"I don't want to go to work, I don't want to go out, I just want to lie down", they were diagnosed with moderate to severe depression

Depression is no longer a strange word to many people. According to the 2022 National Depression Blue Book, there are about 95 million people suffering from depression in China, which means that almost one in every 14 people suffers from depression.

We know about depression mainly through its power - celebrities such as Leslie Cheung, Coco Lee, and Qiao Renliang died of depression; 280,000 people commit suicide in my country every year, of which about 40% suffer from depression. Ironically, even though we are familiar with the power of depression, the rate of seeking medical treatment for depression is not high. Only about 10% of patients have received systematic treatment, and this does not include many more potential patients who have not been diagnosed.

Depression is indeed a treatable disease, and most patients can be cured or at least improve their symptoms after treatment. William Styron, author of Sophie's Choice, recalled the years when he suffered from depression and wrote: "For those who are suffering from this disease, one thing is very important, that is, someone must let them know - no, let them believe - that when the disease has gone through all its necessary procedures, they will get through it."

This time, we asked patients who have suffered from depression to share their stories, hoping to help everyone better understand the treatment process of depression, and to bring confidence to patients and their families who are deeply suffering from depression.

When we asked everyone we came into contact with the secret to recovery, the answers they gave were surprisingly consistent - "It can get better, you must believe that it can get better."

The names of the interviewees in this article are pseudonyms.

Written by Xuezhu, planned by Linlin

"Self-help diary of a depression patient August 26 - Sunny

It’s a rare sunny day, but I can’t feel happy at all. There is no meaning in living except wanting to die.”

"Self-help diary of a depression patient August 27 - Sunny

Looking back on my first half of life, I really didn’t sort myself out. I worked hard to get into college, found a job, and started a family. I never had to worry about my family. But my career choices were wrong one after another. Now I feel like I can’t do anything and can’t do anything well. But I still have a little confidence. No matter how difficult it is, I will get through it. ”

When I wrote these words, Wang Lu (pseudonym), who was about to turn 37, had just been diagnosed with severe depression and severe anxiety. She didn't take the medicine she was prescribed, thinking she could get through it with willpower. However, her condition continued to worsen, and by November, she could no longer leave the house, from barely being able to go to work. She lay in bed for more than a month, doing nothing all day except eating, not washing her face, hair, brushing her teeth, or changing clothes, and she couldn't even get interested in playing her favorite games. Depression patients have a vivid and cruel name for this state - "lying corpse".

She couldn't leave the house, and her son's grandmother was responsible for picking him up and dropping him off at primary school, just like everything else at home. The grandmother didn't understand what depression was, so she could only do her best and be careful not to show negative emotions in front of Wang Lu. The child was just in fifth grade, and while she was encouraging her, "Mom, you will definitely get better," she was also hurting herself.

Wang Lu knew that her beloved family had been dragged into the vortex, but she could not make any changes. She felt like she was walking step by step towards the abyss. There was no end to the abyss, and she kept going down, down, down, and down, and it got darker and darker. She knew that there would be endless darkness if she continued walking, but she had no intention or motivation to turn back. She felt as if her heart had melted, just like the Ebola virus can melt a person's body, depression can melt a person's soul.

She stood in front of the window on the 15th floor for half an hour, in order not to continue to burden her family. She did not jump down, because she really couldn't bear to leave her son, and because she was afraid that the 15th floor was not high enough, and if she didn't die, she would be a burden to her family. After talking to the child's grandmother and seeing the mother crying heartbreakingly, Wang Lu gave up the idea of ​​suicide. Her best colleague came to see her and said, "Although Sister Lu's face is still the same, she is completely different inside."

During the period of lying dead, Wang Lu sent messages to her ex-husband every day, asking for reconciliation. At the beginning of the year, their ten-year marriage officially came to an end. Her ex-husband had cheated on her many times and ignored the family and children, and Wang Lu wanted to do her best to win back such an ex-husband. She "did not want any dignity at all", groveled and flattered, and pestered her ex-husband every day. Looking back, Wang Lu believed that this was a manifestation of her will to survive. She regarded her ex-husband as the last straw and believed that he could pull her out of the abyss.

