Faces of Depression: Andrew Solomon

< Faces of Depression

By his mid-twenties, Solomon established himself as a multi-disciplinary wunderkind, earning international accolades for his work as a novelist, journalist and historian. After the death of his mother, the then 31 year old Solomon descended into a major depression, rendering him unable to work or even care for himself. He was helped by a combination of medications and talk therapy. This experience formed the bedrock for his National Book Award-winning Noonday Demon: An Atlas of Depression, a tour de force examining the disorder in personal, cultural, and scientific terms.

Interview

Can you describe your experience with depression?

I remember hearing the word "breakdown" when I was a kid and wondering how it could happen, because mental states always seemed so gradual to me, shifting from one thing to another. Then it turned out that the gradual can become sudden. When I wrote my book, I said it was like an iron structure that rusts for ten years and then one day it just collapses. A breakdown involves getting to the point at which your mental state prevents you from doing the normal things of your everyday life. I remember from my own experience that I was completely ambushed by mine.

I had always thought of myself as fairly tough and fairly strong and fairly able to cope with anything. And then I had a series of personal losses. My mother died. A relationship that I was in came to end, and a variety of other things went awry. I managed to get through those crises more or less intact.

And then a couple of years later, I suddenly found myself feeling bored quite a lot of the time. The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep out of me. I remember particularly that I would come home, and I would listen to the messages on my answering machine, and instead of being pleased to hear from my friends, I would feel tired, and think, that's an awful lot of people to have to call back. I was publishing my first novel at the time, and it came out to rather nice reviews. I simply didn't care. All my life I dreamed of publishing a novel, and now here it was, and all I felt was nullity.

Then the sense of life being effortful kicked in. Everything began to seem like such an enormous overwhelming effort. I would think to myself, oh, I should have some lunch. And then I would think, but I have to get the food out. And put it on a plate. And cut it up. And chew it. And swallow it. And it began to seem like the stations of the cross. Then I would think, oh, I should have a shower, but I just couldn't organize myself enough for that.

One of the things that frequently gets lost in descriptions of depression is that the depressed person often knows that it is a ludicrous condition to feel so disabled by the ordinary business of quotidian life. And so, while (the depression) was going on, I became annoyed at myself, because I knew that what I was experiencing was idiotic. It was nonetheless vivid and physical and acute, and I was helpless in its grip.

Then the anxiety set in. If someone told me I had to be depressed for the next month, I would say that as long as I knew it was temporary, I could do it. But if someone told me I had to have acute anxiety for the next month, I would kill myself, because every second of it is intolerably awful. It is the constant feeling of being terrified and not knowing what you're afraid of. [Anxiety] resembles the sensation you have if you slip or trip, that experience you have when the ground is rushing up at you before you land. That feeling lasts about a second and-a-half. The anxiety phase of my first depression lasted six months. It was incredibly paralyzing.

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How did you initially find help?

At the time, I was in treatment with someone whom I fondly call the incompetent psychoanalyst, who kept telling me that it was very courageous of me to avoid medication and to try to work things through at a psychodynamic level. I think psychodynamics are very powerful, and have gained great insight into my own depressive tendencies through continuing analytic work. But at that time, I was headed into a serious breakdown, which could have been controlled.

Now had my breakdown been controlled sooner, I wouldn't have written my book, which would have been a shame for me professionally. But in other ways, things could have gone a great deal better than they did. I got sicker and sicker until one day I woke up and I actually thought that I'd had a stroke. I remember lying in bed and thinking that I'd never felt this bad in my life, and that I should call someone. And I was lying in bed and looking at the telephone on my night stand. And I could not reach out and dial the telephone. So I lay there for four or five hours, just staring at the telephone.

Finally the telephone rang, and I managed to answer it. It was my father, and I said, "I'm in terrible trouble." After that, I finally sought antidepressants and began the serious treatment of my illness. For me, it took years of experimenting to find the right medications, and some considerable time to find the right talk therapist.

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Can you describe what you do on a daily basis to stay healthy?

When I began researching depression, I was a real medical conservative. I thought it was all about the meds. But now I believe that there are multiple elements involved.

For me, the medications are essential; I've tried going off them over and over, and I feel fine for a little while, and then I begin to come unraveled again. So I no longer make those rash experiments. I also see a therapist once a week for a 90-minute session, and I find that very stabilizing. Sometimes it feels like a little bit of a nuisance, but I know there is a trained professional keeping an eye on my mental health. My therapist can give me advice or steer me in directions that help me avoid catastrophe.

I also try to lead a fairly well-regulated life. Sleep is my great indulgence, and I get eight hours every night. Being chronically overtired raises stress levels in a bad way and is responsible for a lot of depressive breaks. I am not by nature strongly drawn to exercise, but I make sure that I work out at least three times a week, because studies have shown that regular exercise can be as effective as medication in bringing people out of a depressive state and in keeping them out of it. I also limit my alcohol intake (alcohol is a depressant). I avoid caffeine, and I am careful about diet.

