What I Want My Brother, the Medical Student, to Know About Depression

“On paper, Prozac is my favorite. You should ask about switching to that one.”

I crack open a safety locked prescription and toss back my daily antidepressant dose, chasing it with ice water. My older brother hunches over his laptop at the kitchen table, squinting at a Word Document of psychiatric notes from a recent exam.

“Will that one give me vivid dreams, too?” I ask, peering over his shoulder. “I kinda wanna keep those.”

He shakes his head, fingers clattering across the keyboard. “We never learned about that as a possible side effect of taking SSRIs.”

“It’s pretty common,” I insist. “There’s a Tumblr tag and everything for it.”

“Pff.” Alright, I deserved that indignant scoff. Standing in a baggy shirt and leggings I’ve worn four days in a row, I don’t have a pocket to reach into to pull up my phone’s browser as evidence. I munch on a muffin while my brother scours his familiar medical websites.

“Did you mean insomnia?” he asks.

”Pff, nope.” Through a mouthful of muffin, I mention, “That guy with BPD I used to have a crush on had super vivid nightmares when he was on Lexapro. Did you Google it?”

“I’m not going to just ‘Google’ medical symptoms.”

We’re working ourselves into a stalemate of pride: mine in knowing my depressive symptoms and disorder firsthand, his in the past year he spent in graduate school living, breathing, sleeping and eating medicine. I’ve worried about his mental health sometimes more than my own, hoping against all hope that he doesn’t catch depression like a bad cold.

We fit nicely into our own boxes. He’s logical, I’m emotional. He’s scientific, I’m artistic. He’s an adventurous eater, I really like bread. He spends nights out with friends, I cuddle with my bunny and yell at the latest episode of “American Horror Story.” The typical brother-sister dichotomy.

My brother shows me a clip of a mental health lecture he needed to listen to for school: common grounds we can bond over. “Wait for this line.” He sells it to me like a stand-up joke, and it doesn’t disappoint. We share a snide chuckle at this PhD lecturer who admits to a full classroom, “Uh, no one really knows what, uh, what causes depression.”

“It’s obviously a combination of nature and nurture,” I chide, tacking on a hesitant, “Right?”

“Yeah, hopefully he knows that. More like no one knows the neurological cause.”

I take a moment to translate this and some other medical jargon into plain English. “Hmm, that brings up a good question, though,” I notice. “Like, what causes any chemical imbalance in the brain?” He shrugs. I point to the polar bear coffee mug beside his laptop. “Want a refill?”

“Yeah, I’ll finish off the pot. Thanks.”

“Cream?”

“I’ll grab it.”

I bring him over a carton of creamer from the fridge, along with the last of the coffee.

I like mentioning my mental health flippantly — it takes the edge off of living it. But time and time again, any mental health narrative I share with my family or general practitioner is brushed over like I’m mentioning how I like my coffee.

For me, measurable physical symptoms are a lot easier to discuss: I’m entirely comfortable with my brother knowing about the gastrointestinal side effects of my sertraline – after all, up to 20 percent of users experience diarrhea/loose stool.

Personal anecdotes and emotion distress are typically met with the same statistic-based dialogue. Marathon-crying for over an hour isn’t in a medical textbook. Neither is the explanation of how my decreased sex drive means that physical touch doesn’t give me comfort, like how hugs just feel like arms around my shoulders instead of a rush of oxytocin.

I feel like I am constantly justifying myself, and I’m translating plain English back into medical jargon. And I want medical personnel to meet me halfway. Knowing depression on paper doesn’t mean knowing my depression. Knowing a textbook doesn’t mean understanding a person.

Please don’t immediately write me off as silly when I start talking about my high-functioning symptoms, or my atypical side effects, or how I want to try one type of medicine over another. I didn’t used to have vivid dreams before sertraline, and now I do: so this is one of my side effects, even if you haven’t heard of this happening before. And I guess I’ve got to pit my personal experiences against your medical fact sheets like a dog fight.

Maybe I don’t know how to pronounce the generic names of medicine correctly, but I know what serotonin is. I’ve already researched the most common side effects. I’ve tried to find the human explanation for why my mind acts the way that it does because your medical explanation is “no one really knows what, uh, what causes depression.” So yeah, I get a little pissed off when you tell me that what I’m experiencing firsthand isn’t something you’ve heard of before, so I’m made to feel like I’m the one who is wrong.

The first time I started seriously considering medication for my depression, I spent hours online opening and closing tabs on sertraline, fluoxetine, citalopram… I’d spent at least an hour crying, an hour talking with insurance, an hour bouncing around phone calls with local psychiatrists with closed appointment books, two hours researching SSRIs, half an hour of phone-tag with my general practitioner and another half hour to get and fill my new prescription that day.

I fought for myself when I didn’t have an ounce of strength, when everything seemed to stand in my way. I was messy, and I was desperate, and my depression was hungry.

I don’t think my brother knows this story.

I don’t know if it would faze him.

My biggest piece of advice for medical personnel is one that I’ve gotten as a teacher: speak to understand, not to be understood.

Don’t just ask me about my symptoms: ask me about my experiences. Ask me about my lifestyle beyond what checks off a Yes/No box on your questionnaire. Don’t just tell me that mixing alcohol with antidepressants is risky. Duh. I know. I can understand. Ask me why I’m still doing it. What are the motivations behind my actions? How do I feel about certain symptoms or medical side effects? Ask me, “Do you have any questions?” and offer me a way to contact you when I do think of a question.

My brother’s bedside manner has improved drastically since he started working as a CNA. I guess you develop a kind of unfaltering patience when your job entails lifting nursing home residents back into their beds and cleaning out their bedpans for the third time so far in your shift. Supposedly, he’s also got a knack for making those lab cadavers feel right at home.

I love bragging about his successes to my coworkers and friends, scrolling through photos on my phone of him in a cap and gown, his lab coat or donning a practice arm cast. Just as I’ve got a long way to go as a teacher, I know he’ll have a long way to go as a physician assistant.

It’s nearing midnight on the last day he’ll be home for his winter holiday. He’s about to drive back to school midday tomorrow to avoid the snow. After a quick knock on his door, I barge into his room. I demand to know how he’s not at “med school” if he’s studying medicine, what’s the difference between “medicine” and “medical science,” and how he could practice psychiatry but not be a board-license psychiatrist. After about 20 minutes of back-and-forth, I think I’m starting to understand. Maybe. I don’t want to get my hopes up.

“Make sure to call home with fun work stories,” I demand, hoping to amp him up for his first round of clinicals.

“I’m not going to call home and complain about how so-and-so patient asked a really silly question,” he counters. “Besides, apparently a lot of people get cranky during rotations.”

“Well, I think it’s pretty easy to wanna share stories about my students. Not to, like, reveal names or personal information, but so I’m on the lookout for nice aspects of the job,” I clarify. “Like, when my kids say or do something that’s funny or cute, I immediately think of who I want to talk with about it. It’s not so bad to get excited about what you love.”

He nods, scrunched up in his desk chair, hunched over the hockey game streaming on his laptop. I sit cross-legged on his bed, gathering up loose candy wrappers to throw away. He looks around his room at the mess of dirty clothes and textbooks he still needs to stuff into his suitcase. “You wanna bring your bunny in here and let him explore?” he asks.

Is that even a question? “Um, yes.”

Find more of Devon’s work on Floodmark. 

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