In the past three years, I have received emails from patients or family members who are difficult to count, as well as messages on Weibo, WeChat, and QQ. Some have few words, some have long speeches; Some only talk about their illness, while others also exchange ideas and express their hearts directly.

This letter is one of the representative ones in the category of "expressing one's mind". The letter, as he himself said, was a typical literary youth with an innate sense of humanity. He is sentimental, has a keen self-esteem, is accustomed to learning, and is deeply reflective and introspective. The course of his illness is very representative; He has a deeper understanding of depression; His struggle against fate makes me sigh; I am impressed by the sense of benevolence and social responsibility embodied in his letters.

With my permission, I have edited his letter slightly, made some additions, and presented it here, with the intention of leaving a true record for the treatment of depression and for our time.

Dear Mr. Zhang Jin,

Hello!

Because of the anxiety, depression (and possibly compulsions) of the past ten years, I was lucky enough to find you when I was looking for information on the Internet. Browsing your blog, I was full of mixed tastes and sighs. There is not only admiration for your literary talents, insights, achievements, and feelings of responsibility as a conscientious media person, but also a trace of yearning for your journalism that pays attention to the social process of contemporary China, promotes social change in contemporary China, disseminates common sense, and worries about the people's suffering......

Of course, there is also a little helplessness about not being able to further his studies because of anxiety and depression. Otherwise, today, I may have graduated from Renmin University, Peking University, or the Academy of Social Sciences with a master's degree or even a doctorate, so that I can realize my dream of studying and academics; Or, like you, be a journalist with ideals and responsibilities......

Origin of the disease

Tell me about my general situation.

You can call me Xiao Zhao, born in the 80s, he likes to read since he was a child, and he loves Wen Shi Zhe, and his grades have always been among the best. In 2005, he was admitted to a normal university in Beijing majoring in Chinese. In 2009, he failed to be admitted to the graduate school of the Institute of Literature of the Chinese Academy of Social Sciences, and returned to his hometown to become a teacher, sending food to earn a living. Out of interest, I continue to read while teaching.

When I am in a good state, I will break through the barriers of textbooks in class, talk to students about the origin, evolution and meaning of Chinese characters, explain some social hot issues to students, cultivate their independent thinking and free spirit, and do a little civic education as Hannah Arendt said. In my opinion, Chinese classes are actually very teachable, and they should have emotional temperature, depth of thought, and thickness of life. But in today's middle school Chinese classes, how many teachers are there to read from the book, and they are completely angry......

Let's talk about my depression and anxiety.

It all started when I was in high school. Ten years ago, a boy transferred to the class, and he worked very hard, and his test scores slowly surpassed me. Because of the perfectionism, sensitivity, delicacy, and strength in nature, I was not convinced and launched a super vicious competition with him. Our relationship was very tense and open, and I was always at a disadvantage, feeling stressed, anxious, inferior, self-blaming, and guilty. In order to stimulate the fighting spirit of the two of us, the head teacher deliberately arranged for us to sit together. Many years later, I recall the anxiety and inferiority complex when I sat with him, and I still remember it. I felt like a rabbit around a tiger that could pounce at any moment, for two years. So, can this rabbit's spirit and emotions be normal?

After three years, my personality has completely changed, I am nervous, have low self-esteem, and always regard others as imaginary enemies. In the four years of college, I was alone every day, immersed in my studies, and was full of wariness of others. At the same time, because of reading the books of Lu Xun and Nietzsche, the whole person is pessimistic, decadent, cynical, and thinks he is profound, hehe.

It wasn't until my junior year that I found myself in an unprecedented state of anxiety and couldn't devote myself to studying. At that time, I was highly myopic and wore 1200-degree glasses, and this anxiety was projected onto my worries about my eyes, and I was always worried about whether I would suddenly become blind. This anxiety is so uncontrollable that it later generalizes to the point that when you look at anything, you will worry about your eyes. I started to have chest tightness, headaches, palpitations, palpitations, shortness of breath, difficulty concentrating, forgetfulness, difficulty speaking, and lazy behavior.

Struggle to save yourself

In the surprise of my classmates, I failed the graduate school entrance examination, and I was heartbroken and couldn't sleep all night. There's no way, roll up and go home, and live first.

