Depression in tech

It's not always burnout

I don't know exactly when I noticed the problem, and I certainly don't know when it started, but in the summer of 2014 I was having a bad time.

My projects had fallen by the wayside, I was keeping up at work but I had no interest in it, and I was well and truly socially isolated. So far so burnout, right? Wasn't the first time, wouldn't be the last. So I took steps.

I started looking in the usual areas. Woolwich is a real pain to get to the center of London, so I moved to King's Cross. I was clashing with another developer on my team so I didn't complain when I moved teams. I tried eating better, exercising more. Branching out into other types of side projects and avoiding computers.

None of it worked, so I checked again. Everything seemed fine. Good colleagues, no money troubles, good place to work, short commute, and so on. I was worried that there must be some stress in my life so persistent that I couldn't see it anymore, so I took a month off, to no effect.

It was causing trouble at work, I was snapping at people, unable to focus. At one point a colleague asked me if I was bored with my work and I didn't have the ability to explain that along with losing my ability to find interest in anything I had also lost the facility for boredom.

I was on the verge of chucking in the whole computer thing for the second time in my life when an idle conversation with some industry old-timers put me on the right path.

I was discussing my loss of interest in my career and hobbies with some other senior developers on a forum with something awful in it's name and getting lots of the usual responses, quit your job, take time off etc, when someone said it could be depression.

I was skeptical. When people talk about depression they talk about being "down" or "feeling empty". Allie has written a couple of very illuminating posts over at Hyperbole and a Half. None of that seemed like me.

But whatever, I'm not a doctor, so I checked the NHS's website:

Psychological symptoms include:
  • continuous low mood or sadness
  • feeling hopeless and helpless
  • having low self-esteem
  • feeling tearful
  • feeling guilt-ridden
  • feeling irritable and intolerant of others
  • having no motivation or interest in things
  • finding it difficult to make decisions
  • not getting any enjoyment out of life
  • feeling anxious or worried
  • having suicidal thoughts or thoughts of harming yourself
Physical symptoms include:
  • moving or speaking more slowly than usual
  • change in appetite or weight
  • constipation
  • unexplained aches and pains
  • lack of energy
  • changes to your menstrual cycle
  • disturbed sleep
Social symptoms include:
  • not doing well at work
  • taking part in fewer social activities and avoiding contact with friends
  • neglecting your hobbies and interests
  • having difficulties in your home and family life

I've highlighted the ones that applied to me. 14 out of 22, and one's kinda cheating because I don't have a menstrual cycle.

So. Right then. Best get that sorted out.

Sorting it out

OK. First step, GP. I got booked in, waited a week, and went in. We had a chat about my symptoms, and she agreed something was probably going on.

I already knew how depression is commonly treated medically from my neuroscience days at university, but I didn't know how it worked in terms of therapy. Turns out the NHS likes a technique called Cognitive Behavioural Therapy (CBT). I'd looked this up before the appointment and was very skeptical of its usefulness in my case but I agreed to go along to a 1:1 session, because again I am not a doctor. We deferred the discussion of medication until after that session.

I got a call a week or two later and have a chat with one of the Camden psych people, and she confirms a diagnosis of moderate to severe depression, and we schedule the face to face meeting.

This gap was not a great time for me. By this point I knew what was going on, and was taking a much closer look at my behaviour and how I was feeling. I took notes at the time because I was worried I wouldn't remember it when I started getting better, if I started getting better. Here's a sample:

It's a nothingness. Flatline. Not empty, exactly; empty implies the sense of something missing. What I feel instead is a null state, with no indication that anything should be otherwise, beyond my own memories of times past, or the observation of others.

I'm not incapable of feeling things. Some people get it that bad, but not me, so far. I'm still amused when I watch a funny film, interested by an article, or infuriated by some small irritation, but the difference is those feelings don't stick around. Once I'm done watching, or reading, everything returns to zero.

Here's where it starts to get a little scary. I tried to remember what it was like to be in a good mood, or a bad mood, or anything not directly related to some immediate input, and I couldn't. I can't really express how disconcerting this is, to reach for evidence that you've ever experienced such a fundamental part of being human and coming up empty. You did used to feel things, right? Just like other people?

