Checking Under the Hood

The word ‘Dysthemia’ is a Greek word which, when used as a noun, means ‘melancholia’ or ‘low mood’. (Can it be used as something other than a noun? I don’t know nothin’ about Greek.)

Anyhoo. Dysthemia is at the root of my own personal dance with depression. (Dances With Depression: Kevin Kostner’s new direct-to-film picture!) Sorry. So. Before the Cyclone Of Shit (CoS – beginning with my dad’s death) I was pretty much okay. I had my ups and downs, but they were normal – for my own personal value of normal – and I was, overall, a happy and hopeful little elf.

What dysthemia meant for me is that when the CoS hit, I got kicked down to a lower level of depression and couldn’t pull myself out of it. I call it: SUPERDYSTHEMIA. (No, I don’t.)

Before I go too far into this, I’m going to do a quick bit on how I think (because I’m not a doctor, and I only know what a couple of books and the internet have told me me) depression and anti-depressants work. DO NOT QUOTE THIS. Also do not use this to base any sort of anything on. At all. Ever. Okay? For the purposes of this post alone:

1. The neurons in your brain use neurotransmitters (chemicals) to pass information from neuron to neuron about emotions. For the sake of this example, let’s say the message – aka neurotransmitter – is ‘happy’.

2. Once the message has been sent from neuron A to neuron B via neurotransmitter, ‘happy’ is sent back to neuron A and reabsorbed. Let me again be clear: I understand this about as well as I understand fax machines; that is to say: not at all. Anyway. This process of re-absorption is called ‘reuptake’. ‘Happy’ has now been re-absorbed for future use.

3. There are two neurotransmitters called serotonin and norepinephrine, low levels of which are associated with depression and dysthemia.

4. Cypralex, the medication I’m on, is an SSRI. SSRI stands for Selective Serotonin Reuptake Inhibitors. From this I’m assuming they’re either increasing the serotonin neurotransmitter, or they’re blocking it from being reabsorbed. Either way, serotonin levels go up, and I feel better.

Righty-oh, that’s enough uneducated information from me. So let’s split my life into two categories: Gwen A and Gwen B. I’m Gwen C (wave!) but more about me later.  Gwen A was me before the CoS. Gwen A had dysthemia, but she didn’t know it, because her little serotonin levels had been just a titch low her entire life. It wasn’t bothering her. Also, she had the coping skills of a fox, baby.

Then the CoS came, and those serotonin levels got depleted even more. Gwen A is now Gwen AB (now I’m a blood type? Dammit, this is a terrible way to narrate my story, but I’ve gone this far so I’m just going to barrel through…) with low levels of serotonin. She’s not sleeping well. She’s not eating properly. She has spent more than one night laying on the floor of her living room for no apparent reason, crying. She works sixteen hour days most of the week because it makes her feel like she’s getting something done.

Annnnd Gwen B. Because of the aforementioned fox-like coping skills, she pretty much gets along with life. She maintains friendships and a job and a relationship, and for the most part she seems fine. But she is completely overrun by anxiety and hopelessness. Oh, and a weird, random fear of death. Not a fear, even, really, just a certainty that she’s going to die young. This (to her) is an obvious conclusion of the fact that she can no longer conceive of her own future.

Let me be clear: Gwen B is not suicidal. Just resigned. And I? I am not a person who is resigned.

This is the main difference between the Gwens. (Ohhhh god this is so awful. I sound like I have MPD, on top of all the fun Greek shit. Seriously, I can’t stop.) Gwen B can be easily recognized by her lack of hope and her root-fact convictions. The thing is, you can’t see convictions or a lack of hope. And did I mention the coping skills? Did I make those sound good? In fact, they’re probably the thing that kept me from getting help and therefore, getting better, all those years. You can have the best success network in the world and it doesn’t mean shit if they don’t know what’s going on.

So! Gwen C is medicated. Hi! I’m going to go back to writing like a single human now, yes? Yes. Good. I’m (presumably) at a fairly normal level of serotonin right now. I’ll stay on these meds for a year or so, because that’s where the highest success rate is, and I’m a great believer in going where the greatest successes are. After that, if it seems like the right thing to do, I’ll go off of them bit by bit, and at some point I expect to be Gwen A again – which is a lot like me, now. I will probably have a slightly low level of serotonin or whatever little neurotransmitter is being pissy, but I will be fine. I can cope with that.

Gwen B, though – that gal is out. Still, it’s good to have seen her. Now I know what to be on alert for.

Question of the day: People who deal with or have dealt with depression, what are your red flags for when it’s time to start doing some work, seeing someone, or looking at medication?



14 thoughts on “Checking Under the Hood

  1. Go, Gwen C! (Also, good job other Gwens on your fox-like coping skills. I’m glad you contributed positively to Gwen C’s eventual serotonin adjustment. Okay, I’m going to stop talking to you like you’re separate people, now.)

