will have good outcome without too many bad side effects. We may be years away from knowing the best way forward in the treatment of depression.

In the meantime, drugs that tinker with neurochemistry must stand in as the best-guess response to psychological distress. We accept the little tortures of trial-and-error:  which drug, at what dose?  Sometimes a med does well by you. But if your brain is hardwired for ‘instability,’ are these work-arounds the only option? 

Admitting that depression claims occasional dominion over my life still feels a bit like copping to a secret flaw. How do we make Depression, and mental health in general, part of the wider social conversation – or at least the family conversation?  For so many, depression is the elephant on the coffee table of life. You, dear reader, or someone you love, is needing that elephant to stand down. This is my small contribution to that conversation. Comments welcome.

A Survivor’s Guide to Depression (a series)

Just in time for the Holidays!

The suicide of my nephew at age twenty forced me to take a hard look at the ‘the dark’ in my own life.  I’ve been on the journey for over thirty years, much of it shrouded by the stigma attached to depression. In my mother’s time, it was ‘the blues,” a probable character flaw.  That very notion was, well, depressing, and hard to transcend.

The current epidemic of depression, spurred on by the pandemic, takes a big bite out of personal and professional lives. One in ten Americans, 300 million people globally share the condition. And that’s just those who ‘fess up.  If you are afflicted with depression, you have a lot of company.

One in ten Americans, 300 million people globally, share the condition. And that’s just those who ‘fess up. 

Depression, ‘the soul crusher,’ is rated in the same disability category as terminal stage cancer. If you struggle with depression, you have a lot of extra psychological rambling and shambling in your life.

This is the first of a series of essays about my many passages living as a ‘high functioning’ depressed woman. These are personal experiences, informed by a lot of nerdish research, psychological juggernauting, and the donation of my brain to pharmaceutical guesswork. My hope is that some of you who have to face off with this Beast may find encouragement in what I share. Suffering is optional. Help is available – if not inexpensive.

Passage  One:  The Science

We start with a few general factoids, bearing in mind that each are the subject to vast debate and inadequate / inadequately funded study.


Depression. Anhedonia: the inability to feel pleasure in life, a condition arguably second is awefulness to physical torture .

Depression is a medically recognized psychological condition, with both genetic and environmental roots.

A must-see  tour de force on the topic:  Stanford’s Robert Sapolsky ‘On Depression’  https://www.youtube.com/watch?v=TIcf-2AFHgw

Prevalence:  Occurs among all ages, genders, and ethnic groups. The fastest growing market for antidepressants is Asia/Pacific.

Gender Bias: Women are 2 1/2 times more likely to be taking antidepressants than men.  23% of women in their 40s and 50s take antidepressants, a higher percentage than any other group by age or gender.Given centuries of societal disparagement of women’s value – the environment of gender inequality that pins down women of any hue  – this should be no surprise. 

Ethnic Bias   As with many other health calamities,  African Americans and other marginalized groups are disproportionally affected. Daily reminders of “less than” status serve only to reinforce a sense of worthlessness, grist for depressive episodes.

Heritability: No single genetic variation has been identified to increase the risk of depression substantially. Multiple genetic factors in conjunction with environmental factors are likely necessary for the development of Major Depressive Disorder (MDD).  That is to say, a definitive answer requires a lot more study.

I believe my family is pre-disposed to depression. My mom, God rest her headachy soul, probably seldom had a moment’s peace raising seven children, one born severely disabled, during a time when antidepressants were not available.  Others in my family are less willing to discuss.

Testing and Treatment: DNA testing can be used to predict how your body will react to certain medications, but not whether you have the disease.

The primary treatment options are counseling and medication. By one estimate, approximately 50% of people with depression don’t receive a proper diagnosis or get treatment.

As with many statistics, I wonder how they estimate. How do you count those who don’t show up in a medical setting?

In common use are three assessment tools designed to help diagnosing depression. 1) Beck Depression Inventory (BDI):  often used to measure the severity of depression.  2) Center for Epidemiologic Studies Depression Scale (CES-D):  helpful diagnosing major depressive disorder. 3) Hamilton Depression Rating Scale (HAM-D): measures depression at three different points: before, during and after treatment.  If you are lucky enough to have access to affordable psychological counseling, you will probably find yourself ticking off the boxes on one of these at some point.

Medications – Basic Chemistry

Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of drugs typically are used in the treatment of depression.

High marks and credit to AnxietyBoss for an understandable graphic.

Serotonin is a neurotransmitter believed to positively influence mood, emotion, and sleep. It carries signals between nerve cells in the brain. After carrying a signal, serotonin is normally reabsorbed by the nerve cells (“reuptake”). A SSRI inhibits reuptake, thus leaving more serotonin  available to pass further messages between nearby nerve cells. I think of it as a synapse shell game..

Side Effects

For most people, the meds don’t kick in in terms of possible psychological relief for 3-6 weeks. Meanwhile, common physical side effects, that vary among individual drugs, can feel as bad or worse than the targeted depression. These unsavory effects include:

  • Agitation, restlessness
  • Dizziness
  • Blurred vision
  • Suicidal Ideation
  • Sexual dysfunctions –whose mechanism is not well understood – including erectile dysfunction, diminished libido, genital numbness, and pleasureless orgasm(!) Studies have shown these side effects occur in 36% to 98% of users. Poor sexual function is one of the most common reasons people stop the medication

Discontinuation Syndrome

Serotonin reuptake inhibitors cannot be abruptly discontinued after extended therapy and require tapering off over several weeks to avoid discontinuation-related symptoms. Those may include nausea, headache, dizziness, chills, body aches, tingling or numbness, insomnia, and  “brain zaps”(electric-shock-like experiences in the brain). Oy.

Serotonin Syndrome

Serotonin syndrome is typically caused by the use of two or more serotonergic drugs, including SSRIs  Serotonin syndrome is a condition that can range from mild (most common) to deadly. Mild symptoms may consist of increased heart rate, shivering, sweating, myoclonus (intermittent jerking or twitching), as well as hyper-reflexes.

Take Away

All of this uncertain science, and pharmaceuticals prone to inflicting collateral damage has hardly reassured me in my quest for stability. However, I have a deep fear of the descent into the abyss. So I put up with lesser evils and, in fact, have enjoyed several remarkable runs of freedom from serious depressive episodes.

What I crave is feeling ‘stable.’ I resent depression’s downtime, especially now with my future considerably shorter than my past. I don’t so much fear death as hope for dispensation from a torturous one. Perhaps I’ve paid major tolls in psychological pain – if that somehow matters in the karmic scheme of life.

Admitting that depression claims occasional dominion in my life still feels a bit like admitting to a secret that cannot be spoken.  When do we make Depression a topic in the wider social conversation?  It is, after all and for many, the elephant on the kitchen table in a world overboiling with trauma and conflict.