The Noonday Demon: An Atlas of Depression

by Andrew Solomon

The birth and death that constitute depression occur at once. I returned, not long ago, to a wood in which I had played as a child and saw an oak, a hundred years dignified, in whose shade I used to play with my brother. In twenty years, a huge vine had attached itself to this confident tree and had nearly smothered it. It was hard to say where the tree left off and the vine began. The vine had twisted itself so entirely around the scaffolding of tree branches that its leaves seemed from a distance to be the leaves of the tree; only up close could you see how few living oak branches were left, and how a few desperate little budding sticks of oak stuck like a row of thumbs up the massive trunk, their leaves continuing to photosynthesize in the ignorant way of mechanical biology.

I have said that depression is both a birth and a death. The vine is what is born. The death is one’s own decay, the cracking of the branches that support this misery. The first thing that goes is happiness. You cannot gain pleasure from anything. That’s famously the cardinal symptom of major depression. But soon other emotions follow happiness into oblivion: sadness as you had known it, the sadness that seemed to have led you here; your sense of humour; your belief in and capacity for love. Your mind is leached until you seem dim-witted even to yourself. If your hair has always been thin, it seems thinner; if you have always had bad skin, it gets worse. You smell sour even to yourself. You lose the ability to trust anyone, to be touched, to grieve. Eventually, you are simply absent from yourself.

Maybe what is present usurps what becomes absent, and maybe the absence of obfuscatory things reveals what is present. Either way, you are less than yourself and in the clutches of something alien. Too often, treatments address only half the problem: they focus only on the presence or only on the absence. It is necessary both to cut away that extra thousand pounds of the vines and to relearn a root system and the techniques of photosynthesis. Drug therapy hacks through the vines. You can feel it happening, how the medication seems to be poisoning the parasite so that bit by bit it withers away. You feel the weight going, feel the way that the branches can recover much of their natural bent. Until you have got rid of the vine, you cannot think about what has been lost. But even with the vine gone, you may still have few leaves and shallow roots, and the rebuilding of your self cannot be achieved with any drugs that now exist. With the weight of the vine gone, little leaves scattered along the tree skeleton become viable for essential nourishment. But this is not a good way to be. It is not a strong way to be. Rebuilding of the self in and after depression requires love, insight, work, and, most of all, time.

The relief people express when a doctor says their depression is “chemical” is predicated on a belief that there is an integral self that exists across time, and on a fictional divide between the fully occasioned sorrow and the utterly random one. The word chemical seems to assuage the feelings of responsibility people have for the stressed-out discontent of not liking their jobs, worrying about getting old, failing at love, hating their families. There is a pleasant freedom from guilt that has been attached to chemical. If your brain is predisposed to depression, you need not blame yourself for it. Well, blame yourself or evolution, but remember that blame itself can be understood as a chemical process, and that happiness, too, is chemical. Chemistry and biology are not matters that impinge on the “real” self; depression cannot be separated from the person it affects.

Influenza is straightforward: one day you do not have the responsible virus in your system, and another day you do. HIV passes from one person to another in a definable isolated split second. Depression? It’s like trying to come up with clinical parameters for hunger, which affects us all several times a day, but which in its extreme version is a tragedy that kills its victims. Some people need more food than others; some can function under circumstances of dire malnutrition; some grow weak rapidly and collapse in the streets. Similarly, depression hits different people in different ways: some are predisposed to resist or battle through it, while others are helpless in its grip. Wilfulness and pride may allow one person to get through a depression that would fell another whose personality is more gentle and acquiescent.

If everyone has the capacity for some measure of depression under some circumstances, everyone also has the capacity to fight depression to some degree under some circumstances. Often, the fight takes the form of seeking out the treatments that will be most effective in the battle. It involves finding help while you are still strong enough to do so. It involves making the most of the life you have between your most severe episodes. Some horrendously symptom-ridden people are able to achieve real success in life; and some people are utterly destroyed by the mildest forms of the illness.

Working through a mild depression without medications has certain advantages. It gives you the sense that you can correct your own chemical imbalances through the exercise of your own chemical will. Learning to walk across hot coals is also a triumph of the brain over what appears to be the inevitable physical chemistry of pain, and it is a thrilling way to discover the sheer power of mind. Getting through a depression “on your own” allows you to avoid the social discomfort associated with psychiatric medications. It suggests that we are accepting ourselves as we were made, reconstructing ourselves only with our own interior mechanics and without help from the outside. Returning from distress by gradual degrees gives sense to affliction itself. Interior mechanics, however, are difficult to commission and are frequently inadequate. Depression frequently destroys the power of mind over mood.