  2. It’s funny because I’ve been thinking of going back on my meds again. 🙂

    That smiley face is fucking ironic. For some reason this weekend I had a bad psychological “spill” i’ll call it. I was great one day and then didn’t seem to regain my footing. Got a little better when my wife came back from DC. But still it’s killer. Feeling better now but when you’re in the trough you’re in. the. trough.

    I know for me when I don’t get enough sleep and I start to slip that’s when I need to beef up on my regimens: yoga, working out, eating right, meditating, etc. Easy on the alcohol and no self-medicating (this means cookies and anything else “baked”).

    9/10 I can get myself straight in about a week or so. Some weeks are just better than others.

    • So here’s my question, then: When you know that you need to beef up on the yoga, meditating, etc., but you’re in. the. trough. …Can you do it? Is there a period of pre-full-trough in which one can avoid the full-trough experience?

      And did any of that make any sense?

  3. Hmmm. Usually it sneaks up on me. But often if I don’t get enough sleep – I know that sounds facile but really it’s a huge issue for me and has been fore about 13 years or more – I become just DESOLATE.

    Over the years I’ve come to realize that so long as I just stay on top of my sleep and get enough at night – uninterrupted with the help of some friends like Alprazolam – then I should be okay for the most part. And I must get up and go out. The dog helps with this. Also getting the kid to school and stuff. So long as I get up and do at least one thing I won’t feel like a burden on society, my family and the ancestors.

    Does that help at all?

    • Yeah, it does. Thanks! I’ve often joked that these magic pills are actually just very, very specific types of sleeping pills. So I don’t think it sounds facile at all – after all, sleep is when we recharge and restore ourselves. When we don’t get enough sleep, it makes sense that our brain chemistry would be affected.

      And dogs? Dogs are nature’s Happy Pills.

  4. Interesting discussion. I used to be on Celexa for quite a while, then switched to Cipralex. It seems that the active ingredient in Celexa is a double helix molecule, yet only one of those two twisties does the therapeutic medicating. The other is just …there… and has no therapeutic value, and has also been suspected of contributing to Celexa’s occasional side effects. This bore out in my own experience after the switch, to Cipralex, though to be fair, I wasn’t all that troubled by side effects from Celexa in the first place. But the Cipralex had even less. Unfortunately, after about two years the Cipralex ‘pooped out’ as they say… so I moved over to Cymbalta a couple months ago in the midst of a very bad CoS period (to borrow Gwen’s wonderful phrase), and that stuff is pretty damn good I must say; helping dramatically despite a NASTY year which culminated in a family court trial just yesterday. (Feel hit by a truck today… come oooooon Cymbalta…!) Regardless, C made my depression go from about a 9 down to around a 3 or 4, despite a vicious and psychotic ex-wife with more money for lawyers than I have. Had.

    Cymbalta is an SNRI, which is a serotonin AND norepinephrine reuptake inhibitor. Norepinephrine (or a lack thereof) is implicated in ADD, for one example. Norepinephrine (also called noradrenaline outside of North America — it’s like they just HAVE to be different overseas) is a chemical your brain releases in spades when you find yourself in a fight or flight situation. It enhances your ability to concentrate attention, increases muscle tone and blood pressure (moderately), and so on. So you could say increasing norepinephrine gives you some of the ‘zowie!’ you get from being startled or threatened, without the ‘whoa fuck!’ emotional stress and intense mental discomfort you might expect with, say, the process of being murdered.

    Another neurochemical we have not been discussing is dopamine. It’s a feel-good, energy-providing one. Cocaine and meth etc. block it’s reuptake big time, but with the nasty outcomes we all know of only too well and wish to avoid… There is however a wonderful drug called buspirone which enhances dopamine in much the same biological manner as the antidepressants under discussion here function. Buspirone is amazing for anxiety, can be taken with antidepressants, has no side effects that I can really speak of (except for on the ramp up I got a few night sweats here and there which went away again), and is clinically shown not to diminish in efficacy over time like SSRIs seem to. It can also be taken just fine with alprazolam (Xanax), Ativan, … all the pams and prams and vans and so on, if you require these occasionally too.

    Apparently buspirone also helps offset sexually diminishing side effects often associated with SSRIs, which is a bonus. So to speak.

    Just thought I’d toss all this in to the general discussion… Thanks.


    • Fascinating!

      I mean, firstly I’m sorry to hear about your horribly challenging year. But the way the drugs work is the interesting part. I was on Citalopram and that was okay for a while (it’s a generic of Celexa, I believe). But I believe it helped me put on a few extra dozen pounds. I’d be curious to try the Cynbata though honestly I’ve been treating my depression with a fairly strict regiment of exercise. This seems to be helping.
      When I was diagnosed with ADD back in 1988 they tried me out on a number of drugs, amongst them Ritalin and Norpramine which is what I thought you wrote above. Norpramine is of course another chemical combo entirely. That stuff slowed me down to half speed. It was nuts.
      But I am curious about Cymbalta now. What are the side effects related to it? I could google it but Gwen here has provided a nice forum for human discussion. 🙂

      • Chang – Human discussion: One of the many victims of Google 🙂 Apparently weight gain is a major reason that a lot of people give for not going on anti-depressants. Personally, I find depression itself causes weight gain, so it’s six of one, etc. I find on the magic pills that I have more inclination to get to yoga, go out for a run, walk the dog, etc., so I think I’d happily argue with the weight-gain-as-a-side-effect issue. Still, that was apparently one of the things that they really worked on in the development of Cypralex. I’m glad I missed the age of Celexa.

