There are several things in your post that help me, I’m glad you chimed in.
One thing that you said that was a major “so glad i’m not the only one” sort of kinda way was your story of your “glimpse into the chasm”. I know mental healthcare providers are human too, but this helps make you all more so.
and Bippity, it helps to have friends you can trust with your guns when you feel things going askew
Thank you. Whenever it’s appropriate I tell my patients some of my own story, to reach out as it were. Glad to hear it apparently works here, too.
And kudos to you for undertaking such a demanding course of study even while you were struggling.
Today my psychiatrist asked me if I was feeling any anxiety or depression, and I mean, yes? Isn’t that the whole point, here? She clarified “more depressed or anxious than usual” and I replied that I was stable. But my whole life has been depression or anxiety, to varying degrees. I marvel that some people have anything else as a baseline.
This. Not wanting to kill yourself (or anyone else, for that matter) is a good day in my book.
And usually it’s even slightly better than that.
As for the profession, I seriously considered quitting when I was ill. But the head of residency and some of my colleagues were very supportive and motivated me to stay on. I haven’t regretted it. I immensely like my profession, and don’t think frankly i’d be much good at anything else. So that turned out well. Thanks for your support.
It may pass like a kidney stone, but it will pass.
Indeed. I’m going to remember that too. Thank you.
Is it inappropriate for me to ask what some of the things on the list were?
I’m very curious.
Yep. I have stashed many households worth of knives and scissors and spare meds with more safe people than I can shake a stick at. It actually kind of amuses me. I shouldn’t buy them, I should just rent them.
I don’t even remember them all. I just remember very specifically that there were three that had happened to me. Honestly, I only remember what two of the three were; I don’t even remember the third one-- it was a long time ago. They weren’t anything startling-- all the sorts of things that are stressful to go through. Here’s what I can remember:
Ended a long relationship
Experienced the death of a loved one
Lost a job
Been evicted
Been diagnosed, or had a spouse or child diagnosed with a serious illness
Been in a serious car accident
That’s not the whole list, but that’s what I remember.
My father had just been diagnosed with what was probably a terminal illness, which I’m counting, and, while it wasn’t on the list, I’d also just lost a pet. I don’t want to say what the other one I remember was-- although, eviction wasn’t it, as I owed my house, but it needed some work I couldn’t afford, which was stressing me as well.
So, three things on the list, plus two that should have been.
Thank you, RivkahChaya!
this has been playing in my mind. I’m not always depressed, during the warmer seasons I can even get somewhat manic. I’ve considered doing just that, chucking it all and going on a “life I wish for” spree, but what always holds me back is the thought, knowledge, that doing so would likely end with my losing the ability and freedom to make that final choice. Unlike the machines, there are not “levels of survival” I am willing to accept. I’ve accepted the probable results of the choices I’ve made (another key coping strategy for me) and will quite likely do for myself when I’ve determined it is enough. Maybe those are the keys, acceptance, “this is the way I am” and knowledge that I determine when enough is enough.
Winter, I have seasonal affective disorder. To make things worse, my skin reacts badly to sunlight, and to sunscreen. I’m just a barrel of fun. I’ve done my spring break/winter vacations wearing everything but a burqua so my skin doesn’t act up too much.
Being laid of my jobs. I hate job hunting and would be happy to never do it again but I started doing consulting work and employers don’t want to actually hire consultants; they see us as expensive and as people who get bored quickly. I finally got a real job last year (huge pay cut and all) but was laid off when the parent company decided to close our division. It’s been hell.
I had some serious female problems that contributed to the depression overall, with PCOS. That’s been sorted with the removal of my ovaries. I got several months relief from my depression but it came back with a combination of the recession and no jobs to be had and a basement that flooded.
The fun never really stops.
As someone who has been spared depression myself but who has been … serious recurrent depression adjacent … in my family life, and who has been dealing with a surge of mental health issues in kids professionally these last months, I want to express appreciation for this thread and for the good for many who feel they are alone in this that this sort of thread provides.
