Depression

Tom wrote me this morning, and I applaud him for his reaching out to our forum for help. It takes a lot of courage to air an emotional problem. Anyone else out there who has had experiences with depression, anxiety, and the like--and I know there are plenty of us!--please send your own notes of inspiration and advice to Tom. Here's what I wrote him this morning: Tom, I am so sorry to hear about your depression. I have suffered multiple bouts of this myself over the years, and I know exactly what you mean about the intolerable nature of the pain involved. I am an identical twin, and he too has had problems with this hellish disease. Advice, I know, is hard to take at times like this. But what I want to say is this: even the worst depression gets better, in fact, the deeper it is, the more likely it is to get better faster. I know when every second crawls along like it is a year, the prospect of patience-- six months from now, you will absolutely, definitely be feeling better, no doubt whatsoever --seems very hard to muster. But you are a swimmer, and if our sport has taught us anything, it's how to endure pain until we emerge to the other, triumphant side of the race. In my own case, I have learned that when I am deeply depressed, I can't think well, but I cannot stop thinking. My thoughts, which run riotous, are uniformly hopeless and negative, but they nevertheless seem unassailably believable and logical. This is hogwash. The depressed brain is incapable of thinking rationally about its situation. Do your best to discount any negative thoughts you have. I tell myself whenever I have any thought that causes an intense stab of pain, "This is just a hiccup of the brain, an artifact of my depression; it bares no resemblance to reality. I don't need to pay it any attention." Whatever, for instance, you might be telling yourself about your wife leaving you, it's almost assuredly not true if it in any way reflects upon you as a bad or undeserving person. Tom, as I noted above, depression invariably goes into remission, regardless of what you do or don't do, provided you give yourself some time. Don't think about being "locked up"; would you consider yourself locked up if you had diabetes and you went into an insulin coma and needed acute medical care in a hospital? They used to divide depression into endogenous (i.e., internal brain chemistry run amok for no apparent reason) vs. exogenous (brain chemistry run amok because of some outside stress--illness, death in family, divorce, job loss, etc.) Now it looks like the vast majority are of the latter variety, not that it really matters how things get set off. Once set off, your brain is off-kilter, and it's your brain that needs time to return to its normal state. Despite the self-limiting nature of depression, you can take active steps to hasten its remission and get the brain chemistry back in good order. Taking drugs like Celexa is a great start. You must work with your doctor, however, to make sure you are taking enough dosage. The single greatest reason for pharmaceutical failure in the treatment of depression is the patient/doctor underprescribe the necessary dosage. If you and your doc give Celexa a good trial, long enough (it took me 5-6 weeks before my medication, Prozac, kicked in) and high enough a dose (I had to double my dosage after 3-4 weeks), you can always switch to another medication and try that. There are numerous classes of drugs, and sometimes combinations work better than individual ones. Again, you are a swimmer, Tom. Your body and mind both have inculcated endurance over the decades. You will need to tap into this and use it as you're waiting for the medication to work (and constantly reminding yourself that the depression will go away regardless of what you do or do not do.) Also acknowledge there may be some side effects. So what? Big deal. I get fatigue, dry mouth, a reduced sexual drive every time I do an incredibly hard swimming workout!!! Swimmers are used to these things!!! When I took Prozac initially, it plus the depression made it almost impossible to sleep. I'd just thrash around all night, absolutely at my wits end because it meant there was no respite whatsover from my depression; I couldn't even temporarily elude it by sleeping. So I ended up taking an adjunct drug, amytriptiline, or Elavil, an older tricyclic antidepressant. If you are having any trouble sleeping, ask your doctor about this. I slept like a drugged baby!!! Just being able to escape depression at night through sleep was a true miracle for me; at least I had some harbor from it. (Why seriously consider killing yourself if you can just induce some nice sleep for 10 hours a day; you're tough enough to make the other 14 hours, I am sure of it!) You might also want to consider what used to be a radical solution but is now much safer, in fact, benign: electroshock. I know just the sound of this probably gives you the creeps, but I've researched it and the side effects today are minimal, and its effectiveness is often miraculous. My best friend from college committed suicide from manic depression. I wish to god he had allowed the doctor to administer electroshock. I am certain he would be here--and happy--today if he had done so. Aerobic exhaustion is also a wonderful thing. You may be out of the pool now, temporarily, but do you have access to an exercise bike or even stairs you could climb till you're too tired to think? Talk to the doctor about how best to get some exhausting exercise. I know that when I am deeply depressed, I seek reassurance from my friends and family that eventually all will return to normal, that I will someday be myself again. I swear to God this is the case with you. Please, Tom, just hold on. I know how much pain you're in, but I also know that twenty years from now, when you are blissfully remarried and perhaps swimming USMS record times, and enjoying life like you think today is impossible, you will send me an e-mail saying I was right. For what it's worth, two of the guys on my small swimming team have recently had their wives leave them. I'm not sure how old you are, but these guys are both in their 50s. There seems to be an epidemic of this across the country. You, in absolutely no way, are alone in this situation, nor is your intense emotional pain at all abnormal. Both these guys were basket cases when it first happened (both of them blindsided by an unexpected announcement), and it's taken them a year to ever-so-slightly slouch back. I think for guys, this is maybe the single hardest thing we can endure (other than a death of kid.) It's a massive kick to the balls, and again, all I can say is endurance. You're tougher than you give yourself credit for. Even if your negative thoughts right now don't give you peace, endurance is written deeply into your muscle memory. Tom, please write me back. I think you should consider posting your note on the USMS forum, and I would be happy to post mine to get a discussion going. I am certain that the outpouring of support for you would be overwhelming. I also think you would be astounded at just how common depression is, and how many Masters swimmers do our sport, in part, to keep this disease somewhat in check. There is no reason for stigmatizing this. The fact that you wrote me at all is testimony to the fact that you understand this. Indeed, I suspect you can help a lot of other people in our boat by sharing your experiences with them. Tom, you have my prayers and best wishes--and I am sure those of all the masters swimmers who have ever corresponded with you on our forum, and all those who have suffered the pain it is now your turn to endure. You do not need to endure it alone. Again, please write back, and remember: you can and will endure. As open ended as the pain may seem to you now, there is an end to it, and that end does not involve taking your life. Your friend and fellow traveler who has emerged and can swear this is true, Jim Thornton

