What It Feels Like: Treatment-resistant depression

"When you have depression you feel like you're the only person out there," says Bruce Ross, who lives with depression that hasn't responded to medication or therapies.

Emma Jones 12 minute read March 31, 2022
Bruce Ross, treatment-resistant depression

Through Bruce Ross' 45-year journey with depression, he says he never lost hope. SUPPLIED

Content warning: This story refers to suicidal thoughts.

For Bruce Ross, being told that he might have depression felt like he was a prisoner finally set free. Ross had been coping with symptoms like depressed moods, a lack of interest, fatigue and poor concentration since he was a teenager, so finally putting a name to what he was experiencing gave him hope.

Major depressive disorder is a common, yet serious, condition, often characterized by both biochemical and environmental factors, according to the American Psychological Association. Depression affects each patient differently, but hallmarks of the diagnosis include emotional and physical symptoms like feelings of sadness, a loss of interest in activities once enjoyed, difficulty thinking and/or concentrating, and changes in eating and sleeping habits.

In Canada, symptoms of depression are on the rise. In the spring of 2021, a quarter (25 per cent) of Canadians over the age of 18 screened positive for symptoms of depression, anxiety or post-traumatic stress disorder (PTSD), compared to one-fifth (21 per cent) in fall 2020, according to Statistics Canada. Just over one-fifth of depression (21.7 per cent) cases are considered resistant to treatment — which is defined by a lack of response to two separate classes of antidepressant medications.

Ross sat down with Healthing to talk about his 45-year journey with depression, his new book, and how those living with treatment-resistant depression can lead meaningful, productive lives.

This interview has been edited for length and clarity.

What led to your diagnosis?

I have depression and anxiety. I’ve had depression since I was 14 or 15 — I’m 62 years old now, so it’s been 45 years. It went undiagnosed for the first 20 years. I knew something was wrong, but back then, in the ’70s and ’80s, depression really wasn’t talked about very much. People of my age only really knew about depression from what we saw in the movie One Flew Over the Cuckoo’s Nest with Jack Nicholson. And I knew I didn’t have that, so I struggled for years on my own.

It was my wife who told me in 1995 that she thought I suffered from depression. And when I went to my doctor, we agreed that I had depression. I was prescribed Prozac, which was a new drug at the time, but it didn’t work, and ever since I’ve been on a journey to combat this illness.

I’ve been on over 20 medications — I’ve lost count. I’ve had almost every possible professional measures without much success, a gamut of doctors and therapists, including electro-convulsive therapy, deep brain stimulation, and tons of behavioural therapy.

What does your depression feel like?

I think I typically have the standard symptoms of depression: overall depressed mood and no interest in doing anything. I had a lot of physical symptoms too, like fatigue, no appetite or minimal appetite, poor concentration and suicidal thoughts. Not too much now, but I did. One thing I didn’t have — which is a pretty typical characteristic of depression — I never lost hope. I always had  hope that I could escape the despair.

You finished school and worked for 20 years before a diagnosis — how did you get through that?

That’s a good question and really the foundation of my book. Despite having depression for so long — and anxiety — I was still able to overcome and lead quite a productive life. That’s kind of a message of hope to others [who may be struggling] out there.

I always had strong internal fortitude that got me through a lot of the rougher times. I also have been blessed with pretty strong ethics and integrity. Just like a lot of people rely on religion to get them through tough times, I relied on my integrity and my ethics. [One of my favourite quotes is] the time is always right to do what’s right. I adhere to that.

I was also always fortunate to have good friends. They didn’t know what I was going through, but they were good people so I still keep in touch. By association logic, if they were good people and popular, so to speak, if they liked me, than I must be OK. That kept me going.

The third thing that kept me going was my wife Cheryl, [who is] quite a strong woman, and my daughter, Hannah, who is also strong. I carried on for their sake, really. They didn’t coddle me or portray me as a victim, but certainly, they would support me if I needed it.

What about work?

I struggled to work for the longest time; my concentration was poor. I went through a number of jobs before I landed in one that I finally could lean into. I was actually a chartered accountant when I was in my early ’20s, but I couldn’t handle the work. I just couldn’t concentrate and they let me go, frankly, for good reason. But I did find a career — I worked for a credit union for 30 years, until I retired about a year or two ago.

There was a point, about 15 years ago, that I was off work for about eight months because I was so depressed — I just couldn’t carry on any longer. It was a tough time. And during the time that I was off, I became a research subject at the National Institute of Health in Maryland, which is just outside of Washington, and was there for a whole summer to help with their research on depression. I came back and went back to work, and I was able to cope going forward.

Not long after that my boss — who really didn’t understand depression, he was old school and grew up in an era where depression really wasn’t talked about — he retired and was replaced by a younger [manager] and she was very supportive and understanding and that allowed me to get through until I retired.

What led to the conversation with your wife, Cheryl, when she told you she thought you might have depression?

I think I was down and despondent. I tried to keep it from her, but she had postpartum depression after her [pregnancy in a previous marriage], so she kind of understood the concept. I think that’s what led her to recognize some of the symptoms because she’d experienced them herself.

I felt somewhat relieved, actually, because I didn’t know what was wrong for 10 years. When she suggested it, I felt like a prisoner who had escaped. At that point [I thought] I would get the relief that I needed with the help of a doctor.

But then the Prozac didn’t work, and Cheryl’s doctor did some tests — like testing my thyroid because apparently thyroid issues can mimic symptoms of depression, but my thyroid was fine. Then I was sent to a sleep disorder clinic to see if had trouble sleeping, but that was fine, too. I even had an allergy test to see if there were allergies that were mimicking the depressive feelings I had. But these were fine.

