Depression, Medication, and COVID as the Antidote
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This piece was originally published in Siblíní Journal: The Distance Diaries in June 2020, under the title, “List of Reasons.”
The gravity of coronavirus became clear to me in early March, during my spring break, when I spent 10-hour days writing my master’s thesis in the eerily quiet lobby of a pharmacy building on campus. The situation felt catastrophic but still distant at that time, the way a horror movie plays in your mind after you watch it — terrifying, but you remind yourself it’s only fiction. I paced around the tile floor while on the phone with my mother, speculating about what would come next and how we would handle it. I was dreading social distancing, but I was grateful to have an apartment I loved, work that could be done at home for at least a few weeks, and a list of other privileges. I told my mom that of all the times in my life for the world to seemingly come to a halt, this was a convenient one for me, since I had no travel plans and a thesis to stay inside and write, anyway. I was uncharacteristically level-headed, rational, even optimistic — and I was shocked by my own disposition. My mom noticed my demeanor and let out her signature laugh — loud and sharp — before telling me, You would be a freakin’ MESS right now if you weren’t medicated.
I started seeing a therapist in the spring of 2018, the year after I graduated from college in New York and moved to Providence, Rhode Island. The day we met, I told my therapist that I had struggled with anxiety on and off throughout my life. She asked me questions about what my anxiety looks and feels like. I answered her as honestly as I could, but I withheld some information that I wouldn’t reveal until months later when I trusted her fully. I admitted to her that my anxiety became overwhelming when I was in eighth grade, but really, I think it started long before that. As a kid, I remember rolling up my baby blanket and shoving it under my shirt whenever I felt sad and didn’t know why. I swore the softness on my stomach made me feel better.
For the last two years, I’ve spent nearly every Friday afternoon in my therapist’s office in Wayland Square, picking at my nail polish as we talk about mindfulness, grounding exercises, and actively halting unproductive thoughts and worries. When I think about potentially moving away after I graduate this semester, leaving my therapist is one of the first losses that comes to mind. It is simple to say that going to therapy has changed my life for the better. I do not want to use abstract language to describe something that has been so concretely beneficial to me and my relationships. This is why I grew frustrated in December of 2019, when I felt I had learned so much from therapy but was still waking up with a sadness on my shoulders, feeling heavy and not knowing why. It was a familiar sadness, one that had come and gone unpredictably throughout my life. My sadness was distinct from my anxiety, which I had under control, thanks to my therapist. Anxiety takes root in my head, then spreads to my body, but my sadness does the opposite.
Anxiety takes root in my head, then spreads to my body, but my sadness does the opposite.
I started searching for ways to explain it away, listing reasons why I might be depressed. Temporarily, this list made me feel better, liberating me from the fear that I might be “the crazy girl.” It’s just the circumstances, I told myself each time the sadness creeped back. It won’t be like this forever. But there will always be The List of Reasons if you look hard enough. You can always identify reasons to be sad, and I was searching for these reasons not because I was incapable of seeing the good in my life, but because I was already feeling sad, and I was desperate to make sense of why. But a chemical imbalance doesn’t follow logic. You can’t talk yourself out of a mental illness. And I got sick of making lists, even when they were full of legitimate reasons. This time, I listed my measly grad student stipend, and the knowledge that I’m unwillingly growing apart from my best college friends, and every headline since the 2016 presidential election. But these reasons are not flaws in my life, nor are they problems to be solved. They will change, and perhaps some of them will be resolved, but they will always be replaced with new reasons to be sad. They will inevitably become a measly starting salary, and the knowledge that my parents are growing old, and the way violence against women never seems to leave the patriarchy’s zeitgeist, or some other equivalents. Perhaps the most obvious reason of all to be depressed is a global pandemic that isolates you from your loved ones and kills thousands.
I had never planned or attempted suicide, and I worried that saying I had depression would undermine those who were suffering more than I was.
In January, after crying through most of my Christmas break, I told my mom I was considering starting an antidepressant. She told me that she had been taking one for about a decade, and that before she started it, her sadness looked a lot like mine. I’ve been wanting to suggest this to you for years, she revealed, but I was afraid I’d hurt your feelings if you weren’t ready to hear it yet. Although I no longer felt shame and stigma about taking medication like I did as a teenager, I continued to oscillate, not convinced that my sadness was anything more than a normal part of my personality. There had been times when I was truly happy for several months at a time, even when my life wasn’t perfect. With the exception of a few particularly dark seasons, I wasn’t incapable of feeling joy. I wasn’t a social recluse. No one could see my sadness unless they knew me very well. I had never planned or attempted suicide, and I worried that saying I had depression would undermine those who were suffering more than I was.
Luckily, I had the support of my therapist, who patiently reminded me that although my suffering may not have been as bad as other people’s, I still deserved to take an antidepressant if it would help me feel better. She can’t prescribe medicine, but she diagnosed me with dysthymia, which now falls under persistent depressive disorder in the DSM-V. Dysthymia, which I had never heard of, is different than major depressive disorder (some refer to dysthymia as minor depressive disorder). It typically develops during adolescence, and it comes and goes throughout a person’s life, making it difficult to diagnose. It may be subtle, but it is distinct from healthy, everyday sadness. It is genetic. And it often goes undiagnosed because people think the sadness is just part of your personality.
