It is rather sad that Society has always viewed mental illness as a sign of weakness. Often even the family members of the person with depression do not understand the condition. This Stigma is by itself an epidemic that needs to be eradicated much like polio or small pox before depression is accepted as a brain chemical imbalance that affects the mind unbeknown to the depressed person. It may even be time that the very word depression was replaced by a new term, “brain injury”.
I was myself a man who once considered depressed people as weaklings who were unable to control their minds blaming their childhood conditioning. I called myself a realist and acted like an alumnus from the school of hard knocks who was beyond depression. I thought that people who claimed they were depressed were merely in denial about their inertia.
“It is all in the mind. I have seen strife. I have been through hell. I didn’t lose my mental control”I would say heroically.
Then I fell into depression.
I was 42. It was 2000, two years after my daughter’s death from cancer and a period of intense business turmoil. Despite being advised by my brother, a practising physician for 20 years that I had major depression, I’d refused medication for my severe anxiety and low moods, the stigma of it holding me back. I struggled with panic attacks, insomnia, weight loss and breakdowns. Finally, I turned to antidepressants after I broke down and cried on my wife’s shoulder one Sunday evening. A close family friend and Psychiatrist from Chicago advised me to start on SSRI’s immediately. I had an endogenous predisposition to depression(my mother suffered from severe bipolar disorder when she was alive). He started me on 40 mg of Paxil, an SSRI. Within weeks I started feeling better, and within six months, I was my old jovial self.
Sixteen years passed. I had reduced my antidepressants to a minimum dose of 5 mg of Lexapro, Escitalopram. I was 58. I had exited from all my businesses. The year was 2016. I had tapered down dosage to 5 mg, the lowest available dosage over several years from 20 mg. I had started transcendental meditation in 2001 and shifted to Upasana later on. For nearly 15 years I was practising half an hour of meditation daily, a period wherein there is awareness of thoughts appearing and disappearing without my mind fixating on them and following them. During this daily ritual, I experienced an inner silence and freedom that felt extraordinarily calming to my mind. This thoughtless period lasts to a full period of 20 minutes of absolute silence and stillness. Meditation helped in dealing with day-to-day stressors and acted like my recycle bin for my mental dirty trash. I gave the credit of my reduced irritability and restlessness completely to my mindfulness and never to my pill.
Side by side I had focused on my physical fitness. I trained myself to run a mile within 9 minutes, climb 1128 steps of Chamundi hills without stopping within 23 minutes and still do 25 push-ups at once in place of 45 that I used to do as a youth. I did all this apart from my daily one and a half-hour of tennis that I never missed. I even participated in the Kaveri trail mini-marathon of 10 Kilometers with 1600 participants in 2015 and stood second place among the age group of 45+ and was awarded a silver medal.
I was on top of the world. I spent time reading, writing, travelling and trekking.
One day in late August 2016, I came across a study that reported that mindfulness-based cognitive therapy (MBCT) might be as effective as antidepressants in stopping depression in sufferers. The study revealed that between two groups – one on medication, one treated with MBCT – the rate of relapse was similar: 47% and 44 % respectively. I also found out about Irwing Kirsch’s work that concluded that about a third of people who took sugar pills thinking that they were antidepressants showed significant improvement nevertheless(what is called the ‘placebo effect’).
With my healthy lifestyle supplemented with Omega 3 supplements and my daily meditation, I was convinced that I had conquered my mind and seen the ultimate reality.
I stopped my antidepressant entirely and cold turkey in August 2016.
I was very confident of maintaining the balance of my brain chemistry through my practice of meditation,my hill hiking and tennis . I was even convinced that I could defeat my genetic foes.
The first few months were great, and I lost a few pounds. “I told you so”, I said to the mirror, “you can do away with medication”. Week after week I started to lose control over my restlessness particularly in the mornings. I fought my morning anxiety valiantly by getting out of the house early, jogging and then playing my tennis. The restlessness gradually changed to generalised anxiety that peaked for a few hours in the mornings. My mind got calmer and joyful as the day progressed. I fought on. I increased my evening meditation sessions and gave up alcohol for a few months. But the mood swings continued unabated.
