Monday, September 26, 2011

My Depression Story (Updated)

There's been a request at a discussion blog I frequent to learn more about my story, surrounding my depression and suicide attempts. This is a sensitive topic and so be aware that this may not be appropriate for younger audiences. I'm opening up here to the public, which I've not done before, to educate, bring awareness, and fight stigma/shame, and so I only ask for a listening ear and for you to withhold judgment.

Millions of Americans, including an estimated one in five families are affected by mental illness: severe depression, schizophrenia, bipolar disorder, panic and anxiety disorders and other disorders, which disrupts a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Mental illness is a biologically based brain disease believed to be caused by an imbalance in neurotransmitters, the naturally occurring chemicals in our brains which effect our moods, thoughts, & movements. Just as diabetes or heart disease, mental illness is a medical condition, which can result in serious life-disrupting symptoms and as a result, a diminished capacity for coping with the ordinary demands of life, without treatment. I am one individual with a mental illness. I have major depressive disorder. This is my story.

In the fall of 2002, I began college for the first time. I had a great social life there, but was struggling with academics and having difficulty picking up on life management skills. I have Attention Deficit Disorder (as diagnosed by a neurologist) and began on my ADD medication in August but saw no improvement. Frustrated and discourage, I gave up on it by September. Over Mid-term break in October, I felt even more sad, and very argumentative/irritable. When I arrived back from midterm break, that night I was very depressed and suicidal ideation/thoughts of cutting became overwhelming. I became frightened and sought help and started seeing a counselor. I was diagnosed by the counselor as having a major depressive episode. I dropped out of school and moved back home, which was in my best interests at the time, but I saw it as a failure.

In the fall of 2005, I decided to try college again, this time at a small community college away from home, where I got help with both life skills and my learning disability. I did better in my academics (C average) and had ups and downs with depression, but more good days than bad. My second year I decided to take on an active role in our campus ministry, however on top of the demands of school, it over-taxed me, taking a toll my academics and my depression became worse. I immediately made an appointment to start seeing a counselor, but during the time I was seeing her, I didn't improve. Once again, I made the decision to drop out of school in January of 2005, but this time with plans to finish my degree at a later time.

After returning home to live with my parents, I lost my health insurance coverage because I was no longer a college student and private insurance was difficult and expensive to obtain because the depressive condition was preexisting. Anti-depressant therapy costs upward of $60-200 (at the original time of this writing), depending on the medications and therapy can cost upwards of $90-150 a session. I gritted my teeth and continued to pay for my medication out of my own pockets, however therapy was out of reach.

 In June 2005, I landed my dream job at a library, only to loose it in September and with the realization that it was a hostile work environment and I wasn't suited for the job. Loosing my job on top of my other shortcomings and personal struggles was a big blow to my self esteem and self-confidence. I had already became deeply depressed during my time I was working there (my depressive symptoms were part of the problem) and so sought out a counselor at the local community mental health clinic.

Clinics such as these are a vital part of our community, offering vital mental health services at low-cost and sliding-fee-scale to the homeless, impoverished, uninsured, and under insured of our community. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery. At the clinic, I was able to see a therapist in addition to a nurse practitioner for medication and my medication was affordable. However, like many community mental health clinics, they are under-staffed and poorly funded, which can result in poor quality of care. In addition, persons with a mental illness are often faced with additional challenges in the workplace, in the home, and in the community due to barriers to obtaining treatment and the stigmas surrounding mental illness.

In November, I landed a new job at a small community library with the help of a family friend. In December, my counselor suggested maybe I would also benefit from medicine to help my depression and I started also seeing a nurse practitioner who prescribed a selective serotonin re-uptake inhibitor or SSRI. (Did you know, there are 40 different types of anti-depressants, every person's brain chemistry is slightly different and individuals respond differently to each medication. Usually the most effective treatment for depression is a combination of medication and therapy. Other effective treatment options are available as well, however many are out of reach to many because of prohibitive costs.) On the first night of the medication, I went ice skating with the family and felt great, energetic and I even felt normal again. I started the new job at the library in January, but even with this new job going well, I still struggled with self-doubt and depression. Eventually my doubts began to play like a tape in my head over and over enough to where I started believing myself to be a failure. I had quit taking my anti-depressant after running out, frustrated with side effects, and with the self-doubts and biological influence, I began a downward spiral. (I can honestly say that during this time, I didn't understand my illness very well and the importance of staying on my medication).

