Idle Musings

on software, philosophy, and other thoughts.

This was originally something I posted on the internal blog at the company I work at (Atlassian is an awesome company if you don't already know), and I feel like it's important enough to re-publish publicly. We don't talk enough about this stuff, and I want to change that.

A coworker of mine wrote a follow-up post on our internal blog, and I just found out today that she posted hers publicly as well, which you can read on her blog here: Yes, Let's Talk About Mental Health

This is mostly unedited. The sections like this below are from the original Confluence page, reformatted for this.

I could definitely go in and add things now that it's been about a month or so since I wrote it, but I'll save that for later. Just know there are things I didn't talk about, like DNA testing that I've since explored with my doctor, so it's not something I'm unaware of.

Let's Talk About Mental Health

…because, while I can’t speak for the rest of the world, I do know that in the US, we have a culture of not talking about it, making it seem like a weakness, and a load of other bad approaches to it, including not funding it very well, or substituting law enforcement officers for social workers (a whole different can of worms).

This blog post has been bouncing around in my head for the past few weeks and I’ve finally just decided to sit down and write it.

There's one thing that I was reminded of over the weekend since I wrote this that I’d like to say explicitly. I knowingly wrote this from a position of privilege.

It was an internal blog post at a very open and welcoming company (I didn’t have a space to post it publicly at that moment but I’ve changed that). I’m a straight white guy with a good software engineering job that pays well enough that I can afford to get help and pay out of pocket for it while I sort out the insurance story.

Others, at least in the US, are not so lucky so when I say you should ask for help, for some people that’s going to be especially hard due to their financial situation, or some other aspects I’m not aware of.

I’m not sure what the answer is here, aside from pushing our leaders to make changes to how we fund mental health in this country. It has become far more of an issue for me with multiple family members with more involved mental health issues, so I hope there’s positive change in the future, and I’m trying to work towards that in my own way.

I want to share my story, in the hopes that it helps someone else. I think anyone who is getting help for mental health issues should feel comfortable talking about it, to make space, and make it okay for others, and help them not feel like a failure or that they’re weak for needing help.

I can’t speak to every mental health problem. I can only speak about my own, which centers around depression.

How I got around to asking for help

For years, I’ve been dealing with depression off and on. I don’t think I truly realized how long it’s been going on until I started seeing a therapist and talking about it. I don’t think I really thought of it as a problem for a long time.

I would have weeks where things are going okay, and then a week where it seemed like the world was ending. Every little frustration at work would lead me to questioning whether I was good enough, or whether I was even in the right profession, whether I should just quit. It would cripple my ability to make progress or stay motivated because I’d just feel like such a failure.

During these down weeks, I would oftentimes spend a whole weekend day just sleeping in bed, because I didn’t have the motivation to get up. I’d have days where I’d come home and just lie on the couch watching some old TV show I’d seen so many times before (I guess Star Trek (any of them) is my comfort show?) because I didn’t have the motivation to do anything else, and I had so many things I wanted to do, like woodworking, or working on personal projects.

I would read articles about how to get motivated, or try to find ways to push through it, and nothing helped. I’d see other people being cheerful and successful and motivated and wonder what they were doing that I wasn’t. Where did I go wrong? Why can’t I figure this out? Am I just burnt out? It was especially difficult working closely with people like that. How can they be so fucking upbeat? I wish I could do that.

Finally, around June of 2019, I talked to a friend of mine who used to work in the Psychology department at Texas A&M, and asked her about what I was feeling and going through and if she had some suggestions. She had some recommendations. She pointed me to some books I could read (I’ve never liked self-help books) and she suggested I also consider therapy and recommended me a couple of people she knew here in Austin.

Getting over that hump and actually talking to a therapist

It wasn’t until December of 2019 (over six months later) that I actually got up the…nerve?… to contact one of the people she recommended. We had a phone conversation about what I was going through, what kinds of problems I had been having and whether she thought she’d be able to help. Then we started having therapy sessions.

I want to have a little bit of an aside here, and stand on a soap box for a moment. Whenever you're dealing with a health care professional, don’t hide things. I’m mostly talking to my fellow men here, because (and I can’t find the statistic right now) a large percentage of men don’t tell health care professionals things they should.

When you take your car to the mechanic, you tell them all the weird noises you’ve been hearing, or the vibrations in the steering wheel, or whatever. You even tell them what you think the problem is when you’ve never worked on a car in your life. You don’t leave things out. Why should talking to a doctor be any different?

This especially applies to therapy. The therapist is there to help you, and they can’t if you don’t tell them things. If you’re not gonna be honest with them, with yourself, then why are you paying them.

