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 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