Overcoming Recurring Depression


depression
Illustration by Mark Weber

Five years following my plane crash that resulted in SCI and paralysis at the age of 20, I fell into a psychological and
emotional pit that seemed to have no bottom, no way out. Looking back, it was worse than the immediate aftermath of the crash itself. While my accident was life-changing, my descent into severe depression could have ended in suicide.

At 25, I was without hope, no longer able to imagine a future.

At the time, the term “clinical depression” did not exist. Nor did “post-traumatic stress syndrome.” All I knew was that my life had completely fallen apart, and I seemed helpless to fix it. To an outside observer, I must have seemed catatonic sitting in my wheelchair — silent, still, downcast, no expression on my face, no discernible emotion, not really there. But on the inside I was holding on for dear life, caught in what seemed like a hopeless hell.

See Also:

Depression and Suicide: What the Experts Say

Exercise as a Natural Mood Elevator

A lethal mix of unresolved issues had grown undetected like a cancer within me — grief from my loss of physicality, grief for my friend who died in the crash, survivor’s guilt, rejection by a longtime girlfriend, drug and alcohol abuse, no job, no direction, no friends, no place to call my own. My parents rescued me from a drug house and brought me home, then decided I would be better off in a state hospital, where I would have been forced to submit to electroconvulsive shock therapy.

Fighting Back

Ironically, when I learned they were making plans to have me committed, I discovered an emotion that was still very much alive in me — fear. The threat of having my brain fried aroused me from my catatonia. Desperate, yet unable to articulate my fear, I appealed to my brother to speak for me. I told him I would consent to going to a psychiatrist of my own choosing, but if my parents insisted on sending me to a state hospital, I would fight and scream and become the wacko they thought I had already become.

That single impulse of resistance was the beginning of my recovery. What follows is my personal account of some of the things that proved effective during that yearlong battle — all of which are now recognized as being important to overcoming clinical depression.

We Are Not Alone

I saw a psychiatrist three times before I concluded he could not cure my depression. I threw away the pills he prescribed, refused to go back and embarked alone on my journey to find a future. My decision was based on my desire to confront my personal demons rather than temporarily sedate them. But this is not advisable for everyone, especially those contemplating suicide.

Loneliness and feeling alone are characteristic of severe depression. Everything is inner-directed. The external world and everyone in it seem cold and distant. At times I felt like a rat in a maze, trapped in the dark corridors of my own brain. I got worse before I got better.

It sometimes takes getting worse, reaching a point of extreme desperation, before we are moved to take action. In my case, my action was praying, something I had not done in years. Of course I had prayed for my life while lying in the wreckage of the plane, and later for a healing miracle in the hospital, but I had long since given up. This time, praying from the depths of depression, completely humiliated and terrified, tearful and desperate, my simple and heartfelt prayer could be summarized in three words: Lord, help me!

It is not my intention to convince anyone that prayer is a cure in such situations, or that faith can be manufactured by sheer will, but something happened that night in the quiet of my bedroom. It was the moment of my most desperate need, the moment I now recognize as the low point in my life. After praying, a peaceful calm fell over me for the first time since my plane crash more than five years earlier.

Prayer is related to mysticism, not logic, and when we give ourselves up to it, it is an acknowledgement that we want to make contact with a spiritual reality — invisible yet somehow omnipresent — where hope exists. Connecting hope to something greater than ourselves is the first step toward recognizing that we can choose not to feel alone. We may not be able to change our physical circumstances and bring back what we have lost, but we can seek to cultivate connectedness, hope and inner peace. And when we do, we feel connected to life in a new way.

“Where Words Fail, Music Speaks” — Hans Christian Andersen

For my 26th birthday, which I spent alone in my bedroom, my mother gave me a classical guitar. She must have seen that during my depression music had abandoned me,  or perhaps I had abandoned it.

Prior to my accident, I had taken an undergraduate class in Beethoven for non-music majors at UCLA taught by a respected professor and acclaimed classical musician. Feri Roth made it his mission to initiate us into the great composer’s mystique. The “class” met in an auditorium that held 400 people. After putting a Beethoven symphony on the sound system, Roth would dim the lights and in his distinct accent instruct us to lean back in our seats, close our eyes and give ourselves up to the genius of “Lootfick Fon Baytofen.” As we listened, he patrolled the aisles with arms crossed, calling out anyone who dared open his or her eyes or make a disrespectful peep. Even the shallowest among us — football players looking for an easy grade — fell under the spell of the genius whose moving symphonies soothed the savage beast within us, if only until the class ended.

Left alone in my bedroom with my new stringed companion, I rediscovered making music, and more importantly, listening to it. Three or four times a day I picked up my guitar and tried to teach myself chords and pick out simple melodies. I became reacquainted with a purity in music that is absent with words — a calming, relaxing, reassuring kind of communication. Alone with my depression, the magic of music spoke to my heart and reintroduced emotion into my life.