In the early days of her depression, Wang Lu clearly remembered a dream she had. She dreamed that she was a big green caterpillar, wrapped in a cocoon, and later became a very big butterfly with black and blue wings, shining with light, flying among the green trees. "I could clearly feel the pain when my mouth bit through the cocoon and the sharp pain in my wings when I broke out of the cocoon." This dream is a portrayal of her depression process - hope is hidden in endless pain.

Image source: unsplash, photo by Anthony Tran

The body as a prison

Many people with depression have a bad start to their day.

When depression strikes, Didi (pseudonym) wakes up every morning and lies in bed wondering why she can't get out of bed again today. It's not because of any physical pain, but because she feels that her "action points" are particularly low during that period. Normally, she might have 10 points of energy when she gets up, 8 points for work, 1 point for socializing, and when she runs out of energy at night, she goes home to recharge, and then gets up the next day with 10 points of energy again. But when she can't get out of bed, Didi only has 2 points of energy in the morning, and she uses the only 2 points of energy to lie in bed and think about why she can't get up.

She admitted that she really had a problem, because everything - including shopping on Taobao - could not make her happy. On the one hand, she could no longer feel happy, and on the other hand, negative emotions began to appear frequently. Social news made her angry. The more she browsed, the angrier she became, and the angrier she became, the more she wanted to browse; it was too overwhelming, and she had the desire to destroy things in her heart, so she burned paper at home; when communicating with her husband, she had to distinguish right from wrong and fight to the death. She was not that kind of person before. Whether in school or in the workplace, she was a happy person, bringing happiness to everyone around her with her sunny smile. Later, when she told her friends about her illness, her friends were very surprised.

It is precisely because he realized that the way he sees the world is very different from before that Didi firmly believes that depression is an organic disease, that is, a pathological change has occurred in a part of the brain. This cannot be changed by willpower or one's own efforts. According to the book "The Noon Devil: Depression is the Secret You and I Share", during a depressive episode, many changes will occur in the human brain:

“Increased levels of thyrotropin-releasing hormone (TRH), dysfunction of the amygdala and possibly the hypothalamus, altered levels of melatonin (a hormone produced by the pineal gland that processes serotonin), increased prolactin secretion (increased lactate can trigger panic attacks in anxious individuals), decreased 24-hour body temperature variation, and abnormal 24-hour cortisol (a stress hormone) secretion…”

It is not yet possible to explain these physical changes: which ones are the cause of depression, which ones are symptoms of depression, and which ones just happen to occur at the same time. It can be said that depression is both a mental and physical disease.

Richard O'Connor, author of "Getting Out of Depression," pointed out that the symptoms of depression make patients feel miserable and powerless, which is unbearable for ordinary people, but the biggest obstacle to recovery from depression is the impact of the disease on the world that individuals perceive. Depression changes the way patients view the world and the way they think. Patients create a pessimistic and hopeless world for themselves and confine themselves to it.

After being diagnosed with depression (symptoms assessed as moderate) at Peking Union Medical College Hospital, Didi felt relieved. She said, "If it wasn't for this, I don't know what caused me to be like this now. I didn't feel any improvement in my symptoms after taking the medicine, but the side effects came immediately: nausea, numbness in my hands, my brain felt like it was filled with lead, and I felt numb. When I feel numb, I don't care whether I'm happy or not. It's as if my emotions have been wiped out by the medicine."

Antidepressants generally take 2 to 6 weeks to take effect, and enduring the side effects of the drugs is a difficult hurdle that almost all depression patients have to go through.

Lengthy treatment

After taking the medicine for about a month, the side effects disappeared and the positive effects began to show. Didi became calmer, "I'm not very happy, but I'm not so easily unhappy anymore." She didn't have unrealistic hopes for the medicine, such as that it could make her happy or keep her away from any negative emotions. "If you can be happy by taking the medicine, it's a drug."

After the drug took effect, Didi increased the dosage every three months according to the doctor's advice, from 50mg to 100mg, 150mg, and finally 200mg per day, which she maintained for about a year. After taking the drug for more than half a year, Didi began to feel a significant improvement. She began to be willing to do things that made her happy, such as raising a kitten.