Tom replied to me that he also has had trouble sleeping, and this is what I wrote him back. Anybody else have advice for agitated insomnia? Tom, Here's what you have to do. Call your doctor today, right now if you can, and ask him to prescribe Elavil, relatively low dose (50 mg), for sleep. The stuff is now available as a generic, and it costs about the same as aspirin. When I need this, I actually use a pill cutter and take a 12.5 to 25 mg dosage (though this kind of thing is very individual, and when I was extremely depressed, I sometimes was taking two x 50 mg a night). Start off low--no more than 50 mg--or you may really zonk out. Note: remember this is an adjunct to, not a substitute for, the Celexa. On the plus side, if you're anything like me, you will sleep unbelievably well thanks to Elavil, almost from the first night you try this. In fact, make sure you're at home when you take it, because you will get so sleepy it will be hard to stay awake. Avoid the alcohol while on it, because the two compound each other's effects. Also, you may wake up at night, but you can easily fall back. Also on the plus side, some research indicates that the older tricyclic antidepressants (elavil was one of the first) may be more effective even than the SSRI's, especially for men. They've fallen into disfavor because of their side effects. See next item: On the negative side, there are some noticeable side effects. The ones I noticed were: 1) dry mouth--all in all, not that bad, you can suck on some hard candy if you want or just drink some water every once in a while. A trifling concern. 2) sleepiness--if you're suffering extreme insomnia, this is actually kind of a godsend, but prepare yourself for some grogginess during the day. As the depression starts to lift, you might want to wean off the elavil to give yourself more energy during the day. But for now, sleep at night is definitely more important, in my view. And being a little groggy during the day is also kind of nice, particularly if you, like me, suffer a kind of agitated depression while awake (grogginess takes the edge off this.) Remember, unlike old sleeping pills, elavil is an antidepressant, non-habit forming, and it won't hurt your sleep long term. If anything, you'll need less of it as you start feeling better. 3) difficulty urinating --not tremendously so, but it takes a little longer to get that urine stream started; if you have bashful bladder problems, this compounds them a bit. Again, pretty much of a trifling concern. 4) a bit of a body buzz. actually, this was a side effect i personally rather enjoyed, but not everybody does. Take it with a grain of salt. 5) a slight elevation of resting heart rate -- again, no big deal. All these things are reversible when you go off it. As an athlete, you might pride yourself on have a low, low hr; this will kick it up a few beats, but it's not a problem, believe me. I first learned about elavil in the 70s when I had my first bout of depression, horrible insomnia, etc. A friend of my father's told me about it and said that as soon as he took it, he started to be able to sleep at night, and this was the first domino in turning his whole situation around. Definitely keep me posted on this. If your doctor is at all hesitant to prescribe elavil (generic name amitryptiline), though I see no reason why he or she would be, explain your extreme sleep problem and ask to do elavil on just a trial basis. The doctor may suggest alternative drugs--Trazadone (another antidepressant) or even Ambien (a new sleeping pill)--but I personally would insist on the elavil trial first. This stuff does have some side effects as indicated above, but believe me, it's the closest thing to the Sand Man I've ever found. Good luck and see if you can try it out tonight. If you get a week or two of decent sleep, you will definitely find it a blessing--and you'll have some heavy duty escape from ceiling-staring misery. Think of it this way--if you can sleep 8 hours a night, as opposed to 4, your depression will be 33 percent cured! Congratulations on your distance swimming. You will indubitably set more records in the future, too. Jim

Excellent advice, Kat. I would like to add another strategy to place after Do Nothing (which is paradoxically quite effective.) That is Do Something as in Do Something you used to find fun, even if it isn't terribly fun right now. If you can get caught up in a distracting activity, even for just a little while, it can work like a splint on a broken bone, giving a little pressure reduction and healing time. Music, movies, sports, reading, computer programming, doing arcane math problems! Anything that provides a break from obsessive and negative thoughts is worth doing. You might find you even start having a tiny bit of fun.

