No way out
How depression affects young adults and the people they love
On May 17, 2008, Geoff Lawson married his college sweetheart. He promised to love Amy in sickness and in health; they traded rings and swore a lifetime of affection. The couple settled into a Louisville apartment for their own slice of Happily Ever After.
But four months after the wedding — the night before Louisville’s infamous September windstorm — Geoff’s marriage vows were sorely tested. He found himself driving to the emergency room with his bride weeping inconsolably in the seat beside him. For months, his spouse had been slipping deeper into a depressive darkness. Now, she was in the midst of a panic attack that wouldn’t stop.
Geoff, 27, went into the marriage with his eyes wide open: Amy never hid her struggles from him. “I knew (my wife) had some emotional problems,” he acknowledges. Amy, now 26, told her husband-to-be that she’d wrestled with depression since high school and had taken medication on and off through college. Panic attacks, with crushing chest pain similar to a heart attack, were nothing new.
Yet even with the advance warning, her post-marriage spiral was a shock to Geoff. “I don’t think I realized how severe things were going to get,” he admits.
The trouble began in earnest on their wedding night. Geoff discovered as they checked into the hotel that he’d left their wedding-gift cash in the car. He took Amy to the room and headed out to retrieve the money.
Unfortunately, that’s when Amy started on a perilous train of thought. “I was just lying there,” she remembers, “and it hit me that I didn’t know the next time I was going to see Sarah.”
Amy and her sister were best friends. They attended the same college and had never been apart for long. Even since graduation, when Amy moved from Cleveland to Louisville to be with Geoff, there were frequent visits home in the name of wedding plans.
Now that the nuptials were over, her family wouldn’t be visiting for months. So by the time Geoff returned from the car, Amy was in tears. He tried to console her, only partially successfully.
After the honeymoon, Amy began having trouble at work. She’d been hired as the frame shop manager at a craft store, but her boss soon demoted her to an hourly staffer and elevated a more experienced employee — someone Amy didn’t get along with — in her place.
Geoff’s job as a youth pastor pulled him away from home for several weeks as he took students to summer camp. Amy was left without her primary support. Meanwhile, she began to worry about her wedding pictures. They should have arrived long before, but the photographer kept stalling. Amy wondered if she’d have any images from her big day.
She also continued having interpersonal problems with her new boss. In the end, she resigned under pressure: “(It was) for my emotional health,” she says. “I really liked a lot about that job, but I felt like I had failed.”
For several weeks, Amy hung around the house. She was adrift without her job, friends or family. Her grandfather died around the same time, and she was unable to attend the funeral.
Finally, a long-awaited day came: Her wedding pictures arrived. Unfortunately, the photographer sent substandard images — and only half the number he’d promised. As an art major, Amy took it personally. “I felt like a bad photographer because I’d chosen him,” she confesses. That’s why the wedding pictures finally made Amy snap.
“That night, she started screaming and weeping and bawling and yelling,” Geoff remembers. Amy went to take a calming shower and came out still in hysterics. Geoff had no idea how to handle his bride during what she describes as a “mental breakdown.”
He called Amy’s family. Her mom and sister immediately got in the car and began driving the six hours from Cleveland to Louisville. Then he called his health insurance company’s hotline, which urged him to take Amy to the ER.
By the time Geoff finally got his wife into the car and began driving to the hospital, 90 minutes had passed since the crisis began. Amy was still weeping uncontrollably. She didn’t calm down until the emergency room staff rushed her through a packed waiting room for immediate care and pumped her full of anti-anxiety drugs.
The abrupt transitions in Amy Lawson’s life would have given anyone a rough time. For someone with a personal and family history of depression (her dad has taken medication for years), they were crippling. Clinical depression like hers is more than ordinary sadness.
Sometimes, depression victims continue functioning but feel like they’re walking through a meaningless world. Others stop performing life’s simplest tasks, like getting out of bed or handling personal hygiene. Many (like Amy) also develop anxiety, compounding the sad numbness with inflated fears. In its various forms, depression affects about 15 million Americans every year.
Depression can strike people of any age, but often makes a first appearance during the teen or young adult years. In fact, 75 percent of mental illness sufferers will have the first symptoms by their mid-20s. So it’s no surprise that Amy had an initial brush with depression in her teens — or that it hit her hard right after college.
