Welcome back. Dr. Goldman gave us a lot to think about last week! If you didn’t get a chance to read her blog, or the blog before hers, please take a moment and do so. Click here to access prior blogs Those two blogs lead us to this weeks journey of a young woman who has experienced both depression and thoughts of suicide. Please welcome Anne Brown. Don’t forget to read Dr. Goldman’s response after our sponsor’s ad.
By Anne Brown
There are significant dates and days burned into our memory from the moment of the event until our final breath. First date. First kiss. Wedding and birth of a child are all pleasant memories held in our heart like a precious flower. Death, divorce, job loss, and other negative events creep into our psyche searing a painful burn into the depths of our soul. Depression comes in many forms with a variety of symptoms, those which most people are familiar, including a crushing sense of unhappiness. The illness can also present itself with physiological manifestations including changes in appetite, fatigue, sleep patterns and lowered cognitive functions.
Suicide is the manifestation of the emotional symptoms played out in a physical act, making mental illness a fatal condition no different than that of cancer, heart disease or diabetes.
By all outward appearances, I experienced a happy childhood with loving parents and grandparents. I didn’t know until my late teens and early adulthood how pervasive mental illness was within my family. My parents went to great lengths to shelter me and my brother from the negative behaviors of other family members brought on by their mental illness. My paternal grandmother was severely mentally ill – but her illness was not one I was familiar or witnessed. By the time of my birth and early childhood, inroads had been made with a variety of therapies that proved successful, including ECT (electroconvulsive therapy sometimes referred to as “shock therapy”) and medications (lithium). Success of these treatments made it possible for me to enjoy an amazingly kind woman with a generous heart and soul. Unfortunately, the illness she was afflicted manifested itself in uncles who “self-medicated” via alcoholism along with siblings who acted out in harmful ways – family members my parents worked to shield me from.
I remember my first feeling of profound sadness or hopelessness. On the outside, it would not have been noticeable – I had strong friendships, a job I enjoyed, good grades and a loving family. Nevertheless, my first thought of suicide was on a Wednesday morning of spring break during my junior year of high school. While in the shower that morning, I thought how easy it would be to “help myself” to my dad’s prescription and just “go to sleep.” I don’t know where the thoughts came from.
I didn’t take the pills. Shortly after exiting the shower my oldest sister called to ask me to babysit her twin sons. It offered me an activity and distraction. A month later I quietly sought out the family physician to find out “what was wrong.” Answers, unfortunately, weren’t available.
I was symptom free for five years, until the death by suicide of a good friend. His death and suicide were meaningless. The event surrounding his passing were horrific. He ended his life on January 31. I learned of his death over a week later. It came as a shock. But looking back, not a surprise. The summer prior to his death we’d had lunch on a daily basis and shared many stories. As we confided in each other, I began to learn there were many days he found it difficult to leave the house. He spent days in the dark – curtains drawn and isolating himself from others. To many he appeared to be light hearted with great sense of humor. I saw another side, but at 21, I didn’t understand the signs of his inner torment. The last time I saw him was about eight weeks prior to his passing. He was friendly and we agreed to get together in the not too distant future (“after the holidays” is how we left it). The phone call never made haunts me to this day.
For months I searched for meaning and understanding of his final act. But there was to be none. His death affected me – which I didn’t understand or identify. His passing led to emotions that distracted me from my studies, loss of appetite, and poor sleep. Within four months I’d lost 15 pounds and found myself at the Student Health Center seeing a therapist for the first time. I believed it to be a situational depression, resulting from my reaction to his suicide and my own anxiety of college graduation and unease for my future.
Fast forward seven years later and newly married to the “man of my dreams.” Once again, to the outside observer I had it all: A loving husband, beautiful home, successful career. Inside there was a huge black hole. At the time much of what I was experiencing was a side-effect of infertility treatments and medications matched by my desperate desire and need to become pregnant and start a family.
I will always remember the day my husband called my parents not knowing what do to – I’d been crying 24 hours straight. Nothing could ease a profound sense of loss and sadness I felt in my heart. My mother somehow knew immediately what I was experiencing was not situational and would not easily pass. She prepared us for what was to become the fight of my life for my life. She explained what I was facing needed specific medication that would require a lifetime commitment. She also believed I would benefit from talk-therapy. Medication may ease the symptoms, but therapy would heal the soul.
It took a couple of false starts to find the right medication and therapist. My husband worked on Wall Street and his position and job afforded us not only with medical insurance to cover the cost of the psychiatrist and medications, but also the huge bills for talk-therapy. It was a long process, taking over 18 months to become stabilized, restoring and building my inner strength. Overall, I benefited from mediation and therapy for over three years.
After the end of the marriage I fell back into the black hole, and came very close to ending my life. Tools provided to me with my New York therapist allowed me, with the insight and problem-solving skills, to identify the feelings that I was experiencing as possibly being transitory, and with help and assistance, could once again regain my inner strength. To pick myself back up and turn away from “the plan” (an elaborate outline of how I would end my life), I made the decision to check into a facility. Doing so was the best decision ever! I allowed myself to trust others in assuring I got the needed medication to stabilize and jump-start the talk-therapy again.