The treatment of depression is a long process, which is divided into three stages: acute phase, consolidation phase and maintenance phase. The acute phase takes 6 to 12 weeks, and the patient's symptoms will be relieved after treatment; the consolidation phase takes 4 to 9 months, in order to prevent the recurrence of depression; the maintenance phase is still inconclusive, ranging from 6 months to 2 years, and may be longer if there are multiple episodes, in order to prevent the recurrence of depression.

If depressive symptoms are relieved but recur within 6 months, it is called a relapse. If depressive symptoms have completely disappeared for more than 6 months and then recur, it is called a recurrence. Depression is a disease with a high recurrence rate. The probability of recurrence after the first depressive episode is about 50%, the probability of recurrence after the second depressive episode is 80%, and the probability of recurrence after the third depressive episode is close to 100%.

Ma Hong, chief physician at Peking University Sixth Hospital, often uses the example of fractures to convey to patients the importance of taking medications:

“It takes 100 days for a broken bone to heal. Does it mean that the bone never grows and then suddenly grows on the 100th day? No, it needs a consolidation period. After 100 days, once the plaster or splint is removed, can you jump around and do whatever you want? No, it still takes time to recover slowly.

Unlike when you don’t need to take antipyretics when you have a fever, a depressed patient may feel better, but his nerve repair may not be complete, and the regulation feedback of neurotransmitters may not be complete. "

Dr. Ma Hong herself has suffered from depression. After the Wenchuan earthquake, she traveled back and forth to Wenchuan many times for UN projects. By the third year, she could no longer go. Her depression symptom is that she no longer organizes her computer. Usually, she keeps her file classification and email management in order, but when her depression is more serious, her computer is a mess. The messier it is, the harder it is to organize, and the harder it is to organize, the less she wants to organize, and it will just keep getting messy. Usually, she seems to have 1.5 brains running, and she is thinking about another job while doing the work at hand, but when her depression is serious, she has no motivation to go to work at all, and she puts off all work until the last minute. She even hasn't arrived at the airport when she is about to board a plane for a business trip.

After taking the medicine for a month, she felt much better. She took the medicine for another month to consolidate her condition. After two months, she stopped taking the medicine. Less than half a year later, her computer was in a mess again. She started to wonder how she would have to go on business trips, attend meetings, make PPTs, and go to the clinic again... She used to like reading and would finish a new book on the plane. When she was depressed, she would not read it even if she brought a book on the plane. Later, she would only buy thin books, and later she would not bring any books at all. She used to like a book. After reading the Chinese version, she would buy the English version. After depression struck, there was a pile of unopened books at home.

This time, she took the medicine seriously for a year before she slowly stopped taking it. Ma Hong has heard too many patients who stopped taking the medicine say to her, "Doctor, I stopped taking it for a week and it didn't relapse/I stopped taking it for a month and it didn't relapse either." But after half a year, most of them came back.

It took Didi a year to increase the dosage to 200mg, and she maintained it for a year. It took almost another year to reduce the dosage, and it took her three years to get rid of depression. After stopping the medication, she experienced the epidemic, was locked down four times, and changed several jobs, but there was no relapse. If she didn't mention it deliberately, she would rarely think of this experience between 2016 and 2019.

Didi's smooth treatment process is not uncommon in clinical practice. She has simple depression without comorbidities. At the same time, given her identity as a popular science worker, she has no sense of shame for her illness, and most of her colleagues around her do not look at depression with tinted glasses. She has adapted to the physical reactions brought about by the initial medication, and there is no difference between antidepressants and vitamins for her. She believes in doctors and science, follows the doctor's advice, and has strong compliance. Her husband is well-educated and was curious about the mechanism of action of the drug when he learned that she had brought the medicine back. Although her mother does not understand depression, she will not blame her for being sick. For patients like her, the entire treatment process took almost three years.

Of course, many patients with depression have to go through multiple tests such as changing medications, failed reduction of medications, and relapse before they can break out of their cocoons and become butterflies. Dr. Ma Hong emphasized that even so, depression is still a treatable disease, and most patients can be cured or at least improve their symptoms after treatment as long as they follow the doctor's advice.