Music therapy is now a recognized treatment for depression, and many people have found it a reliable tool — more like a soothing elixir — that reawakens emotions that we have buried deep within ourselves, perhaps out of fear of being hurt or disappointed. But unlike real-life relationships, music can be experienced without risking rejection or failure. We don’t have to be musicians, nor do we have to perform. It requires of us only that we listen and open our hearts.

Breaking Out of Isolation

Once my inner demons were somewhat placated, I knew I had to face the world outside my bedroom, but I was terrified of going out in public. So I forced myself to take baby steps.

First, realizing that I had neglected physical exercise and activity for many months, maybe even years, I put on my ill-fitting leg braces and ventured into the backyard, where no one would see me. I stood with braces and crutches and sniffed the air and looked at the trees. And that was all. Just standing outside was a challenge — and a success.

The next day I attempted to walk in the backyard, but fell hard. With my face in the grass, I remembered how I had been taught to get up with crutches on stiff, braced legs. After several attempts, I succeeded. Falling may have been the best thing that could have happened. It forced me to use my body, to strain and sweat just to stand upright. I began to walk on braces and crutches regularly for exercise, gradually moving from the backyard to the front yard, where people might see me. Fear and self-consciousness began to lose ground.

In overcoming depression, it is helpful to breathe fresh air and do whatever kind of exercise or movement that is possible for you — to get out of your head, out of isolation. I know this was helpful for me, and there is a scientific basis that supports it. [For more details, see Exercise as a Natural Mood Elevator.]

Rediscovering Purpose

Having regained a semblance of confidence, I decided to take a trip to the library in the small town where I grew up. I did not realize it at the time, but I went there seeking a purpose to fill the void that hopelessness had created. I browsed in the stacks, found a few books that interested me and checked them out. That simple interaction with the smiling librarian reintroduced me to the public world. It almost seemed as though I had gained a friend.

One of the books I checked out was about the theory of nerve impulse transmission — how the brain transmits messages and receives feedback from the body. I did not really understand my paralysis, so why not confront it and study it? I became fascinated with the fact that my spinal cord was a complex electrochemical conduit that was not completely understood by the scientific world. Most fascinating was the way that impulses traveled along the cord. A nerve impulse must leap across millions and millions of synaptic gaps at incredible speeds to make a simple movement happen. The gaps themselves — electrified space, not physical matter — captured my interest.

I knew that somehow there was hope in the spark that jumped from neuron to neuron. Physical matter dies when damaged, as it did in my injured spinal cord. But as long as there is a spark, life can go on.

That metaphor resonated within me. Because of my injury, part of me had died, and now, six years after my accident, I was able to accept the truth of my paralysis. My damaged cord would prevent me from walking and regaining my prior life, but that spark — the spark of life — was alive and well in my brain and heart.

I was alive, I was not alone, and I was ready to re-enter the world. Day by day I ventured out, then returned to my safe haven. With the help of my family, I got a menial part-time job and saved money since I was still living at home. One year following onset of severe depression, I accepted the invitation of friends to join them in a trip overseas. It was a long ways from my backyard to Europe, but just going there was proof that I had recovered.

Over the next 20 years, until the age of 45, depression returned from time to time, usually during periods of extreme stress. Each time I was able to look back to the “Dark Ages” I experienced at the age of 25 and rediscover the path I had taken to climb out of the pit. Gradually, the episodes of depression became less serious, less prolonged, and stopped altogether. It has now been 25 years since my last episode, and while I can’t say I am free of it, even at the age of 70, I am now certain — if it should return — I know the way out.


Depression and Suicide: What the Experts Say

by Richard Holicky

According to Michael DeVivo, an epidemiologist at the University of Alabama, Birmingham, people with SCI commit suicide nearly four times as often as the general population. It is the seventh leading cause of death among people with SCI.

What drives people over the edge to commit suicide?

When that question was posed to a number of rehab psychologists, they all cited the same risk factors. Number one on all their lists is depression, with one study suggesting that 75 percent of SCI suicides demonstrated substantial evidence of depression, despite less than 40 percent having been diagnosed with clinical depression.

Other risk factors mentioned, in no particular order, were drug and/or alcohol abuse, chronic pain, social isolation, loneliness, financial problems, and perceived poor health. In other words, nearly every aspect of SCI (or disability in general) puts people at greater risk of suicide. And when problems pile one upon another, finding a way out can begin to seem hopeless. “When people don’t recognize any solutions available for their problems,” says rehab psychologist and researcher Allen Heinemann of Northwestern and Research Institute of Chicago, “suicidal ideation may emerge.”

