Depression with anxiety
I am a final year nursing student and although I am normally a happy, bubbly, capable type of person I have been hit by episodes of depression and anxiety at least in my life, with three-year period of depression starting when I was 11 years old.
Most recent episode
My most recent episode of depression ironically began during my psychiatry rotation. I was ill and my tutors were hassling me to keep them informed, but I was struggling for the energy to do so. After a week I was feeling low - however instead of my mood bouncing back with my physical health, it began to slip down a slope.
Paralysis
A couple of days after returning to work I slept right through my alarm. I panicked, and tried to pull myself together to get ready, but struggled to get myself to do anything. I tried breaking the tasks down for myself - ` go upstairs to wash face & brush teethī. I only made it up three stairs before I sat down - nothing was physically wrong, but I couldnīt go further.
Panic
I felt confused, petrified, and like something was very wrong. At the speed of the sloth, I eventually managed to get washed and dressed. I decided to take a stroll to utilise natureīs calming effect, to no avail.
Emergency appointment
Deciding enough was enough, I made my way to the counselling service to book an appointment. I couldnīt shake off the overwhelming sense that something was very wrong and I needed to talk to someone quickly. The receptionist gave me the link to an online CBT website and arranged for me to see the college nurse that afternoon.
Realising it was a panic attack
That night as I read the website, I realised I had probably had a panic attack. This revelation brought relief - I hadnīt deteriorated to a persistent new level of emotional distress, but experienced a temporary period of extreme emotion.
Downward spiral
Unfortunately I continued to spiral downwards. Irritability at myself and others developed into self-hate, I felt like no-one really wanted me around, and began getting thoughts about killing myself. I tried to distract myself, but I was surrounded by patients talking about their own suicidal thoughts and self-harm.
Antidepressants
My GP put me on antidepressants, and I spoke to my tutors who suggested I take some time off. It was 4 weeks before the antidepressants took effect.
Suicidal impulses
During the interim my impulses to harm myself or kill myself became stronger and harder to ignore. It felt like the thoughts were torturing me, and would leave me crying for hours. They became stronger and I felt weaker.
Overwhelmed
One evening, I decided to write down the torments of the previous night in my diary. As I recalled them, they took over. I tried to fall asleep - the only tool I had to stop them, but remained awake, sobbing for hours. Deep down I didnīt want to die, but the impulses were so strong I no longer knew if I could handle them alone.
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Depression at an early age
I never really told anyone about it, but I can remember from when I was about 12 I was upset enough to think about suicide. I thought about it most days for about three years from when I was 12 until I was 15. I find it difficult looking back on it, to imagine it, because I have got good memories of that time as well as the nasty ones.
Feeling different in the family
I think it was triggered by a number of things. I wasnīt feeling very integrated at home in the family - I went through all those thoughts that maybe I wasnīt really part of the family; maybe I was adopted.
Left out
I have two younger brothers and often felt left out. I remember an occasion where my brothers and my mum were talking about me and it upset me enough to write to Child Line at the time. I felt very alone and rejected.
Puberty and eating issues
I guess I was starting to go through puberty and that had an impact - they saw that something strange was happening to me. The hormones had a role as well. I had felt fat from about the age of 7, but I started having problems with food and eating when I was 11.
Felt parents didnīt care
I felt that my parents didnīt care about me. I remember thinking at one point that my granddad was the only person in the world who loved me. I always felt loved and accepted by him and I think that kept me going.
Parents judgmental
My parents didnīt like my friends - the friends who did in fact end up bullying me - but I felt my parents were judging them for who their parents were and what they did and I got very angry that they couldnīt see that they were real, worthwhile people, and that where they lived or what jobs they did didnīt matter.
Stopped confiding in parents
My dad in particular would judge whatever I said and would judge other people through what I confided to him, so I decided to stop confiding in him and because I knew my mum would tell my dad whatever I said, I stopped confiding in her as well.
Bullying
I grew up confiding in my friends rather than my family. Then I ran into problems at school. My closest group of friends at that time had begun bullying people and then eventually turned on me and bullied me. I guess that has built up a complex of rejection which I am still trying to tackle and get rid of.
Thoughts of suicide
I think I found life very painful because I spent most of the time feeling rejected, whether it was at home or at school, and I just thought it would be easier to be dead than to be alive. I did eventually confide in a friend about these thoughts she said that it was a phase that everyone went through, so I didnīt confide in anyone again after that.