It is mad for adolescents to rage at parents who have done their best, but it is a conventional madness, uniform enough so that we tolerate it relatively unquestioningly. Sometimes the same chemistry kicks in for external reasons that are not sufficient, by mainstream standards, to explain the despair: someone bumps into you in a crowded bus and you want to cry, or you read about world overpopulation and find your own life intolerable. Everyone has on occasion felt disproportionate emotion over a small matter or has felt emotions whose origin is obscure or that may have no origin at all. Sometimes the chemistry kicks in for no apparent external reason at all. Most people have had moments of inexplicable despair, often in the middle of the night or in the early morning before the alarm clock sounds. If such feelings last ten minutes, they’re a strange, quick mood. If they last ten hours, they’re a disturbing febrility, and if they last ten years, they’re a crippling illness.

We would all like Prozac to do it for us, but in my experience, Prozac doesn’t do it unless we help it along. Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason. These fortune-cookie admonitions sound pat, but the surest way out of depression is to dislike it and not to let yourself grow accustomed to it.

“Exercise is the first step for all my patients,” Richard A. Friedman of Payne-Whitney says. “It boosts everyone.” I hate exercise, but as soon as I can drag myself out of bed, I do some calisthenics; or if I can manage it, I’d go to a gym. When I was emerging from depression, it didn’t really matter what I did; StairMasters and treadmills were the easiest. It felt as though the exercise helped to clear the depression out of my blood, as though it helped me to get cleaner. “It’s a very clear matter,” says James Watson, president of Cold Spring Harbor Laboratory and one of the discoverers of DNA. “Exercise produces endorphins. Endorphins are endogenous morphine, and they make you feel great if you’re feeling normal. They make you feel better if you’re feeling awful. You have to get those endorphins up and running—after all, they’re upstream of the neurotransmitters too, and so exercise is going to work to raise your neurotransmitter levels.” Further, depression makes your body heavy and sluggish; and being heavy and sluggish exacerbates depression. If you keep making your body function, as much as you can, your mind will follow suit. A really serious workout is just about the most disgusting idea I can imagine when I’m depressed, and it’s no fun doing it, but afterwards I always feel a thousand times better. Exercise allays anxiety too: nervous energy gets used up by sit-ups, and this helps to contain irrational fear.

You are what you eat; you feel what you are. You cannot cause a depression to remit simply by choosing the right foods; but you can certainly bring on a depression by failing to eat the right foods, and you can to some extent protect against recurrence through careful monitoring of diet. Sugar and carbohydrates appear to raise the absorption of tryptophan in the brain, which in turn raises serotonin levels. Vitamin B6, which is found in whole grains and shellfish, is important to serotonin synthesis; low levels of B6 may precipitate a depression. Low cholesterol has been linked to depressive symptoms. The studies aren’t in, but a good diet of lobster and chocolate mousse may do much towards improving one’s state of mind. “The twentieth century’s emphasis on a physically healthy diet,” says Watson, “has probably given us a psychologically unhealthy one.” Dopamine synthesis also relies on B vitamins, especially B12 (found in fish and dairy products) and folic acid (found in calf’s liver and broccoli), and also on magnesium (found in cod, mackerel, and wheat germ). Depressed people often have low levels of zinc (which occurs in oysters, endive, asparagus, turkey, and radishes), vitamin B3 (found in eggs, brewer’s yeast, and poultry), and chromium; and these three have been used to treat depression. Low levels of zinc have been especially strongly associated with postpartum depression, since all reserves of zinc pass from the expectant mother to the baby at the very end of pre...

Nietzsche once said that the thought of suicide keeps many men alive in the darkest part of the night, and I would say that the more fully one comes to terms with the idea of rational suicide, the safer one will be from irrational suicide. Knowing that if I get through this minute I could always kill myself in the next one makes it possible to get through this minute without being utterly overwhelmed. Suicidality may be a symptom of depression; it is also a mitigating factor. The thought of suicide makes it possible to get through depression.