Once again I was on the phone to my friend, sobbing. She’d put up with my tears every day since I left the hospital. Two or three daily meltdowns were the norm.
Many of my tears were over things that would have merely irritated me before: misplaced scissors, dirty socks in the middle of the living room, a brief computer glitch.
I have cavernous angiomas, tangles of malformed blood vessels, scattered throughout my brain. Two of them — one larger than a golf ball in my right parietal lobe, and the other, smaller, in my brain stem — had bled, and I underwent brain surgeries to remove them.
The bleeds and surgeries led to side effects including loss of balance, vertigo, nystagmus, trouble with sensory overload, and a number of cognitive deficits. My emotions also seemed volatile. I expected that my emotions would settle down as my brain healed. They didn’t.
After putting up with about a month’s worth of meltdowns, my friend spoke up. “I think you need meds.”
I was shocked. The possibility of psychiatric medication had not occurred to me. The people I knew who needed it had major issues: a cousin whose mother had died when she was ten years old, a friend who had been suicidal, a student with bipolar disorder. I wasn’t depressed. I just got really upset too easily. I was just fragile, and, given what I’d been through, that was understandable.
I wasn’t in denial over my emotional state. Aware of my extreme vulnerability, I’d been proactive: I’d started seeing a psychotherapist regularly within days of my return home from the hospital. I had things under control.
I knew that brain injury can cause chemical imbalances, which can lead to clinical depression. In one account I read, a patient lamented not having gone on antidepressants sooner. Feeling fortunate that I wasn’t in that bad of shape, I sympathized with those who were.
I didn’t need meds.
Over the next few weeks, as the tears flowed more often and more freely, my friend grew more insistent. I continued to resist, explaining away my vulnerabilities. It was normal to grieve over losses. I blamed really bad days on my menstrual cycle.
But as the severity and frequency of my meltdowns increased, I had more trouble rationalizing.
I spiraled into the abyss and finally reached the bottom. I felt desolate. I knew I was a burden on everyone around me and that my life wasn’t much of a life. Suicide seemed logical, perhaps the only solution.
I kept my suicidal thoughts secret—I didn’t want my friend or my therapist to try to talk me out of it.
Weeks later, when I began to emerge from the abyss, I kept my silence because I felt ashamed, and later still, I added guilt to the shame—I had betrayed the trust of both my friend and my therapist.
I tried to rationalize my lie-by-omission: I told myself that I could never really take my life, that I didn’t have it in me.
But in some corner of my mind there must have been doubt mixed with the rationalization because a few days later I decided to discuss antidepressants with my therapist. She agreed with my friend: it was time to consider meds.
Until the brain bleeds, I was averse to pill popping. I took painkillers for my migraines and antibiotics for bacterial infections—no other medications. After the bleeds, I started taking blood-pressure meds (Verapamil) to cut back on the chances of another bleed and anti-seizure meds (Lamictal). I was concerned about messing with my body chemistry, and worried about drug interactions—I wanted to avoid medications that listed seizures as a possible side effect. Given my concerns, my therapist sent me to a psychiatrist who specialized in psychopharmaceuticals.
I wasn’t sure whether there was a viable solution within my comfort zone, but the answer turned out to be straightforward: the psychiatrist suggested simply increasing my daily dose of Lamictal. Anti-seizure meds not only prevent seizures; they also act as mood stabilizers and are often used to combat depression and bipolar disorder.
My psychiatrist conferred with my neurologist, who, concerned about adverse reactions to the Lamictal, was firm about capping my daily dose at 600 milligrams. My psychiatrist, determining that my depression was severe, decided to increase the dose directly from the 400 milligrams I was on to 600 milligrams, instead of ramping up in increments, which is the standard procedure.
I responded well to the increase. Feeling like myself once again, I realized just how badly off I’d been. Like my cousin, my student, and my friend, I too had major issues. Except that I really wasn’t like them—my issues were temporary. Once my brain healed, my depression would be over, and I’d be able to get off the meds.
It took a good four years and a couple of trial runs with lowered dosages before I managed to fully shrug off that piece of denial.
A decade later, I’m still on antidepressants, for good reason.
This depression isn’t “situational.” Good friends and therapy help me survive, but they aren’t enough. The bleeds and surgeries changed my neurochemistry. These changes are real, and they’re here to stay. The meds are here to stay, too.
This guest article originally appeared on the award-winning health and science blog and brain-themed community, BrainBlogger: In and Out of the Abyss: Depression After Brain Surgery.