When Depression Ends

Today I’d like to share a positive post with you. I recently pulled out of my latest depressive episode. I have been feeling gradually better for the past month or so. I’m happy to say that the cloud has left for now. Depression always feels inescapable, it is a relief to be reminded that depression isn’t permanent. I have had many depressive episodes in my life and I know myself well enough to know that my depression will be back. Nonetheless, I’m enjoying this moment of respite.

A lot of changes occur when depression ends. In celebration of this return to myself, here are some of the positive changes I have noticed over the last few weeks.

The Big Changes

I’m optimistic about my future

When I’m depressed, I don’t always see recovery as an option. A future that looks any better seems impossible. I feel there are few things worth working towards, because life is what it is: depressing. When the depression lifts I’m reminded of all the things I have to live for and the things that keep me going. I’m able to acknowledge that there is a chance I can make lasting progress. I know that my depression is cyclical and it will come back, but I know that relief from the depression will too.

I feel better about myself

I’m very proud of myself and the progress I have made. I can see how much I have learned in my last couple of years in therapy. I can identify myself as strong and a fighter. I know that I’m a good person and am just doing my best. Conversely, when I’m depressed I feel like a burden. I feel like the worst person in the world and that my existence makes everyone else suffer. Suffice it to say, a break from this horrible self-concept is a gift. As a direct result of this, my self-talk is also much more positive and adaptive when I’m not depressed.

My anxiety is a bit easier to cope with

Since my depression ended I have been trying to leave the house and go for walks more often. I’m even slowly starting to see other people. My anxiety remains painful and debilitating, but I’m determined to try to cope with it when I can. Depression exacerbates my anxiety disorders by impacting my motivation, energy and desire to do things. My anxiety is all the more gruelling when depression robs me of any benefit that facing anxiety might otherwise yield. I’m less resigned to my anxiety when I’m not depressed.

I can feel fully happy

When I’m not depressed I can feel and sustain genuine happiness. When I’m depressed and good things are happening in my life, I can feel a fleeting sense of happiness about it, but rarely does that last. Anything happy is often quickly destroyed by my general sadness or lack of emotion. Or the happiness gets picked apart by unhealthy thoughts like, “I don’t deserve to feel this happiness” or “if I’m happy now it just means something terrible will happen soon.” Those thoughts occur infrequently when I’m not depressed, allowing me to more fully enjoy moments of joy.

I recognize the good things in my life

When I’m depressed, being reminded of the positive things in my life can actually make me feel worse. When my mood is incongruent with the things I “should” be happy about I tend to beat myself up about it. The guilt I feel over being sick is raised because I have so much to make me happy and live for. When I’m not depressed I’m able to appreciate my life and all the good that comes with it. I’m blessed in a lot of ways, chief amongst which is my loving and supportive network of family and friends.

The Smaller Changes

  • My internal alarm comes back. I wake up easily.
  • I sleep more regularly.
  • I make healthier food choices.
  • I want to spend time on my feet.
  • I’m able to play more board games. (When in a low it’s hard for me to focus and cope with unexpected changes so board games become hard to handle)
  • I use positive coping tools as a default.
  • My head doesn’t constantly hurt.
  • I dance and sing throughout the day.
  • I remember everything I have learned in therapy.
  • I drink water.
  • I play with my dog because I want to.
  • My body aches less.
  • I can make simple decisions more easily.
  • I’m able to read more comfortably (no repeating over lines, etc.).
  • I care more about my personal hygiene and self-care.
  • I’m not as easily tired.
  • I can contribute more by doing chores and volunteering.

All of these changes provide much needed light after months of darkness. They also highlight just how much my life is changed by depressive episodes. Depression can be a thief of joy, purpose, energy and self. Depression can make it seem like life isn’t worth living, but even a few short weeks out of depression can be enough to make months of struggling feel worthwhile. I hope that I’ll get a long break before my next low. I hope everyone who is experiencing depression right now will get some relief soon. I hope we all come to know more wellness and joy.

