by Robert Duff
Here’s something that I really, really want you to understand about antidepressants. With very few exceptions, they do not start working immediately. In general, most antidepressant medications take about three or four weeks to alter your brain biology and give you that sweet relief that you are looking for. You need to take my word for this. A lot of people make the mistake of stopping medication because they feel like it “isn’t working”. Don’t be that person! I know that it can really suck to not feel a sudden jolt of relief when you take the medication, but if you stick with it, the relief will come. The other kind of shitty thing about medication is that they can have side effects. As I mentioned before, there is no such thing as a biochemical free lunch. If you are altering your biology, you can have some unintended effects. For antidepressants the common ones are: dry mouth, weight gain, decreased sexual desire, or difficulty reaching orgasm. Obviously these suck. Getting fat and crappy in the sack is not going to help with the depression. However, it is important to realize that not everyone has side effects. Furthermore, if you have side effects from one medication, there is still a good chance that you won’t have the same side effects from a different medication. It’s a cost-benefit analysis. In a perfect world, you would not need medication to help, but since you may need that extra boost to help you kick depression’s ass, you need to be the one to judge whether any the benefits outweigh the potential costs.
I hope this gives you a somewhat better idea about what psychiatric medication is all about. I barely scratched the surface here. There are many different types of antidepressant medication. There are also medications that serve as “mood stabilizers” for people that are dealing with bipolar symptoms. Just like my advice regarding therapy, don’t give up if a medication does not seem to be working for you. Talk to your psychiatrist about it. Everyone has slightly different brain chemistry. Though we are getting closer, we don’t currently have the perfect blood test to tell you the perfect medication for your particular form of depression. Sometimes, a little bit of trial and error is necessary to dial in the right treatment for you. (Yet another reason that you should engage in therapy in tandem with medication.) Therapy does start to make change quickly. Work at this thing from multiple angles and you will prosper. If I might offer a final piece of advice related to medication here, please try your best to see a psychiatrist about it. Your primary care doctor can typically prescribe you psychological medication if you ask for it, but it is important to realize that they do not specialize in that type of treatment. They are not as trained to recognize the nuances involved in psychopharmacological treatment. A psychiatrist has a broader knowledge about the subject and is more readily able to provide you with an accurate diagnosis before moving forward with treatment. Okay. Stepping off of my soapbox now.
I think that about covers it for the treatment section of this book. I know that I didn’t go into excruciating detail about every single topic, and that is intentional. I just want you to have a better understanding of what additional value professional help might be able to provide in your quest. By no means is this something that every single one of you needs to follow through with, but I hope this clears up some of the nonsense. Don’t be afraid to reach out. If you need help in taking the first step toward professional help, ask someone that you trust to give you a hand. If you need someone to take you to your first session because you are too scared to go by yourself, make that happen. Whatever it takes. This is your health we are talking about here. You have the capacity to dig your way out of this and one of the skills that will help you along the way is being able to recognize the best tools that you have at your disposal. Now you have another depression-crushing tool in your Batman-style utility belt should you need it.
Ch. 10 Adventure Time
Maybe you haven’t picked up on this yet, but I can sometimes be a huge nerd. For better or for worse, I was basically raised by video games and the Internet. The downside of this is that I have probably shaved a few years off of my life by spending way too many sleepless nights with abysmal nutrition, binging on whatever game had ensnared my soul at the time. The plus side is that in my own life, I have been able to overcome some pretty significant obstacles and achieve my goals by reimagining my life through the lens of a game. It’s not necessarily a new concept. You have probably heard the term “gamification” before, which basically means integrating elements from game design to make something more engaging, motivating, and fun. Brands and products are no strangers to the idea of making things more game like. Take the Starbucks app as an example. You essentially gain levels by spending more money and time at Starbucks, which in turn unlocks different upgrades and status levels. Humans fucking love games. Why do you think Vegas works? It’s not like that place would still be standing if people actually tended to win money. Gamification is not all about conditioning you to spend more money on greedy brands though. It is a topic that is actually getting a lot of traction in the scientific literature as a way to promote physical and mental wellbeing. What I want to talk about here is one of approximately five zillions ways that you can integrate elements of game design into your life to amp up the already amazing efforts that you are putting forward in your fight against depression. I must mention that, while gamification is broadly supported in the scientific literature for a variety of issues, my particular flavor and spin on it has not been studied. That doesn’t mean that it won’t work for you… I just can’t promise you that it will. If you are interested in seeing an amazing example of gamification that has been proven to work, I encourage you to check out the work on the amazing Dr. Jane McGonigal. She crafted an entire game, program, app, and book that stemmed from her experience in recovering from a traumatic brain injury. For someone that really lives and breathes this stuff, look into her book Super Better.
