The black dog howls at my door

Winston Churchill referred to depression as a black dog.

As is true with all metaphors, it speaks volumes. The nickname implies both familiarity and an attempt at mastery, because while that dog may sink his fangs into one’s person every now and then, he’s still, after all, only a dog, and he can be cajoled sometimes and locked up other times.

That’s a positive interpretation of the metaphor. Depression doesn’t respond to cajoling, in my experience! Perhaps the metaphor is more sinister than that: the black dog is an adversary that cannot be shaken off, always out there (even on good days), though you can’t quite see it, persistently hunting you down. It’s a scary shadow to live with, akin to the Hound of the Baskervilles.

black dog giving chase

My family has a marked history of depression and suicide, which suggests a genetic predisposition. Many years ago, the high school guidance counselor took my girlfriend aside to warn her: “If you decide to break up with him, be careful how you handle it — you never know how someone in that family might react.”

I’ve been fortunate. The teenaged years were a real struggle for me, but I’ve been healthy as an adult. Sometimes depressive; even a low-level depression during a particularly difficult period (when my marriage was breaking down), but tougher and more resilient than some of my near relatives.

But this weekend, the black dog was howling at my door. It managed to sneak inside at least once, and leave its muddy paw prints in my entranceway. The good news is, I think the trigger was my asthma medication, so I’ve stopped taking it.

I’ve suffered from mild asthma every night at bedtime for the past several weeks. I have a prescription for a daily inhaler, but I had never filled it until now.

Saturday, I had a somewhat frustrating day. Then I had a small setback before bed, and I had a complete meltdown. I bawled like my best friend had died, and it took me about an hour to regain control. Poor MaryP — she was trying to find out what was “really” wrong, because my response was out of all proportion to the stimulus.

That episode set me to wondering about my asthma medication, so I googled it. Infrequent (less than one percent incidence) adverse events for inhaled budesonide include “psychiatric symptoms including depression, aggressive reactions, irritability, anxiety, and psychosis”. I suppose my inherent depressive tendency made me more susceptible to this adverse reaction.

But of course I’m speculating. Maybe it was just a coincidence. I’ve stopped taking the medication; now we’ll see whether I start to feel less fragile. I’ll follow up with my doctor when I have more information for her.

In the meantime, I worked out my coping mechanisms a long time ago.

  • Seek a balance between rest and productive activity.
    It’s a mistake to sit idle, with nothing to occupy you except thoughts of how depressed you are. Much better to set manageable goals for the day (changing the cat litter, for example) so you’ve got something to feel good about when bedtime arrives. (For me, “manageable goals” includes blogging!)
  • Do something physical.
    Yesterday, I went for a forty-minute walk despite the cold weather. (Minus 18° Celsius = 0° Fahrenheit — within seasonal norms for Ottawa in January.) Exercise is a constructive response to stress of any kind — even if it’s a cold day!
  • Get extra sleep.
    I had an exceptionally demanding week recently, and I suspect part of my problem is the inevitable letdown from that. I didn’t sleep well that week. Now I’m going to bed early, aiming at an extra hour or two of sleep each night to catch up.
  • Eat nutritional foods.
    Note the theme of the three middle bullets: look after your body. You can’t directly control your emotional state, but looking after your physical health is an indirect lever on emotional well-being.
  • Seek support from friends or family.
    MaryP has been entirely supportive, making little adjustments in the domestic routine. I’m very blessed, and I appreciate it!

I expect the ship will right itself, soon enough. Or (reverting to the original metaphor) the black dog will slink off with its tail between its legs.

Til the next time.

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19 Comments (+add yours?)

  1. addofio
    Jan 30, 2007 @ 22:56:46

    Mood disorders tend to run in my family also, though it sounds like not as seriously as in yours. I used to struggle with periodic bouts of depression, and had almost unconsciously figured out some coping mechanisms for it (one of which was, give in and be a slug for awhile, until some other part of my deep psyche rebelled and fought back–which fortunately for me it always did.) St John’s Wort worked for me–I took it for something like five years–but one of the gifts of old age (or late middle age) for me has been an evening out of the mood swings.

    It sounds like you’re coping well with one of the mysteries of the human psyche. Hang in there.

    And don’t be too ready to discount the possibility of the medication as a trigger. 1% sounds like small odds–but it ain’t zero, and we know that depression has definite biological components. Somebody’s gotta be in the 1%, and maybe you’re one of them In some ways, for me anyway, it was a comfort of a kind to know what I was feeling was an artifact of my biololgy–I didn’t feel better, exactly, but it helped me stop the contribution made by beating myself up about the feelings, which for me was part of the mental feedback loop that kept me depressed.

