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The Noonday Demon: An Atlas of Depression has just been reissued with a new final chapter that brings it up to date, covering developments of the last fifteen years. It has felt strange to reengage so explicitly a topic I had covered in depth and from many perspectives, but the science of mental illness has advanced, and so have the laws pertaining to it, and so have social perceptions. Stigma is not what it once was. In my own life and in the lives of those I interviewed for the original book, depression has changed: in the ways it has manifested, of course, and also because one’s relationship to a frequent incursion evolves. Each of us grows and changes, and so our relationship to our own depression has likewise altered. Good treatment and a more stable life mean that I hear from the demon less often than I used to, and it is less noisy when it comes. But whether it yells or whispers, it constantly escalates the affective background noise, like a psychic tinnitus. One grows accustomed to what one cannot change. The Inuit mostly don’t rail against the snow, and depressives accommodate the disturbing ringing of our moods.
The advent of deep brain stimulation, the recognition of antenatal depression in pregnant women, the investigation of whether SSRIs — the most common antidepressant medications, such as Zoloft, Prozac, and Celexa — can trigger suicidal thoughts: all of this is important, and I’ve covered these and many other topics. But the best research is always longitudinal, and what struck me most in returning to this topic is that one’s depression feels so different after one has had it a long while. This is true for me, and for many of the people about whom I’ve written. Some people get better at accommodating it; some are more worn down by it. Depression sufferers develop habits of informality with the black dog: “Oh,” we seem to say, “it’s you again.” We imagine that being cordial to our own moods might make them go away without too much fuss; we are aggressive but polite, as one might be to an intruder until the police arrive. And then we call in those technologies, old and new; pharmaceutical, psychological, and alternative; situational, particular, and universal. Most of us chug on.
Writing that chapter took a year. The letters I’ve had since it was published indicate that while our ability to treat depression continues to progress, most people who suffer the condition go untreated or undertreated or inappropriately treated. Many don’t recognize that they have depression, or they aren’t informed enough to secure good treatment, or they lack insurance to cover its costs. Everyone hopes for a breakthrough that will erase the worst depression symptoms, but until that comes along, the best thing we can do about depression is to talk about it.