Depresso Espresso

Table of Contents

On Major Depression

hi.

i’m dax. i’m a 43 year old male. on pretty much every important axis society signals is important, i’ve done well. i have a good job, a great family life, wealthy enough that money pressures rarely factor into my thinking, and i do genuinely meaningful and empowering work. i’ve got amazing family, friends, and i’m surrounded by a relaxing environment and enough material possessions to enable an almost endless number of distinct and engaging hobbies.

but for probably a decade, i’ve been deeply, helplessly depressed.

every ounce of energy at my disposal has gone toward maintenance. keep my job. maintain relationships as best i can - but when some relationships started asking or requiring more energy than i was able to devote, i’d just drop them.

i still had goals, but no meaningful way of advancing them. no hope for vibrancy, for enjoyment, nothing.

i told my doctors, and they tried to help. they tried! SSRIs, SNRIs, eating better, working out, meditation, psychotherapy, sleep aids, rest and relaxation, avoiding stressors - you name it.

i thought this was just the way life was going to be for me, forever. okay. not great, not terrible.

deep down, i always had the fear that if anything were to go wrong - job, money, housing, health, relationships with my partner, etc, that i would give up and get out

get out, like getting out of an abusive relationship, or a burning building, but instead of breaking social bonds or relocating to a safer place, i meant get out of this life thing.

What Depression Is Not

Major Depression has a problem, and that problem is that it has some similar expressions as our coloquial definition of the word, but fundamentally it is not simply a feeling of sadness or lack of motivation. Coloquial depression, e.g. you had a bad interaction with a family member that has left you feeling down in the dumps is just something we’ll all experience by virtue of being humans and being upset enough over the lows of life. That’s not really the kind of depression I’m talking about. I’m talking about Major Depression - big D here - and it’s an absolute BEAST. Major Depression isn’t cured by hearing “you need to buck up, buttercup!” You may be able to fake-it-till-you-make it out of lower-case d depression; you might be able to take stock of everything and reorient your thinking. Maybe a walk can fix depression; maybe you need to break out the big guns and find a bucket of puppies that someone is willing to pour over you. Lowercase depression may respond to this, but not Major Capital-D Depression.

Major Depression is not going to respond to that at all. Major Depression would laugh at it, if it could find the energy, but it can’t.

What Major Depression IS

Major Depression is a biological disease. It comes with a profound effect on both your brain and your body. 15% of the world population will experience major depression at some point in their lives; women, yeah – they’re twice as likely to experience it. The WHO has ranked it as the number two cause of disability/lost work/lost function across the globe.

Major Depression has staying power. We’re looking at weeks, months, years of an omnipresent spectre, sapping you of every last modicum of energy. As Professor Robert Sapolsky describes it in this lecture, it is a CATASTROPHE on your physiology. It changes your brain’s physical structure, it changes your neurochemistry, it impacts every aspect of your life, and it is fundamentally a biological disease. Like diabetes, it is not something you simply power through.

Symptoms

(And their implications)

There’s a few symptoms I’m going to leave mostly un-explored here, primarily as I have no meaningful first-hand experience with them.

Self-Harm / Suicide

I never got to this point - yeah, I know, up above, I alluded to it - but that’s the closest it’s ever gotten. A fear that if things got too hard, I would give up. I never got there. But you should know that women are more likely to attempt suicide than men. Men are more likely to succeed.

Cyclicity

Some people experience seasonal cycles to this; seasonal affective disorder (SAD). I did not have this. I had low tides and high tides but they were more responsive to situations (like my beloved dog dying of histiocytic sarcoma …) than they were seasonal.

The Symptoms I Had

(Note the past tense there. That’s called foreshadowing. I am very clever.)

Anhedonia

Nothing is fun. Nothing is pleasurable. Friends, I couldn’t even get excited about objectively exciting things! I could tell the difference between something that would usually be met with extreme enthusiasm and things that would be met with deep displeasure - but if real life has a range of Interest <-> Disinterest that usually is measured from 100 to -100, with Anhedonia, it was more like a range of 1.0 to -10.

Yes. I picked the edges of the range carefully. Dislike or disinterest could definitely be felt more accutely than like or interest could be, but the highs were capped at a 1 out of 100.

Professor Sapolsky describes major depression as a disease of malignant sadness.

I agree.

Psychomotor Retardation

Everything - EVERYTHING - is absolutely and infallably exhausting. An example chain of thought, again from Professor Sapolsky’s lecture, might be an inner monologue like:

I can’t get out of bed today.