That said a picking the brain of @Drsunflower1 if they don’t mind?
Do you believe that certain medications or other interventions are in fact more effective at suicidality prevention than others? Lithium, SNRIs, and maintenance ECT, are often mentioned as particularly effective. How does your experience and read of what data there is fit with that assessment?
Thanks.
My assessment: ECT series did me a world of good during my last 3 episodes of MDD, persistent suicidal plunges followed by 2-4 week hospitalizations during which I had initial ECT followed by maintenance for some months while my shrink and I found a combination of meds that worked, both SNRIs, mood stabilizers and even gabapentin. My experience over 50+ years is that anti-depressants have to be carefully tailored to the person and their response as well as tolerability. Adjuncts such as small anti-psychotic doses also have something to offer (second generation at a minimum). The newest SSRIs and SNRIs are head and shoulders above the earlier ones. Wellbutrin while not an SSRI was helpful as well. Again, carefully tailored to the person. Combo therapy is often needed.
I think it is important to educate the client that none of the above are quick fixes nor sunshine and roses ‘happy’ pills. You still have to work on yourself. CBT or DBT, maybe talk therapy, lifestyle changes like exercise, nutrition, sleep hygiene, getting enough sunlight daily. Even avoiding toxic people and situations.
If I feel another MDD episode coming on, even though I now have years of success with an SNRI+gabapentin (plus 18 months with some Lamictal), I would ask for an ECT series before hospitalization was needed. I’m of an age (71) where ECT is favored over walloping me with a panoply of meds and I’d willingly go the ECT route again, it was helpful. Lamictal I’m kind of ‘meh’, never could tell that it was doing anything helpful and I didn’t miss it when it was discontinued.
A child of mine personally has had very good results for years with Wellbutrin for dysthymia (I’m guessing it is family trait). This child is a psychiatrist so that is saying something. His two siblings use SSRIs.
Lamictal has been discontinued? News to me, I take the generic (lamotrigine) and I really need it.
Wellbutrin gave me amazing results but it also gave me grand mal seizures. So I was put on lamotrigine as an anti-convulsant but it ended up working a charm for depression. (Which is not a real surprise - it’s a mood stabilizer.) I’ve always had better luck with mood stabilizers than SSRIs.
As far as I know only lithium has a marked effect in specifically reducing the risk of suicide. Given the fact that bipolar depression carries more risk statistically that’s a good thing. I think It’s difficult to tell, but there’s a reason the most serious unipolar depressions tend to be treated with lithium add-on to tricyclics, at least in the Netherlands where I practice. ECT is, as BBB points out, often treatment of choice in the elderly, especially with psychotic depressions.
Psychosis without depression, eg in schizophrenia, can also be treated with ECT in therapy-resistant cases, and especially when there’s risk the patient will harm themselves.
BBB explains better than I ever could how to tailor treatment, I fully agree with what she says.
Sorry~Mea culpa! My taking Lamictal was discontinued. Both generic and brand name Lamictal is alive and well. Sorry my writing was unclear.
Thank you both.
I hope this doesn’t come out the wrong way (it might, as it’s late and I’m tired), but my experience with suicide leads me to a few conclusions:
If there are guns in the household, get rid of them ASAP. I’ve personally known an alarming number of people who committed suicide. A majority were white, male, and…gun owners.
Equally critical: treat substance abuse disorder. Most people I’ve known who’ve done the deed have had guns, and…alcohol.
Depression + alcohol + guns = death.
If you remove guns and alcohol, you don’t cure the depression - you probably never ‘cure’ it. But you substantially reduce the likelihood of the worst outcomes.
But mental illness is a thing. My nephew had schizophrenia. He wouldn’t take his meds. We tried to get him medicated. He’d take it for months at a time, but he’d gain weight and just not feel physically right. He stopped taking meds. Started bolting out of his mother’s house. Would disappear for days.