On January 23rd, 2006 I made my first suicide attempt, while my parents were out of town. My then-boyfriend (now husband) found me and called his parents, who drove me to the hospital, where I received intensive medical treatment. I was hooked up to monitors and had a difficult IV insertion. I'd had an innate fear of needles ever since I had to be held down for a blood draw in an ER when I was a kid. My prior efforts to overcome this fear by donating blood had failed, at this point I was scared and mentally out of it, all of my senses were on edge. However, I'm ashamed to say two adults had to hold me down while the nurse put in the IV. Then the staff came in in protective masks & gowns & started setting up to pump my stomach. I'll never forget the name of the kit I saw on the bedside table: Tum-E-Vac. A clear tube the width of an adult thumb was inserted through my mouth, down my throat, & into my stomach, causing much gagging & throwing up even before they began to flush out my stomach w/ a lot of water. This was followed by liquid activated charcoal which tasted horrible & was difficult to keep down. It was humiliating & traumatic, both physically and mentally. I was assisted to a shower to get cleaned up & then was held over night in the ICU for observation. but didn't get much rest. The next morning, I saw a kind psychologist from the hospital, who evaluated me. Because the stomach pumping procedure had shocked me out of suicidal thoughts, following a thorough evaluation the psychologist said it was ok to send me home, with a safety plan and follow-up care in place.

After that experience, my parents took precautions such as checking with me every day for the first couple of weeks and ensuring my safety. At the time, I was in counseling and had been for 4 months. For personal reasons, I did decided to stop seeing the counselor, but continued to see the certified nurse practitioner. She not only administered medication, but also helped me track my depressive symptoms and progress. She seemed to understand what I was going through and was in tune with me.

I was still able to continue to work afterwords and my supervisor has been wonderfully understanding that I was in the hospital and even allowed me to even make up the hours. In February, my nurse practitioner emphasized the need for me to continue therapy and I found a new counselor at a student practicum clinic, through the local teaching college. And for a while, with my nurse practitioner's ok, I tried St. John's Wort, an herbal supplement for treating mild to moderate depression as well as more frequently exercise and light therapy. But I didn't take the St. John's Wort consistently enough for it to have a strong-enough effect, so my nurse practitioner and I decided to try prescription anti-depressants again, this time another SSRI. I was still having major depressive episodes and more frequently, now at least once a month, sometimes with suicidal thoughts.

My new therapist did some diagnostic testing and I was diagnosed as having major depressive episodes. This was a huge relief for me, because now I had an official name to what I was experiencing and it was more concrete to me. I started out on the lowest dose possible of the new SSRI, but it wasn't reliving any of the symptoms and at the therapeutic level, made me feel heavily sedated. I became physically and mentally tired of constantly fighting depression, frustrated and discouraged. In hopelessness and despair, and impulsiveness, I made my second suicide attempt in May 2006, just over two months after my last.

Early Wednesday afternoon (May 10th), I attempted to reach my nurse practioner to schedule an appointment to discuss increasing the dose of my med because I wasn't seeing any changes and I was concerned about how bad I was feeling. Instead I was given to her medical assistant and told her that I was feeling suicidal, but they weren't able to get me in sooner (because she only had short-notice availability during my work hours), so she asked me to come in during their walk-in hours, which would be in 2 days. Well, in retrospective, I don't think the medical assistant understood the severity of the situation (nor maybe did I) and because I was having suicidal thoughts, I should of called their hotline instead. I got worse over the next 24 hours. I left work early that afternoon, telling a co-worker I was feeling ill. I went to my boyfriend's apartment, knowing that he's out of town and in desperation and hopelessness, overdosed again. I then laid down on the couch and while waiting for the end, asked God for forgiveness (I think divine intervention is what kept me alive). I drifted in and out of consciousness and my mom called my cell phone around 4 hours later, worried that I hadn't returned home. After talking to me on the phone, she could tell something was wrong and immediately came over. Seeing the condition I was in, took me to the hospital. It was too late to pump my stomach again so the nurses gave me two bottles of activated charcoal w/ a straw and an order to drink it. I then was held overnight in the ICU at the hospital for observation and my boyfriend stayed with me. The next day, I was medically cleared to be released home. A hospital psychologist came in to speak with me and I was glad to see it was the kind psychologist who'd seen me before. Following the evaluation, when it came to time for him to ask me what I wanted to do, I admitted I was still feeling like hurting myself and was willing to be admitted to the psychiatric medical center in the same hospital, which was operated by the community mental health clinic. It was at first a scary thought for me, not knowing what it's be like, and understandably upsetting for my mom. My admission was voluntary and would last 72 hrs, then we'd decide where to go from there. It was a very safe and non-threatening environment. I was on an adult acute treatment unit, where the majority of the patients had mood disorders. Also, it was nothing like what is portrayed in the movie "One Flew Over The Cuckoo's Nest," but rather it looked like a floor of a college dormitory, complete with single and double occupancy dorm rooms, a nurse's station, a small laundry room, and a lounge where we could watch TV, do activities, and have our meals. Going to the psychiatric medical center helped and it was a chance to get my medication dosage just right. I had an awesome psychiatrist there who used analogies and spoke at our level. He was really kind. Also I saw a clinical social worker, who was my karate class instructor, and while it was a bit humbling, I didn't feel judged, she's kind and got me taken care of.

