The Noonday Demon: An Atlas of Depression

by Andrew Solomon

If the first part of an emotional biography is precursor experiences, the second part is triggering experiences.

“I can do nothing. I understand nothing. I know nothing. Nothing. And all this misery does not even make me particularly unhappy.”

what I was experiencing was only neurotic depression, characterized more by anxious sorrow than by madness.

Depression dawns as gradually as adulthood.

I felt myself shining; I felt ecstatic and did not guess how nothing good was to come of that. I rode from emotion to emotion in a way that was almost absurd.

Major depression has a number of defining factors—mostly having to do with withdrawal, though agitated or atypical depression may have an intense negativity rather than a flattened passivity—and is usually fairly easy to recognize; it deranges sleep, appetites, and energy. It tends to increase sensitivity to rejection, and it may be accompanied by a loss of self-confidence and self-regard. It seems to depend on both hypothalamic functions (which regulate sleep, appetites, and energy) and cortical functions (which translate experience into philosophy and worldview). The depression that occurs as a phase in manic-depressive (or bipolar) illness is much more strongly genetically determined (about 80 percent) than is standard depression (about 10 to 50 percent); though it is more broadly treatment-responsive, it is not easier to control, especially since antide-pressive drugs may launch mania.

The greatest danger with manic-depressive illness is that it sometimes bursts into what are called mixed states, where one is manically depressed—full of negative feeling and grandiose about them. That is a prime condition for causing suicide,

A breakdown is a crossover into madness.

the factors leading to a depressive breakdown gather over the years, usually over a lifetime.

when you affect the limbic system, which controls emotion, you also touch on memory. I remember that party only in ghostly outlines and washed-out colours: grey food, beige people, muddy light in the rooms.

There is a moment, if you trip or slip, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself, a passing, fraction-of-a-second terror. I felt that way hour after hour after hour.

He wrote out a prescription for Xanax, then burrowed around to find a starter kit of Zoloft. He gave me detailed instructions on how to begin taking it.

“Melancholia ends up in loss of meaning . . . I become silent and I die,”

Daphne Merkin wrote in a confessional essay on her own depression. “Would people mourn me if I never returned, never took up my place again?”

“If left to herself, she would have eaten nothing at all and would have gradually starved to death. It was extraordinarily difficult ever to get her to eat enough to keep her strong and well. Pervading her insanity generally there was always a sense of some guilt, the origin and exact nature of which I could never discover; but it was attached in some peculiar way particularly to food and eating. In the early acute, suicidal stage of the depression, she would sit for hours overwhelmed with hopeless melancholia, silent, making no response to anything said to her. When the time for a meal came, she would pay no attention whatsoever to the plate of food put before her. I could usually induce her to eat a certain amount, but it was a terrible process. Every meal took an hour or two; I had to sit by her side, put a spoon or fork in her hand, and every now and again ask her very quietly to eat and at the same time touch her arm or hand. Every five minutes or so she might automatically eat a spoonful.”

If there are issues you have successfully skirted or avoided for years, they come cropping back up and stare you full in the face, and one aspect of depression is a deep knowledge that the comforting doctors who assure you that your judgment is bad are wrong. You are in touch with the real terribleness of your life.

Breakdowns leave you with no point of view.

the ratio between the pathological changes (which cause depression) and the adaptive ones (which fight it) determines whether you stay sick or get better. If you have medications that exploit or aid the adaptive factors enough to put down the pathological ones once and for all, then you break free of the cycle and your brain can get on with its usual routines.

Three separate events—decrease in serotonin receptors; rise in cortisol, a stress hormone; and depression—are coincident.

These events typically involve loss—of a valued person, of a role, of an idea about yourself—and are at their worst when they involve humiliation or a sense of being trapped.

Having a baby, getting a promotion, or getting married are almost as likely to kindle depression as a death or loss.

It is clear that stress drives up rates of depression. The biggest stress is humiliation; the second is loss.

Just before my reading tour began, I started taking Navane, an antipsychotic with antianxiety effects, which, we hoped, would allow me to take the Xanax less often.

Depression is a response to past loss, and anxiety is a response to future loss.”

depression and anxiety are genetically determined, they share a single set of genes (which are tied to the genes for alcoholism).

Sylvia Plath wrote in The Bell Jar, her wonderful evocation of her own breakdown: “I couldn’t get myself to react. I felt very still and very empty, the way the eye of a tornado must feel, moving dully along in the middle of the surrounding hullabaloo.”

With the wonder and bitterness of someone pardoned for a crime she did not commit I come back to marriage and friends, to pink fringed hollyhocks; come back to my desk, books, and chair.

