From “The Billfold” (online), January 17, 2013:

Martha Kaplan and I are both depressed.

This is the first in a series of conversations about depression and money.

Logan Sachon: So we’re here today to talk about DEPRESSION and how it affects our MONEY.

Martha Kaplan: Not well. It has what I would characterize as a “negative effect.”

LS: Yes. I think you are right about that. We both have some personal experience with this. I’d say.

MK: I would say that also.

LS: So we’re going to talk about this. Martha Kaplan is not your real name, though maybe it should be.

MK: Yes I have requested to be anonymous because of my job. It’s hard to be taken seriously in your place of business if it’s widely known that one, you are a lady, and two, you sometimes have trouble getting out of bed. Either of the the two is problematic. But in combination it’s disastrous.

LS: …

MK: I’ll give you the breakdown on my “issues.” So I’ve probably always been somewhere on the depression spectrum. But this got particularly bad during college. There was a week-long period my sophomore year when I didn’t really leave my room. I mean, I got some food, occasionally, but I mostly didn’t go to class. I definitely didn’t wash my hair. I didn’t really see people (probably part of that was shame because of the state of my unwashed hair).

This was maybe right around the period when I started putting vodka into my coffee before going to class. I was, in general, not being the best Me I could be.

But anyway, at a certain point I came out of that, and I started seeing a therapist who I didn’t end up liking that much, but I was diagnosed then with a mild bipolar disorder. I eventually went on a couple medications: Lamictal, which was originally for seizures, but has a secondary use as a mood stabilizer for manic depressives who can’t be on antidepressants because that would make their mood too elevated, and also Concerta, which is essentially time release Ritalin, which I basically got because I wanted to stay up all night writing papers, because I always wait until the night before to start doing things. So that was less related to my “illness” or whatever.

LS: BUT WAS IT I WONDER? (I do that, too.) (Wait until the last minute.)

MK: I mean, my inability to do shit certainly is related to my anxiety re what I’m producing not being good enough. If you self-sabotage, you can blame that for the low quality of the product you make. You set yourself up for failure, so you can avoid larger, failure of SELF. We’ve talked about this. I think we both do it.

LS: Yes. You recently re-reminded me that I do it—many a therapist has told me I do this! And my mother! But I forget.

MK: Self-sabotage. It’s very trendy and helpful. Anyway, I spent a lot of time not being in therapy or on medication; but I’ve been seeing someone for about seven months now, and it’s been a pretty big game changer. Her diagnosis right now is generalized anxiety disorder, though I think I cycle through high and low moods with some intensity and frequency, which is a mark of bipolar disorder (like, also of life, and having feelings). But it’s probably not serious enough to be diagnosed. Bipolar disorder is SERIOUS.

Anyway. I’m managing my shit with talk therapy. And no medication at the moment. And it’s going okay. Probably my best friend, to whom I often write panicked emails and or have very teary conversations with, would disagree to a certain extent. So that is my deal. What is YOUR DEAL, Logan?

LS: Like you, my first experience with pretty intense therapy and an actual diagnosis and medication came in college. I saw two therapists in high school, but only for a few sessions each, and both times it was understood, at least by me, that I was just seeing this third-party adult to talk through some hard times. But my third year of college, everything was going great on paper but I was anxious and miserable all the time and also could not get out of bed. I eventually dragged myself to student health—it’s funny, that seems like such an easy thing to do, but I remember it being this huge internal debate, mostly because I felt like if I just tried harder I could figure this out. But something eventually made me go, and I went.

Pretty quickly I  had a talk therapist and a psychiatrist and a prescription for Prozac. I say sometimes that the Prozac saved my life, which is an exaggeration in that I wasn’t suicidal, but the difference between before I was taking it and after was incredible, for me. My diagnosis at that time was mild obsessive compulsive disorder, but all the docs I’ve seen since then—and it’s been several—have said it’s really more just clinical depression. I’ve taken myself on and off medication and in and out of talk therapy a lot in the past eight years. Sometimes because I felt like I was CURED, sometimes because of the expense, sometimes because my prescription ran out and I didn’t refill it, sometimes because I read an article or got deep into an internet hole about how anti-depressants are a government conspiracy to poison our brains and turn us into zombies, and sometimes because I moved and couldn’t deal with finding a new doctor.

MK: Feeling like you’re cured is a problem. I feel—and this is a dumb comparison—that it’s a little like being on a diet. Like, you lose 20 pounds, or feel mentally stable and you’re like OKAY DONE SOLVED IT. And then you stop eating just pressed fruit or taking your medication or going to therapy and your body is like, guess we’re off the hook and just goes back to doing what it does best, which is hating itself. That is obviously a glib comparison, but it has taken me a long time to accept that I’m never going to be done dealing with this. I have to live my life in a different way forever to be healthy/happy/not sobbing uncontrollably and never leaving my bed.

