Monday, December 1, 2014

Signs that Major Depressive Disorder May be Returning


Those who have been following this blog may have noticed that after a remission of 16 years, depression returned to my life in 2010. I have been diagnosed (from three health professional sources) as suffering from major depressive disorder. As of today, I am not out of the woods yet, but I am slowly improving. I am currently experiencing about one ‘bad’ week of depression for every three ‘good’ weeks. I would also like to thank everyone who has been praying for me.

In my next few posts I will focus on recurring depression, more commonly known as major depressive disorder, and also as recurrent depressive disorder, clinical depression. Major depressive disorder differs from other types of depression in that although the person may have periods of normality between depressive episodes, future depressive episodes will continue to come. The breaks of normality can be anywhere from weeks to years apart. (This is different from the good day/bad day cycle that depression sufferers experience during recovery.)


Many if not most people who suffer from a depression never go through it again - the depression is an isolated event triggered by very difficult circumstances, such as the passing away of a loved one. So it never occurred to me that I could succumb to depression again after recovering from a major episode in the mid 1990s.


I had also learnt many coping techniques to deal with anxiety and depression, and so believed that should severe anxiety or depression attempt to invade my life again, I would be able to nip it in the bud.


Therefore, when in 2010 I began to experience a number of symptoms similar to what I went through in 1989; I did not think them significant nor join the dots to see a bigger picture unfolding.


At the beginning of 2010 my family began attending a new church. Three months later I had a panic attack that we had made the wrong decision. For several days I tried to think objectively and convince myself that we had made the correct decision, but due to overwhelming anxiety, I felt we had to go back. I finally recognised that I needed to get someone else’s perspective, so I shared what I was thinking and feeling with my wife. She helped me to see the correct perspective, that we had done the right thing, and this helped me to dismiss my fears and the anxious thoughts faded away. However, the next day, from morning until mid afternoon, I could feel waves of fearful adrenalin rippling through my body, something I had not experienced for nearly twenty years.


A few weeks later, for minor reasons that felt significant at the time, I suddenly deleted my ‘writing’ blog, where I had written short stories, flash fiction, and poems. Although I had greatly enjoyed making that blog, I lost all interest in it.


Around this time my wife said that I was looking exhausted and weighed down. She suggested that I cut down on my out of work commitments, so I took her advice and cancelled some of my social and church activities.


By April I lost my appetite. Each night I would half my dinner and then push the plate away. In June I noticed that my daughter had stopped teasing me for putting a bit of weight on my midriff, so I went and weighed myself. I had dropped from 70kg to 64kg. This was alarming, so from that day I forced myself to each my whole dinner every night, and added a small meal before bedtime every day.


I also found myself becoming envious of a couple we knew who were in the process of retiring. The thought of retiring was so attractive, so appealing. Why did I, in my mid forties, so desperately want to retire? It was because I was becoming more and more exhausted, mentally, physically and emotionally, as the year went on.


Finally, in July I had a nightmare in which I was afflicted by the fearful ‘topic’ that had terrorised me when I had been depressed in the 1990s. Although it had been largely dealt with by counselling, here it was again.


All of these signs had preceded my previous major depressive episode, yet unfortunately, I failed to join the dots in order to realise what was around the corner - another major depressive episode.


If we have been diagnosed as having major depressive disorder
- What Can We Do?
1. Keep a list in our diary of common signs that have preceded our major depression episodes, so that we can recognise when a new episode is imminent. And then, if those signs reappear, there are a few things we can do that may reduce the severity and duration of the episode.

a. do not fear its return (this will only make it worse)

b. exercise at least three times a week

c. get at least 8 hours sleep a night

d. make sure we are not doing too many activities

e. revise our depression managing strategies, eg, read “Self Help for Your Nerves” again.

f. if currently taking anti-depressants, visit the doctor to discuss the possibility of increasing the daily dosage.

g. and very importantly, if not currently taking anti-depressants, talk to our doctor and seriously consider going back on them now, even if only a low dose. This is a preventive measure, and if depression does return, being back on the meds should reduce its severity from the start.