Then one day after the fifth month of my stopping medication, while I was playing my second set of tennis doubles as I tried my second serve, blood rushed to my head, and I felt a chill run across my forehead along with a sudden surge of fear of an unknown impending sinister danger, an intuitive feeling that something was suddenly terribly wrong. I was having a panic attack after nearly 14 years. I stopped the game immediately and went home. I tried deep breathing. I tried mind calming. Nothing worked.
It was Deja Vous 2000. The only difference was that this time I knew that the feeling would pass and that the fear was real but the danger was not.
I took off on a two-day break and a trek In Coorg and stayed at a luxury resort with my wife and my two adult children. I returned rejuvenated and peaceful but the mornings continued to be bad. I did not go back to my antidepressants. I continued with the firm belief that I could control my illness with my fitness regimen and spirituality. I started Pranayama (yogic breathing exercises) and within four months gradually increased my practice to a regimen of 35 minutes of Pranayama before dawn every alternate day. My routine included Sudarshana Kriya including Ujjayi, ten rounds of Bhastrika, Kapalbatti(350),12 rounds of Nadishodana (6 seconds inhale, 10 seconds retention and 15 seconds exhalation), five rounds of sheetali and five rounds of Brahmari.
My anxiety got worse than before and the panic attacks lasted till evenings. My quality of sleep suffered at night. I lost 6 pounds. I still believed that I could cure myself of my anxiety with the right diet, exercise, meditation and supplements. I continued my fight without going back to SSRI’s.
Finally, I hit the nadir when I broke down to our national anthem at a movie theatre in June 2017. Thankfully I was alone and I realised that I had fallen into the abyss, harder than I ever had before.
I went back to my U.S friend psychiatrist. After scolding me for stopping my meds he put me back on the antidepressant, starting with 10 mg and increasing to 20 mg after six weeks.
“I am not feeling any improvement,” I told him after four months after the usual initial side effects exacerbated my anxiety.
“Take anxiolytics S.O.S” he said.
“As you get older SSRI’s take longer to kick in” my friend consoled me. “You will get there. Hang in there.”
I did what he said. It took almost a year for me to become my usual self again. Life became great again and has been so ever since.
It is essential to know that in spite of a healthy lifestyle and daily religious sessions of mindfulness, a chemically imbalanced brain makes the mind disobedient with irrational fears making life a constant suffering. Medication becomes imperative if mere life style changes are not sufficient to deal with mood disorders. Depression and anxiety are so debilitating and so traumatic that spiritual practice, diet and exercise also eventually become a real struggle if not treated.
My spiritual practice, Pranayama and my morning jog coupled with tennis had only hidden the mess of layer upon layer of past difficult emotions, compulsive conditioning, and countless old wounds, fears, and phobias under the carpet of the conscious mind resulting in a chemically imbalanced brain. All these layers make even minor life challenges appear more grotesque and fearful when they eventually and inevitably take control one day.
I never miss my Pranayama and meditation sessions even now but gratefully take my antidepressants and probably will for as long as I live.
One should meditate, for it is an elixir of mental fitness and I swear by it. But one should also realize that it is not a panacea for mental illnesses. Being enlightened does not mean freedom from diseases, physical or mental. Brain is as much of an organ as the liver is. Mediation makes you understand the banality of suffering, not freedom from pain or chemical imbalances in the brain.
Antidepressants aren’t a miracle drug for everyone, and medical field doesn’t know entirely how antidepressants work. However, for me, like many, they work. I’m not advocating taking medication before trying other methods first since depressive disorders manifest differently for different individuals, and they respond to a variety of treatments in very different ways. But to look upon medication with disdain just because it could end up lifelong is like refusing blood pressure medication because it is lifelong.
It is important to know that one is not a failure if one can’t treat depression with the power of mind.
I will not hesitate to hold a placard that says,”I take anti depressants, but I am not a failure just because I can’t treat my depression merely with the power of my own mind” and take a stroll in a public park.