Unsound Mind

One of the bizarre things about chronic depression is how it can just sneak up on you. You're going along, doing fine, then . . . you realize that you've been increasingly miserable for . . . weeks.

Shortly before Christmas last year, I found myself feeling hypersensitive, for lack of a better word. Things that I ordinarily would have taken in stride suddenly made me weepy and kept me awake at night.

I thought the winter break would be a good respite for me - and it was - but it was not enough to tip the scales. I added yoga to the mix, only to find myself with tears rolling down my cheeks as I lay in corpse pose.

A few weeks ago, I decided to increase the dosage of my happy pills. And that's all it took. None of the external factors have changed, but now I am back to feeling "myself." I feel resilient, confident, balanced.

The bad news about this is that I'm now at the maximum dosage, according to my doctor, though I've been at almost double this while under the care of a psychiatrist. Still, it is an indication that it may be time to adjust my medication, maybe try something new. I'm not thrilled at the idea, but I'm looking at this with a longer view.

From "Spotting the Signs of Seasonal Affective Disorder"

I've started wondering about Seasonal Affective Disorder. Although I wrote above that "none of the  external factors have changed," one external factor has changed: the amount of daylight. And sunlight is known to stimulate serotonin production . . . As I get out in the sun more this spring, perhaps I'll be able to reduce my dosage of medication. And I should probably investigate getting some special lamps before next fall.

I've also been thinking about the ever-present analogy with diabetes, it being another chronic disease, but one for which no one apologizes for needing medication.

(I will point out that people with Type II diabetes do feel shame for having "caused" the disease.)

But back to my point. I'm going to give a short (simplified) lecture here about the difference between Type I and Type II diabetes.

Type I (formerly known as juvenile diabetes) is where the pancreas does not produce insulin. At all. None, nada. The blood sugar therefore has no mechanism to transfer into the cells. It just floats around in the blood until is spills out in the urine. (Before insulin injections came along, doctors used to encourage diabetics to eat all the carbs they could, in the hopes that at least some of them would make it across the cell membranes.)

Type II (formerly called adult-onset diabetes) is where the pancreas produces some insulin, but the insulin isn't doing its job: the cell membranes have developed "insulin resistance" - so it takes more and more insulin to help the sugar transfer into the cells. The pancreas works harder and harder to get the cells what they need, but it can eventually exhaust itself and - ultimately, if not treated - become unable to produce insulin at all, thus turning the disease into Type I.

Bear with me as I draw a parallel.

With depression, we have come to understand that if there is insufficient serotonin (a neurotransmitter) in the brain, patients feel depressed. (Or vice versa: depression may cause the reduction in serotonin. We don't know.) Modern medicine has made the miraculous (to my mind) discovery of SSRIs (selective serotonin re-uptake inhibitors) which allow more serotonin to remain available within the brain, rather than being absorbed.

In my case, I know I have a chronic serotonin imbalance, and have had for decades. What I'm wondering is if there is a comparable Type I and Type II to depression. Is it possible that my brain's ability to produce serotonin has gone from poor to negligible? In that case, inhibiting its absorption wouldn't really help.