There is one thing I would like to stress about major depressive disorder/recurring depression - we must not fear its return. To fear its return can actually facilitate or hasten its return. Instead, we are to obey Jesus teachings to trust God and live each day as it comes, not fearing the future. Matthew 6:33-34 “But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself.”  


And if there are more depressive episodes waiting in our future, there is still no reason to fear them, for Jesus will be there, reading to take us by the hand and lead us through them when those times come. Isaiah 41:13 “For I am the LORD, your God, who takes hold of your right hand and says to you, Do not fear; I will help you.”      


When I look at my future through a perspective distorted by depression, I see a bleak, dark, oppressive future full of pain and suffering. But lately I have looking at my future from the perspective that Jesus is there in my future and will comfort me with His love and presence. And what a different, wonderful perspective that is! Genesis 28:15 “I am with you and will watch over you wherever you go,”


Important Note:

The things that I have mentioned in this article are not the signs or symptoms of depression, but merely a list of indicators common to myself that the return of depression was imminent. To see a list of symptoms that can accompany depression, please see this article :
Symptoms of Depression and How it Causes Them

If you have major depressive disorder/recurring depression, what common indicators have you noticed in your own life that precede the return of each major depressive episode?

23 comments:

  1. I hope you are adding fish oil to your diet...the studies on the stabilizing effect it has are well documented. Think of the Lord on the beach cooking a little fish for his friends while you take some fish oil everyday!

    Thank you for your vulnerability and your out reach to others. May your outlook be increasingly up and and forward in the hope we find in Christ Jesus.

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    1. Thanks Jeannette for the advice, I will look into that. And thank you for your encouragement as well.
      God bless
      Peter

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  2. I stumbled on your blog a few weeks ago by accident as I was researching depression. I was diagnosed with clinical depression in 1993, although I know I suffered from it for many years prior. It's recurrence for me is quite common, and I think the longest my depression has ever been in remission was perhaps three years (although, even during this time, I would have occasional depressive episodes that would last a week or two).

    At this point in time, I am in the middle of another. For me, I generally know when they are coming on.... I, like you, have personal indicators to let me know (which, I do tend to ignore or miss until the depression is in full swing). These include:

    -> Weight loss or weight gain (differs from time to time... some depressions I have no appetite; others, I snack on everything unhealthy)

    -> Pushing people away... I will be rude to people, personally attack them, tell them I hate them, accuse them of not caring about me, etc. (I have very few friends because of this... but I thank the Lord daily for those who have stuck by me). Or, I'll just distance myself from people, including my own family, hiding in my room.

    -> My writing habits change... when not depressed, I either have something to write and will write it; Or, I just have no need at that moment to write. When I am in a depression, I almost always have something I need to write. But, either the words fail me completely (which strengthens the depression), or what I do write is all over the place (dark, strange, unorganized... and often worries people). I'm not sure if this description of the difference between not-depressed writing and depressed writing makes sense. Hopefully it does.

    -> Drinking... I tend to drink alcohol more often, and in too great of quantities, when I am depressed, which of course just makes the depression worse.

    There may be more indicators for me... these are just the ones I can think of off the top of my head. I do like what you said about not fearing its return. I do fear it, but only because I know how I act towards other people. I generally don't like to hurt people. I prefer helping them. But when depressed, that changes.

    What works for me...
    -> Church. This is actually a new one for me... I never was big into attending church, having lost faith in the institution many years ago. However, a good friend of mine helped lead me back to the light, to church, to God, to faith. It is helping more than I thought it could.

    -> No drinking! It's a hard one to follow during a depression, but I have to force myself to work out (dancing is great therapy) or go for a walk or do something else that will keep my mind off wanting a drink.