“Depression means you feel sad most days … for at least a couple of weeks,” explains Fausta Luchini, a principal therapist with Seven Counties Services. “You have this whole cluster of symptoms: a lack of pleasure and interest in activities, sleep and appetite disturbances, feelings of worthlessness and excessive guilt, thoughts about death or dying, and psychomotor retardation (thinking and moving more slowly than usual). If the symptoms interfere with your functioning (in areas like) relationships and work, you might want to think about doing something about it.”
Luchini urges people who suspect they’re depressed to call the Seven Counties Crisis Line at 589-4313. “It’s like free, one-shot counseling,” she says. “They’re not pushing our services, believe me. If you can be OK on your own, we’re all right with that. But get some feedback on whether you need help.”
Unfortunately, there’s a stigma attached to mental illness that doesn’t accompany any other disease. So Luchini understands that asking for help is tough.
“I believe the sooner you find somebody to talk to, the sooner you’ll feel better,” she says. “But I’m a big believer in choices. … Some people think their depression is just going to go away. They try thinking positive. … Well, see how that works for you. You might want to read some stuff; get a self-help book. But I’d really encourage you to consider (therapy) if that doesn’t work. When there’s assistance out there and you’re too ‘manly’ or too ‘independent’ to use it — well, who are you hurting?”
Untreated depression can last for months or even years, and frequently recurs. In contrast, the Depression and Bipolar Support Alliance estimates that about 80 percent of depression victims experience decreased symptoms within six weeks — if they seek counseling, medication or both.
Perhaps the most insidious part of depression is that unlike other chronic illnesses, its affect extends beyond the sufferer. Geoff Lawson could tell you that it’s a blow not just for the victim, but to everyone she loves. That’s why Cheryl Hunt, executive director for the National Alliance for the Mentally Ill (NAMI) of Louisville, urges family members to be proactive when loved ones show signs of depression.
“I think it’s normal to be in denial at first, no matter what illness you have,” Hunt says. “(People may think) ‘I don’t want to see the doctor and have him tell me I have diabetes.’” Yet whether the illness is diabetes or depression, treatment is the first step toward getting better. So Hunt counsels concerned relatives to educate themselves on the symptoms, then broach the topic with the depressed person.
“Identify whether your family member fits in that situation,” she says. “And then be very non-judgmental. If you judge, you lose the opportunity to help. Approach them like, ‘You’re having a rough time — can I help you find some support?’”
No one can force a depressed person to seek assistance. But for an illness that may end in misery or even suicide, it’s worth a try.
As for Amy Lawson, she started looking for help on her own, weeks before her trip to the emergency room. She made an appointment with a counselor and got a prescription for Wellbutrin, the antidepressant that helped her father. But medication may need up to six weeks to work; counseling, even longer. So Amy’s treatment hadn’t taken effect when her lousy wedding pictures arrived. That was the last straw.
Her darkness didn’t lift for more than a month after the night at the hospital. Left to mope around the house with no job and few friends, her illness actually got worse. “There were times when I wouldn’t get out of bed,” she says. She had thoughts about death that disturbed Geoff: “Do you ever think about just driving off the side of the road?” Amy asked one evening.
She began inflicting injuries on herself by “cutting.” Slicing one’s arms with a knife doesn’t sound like pain relief to most people, but for some teens and twenty-somethings, it’s a relief valve for numb, mangled emotions. The bleeding somehow seems to externalize their inner pain.
“There were several times when I came home that Amy was very evasive, wearing long sleeves,” Geoff recalls. “She would cut when she was angry and upset. She was so depressed most of the time that she wouldn’t tell me how she was doing.”
Finally, around the end of October, Amy slowly began to find relief. “It never makes sense what sends me into depression,” she says, “and (coming out of it) seems just as random.” Certainly medication played a role — by now, Wellbutrin was having an effect. Her therapy may have helped some, though she admits she probably stopped going too soon — “I didn’t like my counselor.”
Support from people in the Lawsons’ church was definitely a factor. Geoff joined other staffers in praying for Amy regularly, and the senior pastor gave him time off to spend with his wife. Meanwhile, Amy was encouraged by the members, including an older woman who’d experienced depression herself. “We saw baby steps of her walking out of the darkness,” Geoff remembers.
Yet there were inevitable setbacks. One night in Amy’s Bible Study group, the leader taught that genuine faith requires Christians to eschew antidepressants in favor of prayer. Amy knew that radical view wasn’t shared by her church as a whole, but it still wounded her.
One of the most important steps in her recovery was finding a new job. Now, she had a reason to get out of the house instead of focusing on her tangled emotions: “You can’t just wallow in (depression),” she says, “even though you don’t feel like doing stuff.”
