Flat

In depression, between descending into the dark or coming up into the light, there is flat.

Flat affect. Flat enthusiasm (an oxymoron). Flat attitude. Flat outlook. Flat energy.

For me, it usually happens when the meds aren’t quite right.

A month ago, I had been on the edge of a depressive episode, so the psych doc and I increased one med and I’ve been using my blue light. He said that I’d feel better in 7 to 10 days.

It’s been a month. I don’t feel better. I don’t feel worse, either. I feel flat.

Flat is a lot like depression – indeed, it’s part of it, but I tend to feel it more distinctly – as its own symptom – on the way out of depression. Even though the effects are similar, depression has a downward pull, where flat is flat, not down.

Like I could take it or leave it. All of it. Nothing really matters. I don’t have strong feelings of sadness or anxiety, nor do I feel excitement or joy. I don’t really want to do anything. I eat because I’m supposed to; I’m not usually hungry. I’m able to do the things I need to do, be around the people I need to be with, can even overcome the apathy to run errands or attend the ladies’ Bible study. I don’t really want to, but I will.

In depression, the desire to stay home in my pajamas, is so strong! In flat, I can go out and do. In all truthfulness, I go out and do during depression, too. But it’s way harder; I really have to fight myself. In flat, there’s just the barest speck of desire to go and do, so it’s just a hint easier. I can hardly tell the difference myself.

Last week, I accompanied my husband on a business trip, and got to hang out with my kids while he worked. I wanted to go, but wasn’t overly excited like I’d think I would be normally.  I trusted that I would have fun once I got there. And I had a wonderful visit with my kids – was able to live in and enjoy the moments. Our entire family laughed a lot, especially on a relaxed Friday night. But those feelings didn’t stay with me, nor can I reach back to retrieve them. They simply were. And now they’re not.

This flatness happens on my journey up and down with depression. It’s often a first indicator that something is wrong, that depression is threatening to return and wreak its havoc. That’s flatness with a downward pull.  And it comes back when I’m recovering, emerging from the darkness and into God’s light of hope and expectancy.

Usually a tweak in meds will do the trick, and I can bounce the rest of the way up. So I’ll tell my psych doc on Friday that I’m not where I thought I’d be in my recovery, and see if a small adjustment will fix it.

And I’ll remind myself, yet again, that God is with me through my depression. He has not abandoned me, even when I descend into the dark thoughts of depression.  He’s with me in the flat.  And He rejoices with me when I emerge on the other side. He’s my constant companion – I am never alone.

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Doctor’s Appointment

Today, I am grateful to my psych doc for our appointment yesterday.

I had wondered how I was going to describe what I’d been feeling. I couldn’t understand the emotions myself, so how was I going to express it so that he would get it? I prayed several times that God would give me just the right words to describe these vague feelings of down-ness.  Not just the specific days where I really struggled, but the funk I’ve felt for a couple of weeks.

When I got to the office for my appointment, I was given my med list, and a short  questionnaire.  It asked me, on a scale of 0-3, about  the last two weeks, exactly how long I’ve been feeling a little down.

On the questionnaire, zero stands for “not at all,” one is “several days,” two is “more than half of the days,” and three is “nearly every day.” The questions were:

  • Little interest or pleasure in doing things.
  • Feeling down, depressed, or hopeless.
  • Trouble falling or staying asleep, or sleeping too much.
  • Feeling tired or having little energy.
  • Poor appetite or overeating.
  • Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
  • Trouble concentrating on things, such as reading the newspaper or watching television.
  • Moving or speaking so slowly that other people could have noticed.
  • Thoughts that you would be better off dead, or of hurting yourself. 

Turns out, it’s based on the Goldberg Depression Test, used by NIMH. It’s a standard in the field, a quick assessment tool to help doctors determine the severity of depression in a person. I scored 8.  Not bad, but not a 0, either.

And it allowed me to express myself and what I’ve been feeling lately.

So when I entered the doctor’s office, he asked me how I was. I said I really didn’t know, but the quiz sure helped. I told him I’d been in a funk for a couple of weeks, even before my husband went on a 10-day business trip, which I was sure didn’t help my mood. I told him that I’d been feeling down, but not hopeless.  He asked some of the questions I’d already answered on the questionnaire, for clarification.