Image source: unsplash, photo by Yuris Alhumaydy

The cane you can't throw away

From June to December 2019, Wang Lu was "tortured" by depression for half a year. "Tortured" is the verb she chose for depression. She believes that only this word can reflect the degree of pain of the disease. In December, her second cousin, who is a doctor, came to her home from another place and dragged her to Beijing Huilongguan Hospital. The diagnosis was still severe depression and severe anxiety. She asked the doctor if it could be cured? The doctor firmly told her that it could be cured.

She started taking medication. When she returned home, she was still lying down and still pestering her ex-husband, but she had the motivation to play games. She could not experience happiness from playing games, she just played to kill time, "I have some energy to do other things, but there is nothing I want to do."

On February 4, 2020, the beginning of spring, Wang Lu suddenly got better. She got up from bed, washed her hair, face, and showered, wrote her resume, and decided to leave her disliked job and look for a job in a different industry at the age of 37. "I suddenly became normal, with better perception and will to live. The feeling of 'life is good' came back, and I was willing to do things. I felt better."

Wang Lu felt like there was a switch in her body. When she was sick, the switch was flipped to the other side, but when she got better, it was like it was flipped back. When she went for a follow-up visit in August 2020, the doctor reduced the medication from 3 tablets a day to 2 tablets a day. After reducing the medication, Wang Lu felt that her whole brain was in chaos, and the area from the front of her skull to her forehead was shrouded in a dark cloud, as if it was being gnawed by rodents. A lot of tweets about venlafaxine withdrawal reactions can be found on social networks. In addition to brain chaos, some people will feel nauseous and dizzy, and their heartbeats will accelerate. Some people will feel like they are being electrocuted in the brain, and it can be so serious that the whole person will twitch.

After taking two tablets for about a year, the doctor reduced Wang Lu's dosage again. From two tablets to one tablet, from one tablet to half a tablet, from half a tablet to one-sixth of a tablet, by 2022, she only needed a pinch of powder every day.

According to an article published in the Lancet Psychiatry by Mark Horowitz and others from the UK Health and Environment Action Lab, all antidepressants cause withdrawal reactions. Many doctors recommend that patients completely stop taking the drug within four weeks according to standard recommendations. Such a short period of time will make the withdrawal reaction so strong that it is unbearable, so that patients have to take the drug again. Horowitz believes that any responsible withdrawal plan should give patients a transition period of several months or even years to gradually reduce the dosage of the drug. Surviving the withdrawal reaction is another difficult hurdle that patients with depression have to go through on the road to recovery.

As for when to stop taking the medicine, it is not only related to whether the patient's symptoms disappear, but also to the patient's personal life, life situation and other factors. Before stopping the patient's medication, Ma Hong will carefully ask the patient under what circumstances he is prone to relapse and try to avoid risk factors. If the disease is prone to occur in spring, wait until after spring to stop taking the medicine; if the patient is facing layoffs, academic difficulties or other adversities, Ma Hong also recommends adjusting the medication after this period of time, "let your small splint fix you again."

Xiao Jiang (pseudonym) started taking medication after being diagnosed with depression in her freshman year, and has been taking it for 7 years. "Taking medicine is just like eating." Seeing that she is getting closer to 30 years old and planning to have children, she has the idea of ​​stopping medication. The doctor suggested that it is best not to reduce the medication when life is unstable - she has to adapt to a marriage that "want to divorce on the wedding day", unemployment, and moving to another city - Xiao Jiang insisted on reducing the medication. "I don't want to be controlled by medication for the rest of my life. It's like this medicine has become a pair of crutches. I can't walk without crutches." After reducing the medication for three months, she stopped the medication. Half a month after stopping the medication, the symptoms of depression appeared again.

Unlike Wang Lu and Didi, Xiao Jiang was also depressed and negative due to depression, but this was not her main symptom. She was sitting in the office working on her computer when she realized that depression had hit her. Her heartbeat was accelerating, her mind was restless, and all the negative emotions in her mind made her unable to sit still. She went to the bathroom again and again, trying to calm herself down, but to no avail. After struggling to get off work, she told her doctor about her situation online, and the doctor told her to take the medicine again as soon as possible.