    Reply

  2. JewishAtheist
    Jan 31, 2007 @ 01:42:53

    Depression doesn’t respond to cajoling, in my experience!

    Maybe not cajoling, but you can argue with it! Try the book Feeling Good, by David Burns. It teaches you how to use Cognitive-Behavioral Therapy (CBT) to basically argue with the irrational thoughts at the heart of depression. It works for me whenever I bother to actually do the exercises. :-)

    Here’s to feeling better soon!

    Reply

  3. whig
    Jan 31, 2007 @ 04:02:10

    Cannabis might help asthma and it is also believed to be helpful for some people that have depression.

    Reply

  4. whig
    Jan 31, 2007 @ 04:11:25

    Arguing with your thoughts is usually a sign that you need to do some deep work. If you can reconcile your oppositional forces to a common goal, it might help you in finding inner peace.

    Reply

  5. Stephen
    Jan 31, 2007 @ 17:34:51

    • Addofio:
    Thanks for sharing your personal story. I’m surprised that “giv[ing] in and be[ing] a slug for awhile, until some other part of my deep psyche rebelled and fought back” worked as a coping strategy. My impression is that people who go into “slug” mode usually end up stuck there. But I can’t argue with success! Coping strategies are necessarily specific to the individual.

    I’m almost certain the asthma medication is the culprit, and I felt noticably better this morning, thirty-six hours after I stopped taking it.

    btw, I added you to my blogroll since you seem to have become a regular commenter.

    • JA:
    Thanks for the encouragement.

    I suspect I do a certain amount of talking back to my emotions naturally — I don’t yield to them passively — but the reference to exercises intrigues me! I’ll have to check it out.

    • Whig:
    That cannabis study is interesting — and counterintuitive, since tobacco smoke is regarded as an asthma trigger.

    Personally, I had a bad experience the last time I smoked marijuana. Not convulsions, exactly, but a kind of twitching episode, and gaps in consciousness that caused MaryP to consider taking me to emergency. I gather this is a rare, acute complication.

    It was enough to scare me off the stuff. In general, I was getting diminishing returns from it anyway (not that I ever smoked with any frequency). More dopey, less of the positive elements of the experience.

    btw, I added you to my blogroll. :)

    Reply

  6. whig
    Jan 31, 2007 @ 18:56:14

    Thanks for the add, but mainly I just want to try to clear the air a bit about what cannabis is and isn’t. It isn’t anything like tobacco, except that both can be smoked. Cannabis can also be eaten or prepared as a tea or vaporized. There are many strains with differing effects, some are harsh and will give you little more than a headache, this is ditch weed and is over 95% of what the government destroys every year according to their own statistics.

    There are no fatalities due to cannabis, no established LD-50 or toxicity at any dose has been shown in humans. If it makes you uncomfortable, that is one thing, but there is no reason other than paranoia to think you would need emergency treatment due to a dose of cannabis. In the worst case, sleep it off. Nothing to be scared of, at any rate.

    Sativas and indicas have differing effects as well, and what works for you may take a certain amount of trying different things to see what agrees with you. It won’t diminish, as there is no demonstrated tolerance. It may actually work the other direction, building up in effectiveness as you become more familiar with it, and many people find it does little or nothing the first time or two they try it.

    My guess is you got some weak grass, or something that wasn’t the highest grade at any rate.

    Reply

  7. Bill
    Jan 31, 2007 @ 23:20:34

    I’m somewhat surprised and to some degree I felt like I was prying into your personal feelings.

    I think most of us in our lives had battled with the Black dog, I have even looked at SSRI’s as a way to cope with depression. The problem I have with them are the sexual side effects, and the tendency to turn you into an emotional zombie. Cannabis however aside from the asthma limitations has a tendency in those that don’t use it regularly or are not comfortable with it to produce a small degree of nervous tension possibly due to the fear of the unknown and this counteracts the anti-depressant effect (from personal experience) . I have the dubious pleasure of being allergic to something either in cannabis or in whatever it is usually cut with (my throat swells up).

    My personal depression has been acute and not chronic I suspect it may be chemical in nature as well but it could be associated with stress. It is surprising how many Government wonks suffer from depression aside from the effects of the asthma meds, have you thought of the pent up frustration inherent in your job. (also from personal experience)

    Another scary thing about SSRI’s like Prozac is that some of them can initiate a suicidal fugue of sorts (rare but possible).