What stopped me
One big fear I had was that if I tried to kill myself, I might not be successful and would end up brain damaged or paralysed or something like that. Also that my granddad loved me and that suicide would be something that would hurt God, which I didnīt want to do.
Parentsī difficult relationship
My parents didnīt always show love towards each other or communicate in a positive way. I donīt know whether that affected the way my brothers and I interacted with each other. I also had trouble with my parents arguing a lot from when I was about 15, which really upset me.
Self harm and eating issues
From the age of 15 to the end of secondary school/18 I didnīt feel depressed, but I did still have problems. I self-harmed and still had issues with food. When I got upset, Iīd get angry with myself because I felt unloved and therefore unlovable. Iīd criticise myself for every undesirable quality that I saw in myself and hit myself as a way of punishing myself.
Cutting
I didnīt know what that was then, but a few years later I read a magazine article about self-harm and realised that was probably what it was. Another time I was read about someone cutting themselves in another article and started doing that myself.
Sense of release
To start with it was to punish myself because I was angry at myself, but over the years it emerged that it wasnīt always about punishing myself but to get release because I felt so much emotion and somehow when I hurt myself, it brought relief even if it was only temporary and Iīd be able to concentrate on things again.
Shame
When I struggled with eating and with hurting myself, both made me feel very ashamed and isolated; like I couldnīt possibly confide in anyone because I was really scared that theyīd change their attitude towards me and wouldnīt want to know me anymore. That definitely delayed me seeking help for a long time.
Illness
During my first year at university I felt low and then I was ill a lot with glandular fever. I missed a lot of work and I ended up having to drop out of the year and start again.
Depression in second year
I passed the second attempt at first year, but then during my second year I suffered a series of bereavements and one of my friends attempted suicide. I was feeling ill and missing work again and I became depressed.
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Acceptance and help from others
Although when I was younger I did get support from some friends along the way, I also had friends turn against me. However, love and acceptance from church youth workers and one or two church friends did start to make a difference and help me feel more loved and lovable.
Counselling
It was when I started university that I started to get help and Iīve used the university counselling service quite a bit. I was terrified at first; I remember cancelling appointments at the last minute and feeling really nervous, but I did then go and I found it helpful for dealing with some of my eating issues and the earlier episode of depression.
Telling my housemate
The evening when my suicidal thoughts felt so overwhelming, I eventually told my housemate I was upset. As he comforted me, I gradually opened up. Unsure whether I could keep myself safe overnight, I let him read the innermost thoughts I had written in my diary.
Overcoming fear of rejection
As my own thoughts repelled me, I was terrified theyīd do the same to my friends, but I no longer felt like I had another choice if I wanted to stay safe. I didnīt know what would happen - I felt extremely guilty for burdening my housemate with what I had shared.
Practical suggestions for keeping safe
My housemate suggested ideas for making it safer during the night: hiding my keys from me so I wouldnīt go to the road and jump in front of a car, hiding razors so I wouldnīt slash my arms. I was still scared but was relieved that I was no longer fighting alone, and that I hadnīt been completely rejected.
Support from GP and counsellor
Over the next couple of days I showed my GP and counsellor my diary. They didnīt lock me away as I feared but helped me plan to stay safe, for example by making a personalised list of people and helplines I could call if I was feeling desperate.
Planning for safety
As I was having urges to overdose on medication, I gave my medications to a trusted friend to ration. I also came up with a couple of people who I thought wouldnīt mind me joining their daily activities if I felt it wasnīt safe for me to be on my own, and asked whether they would be happy for me to call them in such a situation.
Writing myself a letter
My doctor also suggested writing a letter from my `well selfī to my `suicidal selfī that I could read at times of crisis. It contains a reminder that things will get better again, reasons why I donīt want to kill myself, other options, and things I can do that might help. Iīve used it already and found it was very effective to read the words coming `from myselfī at that time.
Opening up to others
As I gradually told a couple of friends, to various extents, that really helped because it meant I didnīt have to put up a front and I was being my true self, letting them know what was going on which was quite a big thing in my life at that moment.
Clear communication with friends/housemates
Talking to my housemates to outline what would be helpful to me, what they felt they could/couldnīt handle, planning together where I could get the extra support, and where they could get support, made things a lot easier for all of us. They were able to phone the universityīs counselling service and we had one group counselling session after I had revealed I was feeling suicidal.
Medication
In both my episodes of depression medication has played an important role for me as it lifted my mood, energy and motivation enough to engage in therapy which I may not have been able to do alone. I am aware that many people can recover without medication but also know it can make a big difference.
