Buried Pressure – Don’s Story
Depressive Disorders

Buried Pressure – Don’s Story

Things Aren’t Always As They Appear

Don McCrystal

By all appearances, Don McCrystal was leading a charmed existence. All the trappings of the American dream had arrived right on schedule—a rewarding career, a loving family, summers at the shore house in a quaint resort town. At 54 years old, Don’s success had ripened on the vine and it was time to savor its sweetness.

 

Don had run the rat race and won, yet he couldn’t take the victory lap. Something was sapping his strength.

With everything looking just fine on the outside, next to no one knew how depressed and anxious Don had been for most of his life.

Cover me

Ironically, Don is a health insurance broker, self-employed for 24 years. He’s built a career on protecting people from the calamities of untreated illness. It’s a good living, but Don also finds virtue in the work of matching people to the best plan possible. Maybe because Don knows what it’s like to walk around not feeling so great and the difference a safety net can make.

It felt like there was a dark cloud over my head at all times. I was down. Felt sad, hopeless. And I was in my 20s—that invulnerable age at which lots of people go around with no insurance. Then I got [the corporate job] with a good health plan. So I thought, ‘you know what? With all this stuff going on in my head, let me find a doctor.’

Meanwhile, intense bouts of uncontrollable anxiety also clamored for attention and treatment.

Every three months or so I would be in a group sales meeting of about 300 people, a pretty raucous bunch. While the president gave speeches encouraging the troops to sell more product, I would have panic attacks. I’d break out in a sweat and my heart started beating fast. And I’d be looking at people to my left and my right thinking, ‘Oh, man, they must think, what’s wrong with this dude? He’s sweating, uncomfortable,
whatever.’ So after enough of those types of situations—and having the insurance—I paid the $10 co-pay, went to a local guy, sat down and said, ‘OK, I need you to help me.’

Don’s symptoms fit an all-American profile. In the U.S., both major depressive disorder and panic disorder are most often diagnosed in one’s twenties.

The quest for relief

Don’s first doctor was a “scriptwriter,” although not in the screenplay sense. Between 1993 and 2005, Don estimates that the doctor had him try close to 25 different medications for his anxiety and depression.

Don started with alprazolam—a generic benzodiazepine better known by its brand name, Xanax—to treat the anxiety.

It worked well for a couple of years. Then came Prozac (fluoxetine) to address the depression. Then multiple combinations of other drugs. Luvox (fluvoxamine), an antidepressant, stands out in Don’s memory as “the only one that worked.” Even so, its benefit lasted only seven months.

He [the doctor] basically ran through the gamut. At the end, he said, ‘Don, I don’t
know what to tell you. There’s nothing more.’

Fortunately though, there was much more in store for Don.

He saw a psychotherapist for several months, but found talk therapy ineffective. Then there was a parade of psychiatrists over the years, during which Don continually searched the internet for the next “latest and greatest” treatment to try.

The search led to a series of mechanical interventions for depression. Don first tried a course of Electroconvulsive Therapy (ECT) in 2007. The procedure sends a mild electric current through the brain to produce a controlled seizure, which, in turn, change the brain’s chemistry and results in improvement of depression. Mercifully, modern ECT is performed under general anesthesia, and carefully monitored and supervised by medical personnel.  Also, a muscle relaxing medication is given so there are very little or no significant body movements during the brief seizure.

Don’s doctor recommended three or four ECT treatments per week for several weeks. After five treatments, Don called it quits.

“It really affected my memory. I run my own business, and I was forgetting a lot of stuff. I called my black dog by my white dog’s name. I just stopped going at that point.”

A trial of Vagus Nerve Stimulation (VNS) next provided Don a measure of relief. VNS pulses periodic electrical signals to the brain from a device implanted under the skin. But real help finally arrived in 2009, in the form of a new technology called repetitive Transcranial Magnetic Stimulation (rTMS).

Unlike ECT or VNS, rTMS doesn’t physically intrude on the patient. Instead, a wire coil placed outside the head creates a magnetic field that stimulates an electrical current in nearby regions of the brain.  The patient is awake and alert and can walk out of the office and drive themselves home or to work after the approximately 30-minute treatment.

At the time, rTMS was so new that Don had to travel a distance to find a practice that offered it. The trip was worth every mile.

It helped a little bit the first treatment. By the third treatment, I felt a tremendous lift. To put it in perspective: The Luvox—the medication that worked—brought me up to 75 percent relief. I was at 100 percent after the TMS. After 16 years of searching, I thought I finally found the holy grail.