When that didn’t work [I went to see] the chief of Psychiatry in [my town] and I have been this journey with him ever since — for the last 20 or 25 years.

If you’re OK with it, I’d like to go through the treatments that you tried. We’ll start off with the transcranial magnetic stimulation.

It’s actually kind of crude. It’s done through a private clinic not paid for by the Government. I went every day for two weeks straight for about half an hour, and the technician would take what looked like a clothes iron in the shape of an eight, put that against your head and turn it on. It was like Woody Woodpecker tapping at your head with magnetic impulses that were directed toward the areas of the brain they believe causes depression. That was maybe 15 years ago now, or more.

There were no side effects. The technician would give me Tylenol in case I’d get a headache but I never did. At the end of two weeks I went home and I felt better, but it didn’t last, and I couldn’t afford to keep going.

And next was electroconvulsion therapy (ECT)? 

That happened in an actual hospital and it was a little bit daunting. I was given anesthesia. There were wires attached to my head — to  jolt my brain with electrical current. It’s supposed to jolt the depression out of you. I never knew the underlying science of it, and it has a bad reputation, but apparently it is effective. [The Lancet published a study in 2021 that showed electroconvulsion therapy to be both safe and effective.]

About halfway through [the treatment course] though, the doctor stopped because there was no improvement. There weren’t any side effects — other than the fact that I lost my short-term memory during the treatment. But it came back after the treatment stopped.

Then you tried the cognitive behavioural therapy.

That is thought therapy — that we have distorted thoughts that skew your perception of the world, which I agree with. I went to [the therapist] for — I’m just guessing — 10 different sessions of an hour long. Although I agreed with him on a number of fronts, really, the principle of cognitive behavioural therapy didn’t resonate with me. It [was] like trying to improve my golf by reading a book. I understand that I’m supposed to stop slicing the ball when I hit it, but I slice the ball anyway. So this treatment wasn’t really effective either.

Finally, you tried ketamine therapy.

My psychiatrist at the time suggested it. I tried it probably six or seven times. You go to a hospital and you’re hooked up to an IV with a ketamine mixture. I’d be awake, in a La-Z-Boy kind of chair relaxing, and I’d get quite a buzz — light-headed, I guess — but it just did not “fix me.” The buzz would last for about an hour, as long as the ketamine solution was being administered, but when it stopped, the buzz would go away. There were no side effects, but I didn’t really feel any better.

And then you got into working out.

I took up [marathon running] about 20 or 25 years ago. I did it as a self-help measure: I didn’t want to just rely on medical techniques to feel better about myself. I decided to take on some of the responsibility for myself.

I trained for five different marathons including the New York City and Chicago marathons, and then when that didn’t help solve the depression, I escalated it to triathlons. I completed training for three triathlons in one summer, including a Half Ironman Triathlon. I didn’t finish first, but I finished in six and a half hours. But then I just gave up, I carried it to the extreme and still [felt the symptoms of depression. I haven’t ridden my bike since.

Bruce R. Ross Breaking Free of Depression’s Grip

Bruce Ross’s book chronicles 45 years of living with depression and anxiety. “It’s a message of hope that despite the burden of depression, you can still have a productive life,” he says. SOURCE: Bruce R. Ross

While you’re dealing with depression, how do you motivate yourself to work out to that extent?

That’s a great unknown — I don’t know. I don’t know what kept me motivated to keep trying. Just as I said at the start, I never lost hope. I always thought if I could find the magic, so to speak, I would be OK — but I never did. So I have resigned myself that this is way it is. I have moved on, I guess, to some degree, in my life.

I’ve always kind of been an all-or-nothing person. I’m pretty well educated too. I found education later in life, and it helped me build my self-esteem. I have a Master’s degree in accounting, and a financial planning designation. I actually  got my MBA when I was 55 — well beyond when most people get it.

But I found that, even when I accomplished those goals of getting my education or doing the marathons, I found that the finish line kept on moving further away. I was never satisfied. It was never enough. So I kept looking for something else.

Tell me about your book.

Breaking Free of Depression’s Grip was another self-help measure. I read that if you have depressive and anxious thoughts in your head, putting them on paper relieves some of those thoughts. And then, after I was well into writing the book, I realized that, with COVID and the mental health issues it brought on, that there could be a market for it. It was published last month.

There is this perception that people with depression are unmotivated or that they just have to deal with ‘real life,’ right? But looking at everything you’ve done that can’t be farther from the truth.

No, that’s right. That’s the premise of my book. It chronicles 45 years of living with depression and anxiety — it’s really a message of hope that, despite the burden of depression, you can still have a productive life.

What do you like to do in your daily life now?

I am a member of a Rotary Club [where I live.] I’m also on the executive board of a pickleball club. My wife and I also joined PROBUS — it’s a club for those who are 55-years-old and over. There are social activities such as hiking and biking. We also love to travel — we’re scheduled to go to Italy and Greece in September.

Any last words?

I read that there are something like 300 million people worldwide who suffer from depression. But when you have depression, you feel like you’re the only person out there. I want people to know that you can still lead a fruitful and productive life — despite the scourge of depression.

 

Ross’s book, Breaking Free of Depression’s Grip, is now available. Anyone looking for more information on depression can visit the Centre for Addiction and Mental Health and the Government of Canada

Emma Jones is a multimedia editor with Healthing. You can reach her at emjones@postmedia.com or on Twitter @jonesyjourn.

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