Even if I wanted to, I don’t have any clean laundry.

Even if I wanted to wash my laundry, I don’t know where the laundry basket is.

Even if I did, I don’t have laundry detergent.

There’s really no reason for me to bother getting out of bed today.

Or, more succinctly:

I just… I just can’t even today.

Cognitive Distortions

Major Depression is insidious. It distorts your thinking to extremes, and you don’t realize it - these are, after all, your thoughts. However, you wouldn’t have these thoughts if major depression weren’t leaving your brain’s neurochemistry and physical structures in such a shambolic state.

And these cognitive distortions stress you out - and as it turns out, stressors, especially ones we have no ability to meaningfully take action on, are thought to be a major initiating cause of depression for many people. Which just reinforces the major depression - which reinforces the cognitive distortions.

You’re in a double bind trap, and you can’t even really tell.

MEMORY ISSUES

Oh my dog I cannot stress enough how I thought the cause of my memory loss had to have come from my concussion. It made sense - a few years after the concussion, I started having memory issues - seems like a logical reason that one could go from near-photographic memory to “can’t remember anything that doesn’t have 14 phone reminders set up first”, yanno?

Also turns out that that is about when I started to become depressed, too.

Vegetative Symptoms

People with major depression - their bodies work differently now. We can measure it; you’ll have elevated levels of glucocorticoids in your blood stream. Your sleep architecture is disruptive; rather than a restorative slow-wave sleep, we get less rest, and oh so excitingly woken up wide awake at some ungodly early hour, completely exhausted yet completely awake. Our stress levels already through the roof, circadian rhythm disrupted with a higher level baseline of stress hormones flooding our bodies.

That’s right, our body is now Just Trying to Help by having the adrenal engines running at a high baseline so they are ready for the turbo to kick in as soon as possible. Super useful body, thanks.

Neurochemistry of Depression

We’ve got 4 neurotransmitters in play, three direct chemical levers we can pull to try to address them, and one indirect lever.

Serotonin - and our friends, the SSRIs - are responsible for disallowing a re-uptake pump from snagging hold of the serotonin (selectively!) neurotransmitter for later reuse - allowing it to be reused immediately however many times our body so sees fit to do. In major depression, we know that our neurons don’t come across enough serotonin - so keeping more of it immediately available tends to help with rumination aspects of depression.

Norepinephrine - and our friends, the SNRIs - are responsible for disallowing a re-uptake pump from snagging hold of norepinephrine (again, selectively!) for later reuse. What’s norepinephrine good for? Not much really, just, you know, psychomotor arousal - e.g., “I should do the laundry, first I’ll go to the store for laundry detergent in some scruffy clothes, then zoom home to start a load of laundry. Do I need the basket? Eh, I’ll look for it but it’s not the end of the world if I can’t find it. Alright, let’s roll.”

Dopamine - well, we don’t have a SDRI, really. And it turns out the selective part of SSRI/SNRI is more aspirational than it is a matter-of-fact, because the only way we can really mess with dopamine is through the less-than-perfect nature of SSRIs or SNRIs. Dopamine is responsible for pleasure, anticipation, and reward - more of that in the system is a good thing, because that can provide motivation - something those with major depression rarely have an excess of.

And lastly - Glutamate - and glutamate is interesting! Our chemical lever for that is ketamine - though I would suspect “not elon musk levels of K abuse” here. Unlike SSRI/SNRIs though, which work on a direct chemical level within minutes, but don’t have an impact on your mental state for weeks - ketamine can show relief extremely quickly. In other words, an SNRI or SSRI may take a while to figure out of it it works for you or not, but Ketamine will either work for you or not work for you pretty much immediately. That’s a breath of fresh air for a disease that is notoriously hard to prescribe efficacious medication for.

Enter the Dragon

I have spent probably the last decade in a severe major depressive state. SNRIs were decidedly not tolerated well by my body - despite seemingly being one of the best levers to use for my specific manifestations of major depression symptoms, and Zoloft helped to the point where I could consistently keep my mouth and nostrils above the waterline, but not much more. Every day was an exercise in keeping the panic of near-drowning at bay while trying to maintain, at the barest levels possible, a working life. And I genuinely feel proud that I was so successful for so long - it took so much effort and willpower and if there’s one thing I am sure of at this point, it’s that I’m comprised of 80% willpower, 15% coffee, and 5% dreams.