This episode was very similar to Xiao Jiang's first episode of depression. At that time, she was in a university class, fidgeting and restless. She couldn't listen to the teacher's lectures at all. Her mind was full of negative thoughts, and she wanted to jump out of this space immediately. Her heartbeat was still very fast when she slept at night. She woke up from sleep for a while and couldn't control herself at all. The teacher in the university's psychological counseling room suggested that she go to the hospital's psychiatry department and recommended a famous local doctor to her. Xiao Jiang was diagnosed with depression (symptom assessment was moderate). After taking the medicine, she felt that the whole world was quiet almost instantly. After reading the sharing of other patients on the Internet, she knew that depression drugs did not work so quickly, and she knew that psychological factors might have played a role.

The psychological dependence on the drug was another reason why she failed to reduce the dosage. Whenever she became distracted, emotionally agitated, or in a bad mood, she would be afraid that she had relapsed and that she would not be able to live independently without the support of the drug. Depressed patients describe themselves as having a black dog living in their bodies. Xiao Jiang's fear of relapse was like nourishment, feeding the black dog that was temporarily "paralyzed" by the drug.

When Xiao Jiang went to the Shanghai Mental Health Center for treatment, she noticed a message: three recurrent episodes of depression require lifelong medication. She was not even 30 years old, but she had already used up one chance. Would she have to rely on a "crutch" for the rest of her life? The failure to reduce her medication not only made her feel frustrated, but also desperate. As expected, she did not have the strength to live independently.

Past life

Since she was diagnosed in college, Xiao Jiang has heard that treating depression requires not only taking medicine, but also changing oneself - becoming optimistic, becoming strong, and not thinking negatively about everything. But she doesn't know how to become optimistic, strong, and positive, and these slogan-like suggestions can't bring her any real help.

After years of psychological counseling and actively reading a lot of psychology books, Xiao Jiang slowly found the way. Xiao Jiang is a left-behind child who grew up in a typical Chinese family - sons are favored over daughters, and emotions are never expressed. Parents focus on making money and ignore the care of their children, claiming that it is for the good of the children. Family members are always arguing about right and wrong and no one cares about each other's feelings. This has led to her not knowing how to identify her emotions since she was a child, and she doesn't even know what emotions she feels, let alone how to vent her emotions.

With the help of a counselor, she learned to identify emotions - anger or jealousy, tension or fear. She also used the methods she learned from psychology books to deal with her emotions. For example, when negative emotions appear, she should allow herself to be negative for a short time. No one can be positive and sunny 24 hours a day; treat negative emotions as friends, allow them to come, and allow them to go. She allowed herself to be afraid, allowed herself to be anxious about whether she could successfully reduce the dosage, and no longer regarded any physical or emotional reactions as signs of relapse.

At the doctor's suggestion, Xiao Jiang took the medicine for more than a year. At the beginning of this year, she was determined to "persevere as long as she is not struck by lightning" and encouraged herself that "it can't get any worse, don't be afraid anymore", so she reduced the dosage for the second time.

There are two main ways to treat depression: psychological intervention that focuses on the psychosocial level and physiological interventions such as drugs and electroconvulsive therapy. When we suffer from any disease, in addition to treating the disease itself, we will change certain lifestyle habits to prevent the recurrence of the disease. If you have heart disease, you have to limit your cholesterol intake; if you have high blood pressure, it is best to eat low-salt and low-fat foods. The same is true for depression. Many surveys have shown that the combination of psychotherapy and drug therapy is better than using only one method.

While taking the medicine as prescribed by the doctor, Wang Lu participated in a charity event held by a junior psychologist on Douban. The one-hour consultation cost one yuan, and there were ten sessions in total. The psychologist told her not to struggle. Just like a person trapped in a swamp, the more he struggles, the faster he will die. Don't rush to get better, just let nature take its course and wait for the right time to come.

After a whole course of psychological counseling, Wang Lu vomited out all the garbage in her heart and finally "knew what was going on with her", but she still hoped to get back together with her ex-husband. After that, she found another emotional counselor and asked the counselor to promise to help her win back her ex-husband.

