Depression, anxiety, Covid and the whole damn thing

Last year began with the advice of my psychiatrist of six years that I should undergo electroconvulsive therapy, or ECT.

He was concerned that after a period of equilibrium, minor fluctuations aside, I was experiencing bouts of depression and anxiety that were more frequent, more intense and of a longer duration than had been the case for some time.

ECT is a procedure, performed under general anaesthesia, which involves passing small electric currents through the brain, causing changes in brain chemistry to relieve severe depressive and psychotic symptoms. Drastic as it was, ECT could be the circuit breaker, literally and figuratively, that I needed.

I was open to the idea of ECT, to the possibility of relief from the re-emergent maelstrom of despair, grief, guilt and remorse, feelings of helplessness and worthlessness, of unforgiving self-loathing and self-reproach, debilitating low self-esteem, the tears, the nightmares, the thoughts of suicide, the sensation that one is drowning in life, not for a moment or two, but for weeks at a time. The intensity waxes and wanes but even in moments of relative calm the dread remains. It’s utterly exhausting.

Anxiety came hand in hand with my depression. Anxiety is a natural part of life; a normal and momentary response to stress, worry or pressure. For some, their anxiety is so chronic, so utterly disproportionate and excessive, that it creates a searing nervousness, fear and apprehension of the unknown.

For me, anxiety has been something to endure and crash through. Not that I understood it as a clinical disorder; it was just part of my maddening introverted “personality”. Without even realising it I planned around it so that I could function with apparent self-assurance and, one hopes, aplomb.

Imagine if every time you enter an unfamiliar doorway you do so with a feeling of dread at what you will find on the other side.

I have always avoided arranging to meet someone in an unfamiliar pub or café. The idea of standing in a foreign place and looking around, craning my neck to survey unfamiliar surrounds, was terrifying, as if every eye was on me at this vulnerable time. Meeting someone in a restaurant was preferable. It provided the safety valve of spying my companions at their table, or failing that checking in at the host station, which was especially useful if I was meeting people I did not know, which was a regular occurrence in my business. In the latter instance, once seated at the table, I flicked the switch, and I was “on”.

Rickety house of sticks

This is the paradox of depression: the ability to function, even to reach the highest levels of attainment, to give every appearance of being confident and in control, while being neither. It’s this delusion of “coping”, grinding as it can be, that creates the pretext for not seeking help.

Some will take their undiagnosed or untreated depression to the grave, but for others, and certainly for me, the rickety house of sticks that is coping with depression eventually comes tumbling down.

After decades of living with undiagnosed depression it became clear that I was losing the battle. At the end of 2013, I took a voluntary redundancy package from Fairfax Media, a decision made necessary because I could no longer endure a sustained period of change and instability in the workplace as a feckless management struggled to set a course for the company in the new media landscape. Concurrently, in the background, was my failing marriage, dying the death of a thousand cuts as I progressively shut down, aware but emotionally incapable of responding to the crisis before me. My marriage ended in January 2014.

Some weeks after the breakup I finally reached out for help. My GP referred me to a psychoanalyst and I was diagnosed with clinical – or severe – depression, which I wrote about at the time. He referred me to others and so began a new and intense world of psychiatrists and psychotherapists, which I also chronicled. I underwent treatment, a regimen of anti-depressant medication and therapy, treating a combination of biological and psychological factors.

With that treatment I got to experience the unfamiliar liberation of inner peace. I felt equipped to face the challenge of overcoming the end of my marriage of 25 years and the separation from my three boys. I had the resolve, and the confidence, to rebuild, reboot and refresh. And I was kinder to myself.

One welcome outcome was the apparent reduction in my anxiety. I was much more at ease with the unfamiliar, whether navigating the public transport system or venturing into strange pubs to meet people. I was socialising again after years of being quite reclusive. Although a loner by disposition I was also more comfortable with my own company outside the pub or home, happy to go to the cinema, theatre and concerts on my own, and even to dine alone.

Depression can be managed

As part of the renewal I moved to the Macedon Ranges in regional Victoria, a one-hour train trip from Melbourne. Surrounded by towering gums, delighting in the abundant bird life, it was an idyllic sanctuary for a freelance journalist; when not meeting deadlines I was plugging away at the Great Australian Novel. It seemed to be working.

