Warm fuzzies

Another anecdote about dismissing depression as irrelevant:

I attended a large healing ritual being orchestrated by a well-known practitioner at an interfaith conference.  Before the actual work began, she went to each participant and asked them what, if any, healing they were seeking for themselves or for people who could not be present.  Some had no need, but there were no small number of people needing help for issues large and small, ranging from muscle aches to serious cancer.  Then, she got to me.

"I suffer from depression," I told her.

"Oh, we'll take care of you at the end, during the 'warm fuzzies,'" she told me.

The ritual was conducted in several phases, with the participants collectively focusing prayer, will, and psychic/magical energies for the healing of various conditions, organized by general type.  It was an emotionally and physically grueling experience for everyone involved.

The "warm fuzzies" portion of the ritual was, it turned out, a group hug while collectively singing a whimsical song; only two or three of the attendees actually knew the words.  The group swayed in a rough approximation of time to the music.

Despite the fact that it destroys lives and even kills people, this nitwit decided that it could be cured with a group hug.

Ye gods.

Dismissing diagnoses of depression

Sometimes it's liberating to have a formal diagnosis of depression, or even to self-diagnose, because it can bring the symptoms into focus.  Depression is an illness that transcends the artificial barrier we place between mind and body; it begs for a single word that describes both concepts so as to avoid the idea that "it's in your head."

Of course, it is in your head.  Once, when I was explaining it to a friend, I said, "I know that if I make a conscious decision not to be paralyzed by this, it will happen.  I know that emotions drive physical reactions, and physical states likewise elicit emotions, like how smiling can make you feel happier and being happy can make you smile.  I know all these things, but it doesn't make it easier to decide to stop feeling this way."

Later, my friend said to me, "You're that way because you let it . . . whether you use the excuse of you can't help it or not, you control your mind and body, nobody else."

I don't disagree, but I found his position dismissive.  Yes, I control it all, but we have yet to determine exactly how depression controls me.  Why is it that understanding this concept isn't enough to cure me permanently?  I don't accept that I'm defeatist.  It's too pat an answer.

Rather, I suspect that some people are simply more susceptible to these kinds of physioemotional feedback loops than others.  There's got to be a reason, a cause.  I don't believe that anyone would choose -- even subconsciously -- to be miserable, any more than anyone would choose to be homosexual in a society that still largely disdains the practice of same-gender sexual gratification.

I don't talk about being depressed because I am weary of being dismissed as weak, or patronized because I am not strong, or sympathetically viewed as somehow flawed.  Whether or not a specific event precipitates a depressive episode, the depression is not representative of a lack of willpower.  I don't think I am alone in keeping to myself due to this widespread perception.

Oh, those crazy backslides

I started this blog to explore ways that people have used to help themselves or others with depression, and to discuss the experience of depression; my primary qualification being that I've suffered from it myself and emerged from its grip.

What a nice memory . . . it was nice being a person who could regard it in the past tense.

Sliding back into depression, crawling out, down and up and down again, is exhausting.  Knowing that the feeling of powerlessness can be changed in an instant by simply changing one's mind is no solace if you simply can't do it.

Depression stinks.

Business Leadership and Depression

I read and review business books from time to time, and one thing that always comes up in them is leadership. You've got to stand out from the crowd, go against the grain, create a climate of change if you're going to succeed, they all say.

Really?

Business books target the people that want to be exceptional, want to make more money,want to share a special idea or way of doing things with the world - or so they say. But that makes it sound like depressed people aren't - or shouldn't be - in business.

Deep in the depths of depression, who can pick up a book about rallying the troops to victory and not feel inadequate? Designed to inspire, a lot of these books do the opposite for a depression suffererer - and the truth is, plenty of business owners wrestle with depression.

So how do depressed business people succeed? Do they? Can they grow their companies while neglecting themselves, or do both suffer if both are not addressed? I don't know the answers yet.

Do you own a business? Are you depressed? What do you do to make sure your business stays on track, even if you don't?