Estimates of depression among people with SCI range from 11 percent to 37 percent. The University of Washington’s Northwest Regional SCI Center puts the rate at about 20 percent, or about one in five wheelers. Clinical depression is much more serious than your garden-variety case of the blues or being down in the dumps. It often involves feelings of helplessness, hopelessness and worthlessness. Hopeless, as in thinking nothing will ever change and things will always be this bad; helpless, as in I have no power to change things and make them more tolerable; and worthless, as in I will never amount to much, given my disability.

But there is some good news. Suicide risk drops dramatically once people get past that seven- to 10-year mark following onset of injury, which means most of us find purpose, meaning and worth following disability.

And we also know of many protective factors that make suicide less likely. Scott Richards, a psychologist at Spain Rehabilitation Center in Birmingham, Ala., sees social support as “huge,” and a study of his found greater access to the larger world, often in the form of reliable transportation, a significant factor. Craig Hospital psychologist Lester Butt speaks of quality rehab and the introduction of what is still possible — function-wise, job-wise and recreation-wise. Some type of meaningful activity or pursuit, be it work, family, faith, volunteering, mentoring, can be the key to optimism, hope and self-worth. Strong religious beliefs also serve as a buffer, as does a sense of responsibility to family and having children in the home. Heinemann cited the value of physical activity — 150 minutes of aerobic activity a week — as depression prevention.

All these factors foster a more positive self-image and promote optimism, positive self-talk and useful coping skills. The takeaways would be to diligently monitor for the risks, and aggressively pursue, build and fortify protective skills, networks and activities to successfully challenge the onset of a worthless/hopeless/helpless cycle.


Exercise as a Natural Mood Elevator

by Bob Vogel

Bob Vogel finds that engaging in exercise helps to keep depression at bay.
Bob Vogel finds that engaging in exercise helps to keep depression at bay.

Researchers have figured out how exercise helps fight depression. An article on the Mayo Clinic website — “Depression and Anxiety: Exercise Eases Symptoms” — explains that exercise helps ease depression by releasing “feel-good” brain chemicals including endorphins, neurotransmitters and endocannabinoids.

These naturally-produced bodily substances reduce pain and foster feelings of well-being that recent studies suggest are responsible for “runners high.” In order to get significant improvement in depression symptoms, the Mayo Clinic suggests 30 minutes or more of exercise a day for three to five days a week. Exercise also reduces chemicals in the immune system that can worsen depression.

I’ve had an on-and-off battle with depression for years. To me, it feels like I’m in a fog that sucks away interest in activities, clouds my thinking and creativity and puts me in a state of fatigue that no amount of sleep, napping or coffee can ward off. How much of this is due to being a T10 complete para, 30 years post-injury, is difficult to pinpoint. I do know my weapon against depression is exercise.

When depression floods me with fatigue, a nap only leads to another nap and another. What I really need is exercise. But depression tries to convince me I don’t have the energy. Fortunately, my service dog is often the catalyst that breaks the cycle. Taking my dog on a brisk 30-minute push often gives me the energy to hop on my handcycle — which is mounted on a stationary trainer — to get my heart, lungs and endorphins flowing. About half way through a good exercise session I can feel my energy, mood and creativity return.

Any exercise or activity is better than none. And people who want an arm peddle workout but can’t transfer into a handcycle and/or have limited hand function have a variety of options, too [see Resources below].

Researchers have also found that exercise is beneficial specifically for depression in people with SCI. A September 2004 Journal of Rehabilitation Research and Development article concluded that for people with SCI, recurring exercise leads to significant improvements in pain, stress and depression.

Another study, published in October 2014 Disability Rehabilitation, concluded that the effect of exercise may be comparable to taking antidepressants and undergoing psychotherapy for mild to moderate depression.

Bobbie Humphreys, 59, in her 42nd year as a C5-7 quad, keeps depression at bay by stretching every day and doing an hour of seated aerobics three times a week [see Seated Aerobics Video in Resources].

Terri O’Hare, 57, of Albuquerque, N.M., has been a wheelchair user for almost four years due to a progressive neuromuscular condition called Charcot-Marie-Tooth disease. O’Hare went into several years of depression after deaths in her family and personal trauma. She went to counseling for two years and is on a generic version of the antidepressant Celexa. “The counseling and medication saved me,” she says. “But what is healing me is pushing my chair on a 1.5 mile accessible trail that travels close to the Rio Grande. Getting physical exercise, getting my blood moving and being so close to nature in such a beautiful place gives me a sense of life after a few dark years of depression.”

If you suspect you have depression, it is important to discuss it with your doctor. And do not stop taking an antidepressant without consulting your doctor, as abruptly stopping some antidepressants can cause withdrawal symptoms.

Resources

• Handcycle Trainers for Fitness: www.newmobility.com/2013/12/handcycle-trainers-fitness/


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