Wang Lu grew up in a divorced family. Her mother was the type who "could not live without a man", no matter how much money he made or not. During the wave of layoffs in Northeast China, both her mother and stepfather lost their jobs. The poor days made Wang Lu, who was in junior high school, realize that both her parents were unreliable.

She is also unreliable. Growing up, Wang Lu received almost no affirmation from her mother. Whenever she wore newly bought clothes in front of the mirror to show off, Wang Lu could see through the mirror the "particularly disgusted and contemptuous" look of her mother. Her mother took good care of her during her depression, but her concern was only to ensure that she was well fed and clothed. Her mother never took the initiative to hug her. When Wang Lu took the initiative to hug her, her mother would push her away and tell her to "stop it" and "it's hot." So she chose to rely on men. Almost all of her colleagues and friends disapproved of her marriage to her ex-husband, and believed that Wang Lu deserved better, but she was the only one who didn't think so.

After marriage, facing her ex-husband's repeated infidelity, her in-laws continued to suppress her, making her believe that the reason why men cheated was because the wife was not qualified. They mocked Wang Lu for divorcing and only finding an old man, saying, "All men cheat, why do you want to divorce?" The first time her ex-husband cheated, they divorced briefly. It was Wang Lu who proposed to remarry. Even after forgiving the infidelity, her ex-husband repeatedly pushed her to the limit. Even so, it was her ex-husband who proposed divorce the second time, not her.

According to the World Health Organization, worldwide, the incidence of depression in women is about 50% higher than that in men. In addition to the influence of hormones, there are also practical factors.

Both counselors repeatedly told Wang Lu that she had to believe that she was complete. She could live on her own and become a good person. The window paper was broken. Looking back, Wang Lu admitted that it was the right choice to get rid of this hopeless marriage. But in the ten years of marriage, she never doubted her choice, and she felt very happy at that time. It is said that children's eyes are sharp. The son once said to Wang Lu: "Mom, after you separate from Dad, find someone who loves you."

"I have never worried adults since I was a child. I have always been independent, but I have never really lived for myself. My goal is to leave home early, and I work hard to get into college. After I get into college, I want to start a family and have my own children. I followed this step-by-step approach, and when my marriage broke down, I realized that I had been running but never thought about what I really wanted or what kind of person I wanted to be," said Wang Lu. "Depression gave me a chance to get to know myself again. After recovery, I feel that being myself is a great thing."

In her diary in March 2020, she wrote: "Being alone is a kind of freedom to do whatever you want. Even if you are in the arms of your lover, you still can't escape loneliness."

Image source: unsplash, photo by SamMoghadamKhamseh

Life goes on

Didi felt that her life was colorless during the period of depression, and nothing could touch her. For a long time, she couldn't even cry, as if she had been deprived of the ability to release emotions. After recovery, she cherished her emotional reactions and became tearful. She would cry when she saw beautiful scenery and when her cat came to her. A scene in the Korean drama "Dark Glory" - an aunt who suffered domestic violence and was in a bad situation sat in the car and saw the sunset, and sighed: "What kind of sunset is this beautiful?" - made her cry unstoppably. She likes her changes.

According to Dr. Ma Hong, there are three clinical criteria for recovery from depression: disappearance of symptoms, recovery of self-awareness, and recovery of social functions. When a child recovers, the doctor will write four words in the medical record: "clinically recovered", not "life recovered". Nowadays, the situation of adolescent depression is getting more and more serious. Many schools want doctors to write "recovered from the disease and can go to school" in the medical record, but doctors cannot make this judgment. Doctors do not know how much pressure children will be under in school or how their interpersonal relationships with classmates are. The doctor's responsibility is to treat the disease, and the judgment that the doctor can make is "the condition is stable". After the disease is cured, life continues.

After a serious illness, Wang Lu finally became the black and blue butterfly in her dream. She switched to an industry she likes and has achieved some success in her career. She used to be "unyielding" and "crooked", but now she doesn't need to use outward toughness to cover up her inner fragility. She gives her son unconditional love, "I will no longer treat my son the same way my mother treated me. He is innocent, and the intergenerational transmission stops with me."