The journey out of depression is not linear. Depression doesn’t entirely go away with treatment. It lurks and occasionally makes its presence felt in momentary bursts, but it can be managed. The brain can shrug off triggers that might normally descend one into debilitating melancholia. The important thing is that one is not monstered by it; it is not the tail that wags the dog.

After a couple of years of relative peace things turned. The occasional momentary bursts of darkness were becoming more frequent and lasting longer. The nightmares were back, vivid and pointed. Because my sleep was fitful each cycle would bring on a fresh dream. I would wake up feeling sad, distraught and occasionally tearful. Even when I could not recall details of the dreams I would feel burdened by the night’s unforgiving narratives. Although perpetually exhausted I dreaded going to bed and it became my custom to busy myself until the early hours.

The waking hours were no less fraught. Triggers that had been kept at bay were reasserting themselves with a vengeance. How many tears can one person shed? Almost anything could set me off. Television became a minefield of catalysts – somebody declaring “I love you”, depictions of parents with young children, birth scenes (Call the Midwife was best avoided), a journalist or writer at their keyboard (amazing how many times that comes up), even Metricon commercials. The reference points were unambiguous. Not that it necessarily took a particular event to suddenly find myself mired in a thick tar of torpor. It was not uncommon for me to sleep through entire weekends – a sleep to be distinguished from my fruitless attempts at nightly repose – to remerge on the Monday to tend to the week’s deadlines. The work was tedious – mostly “sponsored editorial” for the AFR – and offered little professional satisfaction but it provided a measure of structure to my week.

My psychiatrist was naturally concerned by this slide; I seemed to be back where I was when he started seeing me. He adjusted the regimen of anti-depressants. The combination that had worked for so long was clearly proving ineffective. But nothing helped and that’s when he finally recommended ECT.

Another layer of angst

I went home to think about this course of treatment for further discussion at our next appointment but I was ready to proceed. I wanted the pain to stop and I was desperate for some clear air. And then Covid-19 struck and everything was put on hold.

The lockdowns and restrictions in response to Covid initially had little direct impact – I was already living an isolated existence – but as 2020 progressed it became apparent that the pandemic was adding another layer of angst to my fragile state of being. There was an overwhelming sense that the world was changing around me and that it was leaving me behind. What if I no longer knew how to function in this new world of QR codes and density limits? Would I walk into a pub or café and set off alarms because I wasn’t doing it right? There is nothing rational about anxiety; I understood the facts of the Covid restrictions but it was the menacing shadow of change and uncertainty that rattled me, magnified by the relentless media coverage of the unstoppable coronavirus. The wearing of masks was a manifestation of this new world; I wore them when necessary, but I hated doing so and had an almost pathological aversion to being surrounded by people wearing masks. (This was not a Karen thing; I had no quarrel with the state’s authority to mandate masks.) There were times when I could not bear to step out of the house; not even my idyllic surrounds could tempt me. Because these moods would lift and wane, I would find myself jumping at the chance to do some gardening; it’s difficult to convey what a magical experience mowing the lawn can be.

Quite apart from the devastating disease itself, Covid must be causing untold mental anguish in the community; for some, it will be a mental torment being experienced uniquely and for the first time as a direct result of Covid; for others, it will be exacerbating existing mental illhealth.

A couple of months ago I decided to give up my solitary regional idyll. I can’t precisely pinpoint Covid as the primary reason for that decision, but it probably was. I moved in with my elderly parents in Melbourne. It’s not going to be easy. They are good people, but as they say in the classics, we have issues. The move is not without personal and material sacrifices. Most notably I’ve had to give up my library – my pride and joy – a wrench beyond words.

On the plus side I hope to wring every advantage from living rent-free and without the burden of having to maintain a household. I’ve given up the advertorial work, which was both soul-destroying and an affront to every tenet of journalism I hold dear. I’m lending my hand to a start-up news site for Australian Defence Force veterans and I will be taking a last stab at finishing that damned novel.

As for the ECT, I can’t be certain that I would have proceeded with it had Covid not intervened. I can only say that I was open to it at the time. Today, not so much. There’s no firm reasoning behind that change of heart. I have chosen to trust in myself to do my best and let the cards fall where they may.

Leo D’Angelo Fisher is a Melbourne journalist, writer and commentator. Connect with him on Twitter: @DAngeloFisher