Most of all, I try to keep my life in balance. I attempt to be among people who can countenance my occasional lapses. The secure knowledge that they are there can prevent those very lapses from taking place. And when I feel as though I'm getting super-stressed, I pull back. If I have another breakdown, it's not going to be useful to anyone.

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Do you still have low days? Are those days different now?

Oh yes, I certainly have low days. I feel that in treating the depression, it's not so much that I've become happier as it is that I can be unhappy in better ways. So instead of being utterly overwhelmed by the difficulty of taking a shower, I am overwhelmed by the difficulty of achieving peace in the Middle East. Instead of feeling that I'd rather be dead, I feel that the world is full of sadness that I'd like to help assuage.

That's the poetic part. But I also just have blue days, or anxious days. And when I have such days, I always worry. Am I feeling just a bit sorrowful and have too much on my plate, or am I headed toward the abyss?

All that being said, sometimes it's nice just to feel sad, and to inhabit the mood, and to feel like it's not going to lead to total decay and that I can therefore live in it. It's like coming to rest on the pavement but not sinking through it into the sewer.

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What do you say to people who ask if you'll eventually stop taking medication?

I say to people that they don't expect a diabetic to stop taking insulin, or someone with a heart condition to stop taking blood thinners. I have a chronic, lifetime disease and the only responsible thing for me to do is stick with my medications.

People wonder about medications' long-term effects on the brain. I explain that while the medications' effects appear to be reversible as soon as you stop taking them, the long-term effects of having repeated depressive episodes appear to be absolutely dire. There is lesioning of the hippocampus, and brain cells die. And this is in addition to the havoc that such repeated episodes cause in your daily life.

Imagine you have heart disease. You're prescribed medication, you do better for a while, so you stop the meds. Then you have another heart attack, so you go back on the medication to get better. Twelve heart attacks later, what kind of shape are you in? It's obviously crazy. If you have recurrent depression, you are not being "courageous" or "genuine" to go off your medication. You're being foolish.

Can you explain the importance of balancing therapy and medication?

Different treatments work for different people, and I am open to the endless possibilities out there. But for most people, a combination of medication and therapy is the surest-fire way to handle depression.

The medication alleviates the worst symptoms and lets you function again. It makes life and the world bearable. But once you have emerged from the horror, you need to learn skills for managing the illness. You need to understand where it comes from. You need to make your peace with the idea that you cannot be fully yourself without the use of medications or other support structures. And you need someone capable who can keep an eye on you.

Ideally, you also need to understand the structure of your own personality and who you are; this gives you a feeling of peace and allows you to get through a difficult time with dignity.

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You became a bestselling author and expert in depression by telling your story. Did you ever "second-guess" sharing such a personal battle?

It was not easy laying myself so bare, and it hasn't always been a comfortable situation. But I believe that the stigma attached to mental illness is making it harder and worse for people who are ill. And the best way to break down that stigma is for those who can to make public declarations about their struggles.

I have a lot on my side: I'm a writer; I live in New York; I have good insurance. If people such as I don't talk about our experiences, who will? And I'm glad I did, in part because talking about it allowed me to turn what I experienced as a completely useless set of experiences into something with value and meaning for other people and for myself. Do I sometimes get overwhelmed by all the people who come up to me at parties and start asking me incredibly personal questions about my struggles? Sure. But on the other hand, it's immensely gratifying to me when I can give those people a message of hope.

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What advice would you give others?

First piece of advice: Deal with it early. Don't wait until it escalates out of control. Like any illness, it's easier to treat before it becomes acute.

Second piece of advice: Find the right therapist and psychopharmacologist. Sometimes that's one person and sometimes it's two people; seek the best. There a lot of bad treatments and too many incompetent shrinks, so if you're not getting better, try seeing someone else. It's exhausting and annoying shopping around, but as in all other areas of life, there are some people who are highly skilled and others who just aren't very good. There are also people who work well for one patient and aren't right for another.

Third piece of advice: If you have a chronic condition, treat it in the long-term. Have the courage to stay on your meds, and don't be tricked into thinking that brave people get better on their own. If you had lung cancer, you wouldn't try to cure it by breathing carefully. Don't trivialize depression. Remember that it can be fatal: A large number of depressed people commit suicide.

Fourth piece of advice: Don't keep it all a big secret. Depression is stressful and keeping secrets is stressful. But tell people selectively and carefully. Some people can deal with it and others can't. And get yourself a support structure. Love won't cure depression, but it will make it a whole lot easier to tolerate.

Learn more about Andrew Solomon and treating depression

Andrew Solomon's Web Site: www.noondaydemon.com

The National Association for Mental Illness: nami.org

The Beck Institute for Cognitive Therapy and Research: www.beckinstitute.org

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