    Yup I have done my homework, and come to the concussion that a combination of friends alcohol and traveling work for me. Keeping me distracted seems to help me not dwell on the depression. (I tend to be way too self critical, a disease many of us have). But as we have discussed before different people react differently to different stimulus.

    I hope it was just the meds and aside from the occasional depression which you don’t deserve there are people that appreciate and love you I think I know one woman that certainly does, and love tends to make depression livable.

    Also living in a climate with more sun and less sub zero days might help all of us Ottawanians.

    Reply

  8. Michael (a.k.a. Snaars)
    Feb 01, 2007 @ 13:03:03

    I don’t know what you’re going through exactly, but I wish you the best of health, mental and physical. Reading this reminded me of a previous post (Saying Goodbye, June ’05). I hope what you’re going through is transitory.

    “My impression is that people who go into “slug” mode usually end up stuck there.”

    I hope not, because I’ve been sluggish myself of late … but lately on a good day I fall more into the category of that person who sets manageable goals such as changing the cat litter. For a picture of my life lately, substitute for “cat litter”, “diapers!”

    The bad thing about depression is that you don’t get the pleasure from things that you know you should. At least, that’s how I feel when I get down.

    You seem to be on the right track. You’re aware of the problem, realize that it can be remedied, and you know how to go about breaking the cycle, hopefully before it begins.

    MaryP has been entirely supportive, making little adjustments in the domestic routine. I’m very blessed, and I appreciate it!

    I suspect you will be over this in no time!

    Reply

  9. Stephen
    Feb 01, 2007 @ 14:37:42

    • Whig:
    You sure know your subject! I have certainly wondered if I was reacting to some impurity rather than the pot itself. But the experience was alarming, either way.

    • Bill:
    No need to feel that you’re prying somehow. I don’t have any embarrassment about the subject. Perhaps the fact that I worked in a group home for people with psychiatric disorders helps me keep it in perspective. It’s just another facet of the complex human reality.

    I’m sure stress is one variable in the equation. My family history suggests a predisposition; but stress can be the catalyst that triggers a depression. I know that was the case in the latter years of my marriage, when I felt trapped in a situation that was destructive for me.

    I’m sure you know that alcohol is a depressant; and therefore it can be a bad option for depressive people. You’re able to indulge in a way that is beneficial to you (blowing off some stress, I presume), but I wouldn’t want to generalize it as a constructive response to depression.

    The trick with medications — I know this from my group home experience — is to get the right medication(s) at the right dose. Psychiatrists typically start with a minimum dose and work up from there, watching for adverse effects or improvement in the person’s condition. A particular medication might work well for everyone in a certain family, but be very bad for someone else. The process of sorting that out is a bit of a long term project — months or even more than a year.

    Regrettably, there are no quick fixes. But once that process has been concluded, the bad side effects you mention can be minimized if not eliminated.

    One day they’re going to use DNA profiling in conjunction with meds, to take some of the guesswork out.

    Reply

  10. whig
    Feb 01, 2007 @ 14:49:38

    Stephen, I live in Berkeley so I have access to a lot of people who have experience. I’m not an expert compared to many, but the level of general incomprehension in the public at large is quite bad and due in large part to many decades (over several generations) of deliberate misinformation and fabrication about this most useful of all plants.

    As you say, even psychiatrists know that patients may not immediately feel like the medicines they prescribe are helpful, but the clinical experience and data tell them whether to be alarmed by any particular reaction. The nice thing about cannabis is that it truly is benign with no demonstrated long-term impairment, though the acute effects are quite another matter. You might feel incoordinated or spastic or confused, and that is certainly not a proper state for doing some things. These effects wear off completely in a day or so, perhaps a few days if you’re a very heavy and regular partaker, and they are compensated by a much elevated capacity to do certain other things, like perceive music. Note how many musicians use cannabis, and the question is whether you could find one nowadays (other than in commercial pop-slut product) that doesn’t partake.

    Reply

  11. Stephen
    Feb 02, 2007 @ 20:29:36

    • Michael:
    Thanks for the good wishes.

    I don’t know why my spam filter keeps picking on you!

    The bad thing about depression is that you don’t get the pleasure from things that you know you should.

    Very true; a sad place to be, indeed.

    I consider it a good sign if a person is self-aware enough to know that he should be getting pleasure from a certain thing, even though the pleasure isn’t happening. As long as a person retains that degree of analytical detachment, s/he can decide on a constructive course of action.

