At my checkup last September with M, my primary care provider, she ran through a list of questions I’ve become used to. Some of them are about feeling safe at home and in my relationship, questions I appreciate, though they don’t apply to me. “Any suicidal thoughts?” she asked. “No,” I answered. “Homicidal thoughts?” That was a new one. “Well, I’m married, so…” I responded, and we laughed.
“How about anxiety? Depression?” Instead of automatically saying no, I paused. It was something we needed to talk about.
She and I had talked about anxiety before. In my first appointment with M a couple of years ago, I told her that yes, I probably had more anxiety than the average person, but to that point, it mostly fueled me. Then she asked about depression, and instead of going into how I come from an Irish family that has a long line of certifiable cases of depression, mostly treated with alcohol, I just shrugged and said no more than usual. Before MS, that was true.
I’ve since known real depression, the kind you can’t get out from under, the kind that paralyzes and punishes. Going from a spinal tap to a major relapse to a course of high-dose steroids in a matter of weeks last summer brought me to my knees in a way I had never known before. Much of my emotional instability at that time was caused by the steroids, but they were more accountable for the severity than the cause. The truth is, I was deeply depressed about my diagnosis and the unwelcome changes to my life, and that depression lasted for months. I kept pushing through, teaching my classes, getting out to see friends, doing things I thought were important. I was so exhausted each day that I would snap at Alvaro when it caught up to me, which was often.
A year later, though not quite as severe, it hasn’t stopped, taking the form of black moods for no reason, lashing out unreasonably, fatigue. Sometimes my depression is caused by steroidal treatments, sometimes by PMS, sometimes because I’m in pain, but those excuses don’t cover all the times I feel that way. Is it because of my brain lesions? Maybe. Some of them are in areas that regulate emotion and mood. Is it my family history catching up to me? Maybe. Some combination of the two? I don’t know, but I did realize recently that I needed to do something about it.
I’m slow to recognize issues when I’m in the middle of dealing with them, often only able to really see them after I’ve come out the other side. I’m reminded of a visit to my dentist’s office many years ago. Dr. A recommended a night guard after having to redo a few fillings, saying that I was grinding my teeth as I slept, that said grinding was responsible for many of the problems I was having. A few years later, he recommended a harder splint, one that cost thousands of dollars insurance wouldn’t cover. I did it because I was worried about losing my teeth, asking if it would keep me from developing TMJD. He looked at me with a mixture of surprise and pity: “Um, young lady, you’ve had TMJD for a really long time. Now we’re at the point where we need to treat it.” I had to wear that splint 18-20 hours each day for the next seven months, taking it out only to teach my classes, eat, and brush my teeth. I still sleep with it in every night.
Just like I waited for “real TMJD” to take a big step in treating it, I waited for a long time for “real depression” because I thought of it as looking like the most extreme versions portrayed on TV: people in darkened rooms, refusing to move, unable to get out of bed. I thought of it as being suicidal, which I never have been. I thought of it as abusing alcohol or drugs. I thought of it as something other people had, not me, that my determination to rise above it was enough. And sometimes it was.
But sometimes it wasn’t.
I often accuse Alvaro of leaving decisions in the foot-dragging department forever, but that best describes what I did with the nagging question of whether to seek treatment. The upside was having plenty of time to think about what I was so afraid of. In part, I was afraid of the stigma, what my family and friends would think, but that wasn’t the most pressing concern. One of my greatest worries was that I’d become a new version of myself, a zombified Pollyanna. I know medications don’t exactly work like that, but fear of how a “happy pill” might make me too happy kept me from making an appointment. My impatience, my crankiness, my pessimism—these are all core parts of who I am. Take them away, and what is left?
It may sound silly, but I was most afraid of not being able to feel sad or moody anymore. Clawing through the muck sometimes leads to raw moments of happiness, pure joy and connectedness, and isn’t that what makes everything else worth it?
M talked me down during an appointment I made with her last week. She asked about my symptoms, which I explained. I understand situational anxiety and depression, caused by stressful experiences, and my depression was certainly worse last summer because of all I went through. But this summer, things are going well. My MS is stable. I’ve accepted my diagnosis and the resulting changes in my life. I’ve taken time off from teaching. I’m exercising every day. There isn’t a concrete reason for how moody I’ve been. She explained how different antidepressants and anxiety medications work, asking what extended family members had treated their depression with. “Besides alcohol?” I asked, no other answer to offer. M nodded somberly, letting me know that we may need to try a few medications before we find the right one. We discussed the option I was most interested in, and she sent in the prescription.
Here I am, one week later. Although it will likely take a few more weeks for the medication to really start doing its thing, I’m already feeling better. Lighter, somehow. I’m sure that is less from the treatment and more from my relief about finally addressing the issue. I still feel very much like myself, and I certainly have impatient moments, but I’m more in control of them.
I could regret not making an appointment sooner, but I don’t. I needed to live with the discomfort of depression to understand it, to see the difference between how I used to be before MS and how I am now. I had to give myself permission to even entertain the idea of medical intervention. Pre-diagnosis me would not have been able to do that. Post-diagnosis me understands how very much is out of my hands and to appreciate and take advantage of the things I can control, depression being one of them.