Into the Abyss and Back

By Steven D. Imparl

 

(Published in Newsweek Japan,

December 4, 2002, pp. 54-55)

 

 

“Beep…beep…beep…beep,” my alarm clock sounded on a sunny, clear morning in mid-October, 2001. A warm breeze blew through the open window. Birds chirped happily in the backyard. Outside, the day was starting very well.

 

There was only one problem: I could not get out of bed. My brain simply could not be bothered to tell my arms and legs to move. During the previous few months, I had begun to dread the mornings and I did not want to face another day. Although I love my work, the thought of going to my downtown Chicago office on this particular day was positively horrifying.

 

Under normal circumstances, I relished autumn days like this one. Now, I wanted to hide under the covers and wait for the world to disappear.

 

My low mood was not a surprise. For the previous three months, a strange fear—a sense of impending doom—greeted me when I awoke in the morning. That fear followed me through my waking hours like a lost black dog. I was having trouble concentrating, working, and enjoying life.

 

Knowing what lay ahead of me, I did not greet the day with my usual enthusiasm. Instead, I found myself tumbling down a bottomless abyss from which there appeared to be no escape. Indeed, at that point, I did not even want to escape. I was content to continue my free fall into oblivion, unconcerned about such mundane things as paying my bills, getting dressed, or even eating. A profound apathy tainted everything in my life; I just did not care what happened.

 

Sure, the economy was deteriorating all around me and I was highly anxious about keeping new clients and trying to find new ones. Yes, I had been chronically cranky, irritable, and restless. I hadn’t slept longer than 30 minutes at a time for several months. I had broken off a relationship with a woman whom I had loved deeply and to whom I had nearly become engaged.

 

I found myself angry almost all the time. Although I am usually calm and fairly even-tempered, lately, the slightest provocation could make my blood boil. Once, while I was walking down the street at lunchtime, a man driving a small red sports car in the snarled Chicago traffic blew his horn just a little too long. I yelled at the driver and he yelled something back. Almost instantly, I was shouting at him and ready—no, eager—to throw punches. I calmed myself with a few deep breaths as the noisy man and his car disappeared into the endless flood of vehicles. My response had been totally out of character; I knew something was wrong and I didn’t like it.

 

On top of this, I was working insanely long hours, yet accomplishing less and less, despite all my effort. On weekends, I mostly laid on my bed, staring at the ceiling. Spending time with friends was unbearable. I was contemplating suicide with an alarming frequency, and I had plotted my demise in gruesome detail. But no, I wasn’t depressed.

 

In my one-man law practice, I counsel and represent small businesses, especially Internet and e-commerce companies. I intentionally surround myself with fellow entrepreneurs, in part, to boost my energy and mood. My work is interesting and very rewarding. However, in the summer of 2001, I was turning away new clients because I could not generate the enthusiasm to work for them. Consequently, my income was dropping. As my income dropped, my mood sank, too. As my mood worsened, my income fell further. A dangerous cycle had begun.

 

Because all of these feelings and behaviors were so unusual for me, I started seeing a therapist. The sessions were helpful, but something was missing. I mentioned my frustration with the “missing” piece to my therapist, and he gently invited me to consider medical treatment. For a few months, I balked at that idea. I told him I was not “crazy” or “unstable,” and I resented any suggestion that I was. I did not want to see a psychiatrist. Seeing a psychotherapist was bad enough, but to see a psychiatrist implied mental illness, with its embarrassing baggage of misconceptions and stigma.

 

Nevertheless, on that October morning, I realized I had two options: try medications or kill myself. Facing that grim Hobson’s choice, I contacted a psychiatrist that my therapist had recommended and scheduled an appointment with her at the end of the following week.

 

Arriving at the psychiatrist’s office, I expected to meet a cold, disagreeable figure who would delve into my earliest childhood memories, fill me with exotic brain-numbing pills, and administer painful electric shock therapies when the former methods failed to cure me. I was pleasantly surprised. The doctor was a friendly middle-aged woman with a soft voice and a gracious demeanor. She asked a few questions, but mostly let me talk. She listened intently and wrote a few notes. After pausing for a moment, the good doctor smiled respectfully and told me I was suffering from major depression.

 

I was shocked. Me? Depressed? No way! I bristled at the doctor’s diagnosis. On the surface, everything seemed to be going great. As a lawyer-businessman in my late 30s, I had been blessed with success and interesting opportunities in law, information technology, business, and writing. I had achieved most of the goals I had set for myself professionally and personally. I had been happily self-employed for seven years and had published a highly successful three-volume book about Internet law. I was exploring some promising new business ventures. My family was healthy. I had a lot of friends. How could I be depressed?

 

Initially, accepting that I had depression was extremely difficult. I felt weak and inadequate, flawed and lazy. I concluded I must have had some terrible character flaw to be feeling so awful. Because most things in my life were going very well, a diagnosis of depression made no sense to me.

 

Nor did I like the idea of taking pills for depression; in part, because I worried they would change my personality or turn me into a zombie. I had read about antidepressants. I knew that the process of prescribing antidepressant medicines could be a matter of trial and error, and that doctors had only “theories” about how those medicines worked, rather than facts. I was very uncomfortable with the idea of medical treatment for depression because it seemed so unscientific.

 

Further, I had thought that depression was an illness that primarily affected women. In the popular media, I had seen many depictions of depressed women, but never of depressed men. As a guy who liked to be active and engaged in life, I felt ashamed of a condition that threatened to bench me in the game of life at a critical point in that game. Depression was too unmanly and, well, too depressing to accept.

 

Since I was paying my hard-earned money for the 45-minute visit with the psychiatrist, I told her all of my concerns. I expressed my disbelief and asked her how I could possibly be depressed. Patiently, my doctor explained that depression is a physical illness as much as it is an illness of the mind. I learned that most psychiatrists now believe depression results from an imbalance of certain chemicals in the brain called neurotransmitters. Encouragingly, the doctor said that depression usually responds well to treatment. She also told me that a lot of people suffer from depression and that there is no reason to feel ashamed of the illness. Becoming somber for a moment, she cautioned that untreated depression could be fatal: as many as 15% of depressed persons who do not receive treatment eventually kill themselves.

 

The doctor prescribed a medication called EffexorXR®. I’d like to say that there was a miraculous change the next day, but it didn’t work that way. In fact, for the first few weeks, I felt nothing. I wanted to abandon the treatment. I called my doctor, who suggested I be patient because antidepressants can take several weeks to reach their full effect. I waited three months, punctuated by regular visits with my doctor. Finally, after taking the medication for about three and one half months, I began to feel consistently better and more like my usual self.

 

A year later, I am feeling much better. Most of my enthusiasm for life has returned. Increasingly, I have moments of joy and a sense of direction and purpose. My income is gradually rising, too, although it will take time to recover the recent losses. I am developing a new Internet-based business, actively networking with other professionals, and seeking new clients for my law practice.

 

I now realize that I did not have to suffer as long as I did or feel ashamed of my depression. Effective treatments are available and offer us hope. I am the living proof.