Catching you up (20)

40 weeks have passed since I wrote my last blog entry, just after I self-referred myself for the next tier of mental health services: cognitive behavioural therapy. I had taken dexamethasone to suppress my cortisol for an endocrinology test, and the side effects were unexpected: deep depression, anxiety, and suicidal thoughts.

The funny thing about feeling depressed, anxious and wanting to die is that they are just that: feelings. We can justify them, embrace them with logic, bury them with piles of sensation, or express them, but, at the source, they are combinations of chemical states in the body that we are consciously experiencing. They will affect us. They are not us.

I don’t often feel like I want to die, but I regularly do. Waking suddenly from an unsettled, deep sleep comes with a flood of deep syrupy emotion – a slick of separation between body and mind – that feels acutely like death. Like dying. I call it Liquid Dread: a sudden rise in cortisol without an associated rise in adrenaline. The DSM-IV calls it Depersonalisation.

Nothing traumatic provoked this particular feeling in this particular moment. My life hasn't been especially difficult, painful, or upsetting lately. For many (many!) years I thought it was. I thought, since I felt so detached and depressed, that I must be reflecting an awful, mad world.

I was, for the most part, wrong.

With practice, I learned to recognise these feelings for what they were: experiential manifestations of chemical imbalances. Distracting, annoying, but at worst: a disability. Not a definition of me. 

The causes:
Sleep deprivation (including Jet Lag)
Alcohol (usually by causing sleep deprivation)
Overconsumption of Carbohydrates
Drop in Progesterone/Estrogen (pre-menstrual)
Stress (especially acute episodes)

The cures:
Circadian rhythm balanced by adequate sunlight exposure
Vitamins & supplements, especially omega 3
Stress management
Balanced diet
Time (← absolutely essential)

If I stop taking my vitamins, start eating more chocolate and ice cream, become  socially engaged, stay up late, and avoid going outside: I can guarantee my poor health within a month. In an ordinary fertile month, the change in hormones in a female reproductive cycle bring a reliably severe and temporary pattern of depression followed by anxiety. If my body doesn't have the resources to cope with this hit, it takes even longer to recover, making me even more fragile to traumatic, stressful experiences, degrading my social relationships, and allowing my mind to associate even more negative feelings with my life.

In short, the further you fall downstream, the harder it is to swim back up.

Do I blame the cycling female hormones? My poor diet? My lack of sleep? A rude acquaintance? Or do I blame me, for being so sensitive and so perpetually weak?

I stop blaming.

Right now, I'm further downstream than I've been in months. I suffered jet lag, hormonal changes, poor diet, chronic stress and lack of vitamins. I felt depressed and,  even worse, detached; my choices continue to deteriorate. Another week of this and my immune system will fail. If my immune system fails again this year, I will be placed on probation for poor attendance. The disappointment and failure will colour my work relationships with shame. I will feel more and more anxious each day. My colleagues will see my anxiety and withdrawal and interpret it as rejection. They will, in turn, reject me. Feeling even more excluded and alone, I will look for and succeed in finding a new position, probably even a new career.

And all because I ate chocolate instead of carrots. Because the egg didn't fertilise and implant in my uterus. Because my cells weren't rejuvenated with sleep. Because I lacked familiarity and intimacy with others.

I'm sipping an iced rose wine in a dark room with no windows. The only light is the green of the football field. The only sounds are vuvuzelas and a quiet chittering of the commentators. I am balancing at high heights, but still, I know not to expect this brief high to last. Tomorrow I will feel worse, but if I make better choices, I will feel better.

Now, we are caught up.

Read on the NHS Choices blog.