He said I’m right on the edge of when these issues become a concern – two weeks.  He told me that for a person who has recurrent depression, and has had it as long as I have, he likes to be a little aggressive in treatment. He’s glad we caught it early, because waiting could make it worse – depression gets deeper and harder to get out of.  I told him that I just recently pulled out my light box and had begun using it.  We also agreed to increase one of my meds; it’s one that I’ve been on for a couple of years, seems to have been working well for me.

He said he sees a lot of this mood at this time of year – the onset of winter, the holiday season, the longer darker days.  He thinks that I should be feeling better in 7-10 days.

I’m relieved. It was good that he understood me, and that the questionnaire helped put into words what I had been unable to express. I’m looking forward to feeling better soon.

5 a.m. Musings

I woke at 4 a.m., laid in bed for an hour. These were the things going through my head:

  • Jack Johnson’s Banana Pancakes song (just the words I know)
  • Does Starbucks have pumpkin bread or muffins? I have to take the car in this morning for a front end alignment; maybe I’ll stop first and treat myself to a mocha and pumpkin bread.
  • What should I take to S’s on Saturday? Brownies? Something pumpkin? (back to thinking about Starbucks)

Then I decided to focus my thoughts on times during depression when I felt relief:

  • Taking a nap at B’s house – I remember laying down on her couch, a throw pillow under my head, her blue chenille-weave blanket over me. I felt so safe and sleepy.  I must have made her whole family, including her two teenage boys, tiptoe around, because I didn’t wake for over an hour. I remember B doing dishes at the sink as I sat up. Her smile at me – just the best thing a weary friend could see. Do you remember that, B?
  • My husband’s arms wrapped around me. Standing in the kitchen with my back up against the counter, and he pulled me towards him. I tucked my arms next to my sides, so he was completely around me, and I put my head down on his chest, under his chin. I felt safe, supported, enclosed. I knew he was with me through this thing called depression – his hug, and holding me, proved I wasn’t alone. I still like that position of a hug, with me wrapped completely up in his strong arms. I feel so safe there.
  • Walking into Ted‘s office (my therapist) – the stillness of the room; the sensation of taking off the invisible heavy backpack with the weight and cares of the world, and laying it beside my purse; sinking into the cushions, usually clasping a throw pillow to my chest (part comfort, part protection of my vulnerabilities that I will be sharing). He sits across from me. He smiles and I can feel the tension of the world leave my shoulders. For a few times, I sat in the rocking chair with the cream-colored fluffy blanket – the rocking motion is still soothing to me. But I prefer the couch, where I can sink down into the cushions, put my head against the back, and slouch behind my pillow. Soft glow from the lamps. A candy dish on the table. Kleenex within reach. I look up to the windows at the top of the wall – stare out at the clouds and branches. The quiet is almost tangible, like the room is doubly insulated against the terrors and pressures of the outside world, where my depression has me in its grip. But this is a safe place, and I can talk about my fears and sadness here.
  • Later, walking into Elizabeth‘s office (my therapist when I moved to FL) – the beauty of the room, the cheerful patterns.  Though my need wasn’t as strong, she had throw pillows for me to clasp, to hide behind. Her gentle voice. Her soft words of encouragement and prayer.

Now, it’s almost 4:45 a.m., and I start thinking about my previous post on Scripture, particularly Philippians 4:6-7, NIV:

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.  And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.

I think more on this verse, and how it has helped me, just not when I was in my deepest depression.  In my “lighter” versions of illness, I can quote these verses and feel some relief. But I’ve also come to realize that the second part of this – the promise of God’s peace – isn’t necessarily an immediate response to the first part – the praying and petitioning. The peace comes eventually, but not necessarily immediately. This in itself is comforting to me, since I felt like I was failing somehow, when I didn’t sense God’s peace after begging Him to help me not be anxious, even after thanking Him for depression and all it was teaching me. To realize that I didn’t immediately feel peace, the peace promised in verse 7, I felt like I was failing at trusting God for my relief and His peace. But now, to realize that the peace of God, which is beyond my understanding, will come and take its place in my heart eventually, is great relief.

Now it’s 5 a.m. I think I’ll get up and write this all down.

A Hard Truth about Scripture and Depression

In my previous post, I included some practical things that were said to and done for me in the midst of a depressive episode that helped me. Here’s more: A friend let me come over and take a nap on her couch so I wouldn’t be alone. Another called me daily to check in. One took me shopping at Walgreens for Christmas stocking stuffers. One gave me a ride to work when I was unable to drive because of medication. Another brought dinner for the family. Good friends even saw me when I was in the psych unit – not an easy place to visit. One sent – and continues to send – encouraging cards and notes.

