FEATURE: A Woman's Journey Down the Long and Winding Road of Depression

A Woman’s Journey Down the Long and Winding Road of Depression

Angela hated Mondays.

As she dressed for work, the back of her closet seemed to be calling her to crawl in where she would be safe and secure. She had hid there many times before. But she had to get to her job at the bank. People were counting on her and letting others down is not in Angela’s DNA. Angela would make the fateful decision on her drive to work. Today, it would end. All of the pain would finally end. The two decades of suffering would stop today. Angela did not expect to see her closet or home again.

Today, she would kill herself.

For someone suffering from depression, suicide too often becomes the only way to end the pain. Unless you have been down in the pit where the demon of depression lives, it is not possible to comprehend why suicide seems to be the only solution to the pain. The pain is so intense that suicide becomes the only way out for too many sufferers.

Suicide statistics are frighteningly high:

Each year, over 44,000 Americans commit suicide.

That’s an average of 120 suicides per day.

Every year, 865,000 Americans attempt suicide.

That means someone attempts suicide every 38 seconds.

When it comes to young people, only car accidents kill more of them.

Nearly 9 percent of college-age students have thought of committing suicide and nearly 3 percent have made specific plans on how they would do it. Each year, over 1,000 college students kill themselves. There is not a university or college that has not had a student commit suicide. Why would someone just on the threshold of adulthood, with decades of life to look forward to, commit suicide?

Among the top 10 causes of death in the United States, only suicide has seen an increase. While medical science has made great strides in curing cancer, heart disease and other illnesses, it has not been able to reduce the suicide rate.

Angela is a petite blonde of 47. She grew up in Lawrenceville, GA, a city located 30 miles northeast of Atlanta. She has lived most of her adult life in Athens, GA, home to the University of Georgia. She is a banker, mother and wife.

As she drove to work, Angela felt content and calm. The decision was made, the plan laid out and now all she had to do was to follow through with it It’s difficult to identify the roots of Angela’s depression. As a child, she would be so sad at times that she stayed in her bedroom for extended periods of time. “Mom and Dad just thought I was going through a sad period and that I would get over it,” Angela said.

Angela’s first major episode of depression occurred after her first marriage ended in divorce. “I was seeing this man and found out he was dating someone else at the same time. That’s what upset me most,” she said. It sent her sliding down into the pit of depression.

She knew she needed help and, like most people, turned to her primary care physician. The doctor told Angela that her depression was likely caused by “hormonal issues” and wrote her a prescription for Prozac.

Despite the Prozac, Angela’s depression grew worse and she checked her self into a mental-health facility. She would spend two weeks there on suicide watch. At night, she and the other patients were locked in their room. They took away her belt and even her shoelaces. But being there gave Angela time to think and gather her thoughts.

“What I liked about being there was the free time I had. In the group, I could talk freely with the other patients. I enjoyed that time and actually met a few people that I could have been friends with under a different situation,” Angela said.

But sessions with the therapists often left her feeling worse. “They would tell me that depression was just something I had to learn to deal with.

Like it was my own fault that I was depressed,” she said.

“I felt so alone. My family didn’t understand what I was going through.

They just didn’t want to talk about it. They would tell me to be happy,” Angela said. “I just thought that this was going to be my way of life from now on.”

Depression can be especially hard on family members. They do not understand why the person strikes out at them, often acting in ways to hurt them both mentally and physically. Yet, these are the people that the depressed person needs and depends on the most.

Two days after Father’s Day (2017), one of Angela’s co-workers was having a difficult time at work, often breaking down in tears. Angela called the worker into her office and asked her why she was crying.

Angela found out that her son’s father had committed suicide when her son was quite young. Father’s Day was especially hard on him. The next

day, he texted his mother at work: “Mom, I love you.” She did not know what to make of the text but responded in kind. When the mother got home, she found her son dead. He had shot himself just as his father had done nearly two decades before.

Some of Angela’s co-workers thought the son did not expect his mother would be the first to discover his body. The suicide was difficult enough, why did he add to the pain by having his mother find his body?

Often the depressed person is in so much pain that thinking about others is far from her mind. In thinking about her own suicide plans, Angela said, “You don’t think about what’s good for your family. I didn’t think about them at all. I didn’t care who found my body. I just wanted to end the pain.”

Angela had often thought “You don’t think about what’s good about suicide but never told for your family. I didn’t think about anyone about it. She knew them at all. I didn’t care who found how she would end her life. my body. I just wanted to end the “I had a lot of pills and I pain.” would take them. Driving down the road, I would look at the trees and think if that’s the right one. Was it big enough to kill me if I crashed into it,” she said.