Take care,

Fiona

Photo by Marko Blažević on Unsplash

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Emergency Departments Should Do More for Suicide Prevention

Photo by paulbr75 on Pixabay

Every day, suicidal individuals are sent home from the emergency room with little to no follow up. I believe this to be one of the greatest threats to effective suicide prevention.

Today is World Suicide Prevention Day. I feel the need to add to this important conversation, not only because of my personal relationship with suicide but also because suicide often fails to be recognized for the serious health issue it is. The World Health Organization estimates that about 800,000 people worldwide die by suicide every year. In Canada every day 10 people die by suicide and 200 attempt suicide. In Ontario alone 1327 people died by suicide in 2014. In short, we need to talk about suicide prevention.

Discussions about suicide prevention are not complete without looking at necessary improvements to our hospital mental health systems. While hospitals, doctors and other mental health professionals work tirelessly to support their at-risk patients, there remain major flaws in the availability, accessibility and adequacy of services provided. Not the least of these problems occurs when suicidal patients are denied care in hospital emergency departments.

The Problem

Imagine for a moment that you feel there is no reason to live. You feel that you can’t stand to go on any longer and have made plans of how to kill yourself. Imagine you reluctantly make it to the hospital, perhaps of your own will or perhaps at the urging of someone who cares. With one last shred of hope, you think maybe the hospital will help you, and what do you have to lose? You wait for hours, growing more jaded as time goes on. After sitting in the hospital all night in high emotional distress receiving only cursory information from busy ER nurses, you finally see a doctor. You describe to them that you plan to kill yourself, you explain your plans, describe your hopelessness and pain. Imagine that doctor, after only spending a few minutes with you, sending you home without offering help. Imagine feeling even more worthless and hopeless, because even the system that is in place to save lives turns you away. Imagine feeling as though doctors are telling you that you are not worthy of being saved. You return home, emotions heightened, even more certain than before that your life has no value.

This happens every day. Every day people who have decided to end it all are turned away from the very systems there to protect them. While my experiences with the ER have often been positive, this has happened to me. It is one of the worst feelings imaginable, to be at the end of your rope and have your attempt to access care rejected. Few things have made me feel less worthy of living than being sent home from the emergency room when I am a threat to myself. To add insult to injury there is often no follow up even when follow up is promised. While this is certainly not the intention of the hardworking emergency department medical staff, the message I internalize from these events is loud and clear, “Your life is not important and you do not deserve to be saved.” When in the depths of a suicidal episode even the act of being assessed by a doctor for my risk of suicide feels stigmatizing. Being asked questions with the obvious motive of trying to uncover whether I am “suicidal enough” is humiliating. Shouldn’t it be enough that we are asking for help?

Suicidal patients like myself and our caregivers have been placed in the position of having to advocate for our need for care during crisis. As a suicidal person, it isn’t easy when you do not believe you should live to present yourself to the hospital and advocate for care to keep you alive. In fact, it’s one of the hardest things I have ever done. Caregivers too are placed in difficult positions, often having to advocate for care they feel is desperately needed, sometimes against the wishes of their loved one. My husband has had to advocate me, and I know it hasn’t been easy for him to simultaneously convince me to accept treatment and convince doctors of my need for treatment. I am forever grateful that he has endured that stress, it has saved my life. These self-advocacy measures should not be necessary. We shouldn’t have to convince doctors of our honesty, our intent and our need for treatment, out of fear of being sent home with no answers.

I believe the result of these interactions with hospital emergency departments can foster a distrust of mental health systems. It is dangerous, I believe, to contribute to a person’s feeling that their suicidal ideation, plans and actions will not be taken seriously. I know many people, myself included, who have at one time or another refused to go to the hospital due to the belief that they will not receive care and their time there will only make things worse. Surely, contributing to that belief is not what hospitals should be doing for suicidal individuals. Emergency departments have a key role in suicide prevention and sadly they are not always up to the task.

