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There’s a great scene in one of my favorite movies that’s been playing in my head.
Campbell Scott plays a traffic and transportation expert. Kyra Sedgwick plays his love interest, an environmental something or other – maybe a marine biologist?
When Kyra Sedgwick knocks at his door, Campbell Scott opens the door and, in an unshaven, exhausted, ‘losing it’ kind of haze, pleads ‘what took you so long?’
Kyra Sedgwick responds ‘I was stuck in traffic.’
It’s a great dialogue.
It’s pretty basic movie irony. He’s a traffic expert; she was stuck in traffic. Blah blah blah.
The scene also harkens back to the beginning of their relationship when he was chasing after her and they acted out the same dialogue with roles reversed.
Here’s the scene if you want to watch: click here for scene
I’ve seen that scene countless times. It’s a movie I’ve watched over and over. It’s one of my ‘helper’ movies – it helps my mood, so it’s good movie choice.
But it’s not just a safe, helper movie. It’s also a really great movie. Not Chariots of Fire great, but Big Chill great. If you haven’t seen the movie, I highly recommend it. The backdrop is Seattle coffee shop and grunge.
“What took you so long?”
What took you so long?
The fact of the matter is that things take time. And often, they really seriously take even more time that you would have thought.
And sometimes, they take so much )(*&^% time that it’s a total *&^%$# annoyance.
Sorry for all the (*&^%$-ing.
Yesterday I saw my brother-in-law.
Oops….shifted the focus just there. Sorry if I lost you.
Anyway, I saw my brother-in-law who isn’t really my brother-in-law. But I have no other good title for him.
He’s the brother of my sister-in-law, the gal who married my brother.
What does that make him?
If you happen to know what I should call him, let me know. Right now the explanation of our connection takes too long to say.
So anyway, I saw him yesterday.
Let’s call him Chris… since that’s actually his name.
I see Chris a few times a year when he visits DC from the far off and exotic places where he lives, works and visits.
It drives me crazy that Chris, in recent years, has had the unfortunate timing of seeing me when I was really just ugh (i.e., really getting the run around from my life partner, depression).
I really don’t like for people to see me when I’m not feeling like myself. It’s embarrassing to me and makes me feel worse. At those times, I feel like my being down detracts from all of the times I was fabulous. Even worse, I worry that my being down distracts from everything else that might be going on around me.
Luckily, Chris is just like family to me. He loves me and he likes me no matter what my mental temperature is on any particular day.
So yesterday, after one meaningful hug and a few brother-sister type teases, I was able to tell Chris that I was having a positive experience with a particularly important drug I have more recently tried. I was also able to share that general conditions were contributing to a ‘positive depression management experience.’
Of course I was also able to report on yet another drug that I will never ever ever get close to again. Yet one more drug that I tried only to find that it seriously spoiled a few (i.e., five) weeks of my life.
Chris was happy for me, obviously. News that depression is being managed effectively is always good news.
But he was also upset.
He didn’t understand why it had taken so long to get to a good place. He might have been mad at the depression for taking so long to cooperate. He might have been mad at the Gods for making me work so hard just to feel normal. I’m not sure what his anger was aimed at, but he was clearly frustrated on my behalf (thanks, Chris!) and he was a bit indignant.
He was bold enough to ask ‘why does it take so long?’
So, you know, there are many questions I really hate in this world.
But this particular question is one of my favorites.
It’s one of my favorites because I really want people to care about this question. I want people to understand the importance of this question. And I want health care providers, scientists, researchers and policy makers to get me better answers than I’ve been given most of my life.
Why does it take so long to recover from a period of depression?
Well, let me explain what I know from my experience and from the experiences of some others I know.
When things go south in depression and life becomes a crisis, all of the focus, energy and resources must initially be directed at relieving the immediate pain and/or stopping the immediate threat to safety or health. In some cases, the focus must be on avoiding harm to self or others.
And it’s hard to get out of a crisis state.
It takes a lot of energy at the exact same time as the person in crisis has the least amount of energy. It’s the worst timing ever.
It’s difficult, in the depths of a crisis, to keep going to work, managing a household, and maintaining a normal, functioning life. But all energy and resources must go to precisely that.
It may be a relatively short time of a few days or weeks to get out of crisis. Or it may take closer to months or years to get out of crisis.
The recent flooding in the southeast provides a good range of crises for comparison. Some individuals who have lost everything will have the benefit of a strong constitution, a variety of tools for managing stress, and quick access to excellent resources. If you think about it, you probably know people who can be described that way.