These folks were Jesus to me – “Jesus with skin on.” And that was the point of the post – practical things you can say to or do for someone in the midst of depression that they might find comforting or helpful.

You’ll notice, if you’ve read many of my posts, that I didn’t include helpful Scripture. Part of that, to be honest, is that quoting the Bible to a person who is in the depths of depression is not necessarily helpful. At least, it wasn’t for me. This is a hard truth – just throwing God’s Word at me wasn’t helpful when it was spoken without “stepping into” my suffering.

Now don’t get me wrong. Many friends shared God’s Word with me, and I found the verses encouraging and comforting – to be reminded that God is always with me, that He desires hope for my life, that He hears every cry from heaven – every prayer – called out to Him. But I only felt this way because these friends first made an effort to understand my suffering.

For me, reading God’s Word in the midst of a depressive episode, at the depths of despair, wasn’t practical. For one thing, I couldn’t read, couldn’t actually focus my eyes to make out the words on the page. For another, I felt so guilty about my depression and the accompanying negative thoughts, that often Scripture felt condemning, not comforting. The comfort came in being reminded that Jesus was with me, not in particular verses from the Bible.

Some verses left me feeling completely inadequate, and unable to call on Jesus for His saving strength. I had to be reminded to do these things – hearing Bible verses didn’t inspire me to do so. And others doing this for me – standing in the gap, so to speak – was invaluable. I couldn’t do it, so others did it for me.  They prayed for me when I couldn’t even form the words to a prayer.

In my better moments, I was able to write God’s Word into my journal, to write out prayers to God for strength and healing. My journal is full of these. I also used a little book, God’s Promises for Every Day, by W Publishing Group. It’s full of verses for particular struggles – verses to read when suffering from depression or anxiety, or when wondering where God is. It’s got verses about peace, God’s love, doubt, eternal life, God’s faithfulness, confusion, Jesus as your friend or Savior or Lord. And the Holy Spirit brought memorized verses to my mind to help me. since reading the Bible was so difficult to do.

I guess what I’m saying is that simply quoting Scripture to a person struggling with depression is not necessarily helpful. Telling me to practice Philippians 4:6-7 doesn’t just make the anxiety go away – I was already trying to live those verses, but wasn’t feeling peaceful. Quoting I Peter 5:7 doesn’t necessarily relieve the burden – it’s hard to cast anxiety on Jesus when I’m drowning in depression and its companion, anxiety. It’s hard to cast anything. That required energy I didn’t have.

Please don’t misunderstand. God’s Word never returns empty – it will accomplish what God intends (Isaiah 55:11). But shared outside of the context of the suffering I was experiencing felt cruel. It left me feeling less than, unlovable, abandoned, misunderstood.

It was better to be told the verses that folks were praying for me. It was more helpful to be gently reminded of the truths of Scripture than having them shoved at me.

So please, in reaching out to a friend in depression, don’t simply quote a Bible verse and expect that to help. You need to show them that verse, living out Jesus’ love to them. Don’t hurt them with God’s Word – apply it as a salve in the context of their suffering.

Things you can say…

I made this list when I was depressed and needed my husband to help me see the way out of the darkness. These are things that I suggested that he could say, preferably as he hugged me.

It turned out that it didn’t matter that I told him what to say… it always made me feel a little better.

If you know someone struggling with depression, try saying one of these things.

  • You’re not alone.
  • You’ll get through this.
  • I’m here for you.
  • Is there anything I can do?
  • Do you want to talk? I’m here just to listen.
  • Come sit with me.
  • You’re doing fine.
  • You are okay.
  • This will eventually end.
  • We’ll get through this together.
  • I’m calling tomorrow to check on you. (Then do it!)

(just show up and say) I’m here to ____________________:

  • do your laundry.
  • make you lunch (bring the stuff for it).
  • sit with you.
  • play with your pets.
  • take your dog for a walk.

Let me just ____________________:

  • sit with you.
  • hug you.
  • hold you.

Sometimes when someone close to you is hurting deeply with depression, you might not know what to say or do. Ignoring it, or pretending everything is okay, is almost impossible for the one suffering. These are just suggestions of things that worked for me, in my life, when others said or did them.

If you’re the one suffering, I urge you to tell someone close to you what you need them to say. It’s okay to have to tell them – they can’t read your mind, and might feel awkward, like they’re afraid to say or do the wrong thing. So tell them what you need from them. You’ll both feel better for it.