    -> When writing won't happen... don't force it. Paint instead. I'm not good at painting (acrylics), but it gives me a different outlet for the depression and emotions overloading my brain.

    -> As for pushing people away... this one I haven't quite figured out how to prevent this. It's almost like an addiction to me when I'm depressed, and I do it without thinking. If you (or anyone) has any advice for this, I'd love to hear it.

    Thank you for this post, and all your articles on depression. It has been very informative, and helpful to me.

    Brandi

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    1. Dear Brandi
      I really appreciate your taking the time to share briefly your journey with clinical depression, and your personal indicators. I found it particularly interesting that like me, you ignored them until depression was in full swing. One thing I am hoping to achieve with this post is to help those like us, who have clinical depression, to be more aware of those indicators so that we can take action earlier.

      Thanks also for listing things that you have noticed help you. I like that you have painting as an outlet when writing will not come. (I really liked your lake in the moonlight painting.) And as for pushing people away, for myself I have an almost overwhelming impulse to avoid people (apart from my family.) But I have also found that the very act of meeting people/socialising/talking with them can actually temporarily reduce the affects of depression, so that is a good motivator to overcome that negative impulse.

      God bless
      Peter

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  3. Peter, so glad to see you writing on this blog again. Glad that you are doing better now. Thanks for being brave.

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    1. Thanks Wayne, it has been quite a while since I last posted. Hopefully a bit more regular for a while :)
      God bless
      Peter

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  4. I just discovered this blog! I'm hoping it will be helpful to me. I'm almost 23 years old and have been suffering from major depression since I was 18. I've been on different meds..because after a while my body becomes use to the medication and I either have to up the dose or switch medicines all together. I'm on four different medicines right now. I also have panic attacks and suffer from anxiety. My medicine is doing well now. Some days (rarely) I start to feel it a bit...the tiredness, not wanting to do anything but curl up under the sheets and watch tv with my kitty cats, lol. Also something I have noticed..even when my medication is working...if I get up, get dressed, do my hair & makeup...usually all I feel like doing is curling up in to a ball. I am not sure if it has to do with social phobia or what. All I know is I feel uncomfortable before I even make it out the door.

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    1. Dear Jennifer,
      Thanks for visiting the blog and for sharing what you've been going through.

      I often have that same feeling of wanting to curl into a ball when I am about to go out. However, I find that once I am out there mixing with people or concentrating on a task, the desire fades away.

      Glad to hear that your meds are doing well now, sometimes it takes doctors a while to find the right dosage/mix. Are you getting or have you had Christian counseling as well? With the right counselor it can be very helpful.

      Please note that you can download all of the articles on this blog, in sequential order, in the booklet When I am Weak, Then I am Strong

      I would also like to encourage you to read "Self Help for your Nerves" if you can get a copy.

      God bless
      Peter

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  5. Hi, Peter. Loss of appetite is a big one for me, as is lost of interest in most things I usually enjoy. I do have that fear of relasping into another episode but try not to dwell on it so as to not feed the fear and actually cause a relaspse. I am glad you are posting. I took some time off too. Blessings.

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    1. Hi Marie
      Thank you for sharing, and also for the encouragement. The lack of appetite would also affect the loss of interest, and vice versa, I suspect.
      God bless
      Peter

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  6. Hi Peter, my story with depression is slightly different than yours. I first experienced depression when my mother died after a 2 year battle with terminal cancer. I believe that first time was probably a reaction to the grieving process. Unfortunately she died before Christmas and since then (2005) the depression has come back every Oct through. Every year I have gone or been taken to the drs and prescribed anti depressants. They've usually given me the lowest dosage and i find I am myself and able to cope in no time. For the first few years I would take myself off the medication come spring when I felt a lot better, but by October they would have returned.