Then there are people who do not have a strong ability to handle stress. They may have excellent resources for getting out of a fire or flood, but they may not be able to make the most of those resources because of their own weakened state.
Of course there are folks who have little access to resources. For them, the greater their ability to manage stress, the better the odds of gaining access to limited resources.
The bottom line is that getting out of a crisis is hard for anyone by definition. Crisis is difficult by definition. Add to that extra stressors such as lack of resources, lack of support, lack of assistance, or a myriad of other factors, and getting out of crisis can get really tricky and take a long time.
After the crisis, there is usually a bit of space to breathe a sigh of relief as the pressure begins to subside. In the case of depression, efforts to feel better may be starting to take effect as the pain of crisis is decreasing. Medications may be starting to work, changes in diet, sleep, exercise or routine may be helping. Changes in treatment may be helping.
The recovery experience for most people is not a straight line but a jagged or winding path, filled with constant steps backwards. It’s the typical one step forward, two steps back.
It is especially this way for anyone being treated with medication. Any change in medication, no matter how slight, may result in an array of effects, most of which cannot be adequately prepared for.
I should note that not everybody uses medication.
And I get that.
But some of us have experienced enough and tried enough to know that we actually need medication. I am one of those people who cannot live safely without certain medications. No amount of supplements, exercise, being outdoors, meditating or yoga will do for my brain what certain medications do.
Now, I should say that it’s possible a vastly different lifestyle could take the place of medications for me, but the fact is that I’m living my life and I can’t easily change the life I’m living.
I work full time and prefer working to being on disability.
I also live in a very expensive area of the country (Washington, DC). I could move to a less expensive area, but that would mean losing my primary support system, which would be a really bad decision in terms of health management.
So it’s not an easy formula. Every decision requires analysis. And analysis is especially difficult during crisis or recovery, when the focus is on getting better, not prevention.
“What took you so long?”
What took you so long?
For me, the average time it takes to tell a medication is NO GOOD is at least a month.
With any new drug, I begin with a very low dose to avoid triggering a worse episode of depression or a new crisis. I stay on a low dose for days or weeks or longer to acclimate. The period has to be long enough to isolate that drug as the cause of any changes.
As the dose goes up, so does my body’s response. And as my body responds, the analysis of benefits versus side effects begins.
Do the benefits outweigh the side effects?
It sounds simple.
The thing is, you want the drug to work. You REALLY want the drug to work.
Every new drug you try is a new possibility that you’ll be feeling better soon and that life will be better.
But the side effects can be awful and can be debilitating.
Some side effects make even basic functioning impossible. Some side effects make going out in public embarrassing. Some side effects feel worse than the condition that requires them.
One promising drug was amazing for me until the fourth month when I had a dangerous reaction. I had to stop the drug immediately, get treatment for the reaction, and clear the drug from my system. I can never again take that drug, knowing I have a reaction.
I remember being so upset afterwards because the medication had been working so well otherwise. And a medication that works so well for your unique chemistry is just so hard to find.
But a bad reaction is a bad reaction.
Bye bye drug. Bye bye four months of my life.
The most recent horrible (for me) drug only ruined five weeks of my life.
But it was a really awful five weeks.
So, you might ask, why would you try to change drugs that work? Why not just maintain drugs that work and not rock the boat by making changes?
Personally, I would be overjoyed if I found a cocktail that worked and that I could always be on.
But it doesn’t work that way. 😦
Drugs stop working over time for many people. Or new episodes of the condition require different types of drugs.
It’s challenging and frustrating and it takes a ton of time.
And that’s the answer.
And I hope that in my lifetime there are more treatment options that are free from side effects.
In the next few years, I’ll be able to try Transcranial Magnetic Stimulation (TMS). The treatment is available now, but only to those who can afford the high cost (or the high copays if their insurance covers it). TMS has no side effects and has been effective for a lot of folks. I hope TMS or something like it will some day be a replacement for some of the drugs I take so that I can be finished with some side effects that slow me down (and not in the good way).
So that is the short version of why it takes so long.
And I’m hoping to help the cause of getting better access to better treatments with fewer side effects. Because we need them.
A really great place to start reading about some of the work I support is here:
Through my non-profit, Living Broken, I make art to help raise money for the important work of Hope for Depression and other organizations with similar missions.
Because if I want to live a meaningful, productive, independent life, I need to be able to take one step forward without having to take two steps back.
Thanks for listening.
♥ www.livingbroken.org ♥
Giving power to personal stories of thriving
through wearable, shareable art.