Don stopped the rTMS therapy after completing a recommended course of 20 treatments. Ten days later, he woke up to a “slight dip” in his mood. Don promptly returned to treatment, sometimes doubling up on sessions. After about a year, the improvements plateaued. That’s when Don ended rTMS therapy for good, with no regrets.

At that point I don’t think I ever felt that way in my life. I remember thinking, ‘Wow—I had depression for a good portion of my life. I can’t believe how effective the TMS was.

Full disclosure

Don got well after the rTMS treatments. Not 100 percent well, but a nice, stable 75 percent well. This beat the heck out of 50 percent well, where Don figures he suffered silently in “overall unhappiness, gloom and doom” for years.

“I held it all in, didn’t tell anybody. The only people who knew were the psychiatrists. I was too embarrassed and ashamed to talk about it. I didn’t share the pain, and that didn’t help.”

Don did let down his guard once—in a single, soul-bearing confession to his wife—right before they married.

“Oh, by the way. I’m seeing a psychiatrist. Wanted to get that out of the way.”

The then-future wife—we’ll call her Amy—“was OK” with Don’s disclosure. Fifteen years would pass before they’d discuss his mental illness again. And when they did, Amy confessed that she couldn’t even tell that Don was struggling.

“I’d explain it to her and sometimes she would say, ‘Well, you’re talking, you went to work, so 1+1=2, everything must be OK.’ I had a hard time understanding that she didn’t see [what felt so obvious to me.] When you have it, you feel like you are wearing a sign on you. But you’re not.”

So Don started explaining it, beginning with the people he could talk to about anything. He’d talk to his mother every day for two hours. She, too, was shocked to learn that Don was depressed. And he talked with his sons, who he calls “my two best friends.” Don credits an invitation to one son’s book club for “a big assist” in his recovery: The discovery of spiritual teacher Eckhart Tolle and his book, “The Power of Now.”

In the book’s first 10 pages, Tolle describes his depressive 29-year-old self on the brink of suicide. Tolle’s revelation that his thoughts were separate from his true self freed him from his depression and taught him the value of living in the present moment.

The message resonated with Don, so he joined the book club. He has since read other authors in that same vein—the exploration of how thought influences one’s perception of reality. Now seven months in, the readings have helped to dramatically reduce Don’s anxiety and depression.

At one club gathering, the facilitator announced a supportive listening exercise. He invited the group of 12 to share anything that was bothering them without fear of judgment.

I decided to share with the group that I’d been holding in this depression and anxiety for years. And it bothers me that I’m ashamed of it. So, I’m trying to get over that by sharing it with them. That was the first time I let it out to a group of unknown people. And I didn’t feel like less of a man for explaining it.

Don’s opened up a lot since then. He drew courage from hearing others’ stories.

These days

Don still works hard at managing his depression and anxiety. He was taking four medications, but now that’s down to two. He sees a therapist, where he’s having better luck with talk therapy than he had in the past. He practices mindfulness-based stress reduction techniques. He looks forward. He lets go of grudges and road rage. And he’s content with his material lot, which has turned his work into more of a calling.

A lot of people need help in the insurance business. I feel a sense of duty because I have the knowledge that can really help. It’s all about helping people. If I can put someone on a $16/month dental plan that’s going to help them, and it doesn’t pay me anything, that’s OK, because it’s the right thing to do for them.

Nor does Don have any compunction about talking about how to beat back demons.

My advice? Stop holding it in. Definitely talk about it. There are lots of treatment options out there. If you don’t do anything, they’re not going to come to you. It’s easy to hide. Be open to help.

Resources
  1. American Psychiatric Association. (2013). Major Depressive Disorder. In Diagnostic and statistical manual of mental disorders (5th ed.) [Citation is on Development and Course]
  2. American Psychiatric Association. (2013). Panic Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.) [Citation is on Development and Course]
  3. Hales, R.E., Chew, R.H., Yudofsky, S.C. (2005). Alprazolam. In What Your Patients Need to Know about Psychiatric Medications, 3rd Edition.  http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9781615371280.rc01
  4. Hales, R.E., Chew, R.H., Yudofsky, S.C. (2005). Fluvoxamine. In What Your Patients Need to Know about Psychiatric Medications, 3rd Edition. http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9781615371280.rc20
  5. Dryden-Edwards, R. (2017). Electroconvulsive Therapy. Available at http://www.medicinenet.com/electroconvulsive_therapy/article.htm.
  6. National Institute of Mental Health. (2016). Brain Stimulation Therapies. Available at https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml#part_152879. [Citation is on section rTMS]