Salt Linked to Depression

I grew up in a family that loved salt - it was always handy in a shaker on the dinner table, and we added it to everything. I can remember the soups my mother made as being particularly salty, and how that made them particularly good. I've since given up adding salt to my foods, but I still enjoy a nice, salty bag of chips from time to time. Salt is an awfully satisfying experience for my tongue.

At the University of Iowa some researchers have posited that salt enhances mood, which certainly fits nicely into my own anecdotal experience. Rats were less likely to engage in pleasurable behaviors, such as drink sugary rat goodness, if their salt levels dropped too low. Between the researchers and me we've come up with a few observations about this:

• Salt is a good conductor and probably affects brain function.
• We evolved in a saline environment (the ocean), and have carried on with the same basic chemistry on land.
  
• Our bodies and minds seek out more salt than we probably need, which could suggest addiction or a system that hasn't adapted to the relative abundance of salt we now have. It's not clear if the reason makes much of a difference in the result.
  
• Mood elevation that's tied to salt consumption could be caused by the salt, but it also could be the other way around. Maybe the lack of salt causes anxiety, which is alleviated by eating salt and giving the body what it wants.

"One sign of addiction is using a substance even when it's known to be harmful. Many people are told to reduce sodium due to health concerns, but they have trouble doing so because they like the taste and find low-sodium foods bland."

Again, it could also be that it takes thousands of years for our bodies to adapt to changing circumstances - two thousand years ago the phrase "common table salt" would have been incomprehensible. The desire for salt could simply be an overexaggeration of a real need.

Migraines and Depression

I suffered from migraines as a child, and I became depressed as an adolescent. I would have thought it just bad luck, but a study suggests migraines and depression may both be linked to serotonin levels. I suppose I should have seen it coming, since it's kind of a dummy smack. My own anecdotal experience, now that I look at it, suggests a link between the worst headache ever invented and depression.

SSRIs are being prescribed as migraine preventatives in response to this area of research. The research suggests a link (47% of Migraineurs experience clinical depression as opposed to just 17% of the general population), but is not yet clear on whether one causes the other or not, or perhaps both are caused by the serotonin levels. I wouldn't be surprised if the serotonin imbalance itself was eventually proven to be a symptom only; however, I don't anticipate that being proven easily by science because of the difficulty of the scientific community in overcoming the body/mind link that depression and related illnesses straddle.

Solutions for SAD sufferers

I found this amazing article about SAD suffering, which is reaching its peak now as the stress and joy of the holidays falls away, leaving us with cold, dark, and dreary (or, if you live in the Northeast, unseasonably warm, dark, and dreary). I was particularly interested in the supplement SAM-e, which I have heard of in passing only. It's refreshing when a medical site recognizes that non-drug treatments can be useful for addressing depression. This particular post gave me the impression that there was some commercial reason for the supplement's promotion, but I am going to do more research on my own and see if the research bears out the claims from this article.

My misgivings notwithstanding, I'm glad to see real research on treatments that may have less side effects. Of course not all options will work for all victims, but that's why I advocate for a variety of treatment options being made available, so the best ones can be found for the individual.

As I side note, I really hate the term "feeling blue" in this context. I think it minimizes the seriousness of depression and sends a message that it's a disease that is not taken seriously.

Fish Oil is not Snake Oil

Studies have not shown if fish liver oil helps with depression. Science sometimes fails to be like the thing that it studies; that is, slow-moving and focused. I have not the slightest idea if fish oil has any impact on depression (although it is probably as effective a placebo as anything else out there), but I'm pretty sure that you aren't going to get fast results out of a natural phenomenon.

Any scientific study must be funded, and most funding comes from the companies that profit from research - the ones making products that they can sell. Sunlight, plants you can pick from your own garden, and air just aren't going to be studied as serious treatments for anything since they're free and plentiful (unless a marketing person can find a way to sell us what we already have, a la pet rocks); things like fish oil and cow pies and cat hair are all common enough that it would be tough to charge a lot for treatments derived from them, also discouraging the really big research bucks. We aren't likely to see long-term studies on depression treatments that nobody can make money from.

