Skulls in the Stars

There’s been a healthy amount of discussion on the science blogs over the past few days about clinical depression, spurred on in large part by questions from aspiring academics concerning the best way to address the impact of their illness on their job and, just as important, their advisor’s perception of that job.  Dr. Isis seems to have started the current ball rolling with a question from a postdoc, PalMD posted another reader’s experience as a grad student dealing with depression, and Mark Chu-Carroll updated an old post concerning his own struggles with depression.  (If you search through the comments on the original post, you can read one of my very first blog comments, long before I had a blog of my own.)

I feel I should throw my own personal experiences in here.  I’ve been on antidepressants myself since graduate school.  I make no secret of it to anyone anymore, though I haven’t talked about it that much on the blog, except in one early post about the unjustified stigma that antidepressant drugs have.

The first part of my story is very similar to the story told at PalMD’s place.  I was a moody, depressed, rather introverted teenager, and passed through my undergraduate years in much the same condition.  When I reached graduate school, I at first did quite well for myself, but when a serious relationship fell apart, and to an appreciable extent so did I.  My work suffered, and my graduate career stalled out significantly.

I was very fortunate to have an advisor who was not only very understanding and sympathetic, but  who was also familiar with clinical depression, having known other sufferers.  He was the first one who suggested that I might look into treatment — he had a talk with me in my office, suggested that my work had been suffering and that I might benefit from medication.  (I still remember walking back into my shared office afterwards, somewhat stunned, explaining to my coworker: “My graduate advisor suggested I start taking drugs.”)

This wasn’t enough to convince me, however; not by a long shot.  People ignorant of the illness seem to have the impression that people decide to take antidepressants on a whim.  On the contrary, all people I’ve known who have dealt with clinical depression (and I’ve known a lot of them — more on this below) have adamantly resisted treatment, against the advice of doctors, therapists, and fellow sufferers, and have only sought treatment when truly at the end of their rope.

This was the case for me.  Instead of seeking treatment, I took up new athletic hobbies.  I started skydiving, skating, martial arts, and long-distance running.  Often I would be running in the morning, skating at lunch, and then going to a martial arts class in the evening.  My impression in hindsight is that I was using the endorphin high from exercise to compensate for my miserable mental state.

It worked, to some extent — until I overtrained and injured my lower back, bringing all my activities to a screeching halt.  I went into physical therapy and some mental therapy, though I still resisted gentle suggestions from my doctor that antidepressants might help provide pain relief.  My back recovered enough for me to take up some running again, as well as my skating and skydiving, and I trudged along again through grad school.

Then, in the summer of 2001, I wrecked my knee in a bad, completely avoidable, skydiving landing.  (For the medically inclined, I completely tore my ACL in my left knee.)  This put all of my athletic activities on hold again, and I crashed hard.  An ACL tear typically causes inflammation which lasts a few weeks, during which one is forced to get around on crutches.  When the inflammation went down, I was able to walk pretty much normally on my own again, and I even went up and made some skydives prior to going in for reconstruction surgery.

Oddly enough, this was the time I finally realized that something was really wrong with my mental state.  Getting back on two feet was an incredible relief, and getting back into freefall was a wonderful feeling.  I had just defended my Ph.D. that spring, and I had a great postdoctoral position lined up overseas.  In spite of things being more or less great with my life, however, it finally occurred to me that I didn’t feel okay.  I realized that my emotional state did not even come close to matching the events in my life.

I started on a mild dose of antidepressants, which was ramped up slowly over a few weeks.  One morning, I woke up with a completely bizarre and alien feeling: everything was just fine.  That was the first time that I realized that my depression was a genuine chemical disorder.  The difference in mood was subtle, but hit me like a thunderbolt.

Once I was being treated for depression, I was able to look back on my previous mental state with a less biased eye.   The biggest revelation is how much our emotions and our perceptions are linked together.  I had maintained for years that I needed somehow to just “get over it” and stop being depressed, but the chemical state of my brain made that nearly impossible.  As I’ve put it previously,

It would be nearly impossible to just ‘get over it’ myself, since everything that happened in life was colored by the fact that I felt bad — in essence, I learned that not only can bad things make you feel miserable, but feeling miserable can make things bad. I would generally assume even positive events in my life were nothing special, because I was taking cues from my brain chemistry: If I don’t feel good about things, they must not BE good.

Trying to “get over” depression by oneself is very much like trying to fight a war that your brain has told you that you’ve already lost.

It astonishes me that there are people out there who still treat clinical depression, and mental illness in general, as some sort of character flaw.  This is especially astonishing to me because there are so many people who have suffered through clinical depression at some time in their life.  I can state without exaggeration that, of the people I’ve discussed my own depression with, roughly 50% of them have acknowledged their own battles with the illness.

I don’t know that I have much of a point to this post.  In my own life, I’ve found that the people around me, both friends and colleagues, are very understanding of clinical depression, so much so that I have no hesitation volunteering my experiences if they’re relevant to a conversation.  (At the stage of my life and my career, I’m more than happy to tell people to go fuck themselves if they aren’t understanding.)

For students and postdocs struggling with the disease, there’s no easy answer in how to proceed: to tell the advisor, or not to tell?  It can be risky not to address the problem at all, because it could very well be misinterpreted as laziness or moodiness.  On the other hand, there are certainly academics, who should know better, that would treat any diagnosis as an excuse for poor performance.

Hopefully we can eventually reach a point where society will accept that clinical depression is a genuine mental illness, and not something that one can “get over.”