Miriam S., Ph.D., specializes in neuropsychology and is a scientist and psychologist at an academic medical center in Dallas, Texas. When she treats patients, it's her job to evaluate cognitive functioning -- which, for most people, means thinking and memory. Occasionally, she has to diagnose patients with depression, and they usually respond with a mix of anger, disbelief and denial. As a survivor of clinical depression herself, this is what she wishes she could say to her patients.
I have [patients] in their 50s and 60s coming in concerned about dementia, generally. They come in, absolutely sure they have dementia or sure they have a problem with their memory.
And I tell them, "Yes, I’m seeing a problem with your memory in my data I've collected from you, but I don’t think it’s dementia. It's depression."
To me personally, this is very good news. I'm very excited to tell them when they're not suffering from dementia, because dementia is not treatable. But it's a little frustrating to me that so many patients are disappointed when they get that [depression] diagnosis. Living with it myself, I know it’s survivable and treatable and that you can have a meaningful existence. When they treat it as if it’s worse than dementia, that’s tough.
It’s tough to be in the dual position of, yes, I am a clinician, but I am also a patient. It’s not necessarily something you want to disclose to your patient -- to say, "I know this is effective. It works for me." Because in the depressed mind, that can actually backfire and be used as, "Well, you're depressed, so you don't know what you're talking about."
It’s a fine line, and I struggle with trying to get people to make use of the resources that are available. Because we have made great progress -- there are resources available that weren’t in the past.
The first time I realized I needed help, I was in college. I found myself in an abusive relationship, and I basically sought help to get out of that relationship. So while I was assisted by my then therapist to leave the relationship, she also expressed concern that perhaps I have this disorder -- clinical depression. And I agreed with her.
I was diagnosed at 20 but I can recall having periods of sadness as a child that were difficult to lift. The very first time that I ever remember that feeling, that particular heavy sadness feeling that didn’t go away — and obviously I still remember it to this day, so it was a big deal for me as a child -- was the very first time my best friend decided she didn’t want to play with me. And this was when I was 5. I took that very hard, and looking back on it, I took it harder than I would expect.
When I told my mother about my diagnosis, she was very upset. She said, "This is a nightmare." And in my state at the time, my first diagnosed depressive episode, I thought, "Well, imagine what it’s like for me!"
My parents are baby boomers, and they are very much of the pick-yourself-up-by-your-bootstraps sort of mentality. So they didn’t understand why I couldn’t just feel better. It was a struggle for several years, and still at this point, 20 years later, I still find myself trying to educate them -- not just on how depression is, but how depression is for me. It's sort of an education that never ends.
For me, depression is a heaviness in the chest that I can actually feel radiating down my arms. I’ve come to know that feeling. I think if you’ve had more than one depressive episode, then you can start to notice the signs.
It’s a very foggy feeling, as if you are communicating with the rest of the world down a long dark tunnel, and you're shouting, trying to communicate with people. You don’t necessarily understand everything people are saying to you. Logically, you understand. But you’re a little bit slower.
I do know that I’m more prone to a depressive episode, and I try to take steps to avoid it. There are things that I know will help, even though I don't feel like doing them -- exercising, interacting with other people. But every once in a while it doesn't work, and I find myself with the low mood for more than two weeks, and I feel lethargic. And then I am medicated, and typically, with everything I do behaviorally and with medication, I resolve it.
Living with the knowledge that it could happen again, I don’t find it as disheartening as one might expect, because you do get to know the patterns of what makes it better and what makes it worse. The more times you survive it, the more you know it’s survivable.
There is a train of thought out there that depression can be useful. And so I've tried to make mine useful. When other people struggle, if they're a friend of mine, I say, "I struggle too."
As told to Anna Almendrala. The interview has been edited for length and clarity.
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