Looking back on the process of treating depression, Wang Lu believes that medication can account for half of the credit, and psychological counseling accounts for the other half. If she had to choose the most critical factor in her recovery, she would attribute it to medication. Without medication to regulate the hormone levels in the brain, she would not have enough motivation or willpower to seek psychological counseling.

In November 2022, after a relationship ended, Wang Lu relapsed. This time, she had experience, and unlike last time, she was not stubborn. "Take medicine if it can be cured by taking medicine," and started taking venlafaxine again. From two tablets to one tablet, she went to the hospital for regular checkups, and she is still taking the medicine now. The doctor suggested that she take it for another two or three years, and then slowly reduce the dosage when her life is stable. Wang Lu knows that a relapse will increase her chances of lifelong illness, and some people live with the disease until they die. Even if she has to take medicine for the rest of her life, she accepts it, "It's better than fighting every day."

She compared her experience of depression to leveling up in a game - after defeating the "monster" of depression, she became an "upgraded version" of herself. Relapse is just another "upgrade". Although she has been "upgraded" again and again, it is not true that what she has gained from the illness to the cure is greater than what she has lost. "I will never forget the pain, which is not something that ordinary people can endure. Do you think being "lingchi" every day is a good feeling?"

As someone who has been through it, Wang Lu said firmly when talking about her advice to fellow patients: "You will definitely get better. You must believe that you will definitely get better. Look at how serious my situation was at that time. I had no job, no income, and my house had a mortgage, so I was ready to sell it. I was divorced, and my son and my mother both had varying degrees of depression. I was at the bottom of my life, but I got through it. Don't give up, and don't worry, you will definitely get better."

After stopping the medication, Xiao Jiang felt as if there was an electric shock in her brain and her heart would suddenly skip a beat. It was obviously more difficult to maintain a stable mood during the day than when she was taking medication. She would occasionally collapse, but the negative emotions would always pass. When she was surrounded by thoughts such as "my life is over", Xiao Jiang would deliberately do things that made her happy to divert her attention, such as eating a bowl of stinky tofu on the street in Wuhan or watching children playing in the park. Facing the pressure of unemployment and finding a job, the divorce crisis, and the pressure of having children, she, who was about to turn 30, survived.

Xiao Jiang didn't feel that the pain caused by depression was "torturing" her. Her pain lasted for a long time, almost throughout her life. When she was eight years old, a man from the same village molested her. She didn't dare to tell anyone, including her parents. From then on, she had a secret. At that time, she didn't know the meaning of the other party's behavior, but she vaguely felt that this was a very bad thing.

It turned out that she always raised her hand the highest in class, actively answered questions, and her grades were always among the top three in the class; after the incident, she wanted to hide herself, said nothing in class, and her grades plummeted. The head teacher asked her if something happened at home, she lowered her head and dared not speak. The teacher was worried and came to her home for a home visit. Xiao Jiang hid behind the door and refused to come out no matter how her mother called her. After the teacher left, her mother called her in and out of the yard, but she still didn't say a word. She was afraid that if she opened her mouth, she would reveal her secret. She was afraid that if she revealed her secret, no one would love her. Growing up in a family that favored boys over girls, she didn't get much love.

After her parents went out to work, her grandmother found a "second old man". The old man had a bad temper and would overturn the table if the food didn't suit her. He always stared at Xiao Jiang with a sinister look, causing Xiao Jiang to have nightmares about him walking towards her with a cane. Sometimes, he would run into Xiao Jiang's room and sit by her bed and smoke non-stop. Xiao Jiang instinctively sensed danger.

During that time, she cried every day under the quilt, and wrote desperate letters to her parents for help, asking them to take her away. No matter how poor she was, she wanted to stay with her parents. Her father wrote back to teach her, "You must be obedient and don't make grandma angry."

