On Everyday Joy

It’s that time of year when merry cheer is lauded as the trademark of holiday spirit. Just look at the lyric sheet for any popular carol and the synonyms leap out at you: 

Wonder, love, light, 

comfort, joy, bright, 

happy, jolly, cheer, delight

bushels of fun and a beautiful sight

… to name a few.

One can feel social pressure to exhibit happiness, an expectation to display laughter and smiles. Certainly, I receive joy from positive interactions with friends and family. But I’m more likely to cue up the “Lonely Christmas” Spotify playlist with its plethora of minor key melodies than to rock around the Christmas tree. And that’s okay.

In fact, one could make a medical argument for my melancholic predilection. According to Johns Hopkins Medicine, up to 50 percent of MS patients experience depression — with the condition being three times more common than in the general population. The French neurologist Jean-Martin Charcot first identified a connection between multiple sclerosis and struggling mental health in  the 1870s, but the connection did not receive more comprehensive study until recent decades. Since then, research in numerous autoimmune diseases from MS to rheumatoid arthritis to inflammatory bowel syndrome has shown a link between depression and inflammatory processes.

Toss in the grief of receiving a life-changing diagnosis, of navigating daily neurologic challenges, of coping with the loss of function or ability, and mental health management grows into a grander complexity to care for.

In the months following my diagnosis, I grieved over the loss of the dazzling, healthy future of my dreams. Then, as the relapses hit with increasing recurrence rate and devastation, I struggled to delineate mourning from a true mental health challenge. Calling on deep-seated stubbornness, I rallied troops of self-generated willpower to quell depression, determined to avoid such a shameful sign of perceived weakness.

My neurologist gently guided me towards a different mindset, assuring me that emotional changes were both common in MS and treatable. What's more, select antidepressants can work in ways that improve other multiple sclerosis symptoms like numbness, tingling, and nerve pain. That was the bargaining chip that propelled me to finally acquiesce and accept a prescription for Cymbalta.

With time, I have come to expect questions about depression from healthcare providers and have developed the comfortability to answer honestly.

During the past two weeks, have you frequently felt down, depressed or hopeless?

During the past two weeks, have you had little interest or pleasure in doing things?

I came to realize that depression did not immediately connote suicidality. Nor was it an uncomfortable state through which one must suffer. Neither was it a constant state. Rather, feelings of helplessness could wax and wane, sensations of sadness could come and go, pleasurable engagement could rise and fall. And, through it all, lifestyle, diet, exercise, disease activity, medications, sleep, and stress could calm or exacerbate my emotional state.

Over the past decade, I have navigated compromised mental health poorly at times, with aplomb at others. I walked a mile then ran a mile then ran 5k (good). I drank a pint of beer then drank two cocktails then drank a case of wine (bad). I journaled and meditated (good). I binged on sugar (bad). I began visiting a therapist with varying frequency depending on my degree of need and availability. And, year by year, neurologist visit by neurologist visit, my antidepressant Rx increased in dosage.

These days, I’m focused on approaching emotional challenges with healthy strategies and self-directed grace. I no longer drink alcohol. I’m prioritizing regular physical activity. I have eliminated major stressors from my day-to-day life. And, in conversation with my medical team, I have gradually dialed down my antidepressant prescription to return to medication amounts from the early stages of my disease progression. My lifestyle has changed, replacing synthetic dopamine deliverers with natural ones, without ruling out the benefits of pharmaceutical stimulation in moderation.

Shifting away from hormonal manipulation and pleasure activation in the form of booze-soaked adrenaline has given me a fortified sense of pride, inner-strength, and capability. It also means that I must adjust to more docile levels of excitability. And still, even though it’s treated, I manage a depression that shrinks and expands in its daily interference.

So here we are, at that “most wonderful time of the year,” and I feel fine. Sometimes down. Sometimes merry. Sometimes energized, other times deflated. Not necessarily fueled by passion, but certainly not propelled by peppermint schnapps. Creative acts like writing may not deliver their highest hits of pleasure right now. And that’s okay. It’s in moments like these that I remember the bigger picture, the grander why.

I share my voice, my perspective, my lived experience as a catalyst for hope and resonance, carving strength from vulnerability, modeling authenticity, and cultivating humanity with empathy and grace.

And so, wherever you find yourself this holiday season, whatever mood, whatever highs or lows, struggles or celebrations, I wish you light and love. I sure am grateful that you’re here.