As she drove to her job at the bank, Angela was content. Her decision was made and all she needed to do now was to carry through with it.

Angela had been transferred to this bank branch only three weeks before. The slower pace and lower-stress work was more suited for her than her previous branch. She also bonded with a co-worker.

“We both have very strong religious beliefs. We prayed together a lot and read verses in the Bible,” Angela said.

Angela decided to tell her friend how she felt and what she planned to do.

“For some reason I decided to go to a co-worker who I trusted and told her I just didn’t want to live.”

Her friend took action. She immediately called the bank’s Human Resources office and then drove Angela to the local hospital.

Looking back on what her friend had done, Angela said, “I owe her so much. God put her there in my life on that particular day.”

At the hospital, Angela was put into an isolation room and evaluated.

After being admitted, “I called my family. None of them realized how severe my depression was,” she said.

Angela’s supervisor at work was supportive, telling her that her job would be waiting for her when she returned to work. She was given a three-month medical leave.

Angela went back to the mental health facility she had been in 15 years before, this time as an outpatient. She didn’t think her treatment at the facility helped much. “We colored pretty much all of the time. It was as though I was in kindergarten again. We colored and talked.” While she was there, she did meet with one therapist but never saw a psychiatrist or any other physician.

But for the first time in her life, she did receive a diagnosis of her illness. She was told she was suffering from severe depression. She also received a referral to see a psychiatrist.

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“Each appointment, I would see her [the psychiatrist] for about 15 to 20 minutes. She would take my weight and vital signs. We would talk for a few minutes and she then would write a prescription.” Never did they talk about how Angela was feeling or explore the potential causes of her depression.

“I didn’t feel any different when I left her and I was asking myself why am I doing this,” Angela said.

During an annual physical, Angela told her internist that her antidepressant didn’t seem to be doing any good. The internist told her that she had had some success with her patients using a different drug than the one Angela had been prescribed. Angela called her psychiatrist and told her what the internist had said. The psychiatrist responded, “Okay, let’s try that,” and prescribed the drug without an in-person visit or any further discussion.

Angela took the drug and her vision soon began to bother her. She had severe headaches and her eyesight began to fade.

She had a difficult time reading. When she asked her psychiatrist if this could be caused by her new antidepressant, the doctor assured her that it was not.

Her vision had gotten so bad that Angela went to see an eye specialist. He conducted a number of tests and found nothing wrong with her eyes. But he did tell her that her vision problem was likely caused by the antidepressant.

Angela told her psychiatrist this and again was assured that the vision problem was not caused by the drug she had been prescribed.

Angela took matters in her own hands and stopped taking her antidepressant. “I came off the drug and the eye issue resolved itself. “ When she told her psychiatrist this, “she didn’t believe me.”

By now, Angela had given up any hope of ever feeling better. “I just thought that this was how my life would always be,” she said.

Antidepressants are powerful and unpredictable drugs. A drug that works for one person will not necessary work for another. Not only is the effectiveness of a drug unpredictable, getting the dosage correct can be challenging. Too small a dosage won’t make much of a difference in a person’s depression, but it can cause some awful side effects. To get both the drug and dosage correct, a doctor needs to have training in psychiatry. Yet, a rotation in psychiatry during residency training is not required during a physician’s training.

“With few exceptions such as family medicine and neurology, the only experience most physicians experience in assessment and treatment of psychiatric disorders is 3-6 weeks during their third year of medical school. Clearly, this is not sufficient, yet the majority of patients with, for example, depression are treated by non-psychiatric physicians,” stated Dr. Charles Nemeroff, Leonard M. Miller Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami Medical School.

In the 15 years since she first talked to a doctor about her depression, Angela has been prescribed over 20 different drugs and none worked .

But the doctors she was seeing were not trained in psychiatry. Yet, they can and do prescribe powerful antidepressants. Angela trusted these doctors.

In Angela’s case, she did end up seeing a psychiatrist who was prescribing an antidepressant for her but at such a low dosage that the drug had little beneficial effect.

By chance, Angela’s life was about to change dramatically. She and the author of this article had a passing acquaintance. In a noisy restaurant, Angela learned that the University of Miami’s Department of Psychiatry and Behavioral Sciences specialized in treating patients who did not respond well to traditional drugs and therapy.

Angela committed to going to Miami for treatment. “I was really excited about going. I had hope again. But I was worried about the money situation,” she said.

To do a thorough evaluation, the patient needed to spend at least three full days in Miami. The evaluation is performed by a team of physicians, psychologists and therapists. The cost is about $7,000.