By the time the 2008 holiday season rolled around, her support system was bringing Amy real relief. The numbing fog had lifted: Happiness was possible again.
Amy’s journey through depression highlights the two major causes of the illness. One is an imbalance in the brain chemicals that regulate mood, often inherited from a family member (like Amy’s father). The other is stressful situations, such as her move to Louisville. “With everyone I see,” says psychiatrist Michael Thompson, “there’s some combination of a genetic predisposition and extra stresses.”
Thompson uses drugs to treat the genetic/brain chemistry problem. He explains that antidepressants act on key neurotransmitters that affect moods (serotonin, norepinephrine and/ or dopamine). Yet he admits that psychiatry remains an inexact science, because the human brain — by far the most complex organ in our bodies — is still poorly understood.
Brain scans demonstrate that there are physical differences between the brains of depressed and non-depressed people. Drugs that act on certain brain chemicals give most people relief. So there’s little doubt that depression has a physiological basis, just like any other illness. But there’s still no blood test or X-ray that can diagnose depression, so psychiatrists must rely on talking to their patients.
“If someone can be open and honest about how they’re functioning, it gives me an idea of what I can do to help,” Thompson says. “But for some people, it’s not going to be a very quick fix.” Often, people don’t give their medication a chance to work — six weeks seems like a long time when you’re depressed. The Depression and Bipolar Support Alliance estimates that half of those who don’t recover stopped taking their drugs earlier than they should have.
Given a chance, however, antidepressants bring pleasure and joy back into many people’s lives. Amy Lawson is living proof. So is Cheryl Hunt (of NAMI Louisville), who has suffered from depression herself. Now in her 50s, Hunt credits antidepressants for keeping her from descending into darkness for the past 10 years. That’s a sharp contrast with her younger years, when she remembers many months of her life as a weary trudge through the fog. She always kept clawing her way out of bed and going to work, but the internal misery was unbearable.
“You can go about a month trying to cope, but eventually, you slide into a very hopeless, helpless feeling,” she says, remembering her episodes of depression. “Now, being on medication makes me productive. It gives me a good life. Our generation, the baby boomers, are the first ones to have access to (good) medications. For family members older than me, there was no help.”
Hunt urges anyone who’s suffering to get medical attention, beginning with an appointment to see his or her primary care doctor, who can prescribe what the patient needs or refer to a specialist. For those without insurance, the Family Health Centers of Louisville (fhclouisville.org) provide care on a sliding-fee scale. No one should suffer in the darkness unnecessarily.
Yet even the best antidepressant in the world only addresses half of the depression equation — the chemical imbalance. Therapy is designed to cover the other half, the stresses and circumstances that trigger an episode. That’s why depressed people are most likely to recover when counseling and medication are used in tandem.
Therapists help clients learn new methods for coping with their problems. That’s Luchini’s goal as she counsels people using Cognitive-Behavioral Therapy (CBT). “What we feel depends not so much on what happens to us, but on what we say to ourselves about it,” she says, explaining the basis of CBT. “Every event can have more than one interpretation. (So in therapy), you begin to look at what your own thought patterns are.”
Many people discover that they tell themselves very discouraging things — like “If I’m not perfect, I’m not good enough,” or “I’ll never get better, I might as well be dead.” Once those questionable beliefs are identified, Luchini can guide her clients through the process of replacing them with new ones. “It’s deciding that what you were thinking isn’t accurate, and you’re not buying anymore,” she says.
Luchini also encourages patients to find activities they enjoy, anything from exercise to visits with friends. Serving others and making a “gratitude list” can help. “Depression is a downward spiral,” she explains — one depressed thought quickly leads to another. “But if you turn that spiral back the other way and do one thing you enjoy, maybe you’ll do two things you enjoy.”
All of Luchini’s advice is useless without the active participation of a client who wants to get better. “Counseling is a collaboration,” she says. “I bring my knowledge from school and working with people. You bring your knowledge of yourself. (Together) we work out what needs to happen for things to get better.”
The good news is that almost all depression victims will improve with treatment. The bad news is that remission — the complete absence of symptoms — remains an elusive goal for some. One study found that only about 50 percent of sufferers get back to “normal” in the short-term. So the quest for remission can become an extended odyssey, requiring trips to psychiatrists, therapists and psychiatric wards. Tragically, a few remain outside the reach of medicine — real recovery never happens for them.
Zach Nord isn’t ready to call himself one of those stubborn cases yet. He goes to therapy, takes medication and has seen some improvements. But in his 23 years, he’s also lived through numerous episodes of depression — beginning when he was a preschooler.
