Friday, after an appointment with my psychiatrist at Emory, it occurred to me that this month marks 13 years of therapy and treatment. I would almost describe those 13 years as an “After” period, denoting a new phase in my life, because it has been so transformative.
Before I finally reached out for help, I was plagued with a whole host of issues I didn’t even know I had, because they were so embedded into my “personality.” Everyone felt like that, right? Deep depression, anxiety, OCD, bipolar disorder, PTSD, all kinds of things that came out of messed up brain chemistry, coping skills I developed growing up that no longer worked, crappy life experiences, and a background that said you deal with this stuff alone. I should’ve started therapy 20 years earlier probably. However, like most people, I kept not understanding what therapy was, what medication could do, or that it really was “that bad.” My understanding is if I didn’t want to kill myself, I wasn’t really “that” depressed. (Also thought if you didn’t have a problem with light or sound, didn’t see auras, you didn’t have a migraine. Also wrong.)
Flashback to today. With help from a host of psychiatrists — all Emory medical residents practicing what they’ve learned under the supervision of an attending doctor — I have confronted a lot of issues that had just been there “forever.”
Dispelling the depression took more than just prescription drugs; it also took a lot of the examination of my behavior and thinking. But I will say that the prescription drugs were an important part of my treatment, especially at the beginning. Some people say “Oh, no, drugs!!!!” but IMO, you cannot begin a successful treatment and stick with it if you are so bogged down in depression or anxiety or whatever that you don’t care. You have to care! You can’t be afraid! That little boost of a pill is like having a step ladder that let you see over the fence separating you from the view, or a life saver when you’re drowning, to be put it in more dramatic terms. Not everybody needs it or wants it, but with depression I think it’s pretty key.
That said, it’s very important that once you start a medication, you continue seeing specialists who monitor you. The psychiatrists I go are part of a clinic that specializes in pharmacological treatment, i.e. Rx. Their careful monitoring over the years has meant that the medication I take is well regulated and adjusted according to what is actually happening with me. My improvement hasn’t been A to Z and never back again. Psychiatric problems are chronic and have flare ups, ups and downs, and can evolve. So like a person with diabetes or epilepsy or a heart issue has to have their treatment monitored and adjusted, so does a person with depression, anxiety, etc.
(This is why so many Americans who have been “treated” for mental illness and even those who take their pills, are still prone to all kinds of problems. A one-time Rx is bull. Then there’s whole issue of people not actually having access to any care or being able to afford the drugs… American healthcare and mental health care is hugely biased.)
But the biggest benefit I have gotten out of the treatment may not be the drugs but the education I received on how to deal with my own emotions and behaviors. My very first doctor, who I began seeing 13 years ago, introduced me to Cognitive Behavioral Therapy (CBT). Beyond just telling me I had to get a copy of The Feeling Good Handbook (“prescribed” by many psychiatrists), he made me do “homework” in between sessions so I would start to learn the tools to help myself. CBT is basically a whole mode of treatment that works on identifying “wrong thinking” that can influence your mood and behavior. Your brain basically plays nasty tricks on you and you learn to be wise to them.
Later psychiatrists continued on with this, with the absolute best help coming from a psychiatrist from the therapy side of the clinic rather than the pharmaceutical side. I had expressed that I was overwhelmed with anxiety (understatement) and was offered the opportunity to do intense talk therapy. The doctor ended up being an expert on CBT and anxiety — and actually when he was not in the clinic treating people like me, he was treating PTSD in people at the Atlanta VA. He was an absolute genius helping me to examine the sources of my anxiety and then teaching me how to deal with them.. I had to go through dozens of “homework” assignments with him, mostly “exposure therapy,” which is incredibly stressful and means facing your anxiety. That was probably about seven years ago but the stuff I learned in those six months is stuff I use every single day. And so many of the things that plagued me then, including the OCD he uncovered (I was clueless), are just not a thing anymore. Or when they come up, I deal with them pretty efficiently. And if I’m not, I’ll take note of that and when I see my psychiatrist for my every three months appointment, we deal with it.
Which brings me to one final piece, which is the fact that these check ups all these years have done an awful lot to make sure I stay safe and sane. The biggest example of this was four years ago, when I had an appointment a couple months after David Bowie‘s death. I was just sort of was casually telling them about how much it had affected me and how it had changed my whole life. I totally changed how I dressed, took up art again, listened to his music totally obsessively, and didn’t even want to sleep. I just kind of got super hyped on on everything. So I rattled all the stuff off and the young resident asked me a few follow-up questions. Long story short, between talking with the resident in the attending, we determined that I have been going through bipolar mood swings my entire life. I thought it was just my “personality” that I became super obsessed and excited about stuff for a few months at a time. Then I would just feel very blah. Especially since I’ve been on antidepressants and don’t really get super depressed in between. But I’ve always had cycles of being super excitable and energetic and interested and obsessed, followed by a cooling down. But it wasn’t until I actually described an instant of it on a check up appointment that they picked up on it and started me on treatment. Now it’s something we talk about all the time. Just this Friday I came in describing a whole bunch of symptoms of a manic episode, including major sleep disruptions I’ve had going on for the last couple months, feeling overwhelmed with constant ideas and projects, and generally just feeling super energetic, way beyond my norm. And after that discussion we sat and talked about exactly what might be going on and then agreed on an adjustment to my medication. (Basically taking down the amount of antidepressant I’m on so that I will be more depressed and less manic.) So I will be back in a month (rather than the standard 3 mo.) and we can check on how I’m doing.
I know this has been a really long post, but ever since I took myself in for treatment all those years ago, I have felt it’s very important to share my experiences. The stigma around mental health issues is something I really don’t understand. To me having depression is like having epilepsy, where you have fits, and then you try to figure out why. (I used to have “depression attacks,” which seemed to come out of the blue.) It’s a medical thing like anything else. But there’s such stigma that people don’t even identify the problems they’re having, they have no point of reference, and then they have no idea what to do about it. And if they do, they often can’t actually access help. I can’t give people health access (and it actually seems pretty hard to get into the program I am in at Emory), but I can tell you that you are worth it and things can get better. Really.
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