After eight years of high-functioning success, including an added academic degree and career change, a concussion brought the beast back out. I’d been told by the ER physician after the injury of Post-Concussion Syndrome and what to expect. Eight weeks after the injury, thoughts of suicide suddenly appeared. I recognized quickly the cascading thought pattern and immediately identified a facility and was checked-in within six hours. My boss wasn’t thrilled with the unexpected and prolonged absence of five weeks – but when I fully explained to him the reality –my being away for a short period of time or the possibility of a funeral, arrangements were made for co-workers to take on my projects for my emergency leave.
Over the years I’ve taken my medication religiously. It is not easy. Mental illness is like any other illness and requires continued monitoring and treatment. There are times early in the healing process where a patient may feel the ease of symptoms equates cure. All too often, this is not true. Unfortunately, the myth of “cure” will result in discontinuation of mediation, which results in the circular pattern and downward spiral of depression. For many, this will lead to thoughts of worthlessness, despair and suicide.
All medications have efficacy periods and after an extended period of time, “poop-out” will occur. This has happened to me. I was successfully treated on one anti-depressant for over 17 years. When the medication became no longer effective, the result was a trip back down into the black hole and rise of the ugly monster. I recognized the physiologic changes in appetite and sleep, matched by negative feelings thoughts of suicide. One call and I was back on a treatment plan with a team of mental health professionals (doctors and therapists) with a brief hospitalization to once again become stabilized and regain my inner strength.
I do not look at my hospitalizations with shame. Making the decision to go to a location where I was able to allow others to care for me and jump-start medications and make appropriate adjustments is necessary and no different from when I’ve needed to be hospitalized for surgery of a physical condition requiring correction.
Management of my illness is my responsibility. I seek out and find the best treatment team possible – and I put my trust in these educated individuals to assist me in maintaining a strong psyche. Treatment success comes in part in the team of trusted professionals. Not all mental health professionals are the same. It has taken me trial and error to find “the best fit” of physician and therapist to meet my needs. I’ve been subject to those who are easily influenced by drug representatives and prescribed the incorrect mediation. It takes strength to question medical providers when you know a treatment plan isn’t working. This is especially true since it takes two to four weeks for a therapeutic dose to begin working. Patience is involved with treatment – but if after four weeks anticipated positive results aren’t achieved, and worse, the spiraling continues, change in treatment becomes necessary.
My disease will always require assistance of the right balance of medication to assist the chemicals of my brain to function at their best capacity while talk therapy allows me to explore and understand better my everyday behaviors, intentions, and interactions. Together, these two modalities of treatment allow me to walk through life not through a fog of insecurity and despair, but one where deeper meaning is sought.
It would be easy to be a “suicide statistic” and allow this disease to prevail in my life. I’d rather be a “life success” based not on the expectations of others, but on the merit of my own achievements – the singular being the management of this disease and choice to live.
From my experience I encourage others to seek help and assistance of others should they begin to experience either the physiologic symptoms of mental illness (changes in appetite, loss of energy or concentration, poor sleep patterns), or, changes in mood and thoughts that begin to focus on self-harm or suicide.
There is a difference between having a “bad day” and depression. Bad days will come and go – depressive symptoms build and last for weeks. The first step isn’t easy, and the second may seem harder – but once you find your footing, you will be standing tall and with confidence in a new and better place. And, remind yourself this isn’t a journey you’ll be making solo. There are dedicated professionals willing to assist – all you need to do is ask.
I appreciate Ms. Brown’s story of her struggle with depression. We are learning more that family history matters. We ask every patient about their medical history and the answers center on cancer, hypertension, or diabetes. Rarely do patients share a family history of depression. It may be that patients are not aware of their family’s struggle with depression and mental illness. Previous generations have hidden mental illness from others as a badge of shame.
Many people are hurting and do not seek care because they do not realize they need help. Others receive incorrect or dismissive advice from medical professionals. Physical medical issues are seemingly easier to manage. Mental health concerns are not often viewed as chronic illness like diabetes or hypertension. Many physicians prefer mental health specialists to treat depressed patients. Many patients do not follow up with the cognitive behavioral therapy.
When a physician or medical provider faces a patient obviously down, often the quick answer is situational depression. While a situation may trigger a depressive episode, people with underlying depression may find themselves not able to stop the spiral into deeper depression, even after the triggering situation resolves.
About Pamela Goldman
Pamela S.N. Goldman, DO, MHSA, FACOI
Dr. Pamela Goldman is a board-certified Internist and Associate Chair of the Division of Hospital Medicine and Academic Hospitalist at Einstein Medical Center in Philadelphia, Pennsylvania. Currently, she serves as the Vice President of the Pennsylvania Osteopathic Medical Association and Chair of the Mental Health Task Force (MHTF). The MHTF is tasked with encouraging osteopathic family mental health/well-being through focused activities promoting conversation and open dialogue regarding personal well-being in all levels of the osteopathic profession from students to attending physicians.