(After the recent suicides of Anthony Bourdain and Kate Spade, I rewrote this blog post that I’d been working on, basically an update from my earlier post about depression back in 2016. It’s a heavy subject but I try to end on a hopeful note. It won’t interest everyone so I won’t be offended if you decide to skip this one. I’ll be back to writing about bondage again soon.)

Earlier this year I had to change my health insurance and, to my pleasant surprise, the new plan covers some visits to see a therapist. I’ve been in therapy many times over the years but it had been a while, so it’s really nice to be seeing someone again and to be able to talk freely about things.

After going through a very thorough intake interview in March, I was finally diagnosed with dysthymia – a low-level persistent depression that hangs on for at least two years, with at least some depression symptoms occurring more days than not. It used to be classified as a “personality disorder,” which sounds so stigmatizing, as if you’re just a permanently fucked-up person. Later changed to a mood disorder, it was most recently renamed in the Diagnostic and Statistical Manual, the bible of mental health professionals, as “persistent depressive disorder.”

One blog I saw recently refers to it as “the depression that stays hidden,” or simply as high-functioning depression. It’s basically like having the personality of Eeyore. I have good days and bad, and I hide it well, although on bad days I may seem overly quiet and inward. I am still able to feel joy and have a good time – things aren’t always bleak – but as I’ve written in this blog before I’ve probably been dealing with this since I was a child.

There is something strange about seeing a mental health diagnosis written down, as if to say, “Well, you always knew there was something wrong with you. Here it is.” Something else that I’ve struggled with for years, social anxiety disorder, was also listed on that sheet of paper. Neither diagnosis surprised me in the least.

I’ve never been actively suicidal but, as I’ve touched on before, I have had suicidal ideation for decades, starting back when I was about nine years old. I remember getting out of bed one morning to get ready for school, and as I walked into the bathroom to pee this wave of sadness and futility came over me and I wished I were dead. Since then over the decades I’ve had similar “death thoughts” probably thousands of times. When things are stressful my mind can easily go to those dark places, sometimes very dark.

Like many people, I was shocked and saddened by the news of Anthony Bourdain’s death by suicide, and Kate Spade’s just a few days earlier. Suicide has always been one of my biggest fears, so whenever I hear about someone actually going through with it, it hits close to home. Of course, with someone like Anthony Bourdain, who just seemed so cool and put together, it’s especially troubling.

Another suicide last year that really shook me up was that of pro-domme and fetish model January Seraph. I had never met her but again, from the outside, she seemed to have such a successful life and career, although she was open about the dark side and her ongoing struggles with depression. Her Twitter feed ominously ended with, “This is the last thing I was working on before The Nothing took hold.” Since last summer there have also been several other suicides and drug overdoses by models in the fetish and porn scenes, with several articles talking about the disturbing trend.

Obviously talk about mental health issues makes many people uncomfortable. There’s a huge stigma around mental disorders and especially suicide. I get it. It touches on our own darkness, and our potential for self-annihilation, which is frightening to consider. We all know that life could take a turn and beat us up so badly that we give in to despair. Suicide has always seemed to me like a temporary madness that takes over, and I have great respect for just how dangerous that impulse can be. One way I try to resist the stigma is to be open here about my own experiences with depression. Keeping the dark things hidden feeds the shame and self-loathing that so easily grow when deep down inside you feel like a damaged person.

Let me be clear again that I have no plans to kill myself. In my own case I’m talking about suicidal ideation versus actually offing myself, though I know my risk is higher than the average person, which is why I plan to never own a firearm and to do everything I can to minimize that risk. When I was going through a tough spell earlier this year, I even vowed to myself never to take my own life regardless of future circumstances. I hope that makes a difference in the end. Life is tragic enough without ending it like that, and I’d hate to have people on Twitter and Facebook writing, “Hey, did you hear about Sandra?”

So I cope, and I do pretty well though I can’t say I’ve ever felt cured of depression. I’ll have times – a few weeks when things are going well – and I’ll think, “Hey, maybe I’m getting this thing under control.” But the low moods, anxiety, and that empty feeling in my chest always seem to return. At this point I suspect it’ll be a life-long thing that I deal with, with ups and downs, although thankfully I’ve never been manic or bipolar, just a gloomy Gus.

But I consciously do a lot of positive things to manage it, some of which – keeping a gratitude journal – are easy to roll one’s eyes at. Corny as it sounds, though, that journal really does help. I also exercise regularly, meditate daily, try to eat my vegetables and drink more water, get a good night’s sleep (not easy since I often get insomnia), and try to watch my rumination and negative self-talk (again, not easy at all). I always look forward to the holidays too, with October through December usually being my best time of the year. I just really like Christmas!

Although dysthymia is a mental disorder, I’m a little skeptical to think of it as a disease in the same way that diabetes is a disease – for example, there is no blood test for dysthymia. And after all these years psychiatrists still don’t really know the underlying causes of mental illness. I’m no expert but it seems to me that this uncertainty just points to the complexity of causes – physical, social and psychological – behind mood disorders.

In my own case, there’s also the whole question of gender. I’ve never been particularly happy with being a man, but I also don’t really feel like I’m a woman. And while I don’t think about gender all the time it does often feel like a weird limbo state. I’ve thought it over many times but going back and starting over again with two X chromosomes somehow doesn’t seem like a particularly viable option.

A few people have asked me, why aren’t you taking medication? It’s a valid question. I actually did take Prozac for many years, and later Wellbutrin too, but after the first year I didn’t get much response from the drugs, which is an all-too-common outcome especially with milder forms of depression. Martin Seligman, the father of the field of positive psychology, points out that one of the dirty little secrets of psychiatry is just how often the drugs don’t work, with only a third of people taking them getting full remission of symptoms. For those lucky souls who get a good response the drugs do make a huge difference. But that leaves two thirds who get no relief from medication or only partial relief.

Although the verdict is still out, there’s even some evidence that long-term use of antidepressants where only partial remission occurs (which is what I experienced) can actually lead in some cases to a permanent depressive syndrome. There’s no way to know if anything like that happened to my brain chemistry but I do regret taking Prozac for so many years when it really wasn’t doing all that much. Having said that, I still follow the research on some of the newer drugs in development, such as Ketamine. It’s bizarre to think that a form of the club drug Special K would ever be used to treat depression, but if it gets good results in the drug trials I wouldn’t completely rule out trying something new.

In his book “Lost Connections,” Johann Hari argues that our modern world with its isolation and lack of social support is making so many of us miserable. Here in the United States, deaths from suicide now outpace deaths from traffic fatalities – close to 45,000 per year according to the Centers for Disease Control – with an increase of 25 percent in suicide rates since 1999 and thousands more failed attempts. The World Health Organization (WHO) now lists depression as the leading cause of disability worldwide, with a global increase of 20 percent in just the last ten years. CNN reported after Anthony Bourdain’s death that the WHO “estimates a global suicide rate of one death every 40 seconds, which by 2020 they predict will increase to one every 20 seconds.” As many have pointed out, something is deeply wrong.

But I don’t want to end on a completely bleak note. Collectively the world may be fucked but individually there’s still connection and beauty and meaning. Simple moments connecting with friends and family, or having one of those rare perfect days when the sun sets and all feels right with the world – I find those times do make it worthwhile. My fears of the future and of eventual decrepitude may tell me otherwise, but in the end I believe the struggle is worth it and that there’s a dignity in continuing on.

I may be a little nuts, but I’m still here and I hope to stick around. Keep the faith…Sandra