It was nice to have a place to just talk, to work through how I was really feeling, to really be honest with myself about what was going on. I kinda wish I had done it sooner, and even if you’re not depressed or having any issues, it’s good to have.

I practice Soto Zen Buddhism, and I’ve definitely used "practice discussion" with teachers in a similar way, which is actually a little problematic.

One of the problems in the US with the fact that we have such poor mental health coverage is that religious organizations end up taking up the slack and they’re not trained for this sort of work usually, and people can and do get hurt by that lack of skill, despite all the best intentions of the priest or teacher. This applies to all traditions, not just Zen.

So I started therapy back in December, and it kinda helped, but I was still having trouble with motivation, focus, and feeling like a failure.

Concerning medication

So around May or June, my therapist suggested talking to a psychiatrist, to get his opinion and whether he thinks I’m dealing with depression, and whether he thinks medication might help.

From the beginning I was very hesitant to consider medication. It’s probably because of the bad culture we have around mental health. If you need anti-depressants, you must be a failure, or you’re weak, or you’ll be dependent on this thing to help you be normal and that’s “bad”.

But, I went into the eval with the psychiatrist with an open mind. I was willing to give it a shot because the worst that could happen is that it doesn’t work, or I have some reaction and I just stop taking it.

So I had the eval, and he thought, yeah I’ve been dealing with this for years, maybe all the way back to high school and that he wants me to try an anti-depressant. I pushed back with my concerns which went something like this:

Dr: “What are your concerns about taking an anti-depressant?”

Me: “Well, I don’t want to be dependent on something, I don’t want to need this to feel better. Reminds me of soma (from Brave New World). I don’t want ‘happy pills’.”

Dr: “Well, let me ask you something, you said you have a family history of heart disease. If you had to take a pill for high blood pressure for the rest of your life, would you do it?”

Me: “Yeah, well that’s different because…”

We went back and forth for a while, and eventually I realized, it’s not different. The brain is just another organ like the heart, lungs, or kidneys. I guess we attached to this idea that somehow our brain is us, and if we mess with that, we won’t be ourselves anymore. Even after getting the prescription in hand, I was still waffling about it.

But then I just said, sure, let’s try it.

Not everyone needs medication. Sometimes therapy can be enough. After about 6 months of slow progress, it was worth trying for me, but that’s me. Talk to a professional, obviously.

Starting the medication

He gave me a prescription for Bupropion. There are several different kinds of anti-depressants, and it’s actually not quite clear how they work, but the basic principle seems to be (I’m no expert here, I just read some stuff) that your neurons will reabsorb neurotransmitters (like serotonin, or dopamine for example) after they’re done using them, and these anti-depressants inhibit that response (they’re usually called something-something-something-inhibitors for that reason), leaving more of the neurotransmitters about to be used by other neurons. He started me on a low dosage, with the idea of doubling it to the full dose in a few weeks.

First impressions

After the first day of taking it, I noticed less resistance to things. I had frustrations at work that before would throw me into a failure despair feeling that didn’t now. They were still frustrations to be sure, but I pushed through them. “Okay, this doesn’t work, what do I need to do to fix it, who do I need to talk to to get that thing working.” I found less resistance to doing hobbies. Less resistance to just getting out of bed in the morning.

It’s not a dramatic change, but it was enough to think this was working. Could be placebo effect, but at this point, I don’t care. It helps. But I kept worrying about whether it would last, or if it was just a temporary effect.

Where am I now

It’s been about a month and a half, and it doesn’t seem to be a transient effect. I kept expecting to wake up one day and have all the old symptoms back, but that hasn’t happened. All I can do is take it one day at time.

I did have some issues increasing the dosage. On the second day at the higher dose, I got what I can only describe as an uncomfortable nervous energy. I noticed that morning that I was rushing while making breakfast because I thought I was going to be late for a meeting, and I literally stopped at one point and told myself out loud, “Why are you going so fast, slow down.”

I ended up just taking that day off, and luckily I had a follow up with the doctor to check in and we ended up going back to the lower dose, and then we later decided to try an intermediate dose.

This is one of the things about this that’s hard. It’s not a magic bullet. Some drugs work better with some people than others, and it takes time and work to figure out what works.

As I’m writing this, I’m on the intermediate does, and the last day or two I’ve been feeling a little of that uncomfortable energy that I had before so it may still not be right yet, but it’s more manageable. I obviously don’t want to replace depression with this feeling but I can work on that with the doctor to find what works best.

Closing thoughts

Mental health is not something to be ashamed of. You shouldn’t feel like a failure for needing help. And you shouldn’t feel like a failure for needing drugs for what might be a chemical imbalance in your body.

I hope this story helps someone else feel brave enough to ask for help. I hate phrasing it that way, because it’s not about bravery.

It shouldn’t be brave, it should be normal.