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TW: suicide/self-harm.I’m only going to share this story once and that’s it. Not because I’m ashamed but because it takes a lot out of me to recount. But I think it’s important given how stigmatized and silenced we are about suicide and self harm, especially in medicine. https://twitter.com/drgoodknight/status/1290763497643573253
TW depressionI’ve been open here, to an extent, about having C-PTSD and the effects it has on me. I have been less open about the fact that I have major depression and an anxiety disorder; as a child/young adult I had panic disorder and OCD. I still experience OCD symptoms.
TW: suicide/self-harm.I began self-harming when I was 7. Let that sink in. 7 years old and banging my head against a wall and drawing pictures of sad clouds shedding tears. My teacher reached out to my parents, concerned. They (we) were dealing with a death in the family.
TW: suicide/self-harmSince the self harming was preceded by a traumatic event, my parents’ response was basically “of course she’s sad, she’s grieving.” Which, true, but undeniably I needed and deserved help. They were struggling themselves, so I can forgive their reluctance.
The thing is, I never really got better. The grief and depression and trauma changed and manifested in different ways as I grew up, but it never disappeared and did not lessen in intensity. My panic disorder was misdiagnosed as allergies, and my anxiety/ OCD as stomach upset.
At no point was I offered mental health support nor told I might be experiencing mental health issues. Worst of all, my recurring depressive episodes were met with disapproval from my parents. They resented my depression and took it as a sign that I wasn’t grateful for them.
They saw my mental health symptoms as some sort of lack of appreciation for the fact that they worked hard to keep a roof over our heads and food on the table. I was told verbatim “You have it really good and need to be more grateful. Cowboy up, stop being so sensitive.”
As you can imagine, this wasn’t very effective but I was loyal to my parents and desperate for their approval, so I dutifully turned it inward as much as possible and hated everything about myself, including the fact that I was so selfish as to be unhappy under my parents’ roof.
TW death of family memberI put myself in therapy in college due to my depression and anxiety. During grad school, my brother died and my father started dying. I began intensive CBT treatment while completing my Master’s. My parents were suffering and not equipped to help me.
TW: suicide/self-harmFrom 2012–2015 I struggled with constant, unrelenting anxiety & depression. I longed to walk into traffic. I resented my loved ones for caring about me, bc they were the only thing tethering me to this world. I couldn’t bear to hurt them by killing myself.
I started sertraline in 2013, which reduced the frequency of my depression spirals. My father died in 2014. A few other traumatic things happened 2014/mid 2015 that I don’t want to get into here. But by the summer of 2015 it was clear I needed more support than I had been getting
TW: depression/suicidal ideationI didn’t want to go to the ER bc I knew it wasn’t the best place to address chronic, unrelenting depression. I went to my work EAP and they helped me find an inpatient mental health facility that took my crappy insurance. So, that’s where I went
TW: suicide/self-harmI stayed for 5 days. It was not very helpful. I don’t feel like sharing details but essentially, I was a “higher functioning” patient and a lot of the techs were just college students with no MH training doing a summer job. So I ended up supporting others
more than I did actually receiving help. I was misdiagnosed with bipolar, put on lithium, and discharged to a counselor, and a psychiatrist who was less than useless. I managed to find a different psychiatrist who upped my sertraline dose and put me on an adjunct therapy (buspar)
TW: suicide/self-harm.Buspar did not work for me and I felt deeply hopeless. I wondered if I had “double depression” ie dysthymia + MDD. This must have been ~2016? Not sure. Timelines are fuzzy and at no point had I felt “better”. I remember calling my brother and asking him
TW: suicide/self-harmif it would ever be understandable, forgivable to kill oneself. Asking him, essentially, whether I could let go of the guilt I had over what my family and friends’ reactions would be if died by suicide. I wanted permission to leave this earth.
TW: suicide/self-harm.I remember him gently explaining that there was no way a person could choose to die without leaving pain in their wake. That I couldn’t explain or rationalize to my loved ones why I needed to die. And that even if I did, it would be no comfort.
I needed to hear that. I remember going back to my psychiatrist, defeated, telling him in a monotone that I didn’t think there was any hope of me getting better. He looked alarmed and reassured me that there were many, many options for me to try. And ultimately, that’s what I did
And it fucking sucked. Trying different therapies and medications, battling the fatigue and hopelessness, looking for stability and comfort in relationships with people that I desperately prayed would deliver me from myself (and who never could, of course). At some point, I was
prescribed bupropion. And that actually made a huge difference for me. The sertraline (which I still take) helps manage my OCD/anxiety, and the bupropion (which I also still take) prevents my mood from plummeting and my brain from getting lost in the fog of depression.
That particular combination has kept me stable for about three years now. I’m not going to pretend it removed all my sadness or that I never get depressed or anxious, because I do. I have been through a lot of shit, and even with medication it’s a battle to keep myself going.
TW: suicide/self-harmI only have impulses to self harm if I go off of the bupropion. If I can’t get my refills in time and go without it for a few days, it is dangerous. About a year ago I ran out for a week or so and was in such a bad place that I remember thinking to myself
TW: suicide/self-harm“At this point you have a better chance of getting into med school if you just kill yourself and wait to be reincarnated into a different body.” That was my exact thought. It haunts me sometimes. Then I got back on bupropion and those feelings subsided.
I want to acknowledge that I have been lucky in that I found a combination of meds that worked for me. Treatment-resistant depression is incredibly painful and exhausting. But my belief is that even if no treatment has helped you yet, there is still hope. If you just keep living.
People tend to focus a lot on telling depressed people how great they are. And yes, feelings of worthlessness are prominent among depressed folks, but what we don’t talk about as much is the enormous toll it takes to try treatment after treatment and find little or no relief.
When you’re depressed, your executive functioning is often severely compromised. So you can imagine how overwhelming and defeating it is to be in the midst of an episode while trying to find a doctor, treatment center, medication or clinical trial to alleviate your suffering.
I managed my mental health almost entirely on my own. I had a loving family + fantastic friends, but I made those decisions about my care alone. And that’s isolating. So while I cannot speak for every depressed person, I think if you want to support someone who really needs help,
you need to really listen to what they’re going through, what they’re feeling, and ask how you can help. Can you call therapists or treatment centers? Are they willing to take part in a clinical trial? Are there support groups run by professionals that could be helpful?
Those are, in my opinion, better ways to support a friend in need than, say, bringing them to yoga class. Everyone needs different things, and your response should be guided by their actual condition and treatment goals, not your preconceived notions about the disease.
If you’re depressed and reading this: I’m not going to bullshit you and say that there’s a miracle waiting just around the corner. I know how fucking hard this is, believe me. But I still want you to stay. I still need you to stay with us, here amongst us sentient meatbags. Why?
Because for as long as you remain alive, there is hope. There are options, even if other treatments have been unsuccessful. It only takes one. Just hang on for that one. Please. Just stick around a little longer. The world is big and every day is an opportunity to heal. Thanks