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Photo by blickpixel on Pixabay

Why I Think This Happens

There are, of course, many reasons why doctors might choose not to admit a suicidal patient to the hospital. A hospital admission isn’t always in the best interest of the patient. For one, there is a broad range of what qualifies as “suicidal” and not everyone who has thoughts of suicide is an immediate risk to their own safety. According to The Suicide Risk Assessment Guide by the Ontario Hospital Association (pg. 25), doctors in emergency settings should assess the risk of suicide by determining the patient’s actual level of intent to die by suicide and evaluating whether the patient is telling the truth about wanting/not wanting to die by suicide. Based on the assessment of risk of suicide, doctors determine the level of care needed and should, ideally, help connect the patient to the appropriate level of care. In Ontario we have a shortage of psychiatrists, hospitals are frequently operating over capacity, wait times for mental health services are long. I imagine that those constraints add an additional level of difficulty in pairing suicidal patients with the treatments they require. However, sending suicidal patients home without follow up care or even a safety plan is irresponsible.

Finding Solutions

Solving this issue isn’t straight forward. This is not about a few stigmatizing doctors who believe their suicidal patients are just attention-seeking (though that is sometimes the case). Often, the capacity to offer timely help to every person who needs it is simply not there. In many places, hospitals don’t have enough rooms or enough beds or enough staff or enough funding to offer immediate support to every suicidal person who comes looking for it. In an ideal world, everyone who has plans to end their life would have a place in the hospital until they are truly safe to go home. Fixing this problem isn’t as simple as admitting every patient who may be at risk to the hospital. As it stands, at least here in Ontario, that just isn’t possible.

There are ways that I believe the emergency departments can contribute to suicide prevention. Information about free community services with low wait lists should be shared. Peer support groups, for example, can be helpful in suicide prevention and often do not have waitlists. Helping the patient create a safety plan can also be beneficial. Follow up from the hospital (calls or appointments) is another way to not only check that patients are okay, but also to reassure patients that they are a priority and have not been forgotten. Doctors should make sure the patient has a mental health professional or family doctor they can follow up with soon. You would think that all of these practices would already be used consistently, but that is not the truth of my experience or the experience of many of the people I have interacted with. The result of a hospital visit due to a suicide attempt or suicidal plans should never be nothing. No suicidal patient wants to feel that they are met with apathy at the hospital. We are failing to prevent suicides by letting suicidal individuals slip through the cracks. When all else fails, compassion from the emergency department medical team can save a life. I should know, it has saved mine.


My own personal experiences with visiting the emergency department when I am suicidal have varied. At times, I am treated with compassion and a level of concern appropriate to the severity of my condition. At other times, I have been sent home without any help, care or follow up. At the worst, I have felt stigmatized and humiliated by the words and actions doctors. My experience is not unique. There are many people who are turned away from the hospital when they truly need help. If you need any evidence of that, I suggest you start looking at the mental health community on Twitter. I see stories every day of people turned away from the emergency room without help, even when they have no other supports in place.

With all that said, I am deeply grateful to the doctors, nurses and administrators at hospital emergency departments who have helped me in the past. I have had some very positive outcomes from ER visits.

Suicide prevention is something I can’t help but care about deeply. Once you have been suicidal, you understand how big the discrepancy is between the need for effective emergency care to help suicidal individuals and what is actually available. We are told to report to our nearest hospital emergency room when we are in crisis, we should be able to expect to receive real help when we do.

Take care,
Fiona

This or That Challenge

The lovely Elizabeth of The Uncustomary Housewife tagged me in the This or That Challenge. Elizabeth blogs about mental health as well as other fun things like cooking and geekiness. You can find her on her blog and on Twitter.

In turn I am tagging a few great mental health advocates who I’d like to learn some more about.

The Good The Human

Terminally Nice

Jen, Comically Chronic

John, The 3 of ME

Tony, The Mental Health Fog


Question 1: Shower in the morning or evening?

In the evening. I like evening showers best as I like feeling nice and fresh before bed. It is also nice to shower in the evening because I have panic attacks every time I shower, so it is nice knowing Tom is home in case I need his help to de-escalate the panic attack.

Question 2: City centre or close to nature?