        All of which is neither here nor there. The fact that I have no side effects from this stuff is pure dumb luck and the fact that Cypralex is really designed to be low on the side effects and easy on the withdrawal.

        Blah, blah. Back to Brian re. Cymbalta!

    • So, you lost me – why would one want a norepinephrine reuptake inhibitor? I mean, unless you wanted the increased muscle tone, but that seems like a high price to pay. Is it primarily for the increased concentration and attention?

      It takes a lot to get me to the fight-or-flight point of adrenaline, which may be the only natural talent that allows me to be a pilot. Still, I’ve been there once or twice, and I haaaaaaate it. With all the extra a’s. S’a lotta hate.

      Brian, I’m sorry to hear about your CoS period. I hope it’s on the way out – that, I suppose, would be the ‘Mild Winds of Shit’ period. If not, then I send you hope and strength to grit your teeth until the winds have calmed.

  5. Wow you guys I feel the genuine love! This is awesome. I’m a recovering alcoholic and attend regular AA meetings, and this forum has same kind of gentle trust and honesty I often wish other people could enjoy without going though addiction first. I bet this stuff catches on, you know: We know the rampantly material consumer society cannot continue, and in fact it seems already over the hump — note the rapid movement to wastelessness and recycling consciousness; the revilement of hummers and bankers and ‘the 1%’ — a change is a a-comin’, baby, speaking of prevailing winds…

    I think the next frontier will be the internal one. The inner landscape. The pendulum is swinging back toward spiritual and psychological fulfillment. So of course we can expect it to be littered with the usual fads and cons too, but there will also of course be truth among it too. Anyway, my point is that this sort of thing is great and promising and I hope we all see much more of it.

    Anyway – the norepinephrine. I did not convey very well I guess about the ‘fight-or-flight’ autonomic response associated with the drug Cymbalta is a) graduated and controlled, as opposed to dramatic and acute as it would be in a real threatening situation, so the sensation is not one of discomfort but rather a sort of focused energizing; and b) the whole shebang is (hopefully) not associated with an actual panicked affective experience — so it is not unpleasant, or even really consciously detectable.

    As I understand it, the added focus lent by a higher level of the norepinephrine helps many people who’s depression is accompanied by anxiety. If you are like me, for example, you would normally go through the day trying to cope with and chart disaster flow charts for a handful of radios in your head, playing different emergency broadcasts with your actual name in them all at once. …And people wonder why you should be terse with them when they dare speak about something irrelevant or needless when you are busy with relentless visceral urgency… Insensitive louts. Don’t know how lucky they are. Hmmmph.

    Anyway so that’s why it helps. Leaves you with only one, maybe two radios predicting your impending disgrace or demise at a time. Much more manageable.

    Plus you get more work done when aren’t as distracted by shiny things. In fact there is a move away from amphetamines like Ritalin, and toward norepinephrine reuptake inhibitors like Straterra, for example, to treat ADD specifically. Straterra acts on norepiephrine exclusively in fact (it was originally intended for depression but didn’t really work; “but hey those ADDs are speaking in full sentences!”)

    Hope that helps. and thanks again for the kind sentiments.


  6. Okay. I take it back. Had to get off Cymbalta, and pronto. Wound up getting TWEAKED by that norepinephrine… To be fair, I am still assured it works as described above for most people, but I seem to have had a paradoxical reaction to it once the larger, ‘regular’ therapeutic dose sunk in after a few weeks. Don’t want to discourage anybody if they want to try it, but suffice to say it became decidedly unpleasant when life situation became rough, and I had anxiety attacks that would have sent ‘normal’ people screaming. Lucky me I am very well-versed in horrible anxiety levels and managed to ride it out.

    Quit cold turkey, which is a no-no and another discussion altogether. All I can say about that is, if you find you have to do so and stop any SSRI abruptly, get yourself some Benadryl and use it for the brain zaps until they subside. And fish oil capsules. Three or so a day.

    No time to elaborate right now but Google ‘SSRI withdrawal, Benadryl’ and you’ll get the gist of what I’m referring to. Otherwise, remember everyone’s reactions to each med can be dramatically different. So don’t be discouraged if you want to give ‘er a try…


    • Yoikes, Brian, sorry to hear that. I’m going to add my general vote against quitting cold turkey, though I’m not judging your choice – just in general, I’m against it. I really hope you’ve got something that works for you now – and a good support network! If not, you’re always welcome here 🙂

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