FOR MORE ON THE UM DEPARTMENT OF PSYCHIATRY & BEHAVIORAL SCIENCES’ COMPREHENSIVE EVALUATION & DIAGNOSTIC PROGRAM, VISIT THIS PAGE The Comprehensive Diagnostic and Treatment Evaluation Program is based in the Department of Psychiatry and Behavioral Sciences. It is unique in the nation as it addresses complicated patients or those who have failed previous treatments. The patient is independently evaluated by three psychologists chosen based on the patient’s chief symptoms and the faculty’s specializations. A neuropsychologist performs extensive testing and a psychologist meets with family members. Once completed, all of the faculty, including Dr. Nemeroff, meet in consensus conference to arrive at the diagnosis and treatment plan. More than 400 patients have been seen in this program.

For Angela and most patients, health insurance does not cover the cost.

While this may save insurance companies money, it takes a large toll on America’s economy. According to the Centers for Disease Control, the annual impact of depression on America’s economy and businesses is a staggering $210 billion in combined medical and work loss costs. About 21 million Americans, nearly 10 percent of all adults, will suffer from a major depressive episode each year, causing many of them to miss work.

Angela’s insurance would not cover her evaluation in Miami and she could not afford the $7,000. What she could afford was a one-day visit with the hope it would give the Miami doctors enough time to treat her.

“Everybody at Miami was nice and very friendly. I felt at ease,” she said.

Angela was assigned as a patient to Dr. Jeffrey Newport, Professor and Director of the Women’s Reproductive Mental Health program at the University of Miami.

“I really liked Dr. Newport. He asked so many questions. He knew what to ask and said things that I had never thought about before. This was the first time this ever happened to me,” she said.

Dr. Newport recognized that Angela was suffering not only from depression but from severe anxiety, namely panic disorder and social anxiety disorder, as well. Neither her depression nor her anxiety had ever been effectively addressed. “Angela had previously been treated with 7 different antidepressants. Unfortunately, her physicians kept repeating the same mistake. They started each antidepressant at a low dose and only made minimal dose increases, if any. Each time Angela failed to derive any benefit from an antidepressant, rather than assertively

increase the dose, her physicians instead switched her to an equally low dose of another antidepressant,” remarked Dr. Newport.

Dr. Newport changed Angela’s antidepressant to one suitable for both her depression and anxiety. “He told me that one of the biggest issues with the treatment I had been receiving was that the dosages should have been increased.” Dr. Newport started a new antidepressant and increased the dose, in a stepwise manner, until she experienced a remission of her depression. Ultimately, Angela experienced a remission of her depression and anxiety at a dose 400% higher than the starting dose.

“Dr. Newport was confident it would work. He reassured me that I would feel better. And it has worked,” Angela said.

Upon Dr. Newport’s recommendation, Angela has also started seeing a therapist. The therapy sessions have been going on for just a short time and it is too early to tell whether they will help Angela. But she already has some frustration. “The therapist just sits there and doesn’t say anything. I have to do all the talking. I want her to ask me questions. I want some feedback from her,” she said.

It has been nearly two years since Angela went to Miami and her life has turned around. She is back scuba diving and very active in her church where she feels most at peace.

Angela talks openly about her depression. “People come up to me and ask what they can do about their depression,” she said. “I try to help them because without help I would not be where I am today.”

Her goal is to help end the stigma associated with depression. “It’s an illness just like cancer and just like cancer it can be treated and cured, but you have to get the right treatment,” Angela said.

“ I could have had a different life if I knew about

Dr. Newport and the doctors in Miami 27 years ago. I truly think my life would have been completely different.

” This piece “A Woman’s Journey Down the Long and Winding Road of Depression” © was written by guest author Dr. John Soloski. John Soloski, PhD is Professor of Journalism at the University of Georgia. He was dean of the college from 2001-05. Previously, he was the Daniel and Amy Starch Professor of Journalism and the director of the School of Journalism and Mass Communication at the University of Iowa. He serves on the External Advisory Board of the UM Miller School of Medicine’s Department of Psychiatry and Behavioral Sciences.

RESOURCES You are never alone. If you or a loved one are struggling with mental health, the following resources may be of help: AFSP | American Foundation for Suicide Prevention https://afsp.org/ JED | The Jed Foundation https://www.jedfoundation.org/

NAMI | National Alliance on Mental Illness https://www.nami.org/ National Suicide Prevention Lifeline 1-800-273-8255 https://suicidepreventionlifeline.org/

Angela today.