Tom, I've tried e-mailing you on both your usms and yahoo accounts. Both have been returned. Please e-mail me. I'm pretty sure you have my e-mail address (I'm in the USMS member directory). Karlene

Now might be a good time to learn how to use the "private messege" if you don't know how.

I'm reposting this, since I accidentally deleted it: It takes a lot of courage to reach out like you're doing. I have fought depression on and off for a while. I've been in the pit, where there seems no hope for the future, no way out, regardless of what I try to do. I'm currently trying to climb out of the pit again. I can tell you some things that have worked for me to keep myself alive until things get better - and they WILL get better. 1. Get in the pool. I know you don't feel like it, but I usually feel a little better after I forcefully drag myself into the water. 2. Pray. This is where we might have differences of beliefs, but personally, I believe that Jesus wants us to tell him exactly how we feel. The shortest verse in the Bible 'Jesus wept.' was when one of his friends died. I'm not going to say much more on this, because this is a swimming forum. 3. Reach out. You're obviously already doing this, so just keep on. 4. Do nothing. When I experience that overwhelming feeling, I sit down and ride it out for a while. I tell myself that it will get better, that this is just temporary. It doesn't make sense to do something permanent to fix a problem that's temporary. I know that's an overused saying, but it's true. 5. Help others. Find something nice to do for someone else. Just do small things. I bring someone flowers, run an errand for someone, whatever. There is always someone that needs help with something around you. I know it doesn't make sense, but I actually feel better after I do something for someone else than if someone helped me out. I hope this helps somewhat. I'm obviously not a professional. There is a lot of stigma attached to depression, which makes things even harder for those that are depressed. It's biologically based, and needs to be treated. Since the Celexa has not worked after 2 months, get with a doctor to see if he/she can increase the amount, change to another prescription, or add another medicine. It can be harder to deal with as a swimmer because the exercise is supposed to prevent this from happening, but it does happen.

There has been some interesting research on the power of prayer. I agree with Kat and this certainly is not a religous forum, however, based upon research it is conceivable that if the vast community of Masters swimmers were to say a prayer for Toms recovery it just might help. I for one will do so.

Hi Jim - You may get this twice as I don't know exactly what I am doing on the web. However,I read your note and felt a keen sense of knowing what you are going through. I had a serious bout with depression a number of years ago - hospital, medications, etc. - and have had subsequent mini-bouts since that time. Recieving the major blow of a lifetime - spouse leaving, job dissappearing, child dying - represents the death of our very own dream. And the best way I finally found to deal with this was to treat what triggered this depression as though it were a death and to deal with it like I would the death of a loved one, going through the stages of death - shock,anger,disbelief, acceptance, etc. After lots of different medications, one broke the hold of the gross depression and since that time, my job and that of my husband is to recognize when I "am close". We have a series of interventions that seem to work for me. However, the most important thing I came to realize is that if one can get through this initial shock,things REALLY will get better, and that is not just bs. I found in my deressed state that I was not eating properly, not drinking enough fluids, generally punishing my body for what I though was my failures. Did not work. As soon as I started to eat somewhat sendibly again, my body began to respond, as did my depressed self. Anyway, you are not alone - obviously from all the responses - in what has happened to you. You WILL be better. Eat you bananas and take your vitamins !!!! Sharon

Originally posted by Tom Ellison ... I see no hope for my life and frankly the pain and torment is so great that I really do not give a rat’s rear end about anything at this point. My problem is a simply one. I HATE being locked up..and all these units can do for guys like me is lock us up. Heck, I take Jerry's way any day to the padded cell stuff. Any suggestions. Currently I am on Celexa and the pain and suffering are horrendous to say the least. Kindest regards, Tom Ellison Tom, indeed I was thinking last week that you didn't post in a while. I was also down on myself at times when things I prepare for don't go my way, and from these instances I am motivated to suggest on how to keep on going anyway: . ) do not accept forceful 'help', like your mentioning of "...all these units...", Celexa which I don't know it but might be a mind altering substance, drugs; gently cut off these kind of avenues, and heal naturally; .) ease off on yourself; you should be your best friend now, in time of crisis; start pleasing yourself above anything else with simple enjoyments in life like treating yourself to ice cream, playing chess, watching light movies, benefitting from the simple friendship and needs of animals, listening to music that gave you energy at your best in life, staying late at night, meeting people who care and appreciate you; .) meet many of us, women and men from the USMS forum from whom you have lots of appreciation regarding your identity, as opposed to the "...no hope..." recently thrown at you; in a swimming competition soon to be, we have lots of jokes and hopes to share with you, when we meet.

D**n it Ion, keep your bad advice to something like swimming. Severe depression is not the blues, and far more serious than you being upset about declining times. Whatever the immediate cause, depression is a biochemical imbalance, and if not treated well, can lead to serious consequences, as we can see in Tom's case. The drugs available now for psychological problems are a near miracle, and should be used - under the care of a good doctor, of course. I got in trouble for saying this before, but I will say it again. Despite the best intentions of posters in this thread, we are not your doctor. Treat everything said here with caution, and see your doctor!