After returning to his hometown, although he was still anxious and depressed, he still passed the exam and became a teacher with years of learning. After that, due to the frequent and intermittent occurrence of anxiety and depression, I spent a lot of time and energy studying my emotions and self-healing. Through several years of cognitive therapy, Morita therapy, Vipassana therapy, etc., my thinking, cognition, and mental condition have changed greatly, and I am no longer as pessimistic, extreme, and cynical as before.

Unexpectedly, greater anxiety was yet to come. In 2013, I found a girlfriend, and after a while, we felt good about each other. One day, a thought popped into my head: Could the other party be a person living with HIV? This was the beginning of my journey of fear of HIV/AIDS, and I fell into great fear, anxiety, and depression again. When it was serious, I even felt that everyone in the world was AIDS. I know that such thoughts are ridiculous, but I just can't control them. Naturally, the love affair fell apart. I also entered the cycle of "normal state - AIDS phobia, anxiety and depression - normal state".

Next, let's talk about my counseling and medication experience:

Although I had the root of the disease in high school, and I had symptoms such as anxiety, depression (and even compulsion) for the first time in my junior year of graduate school, I didn't realize that it was a physiological lesion and I needed to take medicine. From 2009 to 2013, I studied psychology on my own and did online counseling:

1. In 2008, he suspected that he was obsessive-compulsive disorder and began to teach himself Morita therapy. Follow the principle of "go with the flow and do what you should do", use your eyes with concern for your eyes, and gradually desensitize. By the summer of 2010, the fear and worry about high myopia had completely disappeared.

2. In 2011, he accepted a remote consultation from a consultant in Hunan for half a year, once a week, and spent nearly 7,000 yuan. The counselor himself was once a severely neurotic patient, but was later cured by self-study of Confucianism, Buddhism, and Taoism. It has a certain effect, correcting some of my cognitive concepts of extreme pessimism and perfectionism.

3. In 2012, I received hypnotherapy from a hypnotist in Chongqing, but the effect did not seem to be great, and I gave up halfway.

4. In 2013, he received remote therapy from a well-known psychological consulting company in Beijing, and learned to understand the "acceptance of neurosis", which had a certain effect, spending nearly 6,000 yuan for half a year.

5. In February 2014, I received psychological counseling from Vipassana therapy, practiced Zen in motion, and maintained the mindfulness of living in the present moment through awareness of movements, and saw the essence of obsessive thoughts that cause anxiety and fear. There was a break in the middle of the process, and now I am practicing again, and I feel that the effect is good.

Counseling feelings: If you are a depressed patient, you should be able to get better completely by taking medicine. But for people like me who have depression, anxiety, and obsessive-compulsive symptoms, they must go through psychotherapy at the same time as taking medicine. There was a time when I was taking medicine that worked very well, and then the medicine suddenly failed, and the obsessive idea of HIV/AIDS came, and I fell back into a state of great anxiety and fear. Therefore, for anxiety disorders, obsessive-compulsive disorder and other neuroses, it must be combined with psychotherapy, and psychotherapy is the root cause.

Medication history:

1. In 2013, I found that repeated recurrence was not a solution after all, and I began to consider taking medicine. When I went to Peking University Sixth Hospital in August, my mental state was just good on those days, so the psychological test results showed "no anxiety and depression". The doctor prescribed sertraline to me, and after I went home, I took the medicine irregularly, and I took it intermittently for a month, but I felt that it did not work, so I stopped taking it.

2. In October 2013, I consulted a doctor in Beijing Huilongguan Hospital by phone, and he suggested that I take paroxetine hydrochloride, but unfortunately I stopped taking it soon after.

3. In April 2014, I consulted a doctor from Zhujiang Hospital of Southern Medical University through the website of Good Doctor, and prescribed me duloxetine and some auxiliary drugs. It worked very well at first, and the whole person returned to normal within a week, which is really easy that I haven't felt in years. After about a month of eating, I began to deliberately skip the dose, and after about another two months, one day I suddenly lost my condition. Later, it was replaced by Delixin and venlafaxine, but the effect was not obvious.

Doubts to be solved

The above is my emotional state and the process of counseling and medication from the past ten years to today, and my questions are as follows:

1. In your experience, am I depressed? Anxiety? Or obsessive-compulsive disorder? Or hypomania in bipolar disorder? Over the years, my state has been good and bad. The above symptoms are the symptoms at the time of the attack, and after figuring out some problems through cognitive therapy, the emotional state will be good for a while. During this time, I was very confident, I felt that I was very generous and decent in the crowd, I was very willing to socialize with others, I was handy in what I did, I was motivated and proactive, but I also felt that there was nothing excessive.