But friends, I was so far gone that I didn’t even consider a life different than the one I was experiencing. I was chasing 1% improvement in my mental state. Anything larger, broader, more impactful than that was as likely as it is for me to turn into a dragon that lives curled at the base of the World Tree. Pure fantasy.

TMS

A random parasocial encounter on a social media network led me to look into repetitive transcranial magnetic stimulation - or rTMS. My doctor, psychiatrist, and psychologist all suggested I look into it at one point or another, especially as we investigated better solutions than the desultory performance of sertraline.

But, I mean… magnets? I’ve seen the magnetic bracelets in woo-woo homeopathy advertisements before. Using magnets to align my chakras to better prepare my body for the reiki crystals and essential oils was not a path I was willing to consider.

I was, frankly, wrong to not consider it with any seriousness. However, this chance encounter hit me on just the right day with just the right amount of energy that I decided “fuck it, it’s in Poulsbo, that’s not too far, and it’s only 8 weeks - work is kinda slow over the summer anyway, so why not? worst case scenario it’s useless, and it leaves me in the same exact spot I am anyway”. And again, and I must stress this part, all I had to do was type into a Contact Us form to get it started.

Telephones are literally impossible when you have major depression. Really, I don’t think you could come up with a less viable communication method for anyone on major depression. Interpetive dance recorded and then delivered via recalcitrant burro is far more approachable than the telephone.

But I didn’t have to use a telephone - and thus, I could get started.

It Changed Everything on Day One

After an intake appointment, conducted over video call, I got set up with an appointment to map my brain. And then it got rescheduled a month later. Not starting out great, if I’m honest; providers, any friction you add to this makes it less approachable by someone suffering from major depression. However, for having no resilience, I was remarkably resilient - which is to say, when compared to many with major depression, I’m able to perservere at a high level. Compared to literally anybody else, we’re all fragile crystaline fairy figurines, but amongst my peers I was tough! I was ready! I was able to handle the friction! Go me!

Anyway, day one happens. The first part of the mapping procedure is nothing too exciting. They found the button for giving instant headaches and they lined my head up in a certain, reproducible way, blasted me with the instant headache mechanism, and looked to see what part of my body twitched. Left side of the brain, so: right hand, which fingers are jumping? Is your left eye twitching? Feeling it in your left jaw? Is it near your thumb or your pinky on your right hand? It was all super opaque to me, and I still don’t understand why the left side of my face was impacted by the application of these magnetic pulses to the left hemisphere of my brain, but my right hand was impacted by it. The latter, I vaguely remembered from … some… class. Sometime. It was in the long, long ago though. But my left eye? Mysterious.

After finding juuuust the right spot, they locked in the cranial coordinates (my phrasing, not theirs) and gave me my first therapeutic session.

I was not expecting anything

Don’t get me wrong, I was optimistic it would work, but my expectations were still kept quite low. The cognitive distortions; it’s not going to go right, you’re going to be one of the N% who don’t respond well to it, or it’s going to take weeks to notice anything - all of these were the most likely scenarios I envisioned.

I never expected it to be like someone flipped a switch - and now, my anhedonia? Gone. Psychomotor retardation? Gone.

Not reduced. Gone. I literally cannot perceive them, at all, right now. Maybe they’re there and 10 years of being in such a severe depressive state that I no longer have any sense of normalcy anymore, but as far as I’m aware?

They’re.

Just.

Gone.

The only remaining symptom that I’m seeing, at this point - and it’s quite annoying, frankly - is the vegetative symptoms.

NO THANK YOU, BODY, I DO NOT NEED TO WAKE UP AT 4AM ALREADY STRESSED OUT.

Let me fucking sleep, dammit!

Today’s Epilogue

I’ll be writing more about this later. I’ll share more about the process, the effects, the benefits, the negatives, and just generally some other thematic stuff. I just want to say that despite it being so early in the 8 week process – I just finished my 13th session – that it has been, without a hint of hyperbole, more effective more swiftly than anything I could ever have imagined. I don’t want to tell anyone that their experience is definitely going to be the same; I cannot know that, and I know that the statistics do not favor a blanket “this is the instant fix button” characterization.

But I can say, without a doubt, that this is the largest qualitative improvement to my life of my entire life – and that’s counting the back surgeries to rectify burst discs and the agony they caused.

It’s truly extraordinary and I feel like I cannot find the words to describe it. Just amazing.