Most definitely close to nature. I love trees and water, especially. My ideal is small cities/towns, I have always been partial to them. I used to work in downtown Toronto and I did enjoy the hustle and bustle, but I was glad to not live anywhere near it!

Question 3: Bright colours or neutrals?

Bright colours. I love colour. Neutrals are a bit dull for me.

Question 4: Spring or Autumn?

Autumn. I can’t think of anything I don’t love about autumn, it is my favourite season. I love the cool but comfortable weather, the colourful leaves, apple cider, apple pie, apple everything… you get the gist!

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I snapped this photo last Fall on my honeymoon on L’Île d’Orléans, just across from Québec City.

Question 5: Mint or cinnamon?

I love them both but I have to go with cinnamon. So many things are improved with cinnamon: apple pie, apple cider, apple everything… oops! I think we’ve been here before!

Question 6: Planned or spontaneous?

Planned. Always planned. I have found that especially when I am most anxious I can’t handle spontaneity. I can become hugely overwhelmed even when things deviate ever so slightly from the plan. I live in lists and planning documents. When I go on road trips or vacations I make binders full of information to help me cope and minimize surprises.

Question 7: A movie at home or at the cinema?

At home. This is especially true now with agoraphobia and social phobia keeping me clear out of movie theatres, but even when anxiety didn’t get in the way I have always preferred watching movies at home. Cuddling, better popcorn, comfortable seating, etc. There is something to be said about watching movies on the big screen or catching them before they are released for home viewing, but on the whole watching them at home takes the prize for me.

Question 8: Espresso or latte?

Latte for me – but not with coffee. It’s all chai tea lattes for me!

Question 9: Hugs or kisses?

Hugs. I love a good kiss, but nothing comforts like a hug.

Question 10: Spicy or mild food?

Mild. I am that annoying person who always asks for my Indian food served mild. I like a bit of heat but I am a total wimp when it comes to spicy food.

Question 11: Leather or lace?

I love lace. It is the height of prettiness where I am concerned.

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Bonus photo for Elizabeth – my wedding dress also had lots of lace!

Question 12: Overdressed or underdressed?

Underdressed. I mean, overdressed for social gatherings and work. But underdressed whenever it’s appropriate. I am happiest and most comfortable when I’m in my pyjamas.

Question 13: Adventure or comfort?

Comfort. This probably doesn’t come as a surprise given how much I have mentioned comfort already in this blog post. I have dreams of travelling around and trying new things, but even in adventures it is still important that I am comfortable.

Question 14: TV series or movie?

Oh, this question is hard. I enjoy both. The acting and overall art of movies tends to far exceed that in TV shows, but I love getting emotionally invested in the character arcs of TV shows. I’d probably give the edge to TV shows, I love binge watching shows and completely absorbing myself in the story. It something like reading a novel, as I spend more and more time in the fictitious stories I become more attached to them.

Question 15: Rock or country music?

Without question, rock. I love rock music and rock concerts. I rarely listen to country – the primary exception being The Dixie Chicks. I do love artists who are country/rock like The Eagles.

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Def Leppard and KISS Concert in Toronto, 2014

Question 16: Red or white wine?

Neither – I don’t like wine.

Question 17: Working alone or in a team?

Working alone. I enjoy working in teams but team dynamics change everything for me. I would rather work alone than with a team for which I am not a good fit.

Question 18: Swimming or sunbathing?

Swimming! My mom instilled in me a deep love of being in the water.

Question 19: Fast food or sit-down restaurant?

Sit-down restaurant. I love going out for a nice dinner, it is one of my favourite things to do. Chatting with great people while eating tasty food and not having to clean up afterwards is wonderful.

Question 20: Matched or mismatched socks?

Mismatched. I don’t often wear socks, but when I do I don’t have the patience to dig through my sock drawer for matching ones. I only use socks from the same collection, so they all feel the same, but I usually wear mismatched colours.

Question 21: Dancing or singing?

Singing. Singing is everything to me. I love dancing too, but I am not myself if I am not singing. Fun fact – I almost pursued a career in musical theatre. My singing chops are far better (though sadly out of practice these days) than my laughable dancing ability.