When she was in junior high school, her grandmother took her and her brother to rent an underground garage in a small town for the convenience of going to school. On the way from the underground garage to school, a man rode a bicycle towards her and pinched her breasts. Xiao Jiang was so scared that she didn't dare to raise her head or look. Another time, it also happened on the road. She didn't tell anyone that there was no one at home for her to rely on. The only way she could think of to save herself was to study hard and go to college. She thought that as long as she left this home and this place that made her suffer, everything would be fine. When she found that even after going to college, she was still the same person, depression broke out.

Sometimes, Xiao Jiang couldn't tell whether she was depressed or back to normal. She had never been happy since she was eight years old, and her life had always been gray. She always felt that others had a sunny sky above their heads, while she had a dark cloud above her head. She tried hard to live a normal life, but she didn't know if she had done it.

Not all pain can be described as a "disease". Some pain is incurable. We are often powerless to deal with the pain in the world, but depression is indeed a disease that can be cured, although the treatment process is slow, tortuous, and challenging. It is a pity to ignore the pain caused by depression when it can be cured.

The day Xiao Jiang and I talked on the phone was her 30th birthday. After attending an interview in the morning, she squatted on the side of the road and cried when she thought about her current life situation. Two boys passing by on an electric bike handed over two masks. Xiao Jiang thought it was an advertisement and waved her hand to say no. The other party insisted on handing it over, and she took it. There was no advertisement on the mask. Maybe the boy didn't have a tissue in his pocket, so he could only hand over a mask as a substitute. The kindness of strangers made her feel warm. During the call, she mentioned several times the head teacher who came to visit her home, the doctor who knew that her financial situation was not good and fought for free medicine for her, and the psychologist who told her that she didn't have to pay the consultation fee if she really had no money. She remembered all the kindness others had shown her, and kept ruminating on it in her heart.

I asked her what her birthday wish was for her 30th birthday. Xiao Jiang said, "I hope I can go wherever I want to go by myself, and I also want to get out of my marriage. I have a very strong urge in my heart to start my life over again. I used to rely on others and I was afraid of loneliness. Now I seem to have awakened and understand that I must rely on myself. I don't know if I can do it, but at least I have the courage to try, and I want to give it a try."

Finally, here are some suggestions from Dr. Ma Hong for people with depression:

1. Take the medicine according to the doctor's instructions and the course of treatment. Never reduce or stop taking the medicine on your own.

2. Reduce risk factors in your life. For example, if your original work environment is full of pressure, you can consider changing your work content.

3. Increase the frequency of protective factors. Do something that makes you happy regularly, such as picking up your old hobbies; raising small animals is also an option.

4. Exercise. Exercise is a good recipe, and you must develop the habit of exercise. If you want to prevent depression, exercise; if you want to treat depression, exercise, and pay attention to safety.

References

[1] Andrew Solomon. (2020). The Demon of Noon: Depression is a secret shared by you and me. Shanghai Sanlian Bookstore.

[2] Richard Connor. (2014). Get out of depression. China Light Industry Press.

[3] William Stellen. (2022). The visible darkness. Hunan Literature and Art Publishing House.

[4] Horowitz, MA, & Taylor, D. (2019).TaperingofSSRItreatment tomitigatewithdrawalsymptoms.TheLancetPsychiatry, 6(6), 538-546.

[5] Groot, PC, & van Os, J. (2018).Antidepressanttapering strippstokhelppeoplecomeoffmedicationmoresafely.Psychosis, 10(2), 142-145.

[6] Carey, B., & Gebeloff, R. (2018). Manypeopletaking antidepressants discover them can notquit.NewYorkTimes, 7.

[7] Health Times, my country's first epidemiological status study on the epidemiological status of adult depression disorders was released! Only 9.5% of patients have been treated, see the web page: http://news.sohu.com/a/695050462_121687414

[8] Health Industry, 2017 Depression Survey Report: Only 10% of people seek treatment, see the web page: https://www.cn-healthcare.com/article/20170401/content-491111.html?appfrom=jkj

[9] Shanghai Mental Health Center, can depression be treated? See the web page: https://www.smhc.org.cn/HospitalHomepage/contents/1196/1095.html

Author丨Snow Zhu Special Reports Popular Science Author

Interviewed Experts丨Ma Hong Chief Physician of the Department of Psychiatry, Sixth Hospital of Peking University

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association