Okay. Enough of me kissing other people’s asses. This is my book after all. The first step in any game is to define the heroes and villains. If you’ve ever played the old school Pokémon games, you know what I’m talking about. You know at the beginning of the game after you mash the A button over and over to get through the first few paragraphs of dialogue, and then some stupid twerp comes walking into the frame saying something witty and acting all smug? That’s when you get the prompt to painstakingly select one letter at a time to spell out your own character’s name and give your nemesis a moniker as well. If you’re like me, you probably made your rival’s name something clever like your best friend’s name or the name of your worst teacher at the time. Now, I know you are not exactly at the start of your quest to defeat depression, but there is no time like the present to put a name to the bastard. I’m serious. Name your depression. Anything you want. It can be something straightforward like Ned or Dolores, or it can be something snazzy like Sucklord or DepressoTron9000. Pick a name that resonates with you. Imagine yourself saying, “Man. I kicked ______’s ass today!” Personally, I am partial to the funny names. When you are having a bad day, telling yourself that your depression is acting up just doesn’t have the same umph as saying Sucklord is acting like a douchecanoe. See? I’m cracking up just thinking about it. Really visualize this. I want you to imagine a battle scene in your head where you are standing on one side and your evil nemesis is standing on the other. You guys are about to throw down in a fight of epic proportions.
OH WAIT. We haven’t picked your name yet! “But what do you mean, Robert?? I already have a name.” Well sure… you have your normal, plain IRL name. What about your hero name? If you want to keep the same name, more power to ya! You don’t have to though. This name is for you alone. Will you be Sally the Suckitude Slayer? TheSmileBomber? Maybe it’s just a normal name that you think fits your depression destroying alter ego a little better. For some reason when I was a little kid, I always thought Chad was the coolest name. Chad was the dude that had a chain wallet and talked back to his parents. So cool. Whatever name sticks out to you is perfect. You can even change it as you go on. This is your alter ego in this quest. Yo
u don’t need to share it with anyone else unless you feel like you want to. Maybe it’s a name that evolves over time as you make progress and “level up” your character by going through different real life experiences. The DC Comics character Oliver Queen is getting lots of airtime at the moment through the television show “Arrow.” In that story, he starts off branded as “The Hood” or “The Vigilante” when he has one particular agenda to seek justice at any means necessary. Then he becomes “The Arrow” when he tries to turn a new leaf and stop killing people all the time. Eventually, he adopts the moniker “The Green Arrow” when he decides to become the hero that the city deserves. Maybe your name evolves along with you. Either way, don’t stress about it. This is about how you feel right now and who you want to be as you move forward on this journey.
Awesome. You’re off to a good start. Now you have the key players in your game. It’s time to define some of the other parameters. Any good game consists of a series of different tasks that allow you to progress in some way. Not unlike life, eh? Often you have main storyline quests that drive the narrative forward and serve as the ultimate goals for you to achieve. These main quests are broken up into side quests that you need to accomplish along the way. In the search for the Holy Grail, one does not simply encounter it on a leisurely stroll one fine afternoon. Obviously, there are people to talk to, monsters to slay, and journeys to be had before you can get to that point.
It is important to recognize what the main quests are in your story. When you take a moment to think about it, you might be surprised to realize that you have been so caught up in the moment-to-moment grind of simply surviving your depression that you aren’t exactly sure what your ultimate goals are. This is your next task. Get out a sheet of paper, start a new doc, or do whatever works for you and start writing down your main quests. Don’t be shy here. Being able to maintain a romantic relationship without depression interfering may be a huge epic quest that you are nowhere close to at the moment, but that is exactly the thing that you should be writing down here. These are your big goals. Things that seem simple to other people, but nearly impossible to you. Obviously, you will need to come up with your own main quests, but here are a few potential examples: transitioning off of antidepressant medications, holding a job without being fired or quitting for an entire year, finding a healthy long term relationship, being able to look at yourself and feel proud instead of disgusted, or even something more specific like running a marathon. As always, there are no wrong answers here, and you are free to modify and tweak these as you continue forward. In your journey, these are your grails. In time, you will achieve them, but there will most certainly be some steps to take along the way. That brings you to your next task.