Question 22: Phone or the internet?

Internet. I like and use both but most of the time I spend on my phone is spent on the internet anyways. I like the larger screen and easier typing that my laptop provides.


Thanks again to Elizabeth for tagging me in this challenge, it was fun!

Take care,

Fiona

Using a Checklist to Manage My Depression

In early July I had a difficult appointment with my psychiatrist. I had missed my two previous appointments with her because my anxiety and depression were so strong that I felt I couldn’t make it. Finally pushing myself to attend an appointment, I broke down and told her that I was back in a depressive episode. I described how all too suddenly the wave of depression had come back and everything I had built up in my life (my routine, volunteering, etc.) had washed away with it. I was spending my days in bed, barely eating and my sleeping was all over the place. She tasked me with some clear-cut homework: wake up at the same time every day, eat all three meals and get out of bed. For now, she told me, the rest was “gravy”. She asked me to track every day how well I was accomplishing those goals.

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So, I did. I created a checklist that I filled out every day for the two weeks until my following appointment. I tracked my eating, sleeping and whether I got out of bed, as well as some other things like hygiene practices and whether I went outside or talked to anyone. I have tried filling out other similar checklists before and never found it helped much, making my own personalized one has been much more effective. I’ve found the list helps hold me accountable. In my next appointment my psychiatrist was able to look over my checklists to get a better idea of how I was doing and help me set new goals.

It’s often said that when we are in a depression the basics are the first things to go. Depression feels all-encompassing, it feels like nothing else matters, motivation and energy are depleted, and self-worth lowers to the extent that I feel like taking care of myself is pointless. The fog of depression makes even the simplest most routine things seem unimportant or impossible to me. It’s common for people like me to stop showering, neglect eating properly, etc. Filling out my checklist helped keep me accountable to these basic things. It didn’t lift my mood much, but working towards these goals helped me feel more in control.

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I saw a big difference in just a couple of weeks!

The effects of depression create a vicious cycle. When my depression causes me to under-eat I feel weaker. When I feel weaker I am less able to make myself eat. When my depression causes me to miss sleep I feel more tired. When I am more tired I nap during the day which impacts my sleep schedule. When my depression causes me to stay in bed all day I feel less capable and more secluded. When I feel less capable and more secluded it becomes even harder to get out of bed. These things all compound depression. It is vital to break that cycle. Eating three meals a day, having consistently good sleeps and getting out of bed doesn’t pull me out of depression, but it does make it seem less catastrophic. Filling out this daily checklist helped me break my downward spiral.

After my following appointment with my psychiatrist I didn’t print off more checklists, until this morning. Honestly, I just thought printing out more checklists and tracking these tasks was a nuisance, especially now that I was more of my basic self-care. This morning, however, I printed out a fresh batch. As I begun checking items off for today I realized how much improvement I have made in taking care of myself. I am still in the depths of this depressive episode, but I am doing what I can to manage it. Acknowledging my hard work and small victories is so helpful when I am depressed and feeling completely useless. Memory is another thing that depression impacts – checking my list helped remind me of important things I had completely forgotten. Looking back at the checklist made me realize that since I stopped filling these in I haven’t been taking my vitamins and my water intake has been minimal.

I will always have better days and worse days. Some days I am still unable to get myself out of bed and I miss meals. That’s okay, it happens – depression is debilitating. With this checklist on hand those days have become the exception, not the rule.

Take care,

Fiona

If you would like to use my checklist as a jumping off point for your own, feel free to download it by clicking here: Depression Checklist

Photo by TeroVesalainen on Pixabay

Depression Checklist

Gaining strength from my husband’s words

Last week I asked my husband Tom a tough question and was touched by his heartfelt and encouraging answer. I thought today I would share his response with you.

First, some context.

I am struggling through a bad low. The respite from my last depressive episode was far too brief. Now that depression has returned, I am trying to counter my feelings of hopelessness and worthlessness by pushing hard to establish my “base.” This basically means maintaining a basic routine and meeting my immediate needs by eating regularly, maintaining a sleeping schedule, getting out of bed, etc. I have learned a lot in my therapy the past couple of years, I am trying to apply what I have learned in order to keep my head above water. More often than not it feels like I am drowning, but I’m resisting as best I can.

