Depression and Stimulus

Ok so this post has nothing to do with macroeconomics, though it borrows its concepts from there. As the more perceptive of you might have figured out by now (ha, i love that line!) I was diagnosed with clinical depression about a year back. Actually that was the second time I had been diagnosed with that diagnosis, the first being a full six months earlier, when I had suddenly stopped medication after I had lost trust in that psychiatrist.

For over a year now, I have been on anti-depressants. It started with 37.5 mg per day of Venlafaxine (brand name Veniz), which got slowly bumped up until at 187.5 mg per day I started going crazy and having crazy mood swings and had to be scaled back to 150 mg. I was at that level for over six months when I realized that I had plateaued – that there was no real improvement in my mental situation thanks to continuous intake of the drug and perhaps I should consider getting off.

I proposed this idea to the psychiatrist when I met her last month and amazingly she agreed without any hesitation and quickly drew up a plan on how I need to get off the drug (you need to decrease dosage slowly else you’ll have withdrawal symptoms which are pretty bad). I found it a little disconcerting that she so readily agreed to take me off the drug, given that she had herself not given any indication of wanting to take me off the drug. I was disconcerted that I had been taking the drug for much longer than necessary, perhaps.

The doctor, however, paired the paring of my anti-depressant with doubling the dosage of the stimulant that I have been taking for my ADHD for the last six months. As it happened, though, I went through a major bout of NED that evening, and didn’t muster the enthu to go to the one pharmacy that legally sells Methylphenidate (the ADHD drug, ¬†supposed to have similar chemical composition as cocaine) in Bangalore. That I managed to function pretty well the following one week, including the three days spent at my client’s office, meant that I probably didn’t need teh ADHD drug also. So as I write this I’m off all mind-altering substances (apart from my several-times-a-day doses of caffeine and occasional ingestion of ethanol).

Recently I met a friend who told me that I had been too generous in my praise of psychiatric drugs in my blog, and that I hadn’t taken into consideration their various side effects and addictive symptoms. I’ve heard this from other people also – that I probably wasn’t doing the right thing by taking anti-depressants. So do I now regret taking them, given that I’ve chosen to go off them? Probably not.

This is where the analogy of economic depression and clinical depression comes in. In an economic depression, there is a halt in economic activity thanks to which there isn’t much circulation of money. When people start earning less, they start spending less, which further depresses their income and the whole economy goes into a tailspin. Going by Keynes’s theory, letting the economy slowly repair itself would take an extraordinarily long time (in the course of which we will all be dead, as the joke goes), so it is recommended that the government steps in and spends heavily in order to “stimulate” the economy and break the vicious circle it was getting itself into.

When you suffer from clinical depression, there is a shortage of flow of this chemical compound called Seretonin in your brain. Thanks to that, your mental energy is at a much lower level and you get tired and stressed out easily. Moreover, depression also leads to a significant drop in your confidence levels. You start believing that you are useless and not capable of anything. But then, your lowered mental energy levels mean that it is tough for you to be good at work, and do things that are likely to give your confidence a boost. And this in turn leads to further lowering of confidence and there is no way out for you to break out of this vicious circle.

A number of people believe that depression can be conquered with “willpower”, but this is applicable only if you’ve recognized it in its early stages. In most cases though, you realize it only when it’s deep into the vicious circle, and your “willpower”, much like “normal economics” during an economic depression, will take way too long to break you out of the vicious circle, and by then half your productive life will be gone.

Hence, to draw the Keynesian analogy, you need a stimulus. You need some sort of an artificial stimulus that breaks you out of your vicious cycle of low self-esteem and low performance. Sometimes, there can be a fortuitous life event which by matter of chance gives you a sudden sense of achievement and helps you break out of the cycle (for example, I was quite depressed (most likely clinically) through most of my life at IIT, but success in CAT proved to be a good stimulant in helping me break out of that cycle). But then, most of the time, life is structured such that there are few opportunities for such positive black swans, especially when you are older and especially when your mental energy levels are in general quite low.