Cognitive behaviour therapy (CBT)
I have been lucky enough to have two courses of CBT through my university counselling service. I have found the learned awareness and thought challenging particularly helpful.
Books and websites
I have also found CBT-based self-help books and websites extremely useful. These have included Overcoming Low Self Esteem by Melanie Fennel and the online CBT resources at www.cci.health.wa.gov.au/resources/consumers.cfm.
Rating daily activities
During my CBT sessions it was suggested to record the amount of pleasure and achievement I gained from each daily activity and to then build in more of the highly scoring activities into my day to lift my mood and self-esteem.
Planning pleasure and achievement into my day
These could be simple thing such as going to a lecture, emailing a tutor, going to the park to watch the children and animals play, having a coffee, blowing bubbles, even just cooking dinner when my energy was low.
Reviewing the positives in the day
As all my thoughts were naturally negative, I found it helpful to take 5 minutes at the end of the day to look for the good in the day: anything Iīd enjoyed (even if only a little), any good qualities Iīd displayed. This started to balance out the amount of time my brain spent focussing on the negative.
Taking stock
Even just listing what Iīd done in the day was helpful. My memory was awful, and I felt like Iīd wasted the day until I took time to concentrate and remember - Iīd usually done a couple of things. This made it easier to remember certain activities were semi-enjoyable when they recurred.
Giving myself slack
Realising that it was a lot harder for myself to do anything when I was depressed allowed me to lower my expectations of myself while I was ill, so that I didnīt constantly feel like I was failing.
Allowing others to give me some slack
I also spoke to my tutors and parents to let them know I was ill so that they could adjust their expectations of me. Although this was scary to do, it took a lot of pressure off and gave me more space to get better.
Confiding in parents again
I have started talking to my parents and confiding in them a lot more, which has helped. They tend to worry about me an awful lot especially since I have been physically ill and so I tend to be a bit hesitant about telling them the full story, but I do most of the time.
Being my own best friend
Telling myself well done for doing things which were difficult and treating or rewarding myself, for example by buying a book or nice body wash, or by watching a film or phoning a friend.
Relaxation exercises
I found relaxation exercises helped to calm my mind when I was really anxious or agitated. I found exercises on CD the most useful - both progressive muscular relaxation techniques and a `Meditainmentī CD.
Faith
I am a Christian and found prayer really helpful: both in being able to express myself and in asking others to pray for me. I also find remembering bible verses helps me to regain perspective and hope. However depression can make it difficult to read the bible and pray - Iīve found praying with others, or using a book of short prayers or devotions easier.
Mindfulness
I am currently learning about mindfulness techniques. In theory they sound like they will be very useful, in practice Iīve yet to discover....
Healthy habits
Simple things like fresh air, diet and exercise I know are really important and can have quite a big effect on me. Getting enough sleep as well. I notice if I have had lots of sugary foods rather than proper healthy food. If I drink alcohol when Iīm experiencing a low patch, it makes me feel worse and so I tend to avoid it at those times.
Taking it slowly
Things have improved gradually. I have been able to return to my studies, and to cope and enjoy things almost as normal. However tell tale signs still remind me that I am recovering and need to take care: my self esteem is still very low, and I still interpret a lot of what people say and do as evidence they donīt like me very much.
Medication side effects
My memory and concentration still havenīt returned to normal and I fall asleep when I sit down during the day - which my doctor thinks may be a side effect of the medication. However I feel like Iīm living again!
Blogging
I struggle to express myself orally, but when I write down my thoughts and feelings they flow much more naturally, and I have a sense of achievement for conveying difficult things. I hope participating in the blogring will encourage me to continue expressing myself in writing which will be beneficial for my own well being and hopefully also helpful for others.
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Find what works for you
I would recommend all of the above to others to try. We are all individuals and so different resources/strategies will suit different people. However I believe asking for help, and the strategies for managing thoughts of suicide are universally applicable.
Tell others and ask for help
Telling others shares the burden, and can bring the support of other people to help you fight the illness. It breaks down barriers which can be developed by the change in personality and behaviour which depression can lead to, and allows others to make allowances for you until you have recovered.
Plan how to keep yourself safe
I knew that during a crisis I would be unlikely to remember who I could call, so I saved my personalised list of people and helplines in a group called `helpī on my phone.
You are not alone
I hope my story and blog can be used by others as something they can relate to, which puts into words some of the things they have been struggling to express themselves. I hope that for some this may help them feel less alone and perhaps allow them to feel slightly more in control by providing them with a description they can use to verbalise the experience.
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