Depression Doesn't Come Knocking

The appetite is gone. The thoughts start to get darker. Getting up in the morning takes that little bit more of effort than usually, yet at night it is difficult to fall asleep. Things that used to bring joy start to feel indifferent, and the energy levels drop. It's difficult to get started with work, it's difficult to focus and the motivation seems to suddenly be gone. You spend the day waiting for it to be over, to be able to get back to bed in the hope of falling asleep quickly. Another sleepless night follows. 

Over the years, I've gotten good at identifying when an increased difficulty of Depression was starting. Most of the time, I was able to catch it early on, understand what was happening, and try and get better. 

2024 has not been off to a great start; quite the opposite; it's been one of the biggest struggles in a long time. I took all of the above symptoms as individual, attributing them back to fever, Covid, and just being tired. Even after all these years and countless hours of therapy, it was difficult to admit to myself what is happening. 

I am in the middle of another major depressive episode. Depression doesn't come knocking. It's silent and slowly creeps up on you. 

It's never too late to reach out for help, both professional mental health practitioners as well as friends and family. Please remember, you're not in this alone.

Before I begin, there's some housekeeping I'd like to get out of the way.

1. I am not a healthcare professional. In this article, I reflect back on what I've learned about Depression, how it starts, and how it feels going through it, as well as insights from countless hours of therapy, both online and offline. Nevertheless, this is not meant as medical advice, but I hope it can shed some light on a topic that often is skipped.

2. Depression Doesn't Come Knocking is a phrase I've been using for years, the first time in a 2018 speech on teenage burnout. The amazing author Rupi Kaur wrote a poem under the same title in March 2023. You can check it out on Instagram here, but this is not affiliated with her.

3. You can check out more information about Depression as well as dealing with Depression in yourself and loved ones at the following reputable sources:

   1. Mayo Clinic - Depression

   2. World Health Organization - Depressive Episodes

   3. Mayo Clinic - Supporting Loved Ones With Depression

   4. Mayo Clinic 2 - Supporting Loved Ones With Depression

4. These are (just some of) the signs that you or a loved one may be suffering from Depression:

   1. Persistent feelings of sadness, anxiety, or emptiness.

   2. Hopelessness, pessimism, or feelings of guilt, worthlessness, or helplessness.

   3. Irritability or restlessness.

   4. Loss of interest in activities or hobbies once enjoyed.

   5. Fatigue and decreased energy.

   6. Difficulty concentrating, remembering details, or making decisions.

   7. Insomnia, early-morning wakefulness, or excessive sleeping.

   8. Overeating or appetite loss

5. It's okay to not be okay. Please reach out to friends and or family or get professional help. It may be scary, but it's worth it.

6. This post is an experimental one, trying to provide more insight into these topics, while still staying on brand in my voice. Let me know what you think by hitting reply.

Let's begin, shall we?

The Way Not To Do It (and the mistakes I've learned from)

In many ways, I am a textbook example of how one should not go about fighting with Depression. I've been in and out of therapy for the better part of the last 10 years, starting at low points and then abandoning it when I was starting to feel better. After a while, having learned the different styles of therapy, I would be dismissive of psychologists suggesting that a lot of my current issues could indeed stem from my childhood and difficult relationship with my father. I had a very "ancient" approach to antidepressants, refusing them for years since turning 18 for fear of getting addicted and living in the absolute impression that I was "strong enough "to manage this on my own. In hindsight, there was a lot of stigma around antidepressants.

I didn't want to take up the emotional real estate of friends and loved ones, often deflecting questions about how I was doing or replying with generic, "Pushing through; you know how Mondays are; hanging on "or the famous, "I'm fine. " I didn't want my issues to weigh down others; I didn't want them to worry or to "offload "on them. Instead of talking things out, I'd bottle them in. Instead of sticking with therapy even as there were improvements, I've thrown myself from project to project in order to not have time to be with myself or even think about it. I distinctly recall one episode in 2018 where I had to drive to Nicosia a few times a week. It's an hour's drive, but I struggled so much to be alone with my thoughts that I would find ways to call friends, to have podcasts on, or call back to the office to ask how things were going. Anything, just not to be left alone with myself.

The pinnacle of my old ways hit when I checked out from life and consciousness for the first time in 2022, during the first episode of Depersonalization and Derealization. 

