“….deep, dark depression, excessive misery! If it warn’t fer bad luck, I’d have no luck at all…. gloom, despair, ‘n’ agony on meeeee!”
If you’re of a certain vintage, you’re probably already singing this little ditty in your head right now. If not, here’s a little Baby Boomer lore for you: it was sung by four guys in overalls every week on the old TV show “Hee Haw”. I once got to see the set of the show in Nashville, and yes, it was as hokey as it looked on TV……..but I loved being there, even though I never did get to meet Roy Clark or Buck Owens.
Oh, yeah, back to the topic of this post, which is the evil twin sister of mania, AKA depression. I really hate talking about it lest I conjure it up, and to be honest I haven’t experienced much of it since last December, when I went into a funk that lasted the entire month and even ruined Christmas for me. NOTHING is supposed to ruin Christmas—I’m still pissed that I spent the “most wonderful time of the year” feeling like the world’s biggest Grinch—and besides, the winter blues don’t usually strike until late January, or even February if the weather isn’t too bleak.
I loathe depression. I can’t even describe how much I loathe it. I’d rather be manic ten times over than depressed once (although my family and my p-doc might disagree, and rather heartily at that). But of course, one doesn’t get to be “bi-polar” without experiencing BOTH poles at some point, so Churchill’s black dog nips at our heels at least occasionally……and for most people with the disorder, depressive episodes are much more common than hypo/manic ones.
As much as it’s talked about in the popular media, depression remains vastly misunderstood by the general public. It’s not just a feeling of sadness, a case of “the blues”, or the loss of interest in normal everyday activities; it is a complex mental, physical, and emotional condition that contains a constellation of symptoms and is often ignored until it’s too late.
Depression is a state in which people generally become disinterested in life and focus on the negative aspects of their existence. There is often no known cause for it, although seasonal changes can trigger it (one of these days I’ll write something about SAD, also known as Seasonal Affective Disorder) as can stressful events, such as the death of a loved one or the loss of a job.
Nothing feels, sounds, or tastes good. The world is dull and grey; there is no joy, no satisfaction, no hope in anything. Days are filled with anxiety and dread; nights are long, often restless, and fraught with unsettling dreams. Some people overeat, gain weight, and/or sleep for most of the day, while others lose their appetites and burn the midnight oil, playing an endless loop of negative thoughts in their heads: “I hate my life.” “Nobody cares about me.” And the most dangerous of all, “I’d be better off dead.”
Major depressive disorder is a relatively common affliction which has become much less stigmatized in the past fifteen years or so, yet the suicide rate remains alarmingly high. But even more frightening is the fact that many people who present to their primary care providers complaining of depressive symptoms are misdiagnosed with MDD and sent on their way with a prescription for Prozac or Wellbutrin.
This is potentially disastrous for someone who has underlying bipolar disorder. Not only because antidepressant medications can set off mania, but because the longer we go without the proper treatment, the more trouble we’re likely to have in controlling the symptoms, and the poorer our chances of achieving and maintaining stability.
Unfortunately, the average time from the onset of symptoms to the correct diagnosis is somewhere between seven and twelve YEARS for patients whose bipolar isn’t accompanied by floridly psychotic mood episodes. And since the average internist/general practitioner isn’t trained to recognize the subtler “flavors” of the disorder, countless people with Bipolar II or cyclothymia (what some call ‘bipolar lite’) are never appropriately diagnosed.
This is why it’s so important for anyone who even suspects that s/he may have bipolar disorder to be seen by a psychiatrist, psych nurse practitioner, or other mental health professional. Even if 90% of your mood shifts put you in the dumper rather than on the moon, it’s worth the time and money to be evaluated by someone who knows how. You wouldn’t go to a gynecologist to have your aching back checked; therefore, you shouldn’t expect a GP to diagnose a psychiatric issue.
Next, we’ll talk about the hellish experience of dysphoric mania and agitated depression, in which symptoms of both poles are present in the same mood episode.
To be continued…….