LS: Right. I went on and off medication several times and then three years ago I was like, okay, I’m going to give this one more try. I’m going to go off it and do it right, and see what happens. And so I weaned myself off with the help of a doctor. and I was off the meds for a year, and during that time I worked out several times a week, I swam laps, I ate good food. I saw an acupuncturist once or twice a week, I made sure I got enough sleep. I did all the things that you’re supposed to do. And I thought I was doing so well, I thought I’d figured it out.

And then I went home to visit my family, and I can still remember my mom saying, “Yeah, you can get out of bed, but you are not you. You are not thriving.” And it was then that I realized that my life was PERFECT, basically, at that time I had a good job and great friends and great house, and I should have been feeling so much better than “getting by.” So I saw a new doctor and went back on meds and I haven’t tried to go off of them again. But here’s the other fun thing.

MK: Tell me the fun thing.

LS: Is that even though I’ve accepted and decided and even embraced that I need medicine to just be at a normal functioning level, THAT’S NOT ENOUGH. Because three times since then I’ve had to change medications because what I was on stopped working. “How does that work?” UNCLEAR. Psychiatrists don’t even really know how antidepressants work, and they don’t know how they don’t work. So those periods of trying new meds are always really, really terrible.

MK: I guess this is a good time for me to say that I am not super pro-medication, at least not for myself. There were a series of terrifying articles in the NYRB about how doctors literally have no idea how antipsychotics or antidepressants or any of that shit works, and how they change your brain, and how it’s impossible to ever go off them because of that. And that scares me. (I’ve also never had very good experiences with medications. The Lamictal made me feel like my head was filled with cotton balls. I felt functional but very, very dull.)

Though obviously everyone has to do what works for them, and as your friend, who cares about your mental health, I’m really glad you have found medication that works for you. You are typing right now, but I also want to remember to go back to that thing that you said about just getting by, just functioning because I think that’s really important AND has to do with how this kind of shit affects the way that we spend our money.

LS: The “yes meds or no meds conversations” isn’t a conversation I’m interested in having any longer. I’ve accepted that they work for me and I don’t care to explore that further. I’m not going to try to convince you to go on them. Okay that’s not entirely true. I have tried to convince you to go on them.

So basically we are two women. Two women who sometimes suffer from depression (I hate that phrase. Have depression? Can be depressed? Have a diagnosed disease called depression?) We are just trying to figure out the best ways to get through our days.

MK: Trying not to self-sabotage ourselves into an early grave, or bankruptcy.

LS: So to start out, with the money talk. Just going to doctors and therapists is expensive.

MK: Oh YES IT IS. When I was in college, my mother paid for not only my therapist BUT ALSO a psychiatrist I saw every couple of months, for the medication, because my psychologist was not a doctor/could not prescribe meds. And I … did not feel as guilty as I should have about this. I think insurance covered some part of it, but not all of it.

But now I am a grown ass woman, with a job and stuff. And so when I decided I needed to see a therapist again (“decided” = more like everyone I knew was like GET HELP WE CANNOT DEAL WITH THIS YOU ARE SO UNHAPPY) (and I was like a MACHINE OF SELF PITY) (and then finally I was like, “Hey guys, you’re right”), I was determined to pay for it myself, which, ugh, was/is hard.

The first person I went to, who I FELL IN LOVE WITH, was this tiny old woman on the Upper West Side (obviously). We had three consultation sessions, which thankfully I did not have to pay for, because this lady was $300 per session. WHICH IS BONKERS. That was like my entire income, basically.

LS: Did you know that before or after you went to see her?

MK: I found out during session two, which was crushing. But she was very nice and recommended someone. BUT this woman was also very expensive, because I lied about how much I could afford, because I am awkward talking about money. So for two months, I went to the woman I now see. And she was charging me her full rate, and that was … $200 a session. And that was very hard. I essentially took a second job to cover it. And my mom ended up paying $200 total over that two month period.

But finally my therapist, who is not a dumb lady, was like, “So, um, how are you paying for this? How much money do you actually make?” And I was like, “I actually cannot afford this AT ALL thank you for asking.” And she cut her fee in half, which was amazing. And THEN I went through this really rough period. I didn’t go to work for a day, because of the SADNESS. And she was like, “This happens a lot, when you start delving into stuff. It sometimes gets worse. If you want to get through this faster, maybe two sessions a week?” And I was like, “I cannot pay for that.” And she, being an amazing human, was like, “What if the rate was the same? Per week?”

So I’m now paying $50 a session, still kind of working a second job, but making it work and not relying on my mother for dollars, which I think is good for me. I think if she was paying for it (which she would totally do), I wouldn’t take it as seriously. I blew off appointments a lot when I was in school, because, like, whatever, not my money (also because I was sad and she was not a great therapist).