When I'm in a good state, I have a lot of thoughts in my head, and from time to time I think of a lot of humorous ideas and jokes, I don't know if this counts as thinking rushing; Although my original personality was not lively and outgoing, I also didn't feel particularly introverted and autistic. Although it is relatively slow to heat, it can be relaxed with buddies and brothers; But maybe one day, an anxious thought suddenly pops out of my head, and I may fall into a state of anxiety and depression again.

To sum up, I don't know if this is unipolar depression or bipolar hypomania? Will unipolar depression get better and come back again intermittently without taking medication?

2. In either case, it's not the first time I've had a seizure, am I? In the past ten years, the state has always been good and bad, especially in the past five years, when symptoms appeared, I have experienced countless episodes of anxiety and depression, headaches, palpitations, inability to concentrate, etc., which makes my life worse than death, and countless times I think it is better to die. Of course, just thinking about it, it was never implemented. After Morita therapy, cognitive therapy, vipassana meditation, etc., a period of time has passed, and one day my mood will suddenly improve.

It is precisely because of this, coupled with the fear of the side effects of the drug, that I have not taken the drug treatment early, and I have not realized the importance of drug treatment until now. Now that I'm taking medicine, I guess I'll need to take it for life, right?

3. Looking back now, I took the medicine too irregularly before, no wonder it was controlled and relapsed. Like paroxetine and sertraline that I took at the beginning, one tablet a day, for a month, I don't think I should have achieved enough treatment. Later, Osping was very effective, but he only took the medicine regularly for a month, and then he broke it, and he only took it once every two or three days, which may be an important reason for the later recurrence.

Later, taking Osping suddenly didn't work, I think it may be a problem of dosage and course of treatment, I am too anxious.

4. Tell me about my personality, a typical literati character, from reading to working, I have always been a talented person in the eyes of everyone. It is manifested in the inner sensitivity, delicacy, and some pursuit of perfection; Thinking about problems is particularly easy to go deep and slow to heat; Do things cautiously, steadily, advocate mental work, and often think about the meaning of life; I am not particularly enthusiastic about group gatherings, eating, drinking and having fun in life, and the ideal life is to be an economically independent and free-thinking reader.

If it weren't for the depression and anxiety caused by the personality foundation, I actually liked my personality very much. My personality should be inherited from my mother, who is a super perfectionist who has a special sense of words and is extremely striving for perfection. The personality is cautious, and every time you go out, you have to lock the door several times, but in fact, it has already been locked. It's just that she didn't encounter any emergencies in her life, so she didn't develop anxiety and depression.

Mr. Zhang, looking at your blog, after your own recovery, you began to pay attention to the depression group, popularize the knowledge of depression, and help depression netizens, which embodies the transcendent social care of a responsible intellectual. Indeed, in contemporary China, which is undergoing drastic transformation, depression is a disease of the times, and a series of social problems behind the metaphor of the disease are thought-provoking. In this regard, intellectuals who are long thinking and cherish their family and country cannot be indifferent, as Lu Xun quoted in your blog, "Endless distances and infinite people are all related to me".

It's been written for a long time, and I would like to take the time to reply and express my sincere respect and gratitude to your feelings and perseverance (hehe, whether it is a bit tragic, it is a big word)!

My reply is as follows:

Xiao Zhao, I have received the letter. Thank you for believing in me.

I think you're more professional in your understanding of depression and so on. I basically agree with your judgment: your illness is full of signs of depression, anxiety, obsessive-compulsive, and bipolar. Bipolar is less noticeable but may be soft bipolar. Recent studies have shown that patients under the age of 20 who have depressive episodes are more likely to be bipolar.

As for relapses, you're also right, it's likely that you've experienced more than two relapses. The reason, as you said, may be related to incomplete treatment and not taking enough medication for a full course of treatment.

In the next step, I recommend that you treat it formally, systematically. Go to a better hospital, find a more professional doctor, start from scratch, and persevere, it will be effective.

The most important thing is to keep the faith!

Good luck! And I wish you can realize your humanistic ideals!

Zhang Jin, March 3, 2015