This phase of half-recovery can last for a long time. It is the dangerous time. During the worst of my depression, when I could hardly cut up a lamb chop, I could not have done myself real harm. In this emerging period, I was feeling well enough for suicide.

I remember one evening in particular, when an acquaintance had convinced me that I should go out to the movies with him. I went along to prove my own gaiety and for several hours kept up every appearance of the fun the others were having, though I was pained by the episodes that they found funny. When I came home, I felt a return of panic, and a sadness of dinosaur proportions. I went into the bathroom and threw up repeatedly, as though my acute understanding of my loneliness were a virus in my system. I thought that I would die alone, and that there was no good reason to stay alive, and I thought that the normal and real world in which I had grown up, and in which I believed that other people lived, would never open itself up to receive me.

crazy people are better friends when you are crazy; they know how crazy feels).

I did not want to sit on the roof, though I was also aware that if I didn’t allow myself the relief of considering suicide, I would soon explode from within and commit suicide.

I didn’t particularly want to die but I also didn’t at all want to live.

Depression is hard on friends. You make what by the standards of the world are unreasonable demands on them, and often they don’t have the resilience or the flexibility or the knowledge or the inclination to cope. If you’re lucky some people will surprise you with their adaptability. You communicate what you can and hope. Slowly, I’ve learned to take people for who they are. Some friends can process a severe depression right up front, and some can’t. Most people don’t like one another’s unhappiness very much. Few can cope with the idea of depression divorced from external reality. Many would prefer to think that if you’re suffering, it’s with reason and subject to logical resolution.

If I were only Dante, I’d be great explaining what it was like.

“But the thing that saved me was Prozac, which came along in 1988, just in time.

But I would not be the person I am today without the wisdom I have gained from my experiences, the shedding of narcissism they’ve brought about.”

The Russian poet Daniil Kharms once described hunger: “Then begins the weakness. Then begins the boredom. Then comes the loss of the power of quick reason. Then comes the calmness. And then begins the horror.”

The psychopharmacologist thought that, since I had felt light-headed on Zoloft and highly strung on Paxil, it was worth trying something new, so he put me on Effexor and BuSpar, both of which I am still taking, six years later.

In the throes of depression, one reaches a strange point at which it is impossible to see the line between one’s own theatricality and the reality of madness.

Antonin Artaud wrote on one of his drawings, “Never real and always true,” and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true. It’s very confusing.

We would never treat diabetes or hypertension in this on-again, off-again way; why do we do it with depression? Where has this weird social pressure come from? This illness has an eighty percent relapse rate within a year without medication, and an eighty percent wellness rate with medication.”

But you are never the same once you have acquired the knowledge that there is no self that will not crumble.

What if tomorrow I wake up and I am not myself but a dung beetle? Every morning starts off with that breathless uncertainty about who I am, with a check for the cancers of unseemly growth, with a momentary anxiety about whether nightmares might be true.

The standard textbook on emergency room practice in the United States does not deal with the psychiatric aspects of somatic illness.

the conservatism of doctors such as the ones I encountered in that emergency room, who deal with intolerance for extreme pain (physical and psychological) as a weakness of character.

Now I found myself having a total collapse despite the fact that I was on Effexor, BuSpar, and Wellbutrin.

Here’s what I knew that saved me: act fast; have a good doctor prepared to hear from you; know your own patterns really clearly; regulate sleep and eating no matter how odious the task may be; lift stresses at once; exercise; mobilize love.

He said he was not going to take me off Effexor—“it’s been working for you for a long time and there’s no reason for it to stop now.” He put me on Zyprexa, an antipsychotic that has antianxiety effects as well. He increased the dose of Effexor because, he said, you should never ever switch away from the product that is helping you unless you absolutely have to do so. Effexor had done it before and maybe with a boost it would do it again? He lowered my dose of Wellbutrin because Wellbutrin is activating, and in the face of high anxiety I needed to be less activated. We left the BuSpar alone.

As it was, it seemed as though the air around me was setting, the way glue sets, into a weird rigidity, so that people’s voices all seemed to be breaking and cracking through the solid air, and that cracking noise made it hard to hear what they were saying.

A few years ago, I added Wellbutrin to my regimen; it seemed to get my libido running again, though things have never come up to old standards. My psychopharmacologist has also given me Viagra, just in case I get that side effect, and has since added dexamphetamine, which is supposed to increase sexual drive. I think it does but it also makes me twitchy. My body seems to go through shifts beyond my ability to discern, and what works just splendidly one night may be a bit tricky the next. Zyprexa is sedating and I mostly sleep too much, about ten hours a night, but I have Xanax around for the occasional night when I am assaulted by sensation and cannot get my eyes closed.