I started taking an antidepressant by the end of the month, after seeing a psychiatrist who wrote me a prescription for Sertraline, the generic version of Zoloft. My psychiatrist is a bold, abrasive woman with a painting on the wall of her office that reads, Choose Happiness. A strange choice of decor, I think, for a doctor who treats mental illnesses. I don’t particularly like her, mostly because during my first visit, she asked me if I realized how attractive I am, then suggested I have some perspective about the problems in my life. Apparently, if you’re pretty, you should look in the mirror each time your depression flares up. Once a month, I hand her a $25 copay for a 10-minute appointment and pick up my prescription an hour later.
Contrary to the anecdotal evidence given to me (and I’m sure many others) throughout my life, my depression could not be completely cured by positive thinking or the decision to Choose Happiness. I was already able to recognize the good in my life, to lean into fleeting moments of euphoria. I embraced small and grand moments of joy, like dancing to Paramore with my best friend in her parents’ kitchen, or reading Sally Rooney’s novel Normal People in a café with my headphones in, or driving to work in the morning when the sun was strong and my lipstick was red and the Starbucks barista had found the perfect ratio between black tea and lemonade for my iced drink. But fear of my next downswing paralyzed me into indecision. I was terrified of making the one wrong choice that would bring me back to the sadness I had faced so many other times in my life. I blamed myself — harshly — for each relapse. Like during my junior year of college, when I was studying abroad in Italy, and I sat on the steps in Piazza di Santa Maria Novella and let out ugly, unromantic sobs until a kind stranger handed me a pile of tissues from her coat pocket. I cried to my mom on a $32 phone call home that day, telling her, I don’t understand why it’s so hard for me to be happy, wiping my face with the stranger’s tissues all bunched up into a ball. I’m supposed to be having the time of my life. Or during my first semester of college, when I was utterly unable to fall asleep before sunrise, then fell asleep in all of my classes. (I wish someone had checked on me that year.) Or this past summer, when I worked double shifts in a restaurant and woke up feeling nauseous more days than not. Or the summer before my senior year of college, when I had a panic attack every time I stepped foot in a department store. Or my first semester of graduate school, when I got dumped by a dude I went on only one date with, then my sadness spent six months with me, and I kept making that list in my head, trying to make sense of what was wrong with me and how I could feel so heartbroken over someone I barely knew. Even on my best days, I was walking on eggshells of my own emotions, remembering all the times they’d cracked beneath my feet.
The first morning after starting the prescription, I woke up with a thick headache that lasted four days. I was fatigued enough to fall asleep in the Boston Public Library in the middle of the afternoon, with my arms and head resting on the keyboard of my laptop and my thesis draft open in front of me, begging me to wake up and write. I felt like an infant learning how to keep my head up for the first time. Luckily, the side effects faded within a week, and I started to feel the benefits of the medication around the tenth day. I am extremely lucky not to have suffered from more side effects and to have found the right pill on my first try. This is rare, and it is largely because of genetics; if a prescription works for your parent, it is more likely to work for you. (Thanks, mom.) I am also extremely lucky to have health insurance, and I will never stop fighting for an American healthcare system that doesn’t tie insurance to employment.
Even on my best days, I was walking on eggshells of my own emotions, remembering all the times they’d cracked beneath my feet.
I maintained my reservations about whether or not the Sertraline was working for another two months, even after I’d upped my dosage. I’d had good months before, when my sadness had softened, so I thought I might just be experiencing another upswing. I questioned if I was just experiencing a placebo effect. I thought I might just be in a good mood because my thesis was coming along nicely and my boyfriend told me he loved me for the first time. As I said, there will always be The List of Reasons if you search hard enough for them.
Coronavirus has put my past sadness into perspective, demonstrating to me that my downswings were never my fault after all.
But then I hear my mom’s laugh, and, you would be a freakin’ MESS if you weren’t medicated, and I stop pacing. My mom is right. I am extremely grateful that I started taking an antidepressant before the pandemic began to wreak havoc on us. I do not mean to suggest that anyone who is anxious or depressed during this pandemic needs to be medicated. The reasons to be depressed right now are abundant (as are the reasons to start working with a therapist, which I do recommend to nearly everyone). Rather, I am relating my sadness to the pandemic to demonstrate the disconnect that existed between my depression and my experiences. Before starting medication, my sadness was dysphoric, and it was not really caused by the list of reasons I told myself it was. It didn’t follow any logic, as proven now by the fact that we are in the middle of a global pandemic yet I am doing okay. Coronavirus has put my past sadness into perspective, demonstrating to me that my downswings were never my fault after all.
I am not doing well through this, of course, and I wouldn’t trust anyone who is. I have returned to grinding my teeth at night for the first time in months, and I often wake up feeling empty and hopeless again. I am mourning the lives of strangers and of people I know. I am worried about money. There are (many) days when I watch 8 hours of reality TV and eat a family-size bag of peanut M&Ms and don’t brush my teeth because everything feels pointless. I am deeply angry and disappointed, though not surprised, by the actions and rhetoric of our president. There are days when my skills from therapy make me wildly glad to have done work in advance to prepare for situations that test your resilience and your ability to care for your own mental health. And then there are days when I don’t even bother trying to implement them. I miss hugging my mom, and reading in cafés, and spilling secrets over margaritas with my friends, and the two tiny freckles on my boyfriend’s left hand. I am grieving the time I can no longer spend with the people I love — the intangible yet universal loss we are all suffering right now. Coronavirus violently demonstrates how important it is to hold your loved ones close while making it impossible to do so. I am sad every day, but I am not depressed. And one by one, the eggshells beneath my feet have begun to disappear.
