Been a while since I posted anything here. There’s been a reason.
That little git is the thyroid gland. Sits there, wrapped around your trachea, merrily pumping out two hormones that regulate your metabolism, temperature, heart rate and other important stuff. They’re called triiodothyronine and thyroxine and no, I can’t remember those names either but they’re listed as T3 and T4 on the blood test, which is easier. It doesn’t produce them at a set rate – it produces them to order, for the pituitary gland, which dumps a third hormone into the body to communicate how much T3 and T4 should be produced. That one is TSH on the blood tests, for Thyroid Stimulation Hormone, which is a bit more memorable.
Thanks to a genetic gift from my grandparents via my mom and all her sisters, mine doesn’t work. It’s underactive. Hypothyroidism is the official term. Showed up on a random blood test a few years ago when I got a dose of strep throat. My pituitary gland wants a set level of T3 and T4, it pumps out the appropriate level of TSH, but my thyroid takes the day off and doesn’t dispense the T3 and T4 asked for. So the pituitary, like any stereotypical tourist, shouts louder, by dumping even more TSH into the body and eventually the thyroid begrudgingly releases enough T3 and T4 to shut the pituitary up. End result: you feel tired all the time and you put on weight for no reason. Now that might sound like parenthood and middle age, and it kindof is so the symptoms get masked, but the extent is the issue. I was getting eight hours sleep and waking up feeling like I’d been awake and working for a week already. And I’d put on a good twenty pounds that wasn’t shifting even while I was walking for an hour a day. My GP prescribed eltroxin, a synthetic hormone (so yes, I am on hormone replacement therapy), and in a few weeks I didn’t feel like the walking dead anymore.
Here’s the really really shitty part, which my doctor neglected to mention at the time.
About 55% of men who get hypothyroidism also develop clinical depression. As far as I can tell from my idiot’s crash course in neurochemistry, it’s a side effect probably related to the larger amounts of hormones the pituitary is having to release to get T3 and T4 levels up to somewhere near where they need to be. As if it was having to yell at the thyroid and then when it goes to talk normally to the other glands it controls, it doesn’t notice it’s still shouting.
And I lost the coin toss. It’s hard to pin down when it started because it doesn’t just turn on with obvious symptoms, it fades in and out over time, getting worse as time goes on. But looking back now with suspicious hindsight, the first thing I can point to and say “that’s definitely a symptom” would have been around the end of 2015. Things got better around the time we found my thyroid was lazy which was in early 2017, but they got worse again rapidly towards the end of the year, and you can literally look at a graph of my TSH levels in my blood tests and see that they climbed from almost-back-to-normal to way-too-far-into-the-red between mid-2017 and early 2018. And from April 2018 until October 2021, they were never in the normal range again. Maybe my doctor would have upped my eltroxin dose and treated it more aggressively if I’d known to tell him what was going on, but I didn’t know what I was experiencing were symptoms. I was sure everyone else felt that way and I was just being soft and needed to toughen up a bit.
See, here’s the thing. Depression is a mental health issue, and where and when I came from, the phrase “mental health issue” was a polite way of saying “fucking nutter, needs to go back to the Killarney madhouse” (there was a mental asylum in Killarney at the time). It’s not so much that there was a stigma attached to it, so much as that it would be like being an unwed mother in Ireland in the 1950s. Which is probably why a large number of people where I grew up were barely functional alcoholics and why so many others hanged themselves or had “single vehicle collisions” or “swimming accidents” or whatever euphemism the insurance companies would accept on the day so the widows and orphans funds would be released. It was a particularly shitty system.
Adding to that, I don’t have medical confidentiality. I have firearms licences for target shooting, and after the Abbeylara shooting in Ireland a few years ago, we had a Tribunal because that incident had been so spectacularly mismanaged. In that tribunal it was somehow decided that spectacular mismanagement would be best addressed by requiring all firearms owners to be sane. This was to be accomplished by psychologists certifying that firearms licence applicants were sane at the time of application and would continue to be sane for the following three years.
After the psychologists’ professional association had finished laughing and picked themselves up off the floor, they informed the tribunal that that wasn’t how anything worked, and so the tribunal decided that applicants would self-certify that they were sane and healthy on their application form. You do this by ticking a box, in case you’re wondering. You also give full access to your medical records to the Gardai who are then meant to form an opinion as to your mental health from whatever they find. In case you were unaware of the training Gardai receive, it is primarily focussed on crime and law and how to arrest someone who’s giving stabbing you in the neck the old college try. It is rather light on mental health assessment. The end result of which is that very few licence holders wish to speak to medical professionals on anything to do with mental health for fear of losing a licence without reason. All of which rather works against you if you do develop an issue.
On top of the reasons for not talking about it, there’s also the small problem of not recognising it even when staring it straight in the face. See, when Calum was born, I got told a bit about post-partum depression (it’s in the normal prenatal courses these days). What it looked like, what the symptoms were, what diet to have to try to help stave it off, what to do if it showed up (which was just “call the nurse” in case you’re wondering) and so on. Fun fact – depression in men does not present with the same symptoms as post-partum depression, or indeed “regular” depression in women. There are some common symptoms like losing the ability to get much joy from anything and wanting to sleep all the time, but some symptoms seem to be mostly experienced by males and others by females (most of the time – look, I’ve had five months of an idiot’s cliff notes to all of this, for feck’s sake don’t think I know how all this works, I’m just writing this down for therapy here). And some of those symptoms (like wanting to sleep all the time) sound really similar to the physical symptoms of hypothyroidism, just to make it more confusing.
