A vicious cycle

It's happening again. Every so often, I have "episodes. The duration between these episodes vary, from every two months back in my final university years to several months in recent times. Most of the times these episodes are not very intense and after a night's sleep, I "reset" myself and it is like nothing has happened. However this episode has been very severe, so severe in fact that I had to take a day off last Friday.

What am I talking about? The vicious cycle of my depression. The symptoms during the episodes are the same. I dread the oncoming day when I wake up with all the problems that I will encounter. I have difficulty getting up in the morning and lay there in bed, willing myself to start the day. When I get to work, the situation is no better. Throughout the whole day I just want to get to the end, rushing through my consultations as quickly as possible and saying "Yes" to almost every request and every question from my patients. After my work day has ended, there is still job-related tasks I need to do and I try to hide away from the responsibility.

Those are just my behavioural symptoms. Then there are the psychiatric symptoms of pervasive low mood. I laugh at jokes and watch TV shows / listen to radio comedy programmes with amusement but my baseline is always sadness. I completely feel drained all the time and always use weekend afternoons to nap - not a good use of my free time.  What hampers me most is the poor motivation and abysmal concentration. I have difficulty initiating tasks and maintaining focus is a chore. Even with programmes I like, playing them only results in pausing them after a few minutes. All of these psychiatric symptoms are surrounded by the baseline feeling of hopeless about my future, something I'll go into detail much later.

During intense depressive episodes, I get the biological symptoms. There is the chest ache and difficulty breathing but the somatic complaint I most commonly feel is the muscle ache in my arms. When I have the aching sensation in my biceps, I know I have a severe form of depression hanging over me. My appetite is the same, which I'm grateful for. I had a similar depressive episode 10 years ago which made me binge eat and caused me to gain 10 kg in a few months, which I have never been able to shed since. On the flip side, I'm excessively sleeping with wanting to go to bed straight after I had my dinner and evening shower at 21:30. Nobody of adult age goes to bed at that hour.

So why has this come about? My mum reminded me why I have these severe depressive episodes, A piece of advice I have forgotten since my university days, attending my psychiatrist and clinical psychologist. I have a tipping point regarding my depression - go past this point and you have the sombre side of me. I get closer to the tipping point if I have stress. I can tolerate low levels of stress, yet the more stressful things happening to me at once, the closer to the tipping point I get.

Lately my tipping point has been breached. There is the underlying work dissatisfaction, the worry about my future, the resentment of myself for being single for the rest of my life, the annoyance of still living with my parents when I'm in my thirties and the list goes on. Recent events include not finishing my protocol for the audit I have to do in my clinic for my GP higher training, starting an online diploma course on dermatology (skin diseases for the uninitiated readers) and just coming back from an excellent weekend trip to Singapore watching the F1 Grand Prix. I really should stop going on holidays, or more exactly going fantastic holidays where I do something outrageous. When I come back from a vacation is always a downer. I know everybody suffers from this but for me, I don't think my brain can handle the situation well. I really should go on shitty holidays from now on, or not go on holiday at all.

Thankfully for the past few days, my mood has improved. I still feel grumpy when I go back to work but at least I can do my job (just).

I hate going through these episodes. I always wish this is the last episode but I always know that it will always lurk around the corner.