    However, this year when the feelings came back in October and I felt I wanted to try and keep going for as long as possible without medication. (In the past the longest I had been able to go for was until Christmas). This year alongside the depression I experienced anxiety, which I'd never felt before, I reached melting point in December, but after long conversations with friends and my boyfriend (all Christians) i felt that I needed to face whatever this is that keeps repeating. I have questioned whether it is due to maybe not letting go of the past or to do with the anniversary of my mother's death, or even SAD disorder (as the dr suggested). I was offered a referral for CBT (Cognitive Behavioural Therapy) although the NHS here rarely grants it, but after prayer felt it was too self focused and not God focused enough. I have gone through counselling in the past twice and have been considering it this time around again. I found your ebook so helpful, especially the idea of accepting what you're feeling, It has definitely become a good coping strategy with the anxiety. No Medical professional or counsellor has ever said that to me in 8 years! I live in Northern Ireland and wondered if it were perhaps because of our backwardness about mental health.

    Anyway, I have been sorely tempted to go onto my anti depressants but have felt convicted deeply that I can journey through this without them. I am concerned that they are not a solution to the problem and only a short term fix that numb it. I know from past experience that once I started taking the drugs I just felt like nothing was wrong with me and was able to live life and really didn't or couldn't deal with the issue because I could kinda remember it, but when not suffering it, couldn't really remember exactly what it was like, ( it seemed ludicrous that i should feel like that) or focus on how to prevent it.

    Jen

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    1. Hi Jen
      Sorry for the delay in responding. Thank you for sharing your experiences with depression, and sorry to hear about your mother's passing. I guess it is possible that it is a combination of your mother's death and the season, since come October winter is just around the corner?

      I am surprised that no one has told you about the acceptance strategy before, but these days therapists maybe focusing more on Cognitive Behavioural Therapy, as you mentioned.

      If you would like to read more about acceptance, please see these articles on this blog:
      R05. Symptoms of Depression & How it Causes Them
      R06. Facing Distressing Symptoms instead of Dreading Them
      R07. Breaking Depression's Fear Cycle

      I pray that the Lord Jesus will take your hand and lead you through this journey without meds. However, please ask a close family member or doctor to keep a watch over your progress.

      God bless
      Peter

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  7. I still catch myself searching every day for a "Reason" why I feel so ill at ease. Your so right Peter... it could be anything, and I'm trying to put all faith in the Lord. Surrender.. Depression makes everything seem tearful. So, why should I try to blame one reason? I’m on an “Empty Nest Syndrome” as an excuse for now.
    Peter, for some of us who have studied, and have recovered... through Dr. Claire Weekes and other resources...(as I did)there were several years I discarded any fears and carried on with out a second thought. Why do you believe that after years of putting into practice, we all of a sudden question? Fall victim with no clue? No Trust in our own proven accomplishments? I'm talking years. Reminds me of Martha Stewart waking up and all of a sudden not knowing what ingredient to put in her cakes? ....:)
    I'm always blessed to read your encouragements.

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    1. Dear Anonymous,
      Thanks so much, I am greatly encouraged when I hear that the Lord is using my writings/testimony :)

      Have you read this article: Depression and the search for an instant answer, where I talk about how we can spend hours trying to work out why we feel the way depression makes us feel/what is causing the depression.

      I can relate to your question too. I was free of depression for 16 whole years, with only the occasional panic attack. And then in 2010 it slowly crept in until it suddenly erupted into full force, just like before. Like you said, after being free of it for 16 years, yet again I was falling victim to the same fears and doubts that I had been free from, or had been easily able to dispatch.

      My (limited) understanding is that it is a facet of this major depressive disorder/recurrent depression. That is, it runs in a cycle of being free of it for random amounts of time, which can vary from months to years to decades, and then it triggers again. It is this aspect of it that distinguishes it from "normal" depression.

      It is majorly frustrating, but also an opportunity to take the Lord Jesus' hand and let Him lead me through the valley of the shadow of death (again).