One of his first childhood memories came when he was 3 years old and miserable. “I was in my room crying because I was so alone,” he says. “I’ve always experienced a kind of desperation, even being right beside my parents. I was sad, and I couldn’t pinpoint (the reason).”
As he grew older, Zach’s parents sensed something wasn’t right. They found him a therapist, who he saw on and off for years. By the time he was a teenager, he seemed to be doing all right. He pursued interests in theater and music, graduated from Atherton High School, and met a girl named Alyssa. (They’ve been together now for six years.)
All through his teen years, however, Zach was secretly thinking of running away from home — or even committing suicide. He discovered websites that counseled people on ways to end their lives and began exploring them. He realized that he could develop a strategy for painless self-annihilation.
“I’d look at the (message boards), and people would comment, ‘I’m thinking about doing it on Tuesday.’ Someone would respond, ‘Good luck.’ Then it was kind of a nasty snowball effect. I started thinking, ‘Well, how would I do it?’”
Several years passed while Zach resisted the dark impulses. But by March 2010, “I was tired of living.” He wasn’t relishing his job as a shift supervisor at Starbucks, and he’d recently split up with Alyssa. He even gave up a role in a community theater play (although performing is one of his loves). “It all made me think, ‘What can I bring to this world? What can I even bring to Alyssa? How could I make her happy when I couldn’t even make myself happy?’”
So Zach put his latent suicide plan in action one March evening. He swallowed all of the pills in his medicine cabinet and washed them down with a bottle of whiskey. He blacked out on the couch and expected to never wake up.
Somehow in his stupor, however, he called Alyssa’s cell phone and told her what he’d done. “I don’t remember calling, or the ambulance ride, or anything like that,” he says. The next thing he recalls is waking up in the emergency room. “My exact thought was, ‘This is just one more thing I can’t do right.’”
Yet in time, Zach was glad to be alive. Luchini explains, “When somebody is suicidal, they’re ambivalent about it. If they really wanted to do it, they’d already be dead.” Phone calls, like the one Zach made to Alyssa in his drugged state, are a plea for help — a cry from the small but real part of a soul that wants to survive.
Suicide is the third most common cause of death for people (like Zach) in their early 20s. When overwhelming sadness invades an already angst-ridden time of life, existence becomes a burden.
Zach spent the next three days in the hospital (standard practice after a suicide attempt) while doctors doubled his dose of Prozac. Once he was released, he moved in with his parents.
“Living back home was weird,” Zach says, “but I saw my mother genuinely concerned for me — she would listen, like she really understood what I was going through. I’ll never forget that.”
His girlfriend was angry at first. Alyssa was furious that the relationship had been interrupted; furious that Zach had resorted to suicide. Eventually, though, they worked things out: “Alyssa’s best feature is that she’s the most understanding person in the world,” Zach says. “Still, I know she struggles with the fact that I have no self-worth. These past few months, I’ve been feeling really down.”
Zach admits that his thoughts of suicide have returned, which may mean his Prozac needs to be increased again. But he hesitates: “I feel like I’m different from people who don’t have to take pills for the rest of their lives,” he admits. “It’s weird that my body can’t do what other people do naturally. And lately, I’ve been going through the motions. I feel disconnected from everything.” Zach’s worst fear is that he might slip even further into darkness.
Yet there are people willing to hope on his behalf while he can’t do it himself. Alyssa remains stubbornly committed to the man she loves; his parents are supportive. And while therapist Luchini doesn’t know Zach personally, she emphasizes that there’s reason to hang onto optimism — even for someone in his predicament.
“It sounds like he’s gotten into treatment, which is a wise thing to do,” she says. “My sense is that if he follows up with that and takes care of himself, chances are good that there’s going to be a really positive prognosis. You know, a suicide attempt is pretty much as bad as it gets. So there’s no reason to predict it will get worse if he’s proactive about it.”
Still, those words aren’t a huge consolation to Zach, which is why his tale ends bleakly for now. His experience is similar to the millions of other depression victims who experience darkness on a daily basis. It’s no surprise that Zach can’t find a lifeline in his abyss — at least not right now.
“I don’t have any aspirations; I don’t have any dreams,” he says. “I could tell you that I hope to be better in time. For the sake of my parents and Alyssa, I could just go, ‘Yeah, I’ll be fine.’ But that wouldn’t be honest.”
George Halitzka is a Louisville freelance writer (online at www.writingbygeorge.com) who’s walked through the darkness of depression himself. For more information about mental illness and its treatment, visit www.nami.org.