Under these circumstances, I believe, there is no way out but chemical stimulants to help you get out of your depressive state. Clinical researchers and psychiatrists over the years have found the answer to be this molecule called “SSRI” which slows down the rate of seretonin uptake into the brain, with the result that there is greater flow of seretonin in your nervous system (continuing our economic analogy this is like the government cutting taxes as a form of stimulus). Greater seretonin in the system means greater mental energy, and sometimes the difference in energy levels is itself enough to push up your self-esteem levels, and the new energy levels means you have given yourself a chance to perform, and the cycle breaks.

Keynes said, as part of his theory, that it is important that a stimulus is short and targeted, and that in good times a government needs to be fiscally conservative so that, if not anything else, it has the necessary firepower to deliver a stimulus when necessary. Similarly, it is important that you don’t get yourself addicted on these anti-depressants and that you don’t become immune to them. Which is why psychiatrists typically wean you off your anti-depressants six months to a year after you started on it. By then, they expect, and in my case it did, that the stimulus would have been delivered.

Project Thirty – Closure

Today is the last day of my twenties. Which means Project Thirty has come to an end. I had a long list of things to do, and as the more perceptive of you would have expected from me, most of them are undone. Nevertheless, it has been a mostly positive year, and I’m glad I gave myself the year off in an attempt to find what I want to do.

The biggest positive of the last one year was that my mental illnesses (anxiety, depression, ADHD) got diagnosed and started getting treated. Yes I’m on drugs, and face severe withdrawal symptoms if I don’t take my antidepressant for a few days, but the difference these drugs have made to my life is astounding. I feel young again. I feel intelligent again. I have more purpose in life, and am back at the cocky confidence levels I last saw in 2005. I suddenly feel there’s so much for me to do, and for the first time ever, have started enjoying what I’m doing for money.

Which brings me to professional life. I decided to give myself a year to become a freelancer. I must admit I got one lucky break (one long-term reader of this blog was looking for a data science consultant for his company and I grabbed the opportunity), but I grabbed it. My improved mental state meant that I was motivated enough to do a good job of the pilot project I did for that company, and I have managed to extract what I think is a reasonable compensation for my consulting services.

There are other exciting opportunities on the horizon on the professional front, too. I’ve started teaching at Takshashila and am quite liking it (I hope my students are, too). There is so much opportunity staring at me right now that the biggest problem for me is one of prioritization rather than looking for opportunity.

There has been both progression and regression on the “extra curricular activities” front. Thanks to demands of my consulting assignment, I haven’t been getting time to practice the violin and abruptly discontinued classes two months ago. I did one awesome and rejuvenating bike trip across Rajasthan back in February but wasn’t able to follow that up even with weekend trips. I wanted to start on adventure sports but that remained a non-starter. I started preparing for a half-marathon and gave up in a month. I took a sports club membership, tried to teach myself swimming again, but have been irregular.

Personal life again has been mixed. Increasing excitement about work means less time for the family, and have been finding it hard to balance the time requirements. I seem to be putting on weight again, and now look closer to the monstrosity I was four years ago rather than the fit guy I was two years ago at the time of my wedding. I blame my expanding waistline and neckline on my travel, but that is not an excuse and I need to find an exciting way to get fit soon.

For perhaps the first time in several years my car didn’t take a knock that year, but I had two motorcycling accidents (one major and one minor) this year. The former led to the first ever broken bone in my body (the fifth metacarpal) thanks to which I don’t have a prominent fourth knuckle on my right hand. The latter led to major damages to my laptop.

My “studs and fighters” book still remains unwritten, and not a word has been added to its manuscript in the last one year. I was hoping to capstone my Project Thirty by organizing the first ever “NED Talks” but I seem to have bitten off much more than I can chew in terms of work, so that has again been postponed.

So let me take this opportunity to define my Project Thirty One. I want at least two published books by the end of the year. I want to do at least one major motorcycling trip. I need to find partners/employees and expand my consulting business. I want to travel a lot more – at least five weekend trips over the next 12 months. I want to become fit, to the size I was at the time of my wedding. Hopefully I can get weaned off anti-depressants. And I hope to resume music lessons, and start jamming. Ok let me not promise myself too much.