There have been some amazing breakthroughs for treatments of all manner of diseases through new drugs. That doesn't mean that every drug is wonderful, nor does it mean that every disease's cure is in pill form. Well-trained pharmaceutical representatives earn a great living convincing doctors to prescribe their products, and no one is out there equally passionately pitching St. John's wort, taking a walk every day, fish oil, getting a puppy, copper bracelets, and believing in God (at least in doctor's offices). Plenty of alternative therapies may be effective, but the medical community isn't designed to find out.

Of course, I can't say that I would like the idea of being accosted by fish-oil salesmen.

Placebo: What Your Brain Can Do for You

The placebo effect is the measurable, observable, or felt improvement in health not attributable to treatment. This effect is believed by many people to be due to the placebo itself in some mysterious way.

So states this article on placebos and depression from the Skeptic's Dictionary, and appropriate resource. Like this UCLA article about placebo usage, it discusses how, when a patient is told they are receiving a placebo, the effectiveness often goes away. Is this because the treatment was all in their heads? Or that the depression was?

Many studies try to compensate for the "placebo effect." Others, more recently, have specifically studied this factor as a healing process. A study by Dr. Arif Khan showed, according to the New York Times, that:

It turns out that the more severely depressed people are, the less likely they are to respond to a placebo. And people with more mild depressions get better with just about all treatments, including placebos. Since most clinical trials enroll less severely depressed patients, the observed difference between the response to an antidepressant and a placebo can be misleadingly small.

Other studies, including one by Dr. Irving Kirsch, suggest that medications are nearly useless because the placebo effect is so high in depression treatment. Meanwhile, doctors wrestle with the ethics of "tricking" patients with placebos.

I think the point is not quite being realized by the scientific community. Depression is a disease that is has an effect upon the body as well, because the brain controls all things. Placebo is the brain's natural ability to repair damage to all the human systems. This process is easily interrupted by doubts and limiting beliefs. At this point in our development we have identified the process, and we recognize that it can be encouraged by presenting patients with a physical talisman, if you will, of healing; the pill. More severely depressed people need more than a sugar pill because they are so very sick their limiting beliefs extend deep into the unconscious, metastasizing like cancer. They need medications to bring them to the point where the placebo process can recover enough to even try to work.

I foresee a time when the scientific community will focus serious research on placebos, not to remove them as a variable or identify what is "in a patient's mind," but to determine how to harness our own healing ability and hone it. This research will not be conducted by drug companies, because it would not be advantageous to cure such a lucrative market for maintenance medications. It will be research into areas currently sidelined as psychology or superstition, and will tap into the true potential of the human brain.

The lucky depression patients have found other avenues to unlock these secrets, either through sugar pills or prayer or exercise or therapy, and they have been given a chance at true healing, y allowing their brains to overcome depression naturally. It's time the scientific community figures out a way to give the rest of the victims that opportunity.

Self-Care Options

This article reinforces my position on the paradox of depression: you aren't going to get better if you can't learn to do it yourself, but depression keeps you from believing that this is possible. Drugs and therapy can be important tools for recovery, but neither of them will succeed without your help, and neither of them should be considered for a lifetime. If you plan for a day when you won't need them you're much more likely to reach that day.

Either of those treatment options may give you the needed push to get to a point where you can do something for yourself, crawl just far enough out of your own personal pit that you can take at least a small amount of responsibility for your own recovery. If they can't get you to that level, and you aren't functional enough to make it there without further help, you should find that help. Never forget that the worst symptom you have is the belief that you are going to stay this way, that nothing you do can change it, that it's pointless to even try. Don't give in to that crap, because if you expect the worst you're rarely disappointed. Do you have anything to lose by trying for more? Can it really get worse than it is? Really?

Some thoughts on the five suggestions given:

• Keep Active: yep, I've mentioned how important even a little bit of exercise can be. Don't want to get out of bed? Consider having a friend drag you out if necessary.
• Eat well. A well-balanced eating strategy will help you feel better now and later. Good thought. I've had comments here from depression victims that eat like crap, and it shows in the writing that they're just making things worse. Your body needs good fuel to do a good job.
• Get adequate sleep. I would modify this to say, "Get appropriate sleep." Insomnia is a symptom of depression, but I was more prone to the fourteen-to-sixteen-hour power nap. I psychiatrist I knew said that the best way to regulate sleep is to get up at the same time, every day, without fail. Your body will take care of the rest.
• Control stress. Coping with depression is stressful enough, so try to limit other sources of stress. And depression does a marvelous job of amplifying the other stress, doesn't it?
• Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life. I can't emphasize this more. You need to be around people, even if you don't feel like it, because even if you believe you're alone in a crowd it is better than being alone alone. Do it even if you don't want to.
  

