The Noonday Demon by Andrew Solomon Page A

Vermont wedding, the slippage was steady. I worked less and less well. I canceled plans to go to England for another wedding, feeling that the trip was just more than I could handle, though I had, a year earlier, gone back and forth to London regularly without much trouble. I had begun to feel that no one could love me and that I would never be in a relationship again. I had no sexual feelings at all. I began eating irregularly because I seldom felt hungry. My analyst said that it was still depression, and I felt tired of that word and tired of the analyst. I said that I was not crazy but was afraid I could become crazy and did she think I was going to end up on antidepressants, and she told me that avoiding medication was courageous and that we could work everything through. That conversation was the last one I initiated; those were my last feelings for a long time.
    Major depression has a number of defining factors—mostly having to do with withdrawal, though agitated or atypical depression may have an intense negativity rather than a flattened passivity—and is usually fairly easy to recognize; it deranges sleep, appetites, and energy. It tends to increase sensitivity to rejection, and it may be accompanied by a loss of self-confidence and self-regard. It seems to depend on both hypothalamic functions (which regulate sleep, appetites, and energy) and cortical functions (which translate experience into philosophy and worldview). The depression that occurs as a phase in manic-depressive (or bipolar) illness is much more strongly genetically determined (about 80 percent) than is standard depression (about 10 to 50 percent); though it is more broadly treatment-responsive, it is not easier to control, especially since antidepressant drugs may launch mania. The greatest danger with manic-depressive illness is that it sometimes bursts into what are called mixed states, where one is manically depressed—full of negative feeling and grandiose about them. That is a prime condition for suicide, and it too can be brought on by the use of antidepressant medications without the mood stabilizers that are necessary parts of bipolar medication. Depression can be enervating or atypical/agitated. In the first, you don’t feel like doing anything; in the second, you feel like killing yourself. A breakdown is a crossover into madness. It is, to borrow a metaphor from physics, uncharacteristic behavior of matter that is determined by hidden variables. It is also a cumulative effect: whether you can see them or not, the factors leading to a depressive breakdown gather over the years, usually over a lifetime. There is no life that does not have the material for despair in it, but some people go too close to the edge and others manage to stay sometimes sad in a safe clearing far from the cliffs. Once you crossover, the rules all change. Everything that had been written in English is now in Chinese; everything that went fast is now slow; sleep is for clarity while wakefulness is a sequence of unconnected, senseless images. Your senses slowly abandon you in depression. “There’s a sudden point when you can feel the chemistry going,” Mark Weiss, a depressive friend, once said to me. “My breathing changes and my breath stinks. My piss smells disgusting. My face comes apart in the mirror. I know when it’s there.”
    By the time I was three, I had decided I wanted to be a novelist. Ever since, I had been looking forward to publishing a novel. When I was thirty, my first novel was published, and I had scheduled a reading tour, and I was hating the idea. A good friend had volunteered to throw a book party for me on October 11. I love parties and I love books, and I knew I should have been ecstatic, but in fact I was too lackluster to invite many people, and too tired to stand up much during the party. Memory functions and emotional functions are distributed throughout the brain, but the frontal cortex and limbic systems are key to both, and