And I have a five-year plan too. By the time I’m thirty five, I want to have written a book on the economic history of India. Ambitious, I know. Especially for an NED Fellow like me.

Pot and cocaine

Methylphenidate, the drug I take to contain my ADHD, is supposed to be similar to cocaine. Overdosing on Methylphenidate, I’m told, produces the same effects on the mind that snorting cocaine would, because of which it is a tightly controlled drug. It is available only in two pharmacies in Bangalore, and they stamp your prescription with a “drugs issued” stamp before giving you the drugs.

Extrapolating, and referring to the model in my post on pot and ADHD, snorting cocaine increases the probability that two consecutive thoughts are connected, and that there is more coherence in your thought. However, going back to the same post, which was written in a pot-induced state of mind, pot actually pushes you in the other direction, and makes your thoughts less connected.

So essentially, pot and cocaine are extremely dissimilar drugs in the sense that they act in opposite directions! One increases the connectedness in your train of thought, while the other decreases it!

I’ve never imbibed cocaine, so this is not first-hand info, but I’ve noticed that alcohol when taken in heavy doses (which I never reach since I’m the designated driver most of the time) acts in the same direction of cocaine/methylphenidate – it increases the coherence in your thoughts. Now you know why junkies in your college would claim that the kind of “high” that pot gives is very different from the kind of high that alcohol gives.

Elite institutions and mental illness

At the Aditya Birla scholarship function last night, I met an old professor, who happened to remember me. We were exchanging emails today and he happened to ask me about one of my classmates, who passed away last year. In reply to him I went off on a long rant about the incidence of mental illness in institutions such as IIT. Some of what I wrote, I thought, deserved a wider audience, so I’m posting an edited version here. I’ve edited out people’s names to protect their privacy.¬†

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<name blanked out 1> passed away a year and a half back. He had been diagnosed with bipolar disorder and was also suffering from depression, and he committed suicide. He had been living in Bangalore in his last days, working with an IT company here. I had invited him for my wedding a couple of months before that, but had got no response from him.
He was the third person that our 30-odd strong Computer Science class from IIT Madras lost. Prior to that another of our classmates had killed himself, and he too was known to be suffering from some form of mental illness. The third was a victim of a motorcycle accident.
I’m quite concerned about the incidence of mental illness among elite students. From my IIT Madras Computer Science class alone, I know at least six people who at some point of time or the other have been diagnosed with mental illness. I myself have been under treatment for depression and ADHD since January this year. And I don’t think our class is a particularly skewed sample.
I think this is a manner of great concern, and doesn’t get the attention that it deserves. I don’t know if there are some systemic issues that are causing this, but losing graduates of elite institutions to mental illness is I think a gross wastage of resources! I don’t know what really needs to be done, but I think one thing that is certainly going to help is to set up on-campus psychiatric and counselling services (manned by trained professionals; I know IIT Madras has a notional “guidance and counselling unit” but I’m not sure what kind of counseling they’re really capable of) , and to encourage students to seek help when they sense a problem.
Of course, there are other constraints at play here – firstly there is a shortage of trained psychiatrists in India. I remember reading a report somewhere that compared to international standards, India has only one third of the number of psychiatrists it requires. More importantly, there is the social stigma related to mental illness which prevents people from seeking professional help (I must admit that I faced considerable opposition from my own family when I wanted to consult a psychiatrist), and sometimes by the time people do get help, irreparable damage might have been done in terms of career. Having read up significantly on mental illnesses for a few months now, and looking back at my own life, I think I had been depressed ever since 2000, when I joined IIT. And it took over 11 years before I sought help and got it diagnosed. Nowadays, I try to talk about my mental illness in public forums, to try and persuade people that there is nothing shameful in being mentally ill, and to encourage them to seek help as soon as possible when they think they have a problem.
I’m really sorry I’ve gone off on a tangent here but this is a topic that I feel very strongly about, and got reminded about when I started thinking about <name blanked out 1>….
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I know that several universities abroad offer free psychiatric support to students, and I know a number of friends who have taken advantage of such programs and gotten themselves diagnosed, and are leading significantly better lives now. I don’t really know how to put it concisely but if you think you suffer from some mental illness, I do encourage you to put aside the stigmas of yourself and your family, and go ahead and seek help.¬†