Cleaning House

Is a messy home a caused by depression, or is depression caused by a messy home? I've heard passing references to a link between disorganization on the outside and fogginess on the inside, but I wasn't able to find any research on the subject. I know that I'm no stranger to having a bit of untidiness in my life, and there are plenty of other people I know who fall into both the categories of "depression victim" and "house cleaning challenged."

However, as my mother would say, "Dull women have immaculate homes."

There might be some wisdom to the axiom linking an orderly environment with an orderly mind, but until someone does a study I'm not making any pronouncements. However, I think it's fair to say that a messy home feeds really well into the cycle of I'm-not-good-enough that depression creates and builds upon. If you don't have the energy or focus to clean, it's pretty certain you'll put it off. As the mess builds, so does the guilt. The problem gets bigger as the guilt feeds the depression, which diminishes the energy levels and reinforces how impossible the task is. You know the drill, you've probably done it to yourself. Charming little cycle of self-recrimination and self-fulfilling prophecies. You expect that you can't clean the place up, and your mind works overtime to make sure that it doesn't make a liar of you. Didn't think you had that much mental energy, did you?

As with everything depression-related, small victories add up. Commit to not adding to the mess today. You will not create another dirty dish without washing it. One dish isn't so tough. And those socks? Just force yourself to put them in the hamper; you'll be glad you did. Keep up on not adding to the mess, and you'll see you can control your world after all. Then you'll be ready to take a step or two towards the bigger mess.

I would keep making small victories. Don't try to clean every dish in the kitchen, but do try to wash all the ones in the sink. Maybe picking up all the dirty laundry is a bit much right now, but how about just the stuff that you piled on your bed? Each time you succeed you're teaching yourself that you are capable and you are in charge.

Tasteful Research Opens Doors

Scientists have discovered that, not only do depression and anxiety have a measurable effect upon the sense of taste, it is even possible to determine which chemicals are most out of balance by how taste has been diminished. This is exciting for a couple of reasons.

This is the first research I have seen that shows physical evidence of anhedonia, the inability to experience pleasure. Anything that reinforces the physical nature of depression is very important. Research that demonstrates the physical symptoms of this disease go a long way towards dispelling the myth that it is "in your head." That phrase makes it sound like depression victims make a decision to suffer, which is not true. Ironically, the very nature of the disease does cause those selfsame victims to make a decision to continue suffering, but this doesn't occur until the will is compromised. Scientific research can demonstrate the physical nature of this disease, although I am of the belief that it will never discover a physical organism, a "depression virus," if you will. The root is not in the body, although much of the damage ends up there.

Diagnosis by taste-test is really just a fancy way of suggesting that we should listen to what our bodies are telling us. We are given a plethora of clues about our health, day in and day out, and either we ignore them or we just don't understand what they mean. Now we have an additional level of understanding, and another tool to use in the evaluation of our health. Another piece of the puzzle is slipped into place as diminished taste is coupled with diminished appetite in some people. We have been given one more solid tool to use to to sweep away the miasma; something corporeal with which to document a disease that prides itself on being as vaporous and insubstantial as a hunting vampire.

You Deserve Better Than Hope

Hope implies that we have a chance, even a small one, of getting what we hope for.

Hope is a funny construct - it can pull people out of the pits of despair, giving them the power to survive and succeed, but when dashed it can shatter a soul.

Hope is a passive, yet passionate, state.

Hope does not lead to action. In many cases it is a substitute for action.

Hope is somewhat optimistic, and largely dangerous.

If you're emotionally vulnerable and have a desire for a better turn of events, I don't think hope is the best way to go. Yes, there is a chance that things will turn out as you hope they will. But only a chance.