All that to say that last weekend at this time I was ruminating about my life and what was to come of it. What was going to happen to me? Would I get back to how I used to be a few years ago or would I die soon? What was most likely? Not for the first time, I decided to turn my questions to Tom. Not for the first time, he answered with exactly what I needed to hear.

Here is what he said:

I definitely don’t think on either one extreme. I don’t think you’re going to be dead in the next couple of years or anything like that. And I don’t think you are going to find a magic miracle pill that all of a sudden makes everything peachy. But, I think that right now you’ve got a really great set up with Dr.___, who I think understands you a lot better than when we first started seeing her. I think she’s a really good doctor and she’s really helping.

You’ve also learned a lot of really good coping skills quite recently. I think right now you use them but they’re going to become a lot more so second-nature [with time and practice]. As more of those become more second-nature you’re going to struggle through the day to day a lot less. If you’re struggling through the day to day a lot less then all of the sudden it opens things up and you can be doing things like go out with me or go see a friend or you know, all these other things… Do a chore around the house kind of thing… That’ll really mean that all the sudden your lifestyle will improve a lot just with minor amounts of improvement to building your base. I think with the base right now we’re just locking it down and I think we’re going to get it locked down. And then the next time if you’re ever in a spot where you don’t have that locked down, you’ll know you can do it. You’ll know and it’s going to be easier, you’re going to be more confident and it’s not going to be so scary. Right now, it’s obviously really scary.

I think we’re going to continue to find more things like the click and collect groceries where for a long time we were worried, “we’ve got to find a way to get these groceries done.” It was really tough for you but we found a way to do the groceries.

[Me: Yeah, adaptations that suit our lifestyle. I think we’re getting to a point where we’re realizing that that’s okay.]

Yeah, there’s nothing wrong with it – it’s awesome. Click and collect groceries is growing like mad. I think we’ll find a couple more things like that and you get that base built so that on the days when you’re pushing, you’re pushing to do something like a little more. It’s going to bring the whole quality of life/lifestyle way up there. Just a small improvement is going to make a massive change to the lifestyle and the day-to-day. I really believe that.

There are so many things I love about his answer. I love that every bit of it shows just how much he understands what I am going through and my goals. He lives this with me every day, after all. I love that he acknowledged that I was thinking in extremes without mocking me for it; instead gently helping me recognize it for myself. I also love that the emphasis in his answer is that I have gained and continue to gain information and tools from therapy, the impacts of which are beginning to be established and will grow with time. He is right, if I am able to get to a point in which the beginning of depressive episodes don’t completely wipe out any semblance of my routine and my most basic of self-care practices, I will feel a lot better. That’s within my grasp. His answer places power on my shoulders, the belief that I have the ability to advance to a better situation by continuing my hard work.

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My rock.

Had Tom told me he thought I would fully recover, I wouldn’t have believed him. He wouldn’t have believed himself either. It might sound strange, but that is incredibly validating to me. We both awaited my return to “normal” for a long time. However, as time has gone on it has been clearer that we have to adjust what our perceptions of my normal are. This has been a challenge, but is bringing on some good changes for us. We have begun to embrace adaptations that work for us, like his example of ordering groceries online. This allows me to contribute in a manageable way – I make the list, I place the order and Tom goes to pick it up. I hope he is right that we will continue to find more adaptations that suit our needs.

I have found firmer footing and new motivation from Tom’s answer. What he explained makes sense and it helps me feel like progress is attainable. It reinforces my purpose with my short-term goal: strengthen my base, that alone should help make other improvements easier to achieve. Tom doesn’t think I am a lost cause, he sees me applying what I have learned and believes more improvements will come of it. That bit of hope is enough for now. It has helped me find the strength to keep trying.

Take care,

Fiona

P.S. Many thanks to Tom for not only being unfailingly sweet, honest and encouraging but also for patiently repeating his whole answer so that I could record him and write about it.