What I Want You to Know as a Psychologist Who Has Depression

I have a mental illness.

It’s taken hours of talk therapy, months of finding the right medication and years of work to learn how to live successfully with it.

I’ve redefined how I think and feel — and learned what kinds of people and experiences to limit or allow in my life.

Now at age 55, I’ve come to know the textures of my own mental illness and the wisdom that comes from living within its margins.

But there was a time when I wasn’t so wise. A time when my mental illness overwhelmed me. A time, when at age 19, I was ready to end my life.

As a young girl, I didn’t even know was depressed. I was always tired and tearful and just thought everyone felt those kinds of things. And no one — teachers, friends or family — took notice of my depression back then either. Partly because children weren’t thought to experience clinical depression. Partly because I was able to use a smile to hide my pain.

But as I grew older, my depression worsened. The tiredness and tearfulness I felt as a child morphed into an unshakable fatigue and a looming despair. In college, I became withdrawn, had trouble keeping up in school and was socially splintered from others. I skipped classes and then stopped going to college altogether. I slept hours at a time in bed. Sometimes I didn’t know if it was morning or afternoon, or if it was a Tuesday or a Thursday. And the fatigue was just the tip of the iceberg. What bubbled below the surface were negative, menacing and dangerous thoughts. And feelings that completely overwhelmed me.

Luckily, my suicide attempt was interrupted and I got immediate help. I began working with a psychologist who helped me understand mental illness — more specifically, mood disorders — and the one I was struggling with which was called unipolar depression. I learned how my own life story and my genetics created the perfect storm for my mental illness to hit. Psychotherapy not only saved my life, it changed my life. I decided to become and psychologist and treat others who had the very same mental illness I did.

Now in full remission over 25 years, I use my personal experiences with depression to inform my professional work. This dual approach gives me a unique perspective because not only do I know what it’s like to diagnose and treat depression… I know what it’s like to live with it, too. I don’t just talk the talk, I walk the walk.

Personally, I understand what it’s like to have mental illness. How you can feel betrayed by your own mind and body. I understand the shame that comes from needing medication. And the frustration from side effects. The weight gain. The loss of libido. The night sweats and the hand tremors, just to name a few. And I know how hard it is to take the skills learned in therapy and apply them to real life. I’ve also felt the cold hard stares and stigmatizing remarks from others when they discovered I have a mental illness. I remember a pharmacist once telling me when I called in for a refill, “Yes, you can’t forget to pick up your Prozac. There’s a full moon out tonight.”

Now, a therapist doesn’t need to live through an event or have firsthand knowledge of illness to help someone heal. But my own depression informed me in ways that clinical training and education never could.

So, what if you knew depression as a doctor and as a patient?

Well, you’d know these six things.

As a doctor I’d tell you:

Stigma is still as bad today as it was decades ago. Instead of technology and science helping explain mental illness, the general public is still uneducated about what a person living with mental illness is really like. Fear and ignorance is also found in the healthcare community — with doctors and nurses stigmatizing people with mental illness. Research has shown that diagnostic overshadowing — which is defined as the tendency for health professionals to overlook symptoms of patients with mental illness because they stigmatize them — is a huge problem. As a result, children and adults with mental illness suffer higher rates of physical illnesses and undiagnosed disorders — and are more likely to die prematurely than members of the general population. The state of stigma is so bad,  the World Health Organization called the conditions endured by many with mental illness “a hidden human rights emergency.”

As a doctor, I’d tell you health professionals aren’t using enough of new technology to help patients with depression. Personalized medicine, particularly genetic metabolism testing, can help depressed patients shave months, even years of trying to find the right medication. Genetic testing also reduces the likelihood of side effects and adverse reactions — some of the big reasons why patients stop their meds. And can help find more genetically-suited medications. And can detect treatment resistant depression. Personalized medicine is a field that offers enormous hope.

As a doctor, I’d tell you that the most important part of recovery for depression is consistency — or what is clinically called treatment adherence. Consistency doesn’t just mean going to psychotherapy. Or taking your medication. Consistency means making every psychotherapy appointment. Being on time for sessions, and making sure you don’t skip treatment because you want to go to the beach or just don’t feel like talking. Consistency means taking your medication every day at the same time, with the same dose. Consistency means making sure you get refills in time so there’s no break or gap in your medication regime. Treatment adherence means you aim to eat well, sleep well and exercise. The single biggest issue I see as doctor treating depression is how children and adults rarely adhere to their treatment plan. But thing is, once consistency is attained, recovery begins. And that’s where hope of feeling better becomes a reality. The mantra of real estate is location, location, location. For living with mental illness, your mantra needs to be consistency, consistency, consistency.

As a patient I’d tell you:

Please watch your words. Don’t tell me to snap out of it. Buck up or work harder. You’d never say that to someone who has another illness. You need to respect depression is an illness. One that involves serious neurobiology. Just like you wouldn’t expect one round of chemo to cure someone’s cancer, or one shot of insulin to regulate blood sugar, recovery from depression won’t happen with one dosage of medication or a therapy session. Depression is a chronic illnesses that requires acceptance.

Living with depression means I need to know my triggers. So, please respect me when I say no to things that may be too much for me to do. Like, if I say I can’t have a drink on your birthday, or can’t stay out till two in the morning — or that I don’t want to go see the latest tear-jerker film. There’s a reason for my “No’s.” I can’t mix alcohol with my medication. I can’t stay out too late because lack of sleep is such a serious trigger for me. Or a super sad movie can be too emotionally overwhelming. So please honor my needs so I can keep my treatment plan strong. Self-care is a vital piece to my well-being.

As a patient, I want you to know there’s a good chance my depression might overwhelm me again. Studies show that upwards of 70 percent of people who have experienced two episodes of depression can have a relapse – so I need you to know what to do, who to call and where to go if I fall into a serious depressive episode. This is called an emergency plan. My emergency plan contains the contact information of my healthcare team, my pharmacy, the nearest hospital and other important things. You may have to call 9-1-1 to get me to the ER if I won’t go willingly. And don’t worry if I get angry, become resistant or say mean things to you. Once I recover, I won’t care about being mad. I’ll be thankful that you cared enough about me to help when my illness was clouding my reasoning. I’ll be thankful to be alive.

Depression is a serious but treatable disorder.

As a doctor, I’m here to tell you there is hope.

And as a patient, I’m here to tell you there is healing.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.