    Once someone plummets to the point that all is despair, they’re likely incapable of helping themselves anymore. It isn’t easy being aware that you’re depressed, but there’s hope in that awareness.

    Reply

  12. McSwain
    Feb 04, 2007 @ 01:06:23

    An interesting post, Stephen. I’ve heard a lot about depression from the points of view of different women, but not much from men. My first husband went into deep depressions, and I’ve never really understood it. This helps. It’s wonderful that you’ve worked out coping mechanisms, and I hope that your ship is sailing smoothly soon, if not already.

    Reply

  13. Stephen
    Feb 05, 2007 @ 16:17:59

    Thanks, McSwain. Friday was the first day I felt like “myself” again. The last dose I took of the medication was on Sunday evening, so it took four or five days to get it out of my system.

    Reply

  14. Carolyn
    Feb 07, 2007 @ 09:58:48

    Depression and other things run “beneath” my family. Nobody talks about it, but people will just drink it away (not my immediate family…extended).

    I’m the only one, besides maybe my dad, that suffers from depression. I withdraw from everything, including blogging – then I feel guilty for withdrawing, and beat myself up and make myself more depressed.

    Even with medication it waxes and wanes, kind of like your dog analogy. The most important thing for me to do in those times is to remember that it’s a chemical/genetic issue and that it will pass. I try to remember that without these downs, the highs (let’s call them normal times…I don’t get manic, we’re still talking about depression and not bi-polar disorder) wouldn’t feel as great.

    Depression is really common in human nature, but most people are too ashamed to admit they’re affected by it. In recent years I’ve felt empowered by owning up to less well thought of aspects of me.

    I do appreciate you writing about your coping mechanisms…never hurts to be reminded of wha tI already know (I’m actually going through kind of a low point – as is apparent by my lack of blogging).

    Reply

  15. Stephen
    Feb 07, 2007 @ 10:20:26

    Hi, Carolyn. I suppose depression is equated with emotional weakness, so some people don’t like to own up to it. I actually think I’m quite strong emotionally. As you say, the depression is chemical/genetic — it has nothing to do with a lack of willpower or mental toughness or whatever.

    It helps a lot to detach from the experience and say to yourself, It’s just that damned black dog … I’ll be patient with myself til it moves along.

    I hope you’ll rebound soon!

    Reply

  16. Stephen
    Apr 26, 2007 @ 11:19:41

    Earth to “one who knows” —

    This post has nothing to do with Colonel Ted Westhusing.

    Reply

  17. Judy
    Apr 28, 2007 @ 18:28:34

    I am 57 years old and have suffered from mild depression most of my life. Everybody told me just put a smile on your face and everything will we alright. I did that for 25 years. Then at 52 my mother in law came to live with us and I kept smiling and she kept whining. Being a pleaser whiners destroy me. After 6 years I totally broke. Panic attacks, anxiety attacks, cutting anything you can think of. It’s been four years since I was hospitalized and I am just slowly starting to make my way back. I vowed to my family I wouldn’t commit suicide, my brother did and I can’t do that to them, but sometimes for weeks at a time I think every minute of every day I want to die. A good day I only think it about 4 times. Sometimes I have a really strong desire to cut my hands of with a machete. What’s that all about

    Reply

  18. Stephen
    Apr 28, 2007 @ 19:50:40

    Judy, I don’t have a glib answer for you. Several of my family members committed suicide. My sister died of cancer; but her whole life, she was troubled by thoughts similar to yours. Every small setback would cause her to think, “I wish I were dead”. It was a mental reflex.

    Congratulations on four years of putting one foot in front of the other, doing the small things you need to do to get through each day. You are creating the possibility of a good future for yourself.

    I assume you’re receiving medication. I know a little bit about that process: introducing medications one at a time, trying to find the right dose and the right combination of drugs. Unfortunately, the process involves a lot of trial and error, but I encourage you to stick with it. Eventually the doctors will help you to reestablish yourself; it won’t always be two steps forward and one step back.

    I will keep you in my thoughts. I don’t pretend to know what you’re going through, not really; but I hope you will find reason to hope.

    Reply

  19. Judy
    Apr 30, 2007 @ 18:34:02

    Stephen: I thank you so much for your kind words. I have wonderful friends and a great family, but they don’t really understand. I’m not blaming them because I am having a hard time understanding and accepting it myself. I have had a good and productive couple of days.
    I just have to quit worrying about when the Black Dog will catch up with me again. I am up and down day to day and week to week. After a good period though sometimes I find the bad ones harder to take. Again thank you so much for taking the time to reply.

    Reply

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