      God bless
      Peter

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  8. Dear Peter,

    Your blog had helped me so many times over the years. I have recently gone over the depression/anxiety cliff again. When I fall I fall terribly hard and have no idea how to get back up. My anxiety is so terrible I've decided to take some klopipin to see if that can stabilize me a bit to take care of my baby. I'm also on Prozac foe my depression. I just need someone to tell me I'm going to be ok. I've been low before and remember the horror and anguish. I hate that Im doing it again, all because of some unchecked anxiety that I didn't deal with immediately. I just want this time to be easier than the last times....Please tell me I'm going to be ok.... Jenn

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    1. Dear Jenn
      You are most definitely going to be ok.
      First, do not be afraid, but keep reminding yourself of these truths; you recovered from this before, so you will recover from it again, because you learned coping techniques last time, you know how to face it and deal with it this time, and Jesus is with you, holding you by the hand.

      I trust you are having regular checkups with your doctor, and seeing a counselor too? Can your mother or a friend stay with you, or visit/ring you often to help encourage you?

      Please go over these articles and refresh your strategies to dealing with it too:
      R07. Breaking Depression's Fear Cycle
      R06. Facing Distressing Symptoms instead of Dreading Them
      R05. Symptoms of Depression & How it Causes Them

      Hang in there
      Cling to Jesus, He is always with you.
      Peter

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  9. Hi Mr Stone , i am glad you are doing better , and i am sure that God will hugely reward you because you are helping people .your blog helped me a lot ,you are helping a lot . you are an inspiration . i am not very good in english i wanted to thank you . Thank you very much .

    Hassan Halabi

    italy,milano.

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    1. Dear Hassan
      Thank you for your comments, I am very encouraged. I pray that the Lord Jesus will continue to sustain and help you, each and every day.
      he LORD is close to the brokenhearted and saves those who are crushed in spirit. Psalm 34:18
      Blessings from Australia
      Peter

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    2. Dear all
      To Peter and all who Write on this blog thank you in Crists name for sharing for your love. All of your comments and suggestions have encouraged me in the middle of a severe depression. I am receiving help from the health service here in uk sand my appointed counsellor is a Christian! I am in my fifties and have suffered depression over the years. I am currently focussing on 2 Corinthians 10 v 5
      Love in Christ to all
      Rod

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  10. I cannot tell you how much this blog has helped me to be able to come to for some perspective when I am going through the dark tunnel that is depression. I have had two major depressive episodes in this year alone. The current one I am going through is esp. hard because I am 6 months pregnant with my little girl. So I can't take the same medicines when I'm having panic attacks. I have to think of Baby first. So it has been very helpful to come here and get some spiritual medication in my time of darkness. Thank you so much and may God truly bless your fruits!
    -Rose-

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    1. Dear Rose,
      So glad this has been encouraging to you.
      Have you read the article on this blog about panic attacks? That may be of help to you as well.
      I will remember your and your baby girl in my daily prayers.
      God bless
      Peter

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  11. Hi, At the base I think I value "feeling deeply" too much - it's sort of like having empathy for everything, to an extreme in an attempt to fully realize/embrace an existing impossibility, to become familiar with all the potential negative space, in advance of what appears to be a pending catastrophe. Well beyond fear. Dread, even terror. All my fault. Blown opportunities because of inadequacies and poor choices due to foolishness. Very tough to keep from going under. God is just and faultless and loving. This just really sucks and I can't seem to get the heart ramped up to perform as required.

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    1. Dear Anonymous,

      May I encourage you to recognise that God is greater than our inadequacies and poor choices. All things, including every aspect of your life, is in Jesus' almighty hands. May I encourage you to press in to Jesus and focus on coming closer to Him, on knowing Him. Forget about feeling the need to perform in any particular way. Let Him do His work in your life, and the works of faith should happen naturally as a result of your relationship with Him.

      God bless
      Peter

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