The Aditya Birla Scholarship

I spent this evening attending this year’s Aditya Birla Scholarship awards function. Prior to that, there was a networking event for earlier winners of the scholarship, where among other things we interacted with Kumaramangalam Birla. Overall it was a fun evening, with lots of networking and some nostalgia, especially when they called out the names of this year’s award winners. My mind went back to that day in 2004, as I sat confident but tense, and almost jumped when I heard my named called out only to realize it was another Kart(h)ik!

You can read more about my experiences during that award ceremony here (my second ever blog post), but in this post I plan to talk about what the scholarship means to me. During the networking event today, one of the winners of the scholarship (from the first ever batch) talked about what the scholarship meant to him. As he spoke, I started mentally composing the speech I would have delivered had I been in his place. This blog post is an attempt to document that speech which I didn’t deliver.

People talk about the impact the scholarship has on your CV, and the bond that you form with the Birla group when you receive the scholarship. But for me, looking back from where I am now, the scholarship has primarily meant two things.

Back in the day, the scholarship covered most of my IIM tuition fee. When I’d joined IIM, my parents had told me that they wouldn’t fund my education, and I had taken a bank loan. However, the scholarship covered Rs. 2.5 lakh out of the Rs. 3 lakh I needed for my tuition fee, and the loan that I had taken for the remaining amount was cleared within a couple of months after I worked.

My first job turned out to be a horror story. It was six years before my ADHD would be discovered, but I was in this job where I was to put in long hours under extremely high pressure, and deliver results at 100% accuracy. I wilted, but refused to give up and pushed myself harder, and I’m not sure if I actually burnt out or only came close to it. But it is a fact that one rainy Mumbai morning, I literally ran away from my job, purchasing a one-way ticket to Bangalore and refusing to take calls from my colleagues until my parents told me that my behaviour wasn’t appropriate.

While my parents were broadly supportive, the absence of liabilities made the decision to quit easier. Of course I still had the task of finding myself another job, but I knew I would pull through fine even if I didn’t find another job for another six months (of course, I had saved some money from my internship at an investment bank, but the lack of liabilities really helped). The Aditya Birla Group, by funding my business school education, played an important role in my being free or financial obligations, and being able to chart out my own path in terms of my career.

My six-year career has seen several lows, aided in no small amount by my ADHD and depression, both of which weren’t diagnosed till the beginning of this year. I got into this vicious cycle of low confidence and low performance, and frequently got myself to believe that I was good for nothing, that I had become useless, and that I should just take some stupid steady job so that I could at least pay the bills.

During some of these low moments, my mind would go back to that day in September 2004 when I (at the end of the day) felt at the top of the world, having been awarded the Birla scholarship. I would then reason, that if I was capable of convincing a panel consisting of N. Ram, N K Singh and Wajahat Habibullah to recommend me for the Aditya Birla scholarship, there was nothing that was really beyond me. Memories of my interview and the events of the day I got the scholarship would make me believe in myself, and get me going again. Of course on several occasions, this “going again” didn’t last too long, but on other occasions it sustained. I credit the Aditya Birla scholarship for having given me the confidence to pull myself back up during the times when I’ve been low.

These are not the only benefits of the scholarship, of course. The scholarship has helped build a relationship with the Aditya Birla group. In the short run, when I won the scholarship, it helped me consolidate my reputation on campus. And last but not the least, it was a major catalyst in reviving a friendship which had gone awry thanks to some of my earlier indiscretions. Most important, though, was the financial security that scholarship offered, which made potentially tough decisions easier, and the confidence it offered me which has carried me through tough times.