In my case, I had constant overwhelming anxiety about almost everything. I’d spend most days dreading about six different things, all of which I absolutely knew it would be hopeless to try to counteract because they were utterly inevitable and there was no hope that anything would work. We were going to lose the house, our son would never have a normal life, we were all going to die alone, work was going to find out I was an imposter who didn’t know anything, the car was going to shed a wheel while driving on the M50, the revenue was going to audit us and find we had underpaid our taxes six years ago by ten euros and we’d be thrown in jail — you know, all the usual completely sane worries we all have. I lost all real joy in doing things, I’d spend all my time working or in the shed because being around family or friends was exhausting and when I’d try to talk about this to my wife, my chest would seize up and I’d find it physically difficult to breathe (that’s an anxiety attack, I’ve since learned) and I’d panic and couldn’t talk about anything. I’d want to sleep all the time, food just became fuel, and then the frustration and the snappiness would start and I’d wind up not knowing why I felt that way, what was going on or what was coming next and I’d try to go and hide away from people.
And then we had a global pandemic. In case anyone was wondering, having an actual existential threat show up when you’re having issues with depression and anxiety is initially very weirdly comforting. Ever see the Father Ted scene where he has to climb out on the wing of an airplane mid-air to fix something and is rendered completely calm by this because the bad thing he’s always feared is just, well, here, and at least now he’s not dreading its arrival anymore? Yeah, that seemed to actually happen, at least for a month or so. But it doesn’t last, and then the impact of everything is amplified once the initial relief wears off. And then a few months later in January 2021, right as my Eltroxin prescription ran out, Irish cases hit the worst spike of the pandemic so far, and our per capita case rate was for a while the worst in the world. My local GP’s office has a ten foot by fourteen foot windowless waiting room with no ventilation and not every eejit who lives here wears a mask. So I figured, why risk going in for the blood test and the new prescription when the only side effect of not taking the Eltroxin is that I’d be tired, but the side effect of getting exposed to an airborne virus (nobody had yet been vaccinated remember) was possibly dying in an ICU with a tube down your throat. So I’d just wait till the worst passed and sort it out later. Sounded reasonable at the time, since I didn’t know about the other side effects.
So if you’ve been suffering from clinical depression caused by thyroid issues for five years or so, and you’re in a high-stress situation like surviving a global pandemic, and you stop taking your thyroid meds, bad things happen, rapidly. Stuff gets worse – a lot worse – in a hurry. I have all the memories from that time and none of them make sense. It’s like remembering stuff done by a stranger. And the inside of my head got deeply unpleasant to be in. And in the end, I snapped. For no real reason at all, I started shouting at my wife one day in front of Calum, and wasn’t able to stop. Ever been driving on a winter road and hit black ice? Like that, but it’s your mind instead of a car. I ran away and hid and the next day Claire asked me to leave and go to my parents (by this point they were vaccinated).
It took me a few days to get my feet back enough to be able to think straight once I got there. I talked about it with my brother (who has a rather high-stress job and deals with broken people a lot), and I thought “It’s probably nothing, it’s just stress” and I went to talk to a GP about it. And broke down crying in her office three questions into the chat. Which, I should point out, is not particularly normal for me. She explained in small words that idiots could understand that it was not just stress, and that I needed to (a) get back on the eltroxin quickly, and (b) see a therapist and possibly a psychiatrist (therapists can’t prescribe antidepressants in Ireland, only psychiatrists can).
So that’s where I’ve been for six months. My eltroxin dose got doubled (my new GP is also a psychiatrist and he basically walked me through the blood tests I’d done with my old GP and pointed out how things had been bad, started to correct, then gotten worse when my thyroid degraded further) and until my thyroid was corrected I got put on serotonin reuptake inhibiters (that’s anti-depressants for anyone wondering), and every week I get to go into a room with a therapist and talk about deeply private stuff that I rarely want to think about, let alone talk through. But it helps. And I walk a few kilometres a day, and lift some weights if I can’t walk, and I keep my hands busy with knitting and leatherwork. And put all together, it’s effective as a treatment. My blood chemistry is now back to a normal it hasn’t seen in at least five years, my blood pressure is down from 150/110 to its normal 110/80, and I’ve dropped a little over thirty pounds in weight so far over the last two months or so, once the thyroid levels came back up to where they should be. And I don’t constantly feel like there’s several swords hanging over my head all the time, and I’ve started to enjoy things again.
It’s hard to put into words the difference there is between now and six months ago. I can remember what was going on then, but it’s like having a stranger’s memories in your head. They don’t make a lot of sense. And going from being that miserable to being free of it is such a phase change that it’s nearly impossible to convey. So there you go. A few hundred words to explain that I can’t actually explain what’s happened.