Because hope doesn't do the work, and for a depressed person it just becomes an excuse.

"Nothing ever goes right for me. I should just give up."

If I hope to win the lottery and don't buy a ticket, whose fault is that? That one might be too obvious. If I apply for a job, and hope I get it, but I never call to follow up on the application, whose fault is that? The hiring manager's? Mine, maybe?

It's really easy to be passive about life when you've got the thousand-pound weight of depression on your soul. You hope for good things to happen, but you expect those hopes to be dashed. When they are, you can easily confirm your suspicion that your life sucks, your luck is terrible, the Universe is against you, and you smell funny.

Okay, that last one is just your imagination, unless you have another issue.

But actually that last one is just like the rest of them - they're all things that you can change, but only when you stop being passive about them!

Hope is a dream killer. Sure, sometimes things work out as we hoped they would. But then we are robbed of the satisfaction of accomplishing them, because they just . . . happened. And if those good things didn't happen through our actions, then we have not learned how to make them happen again. Dreams that come true through the random action of the Universe don't turn into phenomenal stories of personal transformation any more often than single-celled organisms evolve into sentient primates with language and culture.

I'll let you look up the odds on that for yourself.

If you feel the need to hope for an outcome, do yourself a favor and find out what it would take to get yourself there. Does it seem too big a goal? No worries. Find a smaller goal, one that you can achieve, that will move you closer. Is your goal to be free of depression? Maybe the best goal you can achieve for yourself is calling a counseling center. Doesn't seem like much, but if you make that call, you have taken action. You are teaching yourself that you refuse to allow yourself to drift aimlessly through life. You are empowered to make decisions that will affect your fate.

Personal responsibility is washed away by hope; hoping absolves us the obligation for our own lives.

Don't let depression suck you down into that hole where you believe all that claptrap about not having power. You do. And you can start using it as soon as you realize that there are much better tools out there than hope.

Postpartum Depression

I'm not a woman, so until a friend gave birth I really never gave any thought to postpartum depression. I've never experienced the massive hormonal changes that a woman's body is put through, and that are a significant factor in these cases. But this site had some really interesting things to say.

"Some women don’t tell anyone about their symptoms because they feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. " Hmm, that sounds familiar . . . I guess postpartum depression might have some different causes, but it's the same evil monkey on your back regardless. The extra twist of guilt that comes because you have brought a new life into the world and feel bad is a nice touch.

"Some researchers have found that depression during pregnancy can raise the risk of delivering an underweight baby or a premature infant." In case there is anyone left on the planet that doesn't get it yet, depression is a disease that has physical symptoms. "It's all in your head" is a fine and dandy way to minimize it unless you consider the fact that your head, your brain, is the controlling force in every aspect of your life. Your body is affected by depression. Your spirit certainly so. And if you a bringing a new life into the world, its very survival can be affected by depression. It's not about guilt or shame. If you had cancer and you were pregnant you would take care not to let the treatments harm your child. If you had HIV you would take pains to minimize the risk of your child getting the disease. If you are sick and pregnant, or become sick while pregnant, you need to get treatment, for your child's sake as well as your own.

"Postpartum depression can affect a mother’s ability to parent. She may lack energy, have trouble concentrating, be irritable, and not be able to meet her child’s needs for love and affection." This just adds to the cascading failure that depression feeds. If you're limited in your energy and motivation to parent, you know it. It causes guilt, which feeds the depression.

Many women experience massive mood swings in the days following a birth. Anyone who knows a woman who is about to give birth or has just done so needs to be especially aware of her state of mind, so that it can be quickly determined if those hormonal changes have set into motion a longer term problem.

Depression Stinks

This blog is about the depths that we can sink to.

It is about the heights that we can reach.

It is about the powerlessness that we may feel.

It is about the control we can take.

Depression incites suicidal feelings because it erodes hope and happiness. It causes physical pain, emotional instability and spiritual barrenness. It attacks us on every level of our being, and must be treated on all levels as well.

It is understandable that some of us are without hope, that some of us believe that there will never be an end to the blackness. That's what depression does, it undermines our very ability to fight it.