LS: I’m not seeing someone right now, but have an appointment next week to see someone, a consultation appointment. We haven’t talked money yet, but I know the friend who referred me pays a discounted rate, though that might not mean anything. You can only afford for so many people to not pay you your rate, right? So his sliding scale spots might be filled. So I’m preparing myself for that. But, like you and your UWS lady, you just need somewhere to start. If I can’t afford him, I’ll get names from him.

I also cannot really afford to be going to therapy, but … I also cannot really afford NOT to go to therapy. My parents have said they’ll help me, and they’ve helped me in the past, but like you, it’s not something I want to get into. Even though I’ve been to five zillion therapists, finding a new one and starting with a new one is always a big step, a positive step. This annual or biannual or whatever it is acceptance that this is not just a funk I’m in and I can’t just pull myself up and snap out of it. So making this appointment was big, and it’s something I want to do on my own.

MK: I think this is a totally acceptable thing for your parents to help you with if that’s possible for them. Like, it’s possible for me to make this work financially without help. But if you can’t make it work financially without help, I don’t think that’s a reason not to do it. Because so many other things, including your financial situation, will improve if you get help on this thing. And you are 28, so you will probs not be a dick like I was in college and not take it seriously.

I think this is a good transition to: how does being depressed/anxious make you spend more money? Because I really, really think it does and not just on meds/doctors/etc. at least for me. I am, right now, wearing a “panic sweater,” a sweater I bought while having a small panic attack. (I also bought a cardigan.) (They’re both great.) (But I DID NOT need them / could not really afford them.) But the brain situation was so crazy for me at that moment that I HAD TO PURCHASE SOMETHING to take my mind off it.

LS: It really is a beautiful sweater. I’ve been admiring it all day.

MK: Why thank you. Being panicked apparently makes me a discerning shopper. Who knew. That must be why shopping at large malls during the holiday season is so productive. (JOKES)

LS: Yeah I am wearing sad jeans, bought when I was sad. They aren’t that great. I am a bad sad shopper. Which is also one of the reasons I don’t have any cool stuff to show for all my credit card debt. It’s more like, this is a shirt, that’ll work, cha-ching, ten minutes of … not misery.

MK: I’ve made bad sad shopping decisions. Once I flew into a panic because I was going on a date and was too sweaty. So I bought an entirely new outfit, which included a tiny short-sleeved sweater, which I never wear because it is SUPER hideous. I think part of the problem is when you’re depressed or anxious, you don’t feel like it will ever be better. You believe you will exist in that state forever, and if there’s anything that you can think of that will make you feel better, you just fucking do it. Including buying tiny sweaters and sad pants and pounds of macaroni and cheese.

LS: Yes. It’s very much about what will help me NOW. For me, depression has a lot to do with stasis. I stayed in bed most of today. Reading. Watching TV shows. Napping. And I knew, theoretically, that if I got out of bed and took a shower I would feel SO MUCH Better, but there was also this part of me that was like, but what if I don’t? I’m miserable now, but at least I’m comfortable and miserable. And if I’m out in the world, it’s like, well I’m miserable, but if I buy something, at least i’ll have a cute outfit and be miserable. Or an ice cream cone and be miserable. I don’t ever think about future me. I’m really mean to future me. Only nice to this moment me.

MK: Being depressed is a lot about just surviving. It promotes a subsistence lifestyle. You were talking earlier about going home and your mom noticing that you were just “getting by,” but not doing well. I think if you’re depressed or anxious and you’re not treating it, you just do a bunch of shit in order to just get by. And the fear is, if you don’t there will be no future you. Not that I’m saying you would have killed yourself if you hadn’t bought those sad pants or I would have killed myself if I hadn’t bought that tiny sweater. But it’s true that my feelings felt unsustainable, and feelings are facts. (I stole that from a friend, but it is The Truth.)

LS: Oh that’s good. That’s really good.

MK: It’s hard to argue with them. They’re worse than facts, because they don’t respond to logic. They only respond to impulsive purchases, and massive amounts of cheese, or whatever it is that you’re doing in order not to rip your own face off. If you’re facing a choice between harming yourself financially and harming yourself physically, it seems pretty clear to me that price of a tiny sweater is not such a high one to pay.

LS: ON THAT NOTE. This has not been a terribly uplifting little chat we’ve had.

MK: No it has not been. I think we need to do more. But I have a birthday dinner to go to now.

LS: Oh, we’ll do more. So much to cover, so much to share. But for now, you’re going to leave, and I’m going to go back to bed.

MK: Do what you got to do. Seriously. The other options are kind of terrible, and it’s helpful sometimes to remember that you could be a lot worse to yourself, to future you AND present you, than going to bed. Or buying some jeans.

See also: How to Lose Four Months to a Depression/Spending Death Spiral

Martha Kaplan lives in New York.