Now that you have a nice list of your epic final quests, it is time to break them down into side quests. These should be things that you need to accomplish along the way to your final goals. In the gaming world, these are tasks such as slaying a minor foe blocking the path to your final destination, fetching some relic from a faraway land that will imbue you with new strength and powers, or gathering materials to construct a stronger weapon. They should still be a bit difficult and take work, but they should be smaller, more attainable quests that you can conceivably get started on now. For example, if one of your main quests is to have a stable job for a year, there are definitely a few steps that would have to come before that. Obviously, you need to get a job before you can start worrying about keeping it over an extended period of time. So what do you need to get a job? Well, you will need to apply, interview, and agree to some sort of contract or work agreement. Each of these elements will be comprised of other small tasks, such as picking up and filling out applications, writing a resume if applicable, getting appropriate clothing for the interview process, and following through with interviews when offered. So, you can see here how the main quest of keeping a job for a year breaks down into several side quests that must be completed along the way. While it is always wise to break complex undertakings into smaller parts, using the frame of a game certainly helps me wrap my mind around the ways I might need to deconstruct my larger goals into more manageable pieces.
Another aspect of games that makes them so addictive is the process of getting better and better. Most games represent this progress through “leveling up.” For instance, most role playing games give you an overall level and also allow you to increase the level of different skills and attributes. This gives you many micro-level progressions to focus on. There is a game called Diablo 2 on the computer that I played for many years when I was younger. The final goal in that game is to defeat the ultimate boss, Diablo (or Baal in the expansion). If that was the only goal of the game, it would be really boring, but the beauty of the game is that they reward you for playing from the first few moments. Let’s say I decided on the sorceress character, because I wanted to slay the hordes of demons and undead with vicious arcane spell craft. I start the game as a level one sorceress, but soon after I leave town and begin defeating enemies, I level up. Awesome! That means I get to decide what skill I want to invest in. Let’s put a level into firebolt, so I can keep my distance and set some bastards ablaze. I also get 5 points to spend on my attribute points. Do I dump them into vitality so I can have more life force and take more hits? Maybe I should put them into energy so that I can cast my shiny new firebolt skill more often. See what’s going on here? I have barely played the game for 5 minutes and I’ve already been given a bunch of micro-choices and micro-rewards. You can apply this same concept to your self-help quest.
I want you to think about the various skills and attributes that are integral to your own personal depression journey. Skills would be tools like the things we have talked about in other chapters of this book. For instance, the thought log that we mentioned. That is a skill that totally fits into this conceptualization. The first time you encounter with a foe in the form of some negative thinking patterns, you will probably get your ass handed to you because your skills aren’t that strong. Maybe you remember reading about how writing down your thoughts can help, but you can’t quite recall the method and the different distorted thinking patterns that you were supposed to identify. That’s okay; you give it your best shot and work toward improving that skill. Once you level up your thought log skill a bit, you can be more confident as you tackle situations that have potential to send you into a depressive spiral. Other skills to level up might be deep breathing, mindfulness, or even physical abilities like running or using the squat rack at the gym. There are different schools of thought when it comes to levelling up skills. Sometimes, it is most useful to try to level up all of your skills equally, so that you have a well-rounded toolkit to draw from. There may be other instances where investing heavily into one skill will help you most in your particular situation. Maybe you have nothing to worry about when it comes to physiological issues, but you find yourself consistently crushed by guilt, procrastination, and distractions. That would indicate that you don’t need to level up physical skills much. Instead, you should probably dump as many points as possible into mindfulness so that you can better take things in stride and build up some resistance to getting thrown off track by negativity.
That brings us to attributes. These are slightly different than skills. I will use a physical example again because it is easy to understand. In the previous paragraph I talked about running as a skill that you could focus on leveling up. However, leveling up your running skill is going to be somewhat difficult until you invest some points into your cardio attribute. See what I did there? The attributes are the underlying aspects of yourself that provide the backbone for building your skills and working toward completion of your quests. Remember the job example? If you dove in at level one and tried to snag a great job, you might have a hard time because you are missing out on some attributes. Confidence, charisma, verbal and written communication, and motivation are all attributes that underlie that particular quest. You will probably want to level those up a bit to make the
process easier for you. There are many different attributes that could be areas of focus for you. You will need to decide those for yourself by breaking down your goals step by step like we have been. Break up your main quests into side quests, ask yourself what skills you will need to accomplish those side quests, and then consider which attributes underlie those abilities. Some of these attributes may have a very clear method of leveling up. For verbal communication, you can practice interview questions with a friend. That’s pretty straight forward. You practice your verbal communication more, you ‘ll level up that attribute. Confidence is one that might be a bit more abstract. For attributes like that, you can certainly find your own ways to train them, but will often find that you are leveling them up as you continue that natural process of bettering yourself as you pursue your quests.