I'm planning on writing about this illness at a later point, the link to which will be here. This mental breakdown was the result of years of bottling up, of not dealing with things the right way, and of avoiding antidepressants - medication - at all costs. August that year was the first wake-up call. Two more followed, getting increasingly worse every time, until in April, there was nothing else I could do except change everything about my life. 

A Healthier Approach To Mental Health

When we break a hand, we go to the ER. We get pain medications, a cast and take time to heal. When we have a cold, we take antibiotics.

1. Antidepressants aren't evil. They really do help.

Antidepressants are medicine. They are the cast that allows our minds to heal. It's what gives us that bare minimum of energy back, to be able to stand up and reclaim a little bit of that energy that's needed to try and heal. It's a medicine, and there's no shame in taking them. In the summer of 2022, it was not my choice to start on Zoloft. If it were, I'd likely have refused, going back to my reservations around them and the stigma that follows. Luckily for me, it wasn't my choice, as I didn't have contact with the world and didn't understand what was happening to me. It was only after them that I started to get better. 

Antidepressants quite literally saved my life. Now, please don't get me wrong. I'm not saying they're a magic solution for everything or that everyone should be taking them. The point is that when needed, when administered correctly, they can be the thing that will break the cycle. They are not something to be feared. They're not a sign of weakness. They're likely not for life. They will help.

2. Therapy is a process. You shouldn't quit when it gets better before you're ready.

I've started therapy once more and have managed to stay consistently for over a year with the same therapist, showing up once a week. The moment I started to be better, life started getting in the way. It was summer, the sun was shining, we were going all around Poland with Natalia and her firm, and things seemed so much better. Suddenly, showing up every week was no longer guaranteed. Life got in the way, trips got in the way, and the business of everyday life really hit. 

Previously, that would have been it, but this time, luckily, I've managed to stick through it. I missed a session here or there, but overall, I didn't abandon therapy this time once things got better. It gave me the tools I needed to heal and work through it, but it's also an ongoing process. When things get better, it's time to celebrate, take the win, and cherish it. It's not time to quit or abandon it. It's easy to, I know. Life's busy and gets in the way, but it's crucial to continue on. When the time is ready to phase therapy out, your mental health professional will talk about it with you and help make a plan. It's also okay to switch if things aren't working the way you'd like to or you've reached the end of the capacities of a given practitioner. I know from experience that there's the sunk-cost fallacy. You've invested time into this person, opened up, and shared so much that it may be difficult to make the decision to switch, but it's important to remember that you can.

3. Depression doesn't knock, even when it returns.

Depression is a silent illness. It doesn't announce itself, and it's often easy to miss the signs. If it were to happen overnight, from day to day, you no longer have the energy to get out of bed, put your pants on, or do anything at all, it would be a clear signal. It would be evident. It would be simple to identify. But it doesn't. It slowly creeps up on you, chipping away bit by bit, often going unseen for a long time. This can happen the first, the second, the fifth, or the last time. It's scary when you realize one day that it's returned. It may be hard to admit to yourself that it's back, and that's completely okay. 

Acceptance is the first step to healing. No matter how hard or scary it is, we must tell ourselves the truth and then take the appropriate action. Talk about it with a professional, talk about it with a close friend or relative. Start to apply all the tools you've learned in therapy. Journal, take walks and ensure good nutrition. When that happens, you just do what you need to get through it, and you will. It'll get better, I promise. 

Depression changes from person to person. For some, it's a constant state; for others, it's episodes, and for others yet, there may be breaks for weeks, months, or even years. 

There are better days, and there are worse days. It's okay if it comes back; it just means that there's more to deal with and unpack, and it may be a chance to look inward and heal more.

What comes next…

For the last 3 weeks, I've been going through an episode again. Between the end of the year, the changes to my life, and the death of Antonis, it kind of crept up on me. At the start, enough coffee and productivity "hacks "were able to get me through the day. Sometime in early January, even that stopped. It's taken a while to admit it, but now I do and see it clearly. I don't know how long it will last or what I can do for it to be over. I struggle to motivate myself to work, do things around the house, or even do things I enjoy doing. Food has become more fuel than enjoyment, and I've resorted to my comfort zone by re-watching sitcoms. Having completed 4 seasons of The Good Place and 4 of Brooklyn 99, my productivity and momentum have fallen drastically.

I know this will pass. I know that it will eventually be over, and I know I have the strength and tools to work through it to come out the other side better. I know I will be okay, but it doesn't make the time between now and then any easier. 

I have hope. I have gratefulness… and I will make the time. 

To better times, my friends!

Love from Milan,

Julian