Initially after I got out of the hospital, I struggled with depressive symptoms. I did attend the follow up appointments scheduled for me in the hospital as well as went to an appointment with my counselor at the University. During that time, I made some breakthroughs in a couple of issues in therapy. Also, 3 weeks later I had another appointment with my nurse practitioner and we made some adjustments and tried different medication combinations over the next several weeks. My boyfriend and a couple of close friends who know had been really supportive and encouraging. As for my parents, well there were supportive, but were having a hard time trusting me, understandably.

I stayed on an SSRI for about 5 weeks consistently, but didn't see any improvements and at my last couple of appointments with my nurse practitioner, my depressive symptoms were marked as worse. In addition to depressive symptoms, I was having difficulty with my Attention Deficit Disorder as well and my work performance was suffering. Also, in early July, I'd been depressed and one morning felt especially depressed, sleeping most of the day. But, went from depressed to hyper and impulsive that day, where I impulsively chopped my hair and my thoughts and speech were racing. I had a therapy appointment that day, where I was very antsy and couldn't sit still. The hyperness resolved itself back into depression the next day, but I was still experiencing what I can only describe was rapid cycling up to a couple of times a day.

My primary care doctor had taken the time to come to see me that last time I was in the hospital and seemed to have both compassion and a knowledge Eastern and Western medicine. So I went to see my primary care doctor for a second opinion on the best medication for me and diagnosis. I didn't feel like my needs were being met by my nurse practioner, we'd run out of options and she was about to put me on lithium. After the initial consultation and reviewing the notes from the psychiatrist at the hospital, he gave me a diagnosis of major depression 1)with a possible genetic disposition and 2)aggravated by premenstrual syndrome. Based on my past history with medications interactions and depression/ADD, he recommended a new atypical anti-depressant which was supposed to work on a few different neurotransmitters (the chemicals in our brain which regulate our mood, appetite, behavior, etc) called Effexor. After the medication change, my moods were a lot more stable and I hadn't had any pronounced side effects, that is until I had, looking back I'm pretty sure was, a hypo manic episode.

My younger sister was home and I was quite irritable that day and got into an argument with her. That evening,I went over to a friends house for dinner. At one point, after putting my friend's toddler to bed, in my mind I thought I'd heard her crying, but when I went in to check on her, she was just fine and quietly laying in bed. My friend asked me then if I was hearing things and manic and I told her that I didn't think so. But I was becoming more and more hyper and antsy as the night went on. Also, my friend was hyper that evening as well, which didn't help and fed into my anxiety or what the heck ever it was. After I left my friend's house, impulsively I decided to drive an hour to go see my boyfriend as soon as he got off work, now this is 10:30 at night. I didn't care about the consequences, I didn't care if my parents were worried, it's like I'd made up my mind and got stuck in one gear. My boyfriend was pleasantly surprised, but wasn't too worried. We went for late-night walked, then I stayed the night there and drove back early the next morning for work. The hypo mania or whatever it was eased itself into a stable mood a couple days later. I discussed it with my mom and she recommended getting enough sleep and taking the medicine in the morning instead of evening to see if that helps and rule out minor problems before assuming its bi-polar. I was afraid it was, but the weird thing is that while major depression runs in my family, bi-polar depression does not. But for the mean time, my doctor put my on a mood stabilizer, "Lamictal" which helped, but made me feel sedated and "out of it."

