Completing the Burns Depression Checklist on a regular basis helps me to understand my depression better. However, it doesn’t include everything I believe is important to consider when assessing my mental health (such as symptoms of anxiety). In this post, I’ll review my scores on the Checklist and reflect on what I think they mean. My goal is to eventually develop a way to keep track of changes in various indicators of mental health, including signs that I am becoming more healthy (e.g. laughing and smiling, feeling at peace) and not just less diseased.
Checklist Scores: The Big Picture
My scores on the Burns Depression Checklist for the past 4 weeks. Daily scores are marked in blue, while weekly averages are marked in red. Although the severity of my depression symptoms can change drastically from day to day, there has been a steady decline in weekly averages from July 29, 2013 to August 24, 2013.
I think the most noticeable thing about this graph/chart is that my daily scores oscillate. If I have a bad day (indicated by a higher score), things seem to get better soon afterward (causing the score to drop). Unfortunately the same is true if I have a good day (indicated by a lower score); in the days following, the symptoms that had been absent on my good day return (causing the score to rise). While I’m inclined to consider some oscillation normal, I think a reasonable goal would be to try and get to the point where scores are consistently low, with less day-to-day variation and only occasional bad days.
I’ve been tracking the average score for each week by adding up the daily scores for the week and dividing by 7 (6 for the first week). Admittedly it’s not the most statistically accurate method, but I believe it suffices for my purposes. Despite the daily oscillations – including some very difficult days – the weekly scores have been decreasing. I take that as a good sign.
Context is Everything
It’s important to put at least some of the scores into the context of what was going on for me at the time.
In the first week I’d had enough of being severely depressed and felt motivated to finally take charge of my own life. I came up with a plan for taking care of myself and felt optimistic that it would help me beat the depression. I hit some rough patches though, particularly in regards to sleep. There were aspects of the self-care plan I needed to adjust. I was also still on the fence about whether to continue my seemingly futile efforts to make an appointment with a psychiatrist. Finally, I had just started taking SAM-e, a supplement to help my brain produce important neurotransmitters such as serotonin.
Monday and Tuesday of the second week were bad enough that I didn’t even feel up to completing the Checklist. I repeated my scores from the Sunday for purposes of my chart/graph (particularly, to keep the average for that week from being too low) – though, I suspect the scores would have been much higher if I had completed the Checklist on those days.
I was coming down (arguably, crashing) from a high-energy social weekend, struggling with wedding-and-gender-norm-related family drama, and panicking over my pending loss of health insurance. Somehow, in the midst of all this, I was able to resume tracking my finances. The “return to functional humanity” did wonders for my mental health.
On Sunday of the third week I learned that a mentor from my undergraduate years had died. Prior to learning the news I’d been having a rather good day, relatively free from depression symptoms. Afterward, understandably, I was very sad and angry.
I needed a few days to process the sudden change and grieve, resulting in higher scores on the Checklist as that was pretty much all I did. To some degree I believe the rise in scores is normal/healthy – anyone would experience some depression symptoms following the death of someone important to them. Mine were just more severe because my baseline is much higher (worse depression symptoms are “normal” for me).
I felt absolutely horrible the night of August 13-14, but with Fox’s help I was able to channel the immense energy of my emotions into creativity and
efforts to change my environment for the better.
The very low score on August 16th was the result of visiting a beautiful bed and breakfast, where I was able to relax, savor delicious food, enjoy wonderful company, and reconnect with nature. I didn’t have my laptop with me, so I completed the Checklist the next day from memory.
Unfortunately, our visit to the bed and breakfast was not purely in the interest of getting away and enjoying a nice vacation. We were considering it as a potential wedding venue. Saturday August 17th was the beginning of horrible wedding insanity as we learned the venue we’d fallen in love with was much, much more expensive than we’d anticipated. Long story short, Mom, Fox, and I now have regular nightmares related to wedding planning. It’s become a horrible monster!
The monster posed a very, very serious threat to me on August 19th. That peak for week 4 is a score of 71, only 4 points away from “extreme” depression. Wedding-related family drama hit me especially hard on this day – but it’s really not anyone’s fault I responded this way.
The things that were said were a catalyst for something much deeper and darker in me: a sense that my existence as an autonomous sentient being is tenuous at best. Feeling like I need permission to do everyday things, even to breathe. I felt so trapped, like the Warden would come in any moment to punish me for daring to have my own thoughts, my own will – never mind to assert myself or act on my needs! Even just to write about it is terrifying.
Yes, I need people to respect my boundaries. But more than that, I need to know in my heart, to fiercely believe with every fiber in my being, that I am worthy of having boundaries. That it’s worth enforcing them. That if someone hurts me for any reason, I have every right to feel angry and to defend myself. That if someone hurts me, it doesn’t mean I did something wrong.
Sure, this brought out a lot of depression symptoms, but I don’t think “depression” really explains what’s going on. And sure, it involves fairly severe anxiety symptoms, but I’ve never heard anxiety described or explained like this. I felt like I wasn’t allowed to do anything, and if I made a noise I’d be caught, and if I was caught …
I don’t know, maybe it’s PTSD? Call it “Barbie” for all I care! The point is, it’s a serious problem for me, an underlying cause or component to all my mental health issues. Perhaps it is my mental health issue.
Fortunately, I was able to rebound from that day. Writing No Space for Me definitely helped because I was able to express what was going on, assert myself, and realize that Fox does respect my boundaries. I also did more wedding-related research on my own terms and learned that the venue we’d fallen in love with isn’t actually that much more expensive – and might even be less expensive – than the other options we’d consider. It helped me feel empowered to make decisions instead of feeling obligated to follow someone else’s rules.
I’d intended to write about my daily scores on the 4 subcategories of the Burns Depression Checklist – Thoughts & Feelings, Activities & Personal Relationships, Physical Symptoms, and Suicidal Urges – but I think it would make this one post a bit too long. Stay tuned for Part 2, in which I shall examine these components of depression as they manifest themselves for me.