Not Waving But Drowning: Working to Stay Afloat When Depression Strikes

“Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self-to the mediating intellect-as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode.” ~ William Styron, in Darkness Visible

Depression is truly dreadful, a curse on the soul. It is, as Styron notes, so awful as to be indescribable to the person who has not gone through it.

Nor it kind enough to be rare. In fact, Thomas Insel, MD, director of the National Institute of Mental Health, claimed in 2007 that depression is the “leading source of nonfatal medical disability among people ages 15 to 44 in developed countries like the U.S. and Canada. It is the leading cause by far. Nothing else is even close. In the whole world it is the second or third greatest cause of disability.” (See http://www.ama-assn.org/amednews/2007/04/02/hlsb0402.htm)

So how do we even begin to deal with an illness that is so prevalent, so life-draining–and, at times, so difficult for others to see?

One of my favorite British poets, Stevie Smith, wrote a poem “Not Waving But Drowning.” I copy it in full below because it speaks to me–and, I believe, will to others–of how the person suffering from depression calls out for help–and, it seems, the response is all wrong:

“Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he’s dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.”

All too often the depressed person feels her cries for help are seen as just so much more meaningless attempts to interact.

It seems like every quarter drug companies come out with a new medicine–or re-invent an old one, so they can put it on patent again–to assist those suffering from depression, and the choices now are manifold [even though I begin to suspect so many of them are fundamentallly similar]. But still, I’ve found in my practice that many people are helped by these drugs, and thus antidepressants can be life-altering.

But what of those who aren’t significantly helped by their anti-depressant medication, perhaps aren’t helped at all? It’s not as uncommon as you think.

Dr. Maurizio Fava’s article “Diagnosis and Definition of Treatment-Resistant Depression” in the April 2003 publication of Biological Psychology defines treatment-resistant depression rather loosely, with a patient qualifying after lack of response to only one antidepressant trial “of adequate doses and duration.” [Others assert a person cannot be diagnosed as treatment-resistant until a second med has been tried and failed, as the FDA did when approving Symbyax, defining treatment-resistant patients as those who “have not responded to two separate trials of different antidepressants of adequate dose and duration in their current episode.” Symbyax is another re-working of old meds into a new and money-making patent through the genius move on Eli Lilly’s part of putting zyprexa and prozac into one pill–and charging plenty for the service.]

But back to the point–Dr. Fava, of Harvard medical school, notes that treatment-resistant depression “is a relatively common occurrence in clinical practice, with up to 50% to 60% of the patients not achieving adequate response following antidepressant treatment.” [italics mine]

As disheartening as it is to the depressed patient to ‘fail’ an antidepressant trial, s/he should keep in mind that there are more options out there. There are numerous medications that can be tried in a variety of permutations–not just antidepressants, but also mood stabilizers and the atypical antipsychotics. Transcranial magnetic stimulation is holding much promise, as is vagal nerve stimulation. And, as much as it scares people and reminds them of Nurse Ratched herself in her “One Flew Over the Cuckoo’s Nest” incarnation, I’ve seen tremendous turn-arounds with ECT.

I myself am not an MD and don’t prescribe, so I wanted to address in the next posts two components of mental health that are in all of our hands, and that it turns out make a significant difference in the treatment of depression: diet and exercise.



I help adults and adolescents through the particular struggles of our time: tension between couples, parenting frustration, blending new families, separation and divorce, (un)employment, cancer, and loss. When relationships come to an impasse, I use mediation techniques to try to ensure that each party will have his/her needs heard and accounted for in a dignified way. In addition to talking, listening, and reframing, I utilizes the tools of metaphor, active teaching, role-playing, visualization, and hypnotherapy.for families and businesses, as well as in cases of divorce.

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