Now into August, after the previously mentioned hypo manic episode I had or whatever it was, I continued to feel worse and I talked to my counselor about my how I've been doing depression wise and we looked over my mood chart. Also, he asked questions and used reflective listening to help us understand what I was feeling. I wasn't feeling suicidal at the time, but did let him know about recent depressive/hypo manic episodes I've had. He seemed almost skeptical that I was having hypo manic episodes, I don't quite fit all the criteria. He advised that I review my medication with my doctor, we needed to make sure this is the right medication for me and I'm on the right dose. I went into work as normal, but continued to feel more and depressed (slowed thinking/movement, feelings of hopelessness) and by early afternoon was having suicidal thoughts. By mid afternoon, I just felt like I couldn't go on and planned on committing suicide after I got off work. But at the same time, there were times were I was better, so part of me knew I still had hope, so I went back to the break room to call my counselor. The counseling clinic was already closed for the day so I called the community mental health clinic hotline and talked to a counselor. After talking to the counselor, I called my best friend, who's been my rock and support through my depression, and asked her to come pick me up from work. I asked to sit with my supervisor, who knows about my depression issues and understands, until my friend got there. My friend drove me to the hospital and stayed with me until a little while after my mom got there. My mom reassured me that I was doing the right thing. Basically, in my ER room, they took my vitals and I talked to a doctor. I was mentally out of it, groggy and slightly confused. I slept until the actual evaluation itself, which was done by a social worker. from the community mental health clinic. I groggily woke up to the sound of voices, confused and dazed. The social worker talked with my mom and I about what was going on, medication, and my support system. She decided that I didn't need to be held overnight and we created a plan for safety, which included involving my mom more in my mental health care. Also she gave me their after-hours emergency hotline (which I of course already have) and my nurse said to come back in if anything changed or things became worse. The next day, I still felt a little depressed, but was defiantly more clear minded and more functional. I'm glad I called the hotline and went to the hospital.

Fast forward 7 months to April 2007. Once I got past the initial months of first being on the atypical anti-depressant, the hypo manic episodes decreased and eventually ceased and I eventually was taken off the mood stabilizer since I wasn't have the hypo manic episodes and the side effects outweighed the benefits. Also, I hadn't had a major depressive episode in a few months (and virtually no hypo mania in around 10 months) and with my doctor's ok, I was off all meds, although continuing therapy. I was stable for the first time in over a year, engaged to be married, and had received a job promotion at the library. Life was good.

However, in May, my paternal grandmother lost her battle with a cancerous brain tumor and I began to grieve. Also, the stress of planning my wedding caught up with me. At that time, I was diagnosed with treatment resistant depression and my doctor and I decided for me to go back on the Effexor as well as another atypical anti-depressant called "Wellbutrin", but I've got to admit that I wasn't exactly compliant either due to side effects. I got fed up with the constant hunger and weight gain I had experienced while on Effexor. I had expressed concerns about this with my general practitioner at one of my three month check-ups and pretty much felt like my concerns about weight gain weren't taken seriously. I finally reached a point where I was fed up and frustrated and dropped the medication completely against medical advice, while still continuing the other anti-depressant in my regimen (Wellbutrin).

Then in about mid July, my mood took a downward turn very quickly and I didn't see it coming. On the day for my regular counseling appointment, I felt off and really didn't want to go, but know I because I wasn't feeling well, I needed to. My counselor immediately sensed something was up. When I told my counselor what was going on he became concerned and asked me to sign a no-self harm contract (which has been effective in the past). Well, I was set into the suicidal mindset and refused to sign a no-self-harm contract. He told me he was concerned about my safety and wouldn't let me leave until he felt I was safe. He asked if I wanted to go to the hospital and I blandly told him, "Do what ever you feel you need to do." He thought about it for a few minutes and then asked if he could speak discuss my case with his supervisor and I nodded my head yes. He told me he'd be gone for a few minutes, leaving me in the counseling room alone. About 15 minutes later he returned and told me that they would like to send me to the hospital for an evaluation. At the hospital, I was put into the same examining room I was in for my first suicide attempt, which brought back bad memories. The attending physician decided it would be best if I was hospitalized for 72 hrs observation. While I was in the hospital, I had a different psychiatrist, they changed me to Cymbalta, instead of Effexor, in addition to the Wellbutrin which has worked better and I've been on this combination of anti-depressants for the last few years.

Today, I look back at how far I've come: I've learned and improved in my coping skills, learned to be aware of how I'm feeling, learned the warning signs of when my depression is worsening, reached out for support and found some great resources as well as strength in my friends and family which I didn't know I had. Sure, it's not all rainbows and unicorns, setbacks are bound to happen, but I can honestly say I'm in a better place than I was 5 years ago. The outlook for individuals with depression, who seek treatment is hopeful. By working with a qualified and experienced mental health care professional, you can regain hope, as I have.