I am not convinced that hope comes in a bottle, be it prescribed or self-selected. It is not placed neatly on an altar, nor is it asking us to lie back on a couch and share feelings from our childhood. Hope must blend these things, in a recipe as unique as the person who suffers from this disease.

This post, and this blog, is dedicated to the countless thousands who believe that hope has abandoned them in the darkness.

Maybe it's the fur?

RemedyFind has an extensive amount of information on depression, ranging from details on the various kinds of depression, to a regular newsletter on new research, to an extensive list of treatments rated by members. Only the top ten best-rated treatments with at least one hundred ratings are displayed on the front page, but the complete list is really quite instructive. Sortable alphabetically, by average rating or number of ratings, it goes through so many options that I realize I have a lot more research to do just to understand them all. For example, I did not know that a gluten-free diet has been proposed for treating depression. Apparently none of the RemedyFind members have tried it yet, but it's interesting to see that an alternative like that, or contraceptives, or even just reading blogs and email newsletters are included as potential alternatives.

I think some of the therapies that have not yet been sufficiently evaluated to be included in the top ten are quite instructive. Only 36 members have tried prayer, and it scores an 8.1. More amazing still is the emotional support of pets, scoring an impressive 8.9 with 63 votes in. I'm going to keep an eye on the list to see how those two, in particular, do as more ratings come in. I've spoken a bit about prayer already, so I'm going to speculate a bit about pets, in particular mammals, since that's where my own experience lies.

I have had cats as companions all my life. They are incredibly empathic creatures, sensitive to your moods and able to sense when you're about to go to the bathroom, settling on your lap just moments before the pressure in your bladder builds to a climax. Granted, they have a sadistic sense of humor, but they also use this sensitivity to know when you need to be reminded of the nature of love. I have only had one dog, but he and the others I have known have made it obvious that, although they may be slightly less sensitive to the shifting moods of the human, they are even moreso a vehicle of unconditional love. Love is, in my opinion, the vital tool that pets wield, both innocently and adeptly.

Your pet does not judge you if you can't get out of bed one day. Their eyes do not accuse if you forget their birthday. They don't laugh at you when you try and fail, or give up without trying. This raw emotion of love that they project is in its most primitive form, unrefined by the nuance of human behavior. It is easy to understand, and it is easy to accept that there are no motivations for it. If depression has led to anhedonia then that love may be the first form of pleasure the victim is again able to feel. In turn, the victim will be more likely to take care of basic tasks, such as feeding, walking, and litter cleaning, for the pet than they are for themselves in some cases.

Feeling love. Completing basic tasks. For some serious sufferers, this marks amazing progress.

Other animals, rodents and fish and reptiles, probably can achieve similar results. However, insidious as it is, depression can turn that love into responsibility, and responsibility into guilt. There is no magic bullet, but the right pet can make a wonderful impact.

Irony of Prayer

Prayer is a powerful tool for healing, whether it is physical, emotional, or spiritual damage that must be repaired. In the case of depression, what better treatment option can there be but prayer?

Of course, prayer requires faith, which is generally rooted in hope. Depression attacks that hope as thoroughly as leukemia attacks white blood cells. If you're deep in the black pit, there is very little chance that you have any belief in God, by any name. Your pain is so complete that you no longer feel it, and your hope has been replaced, if you're lucky, with a desire to subsist and survive in the dark world you have created for yourself.

Mr. Bloch suggests having others do the praying for you as well as trying it yourself. This is an excellent suggestion, because it removes the victim from the onerous task of having any hope. I never had that idea when I was myself depressed, since that's the nature of the disease. I will expand on his list of services if I find more and varied ones.

Ketamine No Quick Answer

Ketamine is a veterinary anesthetic that has been used recreationally for at least ten years. Early research suggests that it could have the ability to address all the symptoms of depression, with the effects being felt in hours, rather than the weeks it can often take with traditional antidepressant medications.