4 weeks pass and I finally get my CBT intro session. It didn't take long before we were both clearly aware that this wasn't going to work for me. CBT is all about finding triggers that kick off negative cycles of thoughts or behaviour, whereas in my case I'd just wake up feeling nothing at all for the entire day. There were no triggers and no negative thoughts to counter.

Back to the GP for another appointment (different doctor, 2 weeks wait) and we discussed medication. She prescribed a course of SSRIs, slowly ramping up the dosage to recommended levels.

Since I'm still taking these now and will be for some months to come, I should take some time to explain what SSRIs are and how they work.

Many people think of the neurons in the brain as being an electrical system, if they think of them at all. This is correct but incomplete. The brain is actually an electrochemical system, where the neurons act like wires carrying electrical pulses but are connected by synapses which are chemical junctions.

The chemicals which bridge these synaptic gaps are called neurotransmitters, and it's these that are affected by SSRIs.

You might be wondering why the brain has such a complex mechanism for making what could be direct electrical connections, but while the brain is malleable (facilitating learning) the creation and modification of connections in the brain is a slow process, meaning the body cannot use them to alter behaviour quickly, like in emergencies. With neurotransmitters it can.

Neurotransmitters not only bridge electrical gaps in the brain, they also have a differing effect on the signal depending on the neurotransmitter and synapse in question. Some transmitters act to boost a signal at a synapse, whereas some dampen it. The same neurotransmitter can even do both depending on where it's acting, meaning it can spark up one part of the brain while calming another.

This multitude of different chemicals and their differing effects on the brain is what provides a massive combinatorial complexity to the ways our behaviours and thoughts can be affected based on the situation in which we find ourselves, and provides a fast and clear route for our bodies to affect our brains through hormones and other body chemicals.

Getting back to the meds, SSRI stands for selective serotonin reuptake inhibitor. It's a "reuptake inhibitor" because instead of dumping a neurotransmitter directly into the bloodstream it acts to reduce the amount that is reabsorbed after transmission across a synapse, therefore leaving more behind to do its thing. It mentions "selective serotonin" because it targets one neurotransmitter, serotonin, out of three related neurotransmitters called monoamines.

The three key monoamine neurotransmitters are serotonin, norepinephrine, and dopamine. While it's unclear exactly what they all do, serotonin is associated with sleep and feelings of wellbeing, norepinephrine (aka noradrenaline in the UK) is, as you might have guessed, related to alertness, and dopamine is associated with motor control, especially in conditions such as Parkinson's, ADHD, and restless leg syndrome.

SSRIs therefore raise the level of serotonin around your synapses, hopefully improving wellbeing and happiness. There's also a set of medications called SNRIs, or Serotonin-Norepinephrine Reuptake Inhibitors, which target both serotonin and norepinephrine. There's some evidence that SNRIs are more effective than SSRIs, so I asked my GP why the NHS preferred SSRIs. Her response was 1) cost, 2) they're more familiar with it. So there you go. There are chemicals which target all 3 of the main monoamines, but they go by names like cocaine and ecstasy, so I wouldn't recommend it.

Did it work?

Yes! That feeling of flatlining emotion was gone, replaced by a much more healthy (and happy) baseline. I felt content, at times, probably for the first time in a year. Even feeling angry was good, because I could.

You're expected to have fairly significant negative side-effects for the first couple of weeks until your system adjusts, often worsening the symptoms you're trying to treat. Fortunately this didn't happen to me, and the only side-effect I've noticed is that I've started dreaming again. I don't mean that figuratively, I mean I used to sleep in a void of nothingness, and now, dreams, just as meaningless and tedious as everyone else's.

So that's it. I'll be on the meds for up to 6 months, can't drink alcohol or take ibuprofen, but other than that I'm fine.

I'm rather grateful to the anonymous person that suggested depression might be causing my malaise, and if you're struggling with burnout or disinterest with things you used to love, check out that list of symptoms again, and maybe I can do the same for you.