September 2013
Since I've last wrote, I divorced my husband in 2012 (another story for another time) and moved back to my hometown to be closer to family. While I was married, I was living in another city and the medical practice where my primary care physician and physician assistant had diagnosed and treated my depression closed in 2011, at the time of original writing. Having lived out of town at the time, I did not know about the medical practice closing until a couple months later when a family member saw an announcement in the paper to obtain medical records, however I put off getting copies of my medical records until too late and as a result lost 10 years of medical history, including my depression diagnosis and treatments. While still married, I went to the local hospital healthcare system urgent care center as needed when I got sick and found a great psychiatrist, who took the time to listen & his laid back demeanor was calming.
Also, speaking of, psychiatrists, I just got out after a short stay in the pysch unit at our local hospital again last month. The pharmacy where I get my Wellbutrin filled kept telling me for nearly two weeks that they didn't have it in stock but would be getting a delivery anyday, & looking in retrospective, I wasn't too motivated to go through the hassle of taken my script elsewhere, but should have. While waiting, the inevitable happened, I ran out of Wellbutrin and being on the Cymbalta alone wasn't enough to manage my depressive symptoms,  I spiraled downward. Feeling worse, I didn't feel up to making an hour and a half drive to see my psychiatrist, but didn't want to burden others by asking thrm to drive. Since moving back to my home town, I had began to see a new counselor through the local university practicum counseling clinic and still, I kept my appointment that day. After speaking with my counselor for a few minutes & telling her how I was feeling & probably noticing my disheveled appearance, she consulted with her supervisor (PhD psychologist & program director), whom once again referred me to the hospital. I was given the option to drive myself voluntarily or to be taken by University police, so I opted for the prior and signed the consents to be admitted voluntarily for 72 hrs. Only this time, I was one probably a dozen people waiting for psych evals in the ER, so I ended up bedding in the ER overnight and didn't end up seeing a social worker from the community mental health clinic until the next morning. Including the weekend, I stayed a total of 5 days this time. At this time, my friend S & I are no longer on speaking terms following a fall out and not wanting Mom to worry, I chose not to let her know, leaving me without much of a support system. I felt pretty anxious the entire time, spent the evening in the ER pacing and my first day on the psych unit pacing the hall. Also, didn't get along with a bitchy old nurse, whom I'll just call "Nurse Ratchet" and despite telling the psychiatrist I have treatment resistant depression and SSRIs haven't worked in the past, he insisted on trying another SSRI w/ the Wellbutrin. Not sure this SSRI is going to work, but I'll give it a month or two to see. Unfortunately, at the time of my counseling appointment at the practicum counseling clinic after I was released from the hospital, my counselor expressed the clinic didn't feel they could meet my needs & I would be better served by the community mental health clinic (in other words, I'm too severe of a case & too much of a liability), which left me without a counselor when I needed one the most, as I was still struggling w/ moderately severe symptoms after I was released. Based on my prior counseling experience with the community mental health clinic, I wasn't too keen on seeking counseling through them either. Fortunately I was able to find an affordable private practice physiologist near my home a short time later. Also, I've made the difficult decision to no longer see my psychiatrist, as his office is too far away & to seek care closer to home. I found a new, kind primary care physician through our local hospital health system & he is prescribing & managing my medications for now.
Unfortuantly, my hospitalization left me with a five-digit hospital bill to contend with. At the time, I went into the hospital, I was working in home health, with inconsistent hours, and had a short-term high-deductible health insurance plan. Unfortunately, unknown to me at that time, my insurance had expired just two weeks prior to my hospitalization, resulting in my being responsible to pay for the full amount of $13,000 hospital bill. I knew going into the hospital, I wasn't sure how I was going to afford it, I but knew I needed to take care of my mental health first, and I'd figure out how to pay later. Although low-income, I don't qualify for traditional full Medicaid because I'm not disabled and don't have any children (my state only covers family planning for single women) and the Affordable Care Act health care exchange plans don't begin until this coming January 1st.  I've applied for patient assistance and with careful budgeting, am making monthly payments until the balance is paid off.

May 2014
Despite being compliant and consistently taking my meds, I've remained in a low mood and barely functioning  & it's began to affect my work. Also, the primary care physician I had been seeing through our hospital health care system had moved away, with the practice failing to notify me, leaving me without a physician. At my mom's insisting, I went and saw the physician's assistant, from the old medical practice (which closed), who's now working at a local urgent care clinic. He's always seemed to know what he's doing, he prescribed Cymbalta and upped my Wellbutrin dose. Unfortunately, I can't continue to see him at urgent care for ongoing medication management because it's outside of their scope of practice. In the mean time, I will need to find a new primary care physician.Fortuantly, through the Federal Healthcare Exchange with income-based tax credits, I now have affordable full-coverage health insurance, even if it is an HMO :P

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