However, the hallucinatory properties of this drug have to be considered before any serious look at it as a treatment option could take place. And considering how easily depressed persons self-medicate with any number of substances, it would be counterproductive to prescribe a drug that already has a history of being abused. Even though it appears to be treating the actual symptoms, not just inducing euphoria, the frustrating truth is that it would be too easy to turn a blind eye to "Special K" as a fun drug and doom many depression victims to a life of more drug dependence instead of more freedom from pain.

Seems like a cruel joke, but it really isn't. If ketamine had "instant relief" properties with no obvious dangers, it would be fast-tracked through the approval process, with drug companies rubbing their hands together with glee at the thought of being able to sell it at a much higher price, since the potential market would be expanded from house cats in need of surgery to a large percentage of the human population. Media reports would herald it as the cure we've all been waiting for. Much fanfare would ensue.

Drugs, however, have a strange habit of hiding some of their side effects for months, even years. Fast track research didn't benefit the users of Vioxx. Better to not allow large companies to quickly capitalize on the desire for hope, and make sure they do their homework. The last thing we want is to cause more harm than good.

Male Fertility Affected by Treatment

Two case studies suggest that certain serotonin reuptake inhibitors may reduce sperm motility. My first thought was, "do these guys need another, literal kick in the jimmy?" But in truth, I doubt it would make a whole helluva a lot of difference to them.

Antidepressants frequently inhibit sexual desire. Depression itself is more likely to inhibit any desire to do anything about that sexual desire. Social interaction is almost completely beyond your abilities, and masturbation, if you can be bothered, often leaves you feeling worse than you did before you started. It's sometimes the price a victim chooses to pay, give up a meaningful sex life for a chance at a meaningful life.

This case study suggests that under certain circumstances, it's possible that one would lose the ability to have children by treating their depression. To some, the idea of being without children would easily overpower the SSRI that they were using in treatment. The disease would key into that primordial instinct, propagate the species, and use it to overcome the drugs. For others, the desire to procreate has already been satisfied, or is already compromised by other factors, such as a vasectomy, vow of chastity, sexual orientation, or erectile dysfunction. If the victim has already made peace with not having children in the future, it is possible that a treatment which had this side effect wouldn't be such a bad thing. However, depression is a wily foe, and it's not unheard for someone that has had a vasectomy, for example, to be suddenly hit by a wave of depression upon hearing that their depression medication is rendering them infertile. Such is the insidious power of this disease, which is why it can never be treated as if it were a merely physical disease.

It Sneaks Up

What are the early warning signs of depression?

Not as easy question to answer.

For starters, the early signs of depression are entirely internal. Lack of motivation. Lack of pleasure. Lack of focus. Maybe lack of sleep. So if you don't share your life with an incredibly astute and empathic person, nobody else is going to have a snowball's chance in Hell of noticing.

Secondly, symptoms of depression are incremental, and creeping. They build like the lengthening darkness builds after the summer solstice: gradually, naturally, so that it doesn't seem for quite some time that anything is different. We are creatures of routine and habit, so it's easier to believe that nothing has changed by subconsciously adapting to these new circumstances than it is to identify a problem and change to resolve it. Change causes pain, right now. Depression also causes pain, but not right away, and since you can build up a tolerance, it doesn't seem so bad. It's easier to ignore it, deny it, forget it.

Of course, that's the amazing thing about depression: it works within the psychic immune system to maintain its own invisibility. It uses our own adaptiveness to hide the destruction that it's wreaking for as long as it can. If and when it's noticed, there's very little chance that the victim can do anything on their own to fix the problem.

When I was first diagnosed as having depression, in my early twenties, I was able to trace the symptoms back over ten years. I didn't know what it was and I didn't get concerned, because it happened so organically I just assumed it was life unfolding in the ordinary way.

The next time I succumbed to its darkness I again tricked myself. I should have known what it was and actively worked to abolish it, but it managed to slide into my spirit and insinuate itself into my life, again without my noticing. We are a prideful and stubborn creature, and we don't like to admit weakness. Depression masks itself as a weakness, so we hide it rather than treat it like the disease that it is. We accept the social stigma at face value and cluck over the sadness of it, rather than recognize it as a strategy of a willful, malevolent disease that will do whatever it takes to inculcate itself into our lives.