When I was little, my family took me skiing. I remember how heavy the boot rentals felt.
I quickly forgot the stiffness, weight, and awkwardness in the exhilaration of flying down a snowy mountain. So much that after several hours I became almost adept at walking in the ski boots. When it was time to go home and the boots came off it felt like the laws of gravity no longer applied. I felt light.
I have a new metaphor for depression. It feels like wearing ski boots. Without it, or coming out of it, it feels like gravity doesn’t apply.
I wrote the above in my journal the first week I started an introductory dose of Celexa, an SSRI prescribed by my psychiatrist for anxiety and depression. It took me years to seek psychiatric help for the anxiety and depression (and possible ADHD) I have lived with as long as I remember. Mental wellness felt like a fairytale. I’ve kept much of my mental health status on the down low, at least until I found myself on the upswing. I guess that’s what I’m still doing. It’s hard to be honest about how bad things are in the messy middle, when well intentioned concern from others is sometimes just one more exhausting thing to process and field.
I have a lot of mixed feelings publicly talking about taking meds. I want to avoid inviting commentary on my health choices. There’s still a heavy stigma about seeking mental health care, including in my own family. But I also feel so much better and want to talk about it. Hell, I want to celebrate. I’ve always been and want to continue to be the person speaking out about breaking stigmas. One of the lies depression tells us is that nothing will actually make us feel better, that depression is really normal. I want to give hope to anyone stuck in that space that things can and do get better. One of my friends (Kelly, also known as the spunky canuck on the interwebs) sharing about her journey to finding psychiatric care was a huge encouragement and inspiration for me. I want to pass that on if I can. My ancestors on both sides have histories of mental illness, and I am doing my damndest to slay our generational foes.
A few years ago I made an Instagram post where I discussed my fear of needing depression medication that could result in weight gain. I noticed that I was prioritizing my aesthetic over my actual health. I wasn’t taking any meds at the time, but my mom saw the post and very seriously asked if I was. She then shared how a mutual acquaintance had experienced depression as an adult for the first time and “just ran right to the doctor.” Like she was selling out. My mom has experienced depression most of her life too. The context is somehow we are stronger for suffering more. We show up and hustle in ski boots every damn day. But you know what? It does none of us any good. Knowing what I know now, I wish I’d had the support of medication during that period of my life. My job was beyond stressful. I had actually called my telehealth service with insurance one day because I felt an anxiety attack brewing, and the doctor on the other end chided me for not being grateful that I had so much in my life together. He pushed me over the edge into tears and hyperventilation. I still had to pay 40 bucks.
Years before this, I was at a rare primary care appointment for bronchitis that wouldn’t quit. The nurse asked me if I had a history of any health conditions. When I told her I had depression she asked “do you really want me to put that in your chart?” If the nurse or doctor had asked more about my history, they might have discovered that I was in the gym every day, refusing to take breaks, and that was why I was run down and getting sick. The gym was “therapy” after all. The gym was the place I felt powerful and in control, and my body paid the price. But no one noticed because working out is healthy, right? Commitment is to be celebrated, right? Pain and sinus and bronchial infections are just one more thing to push through, weakness leaving the body, right?
Every time I thought about seeking more support for my mental health (besides therapy or working out excessively) this was the first associated memory in the queue.
Do I really want that in my chart? Isn’t everyone actually depressed? Am I really going to bother busy and burned out medical professionals with this when there are people so much worse off?
I’ve written pretty detailed accounts of seeking therapy in my book Dear Sister. Going to therapy is a fundamental part of mental health care, and it’s a practice I will probably continue on and off for the rest of my life as I have need for it and access. But therapy only covers one approach. This is something I feel like most people don’t talk about. Therapy is often the magic answer we want to offer anyone struggling. Well, have you tried therapy? What happens when you have? When you know the answers and can reframe the shit out of difficult situations and you’re still depressed as fuck? What happens when you have the house plants, the light lamps, you take the morning walks, the vitamin D, and you still have seasonal affective disorder?
2020/2021 winter might be the worst seasonal depression I’ve experienced. It was a mix of serious pandemic fatigue as a healthcare worker and the usual seasonal affective disorder thanks to the short days and Connecticut winter. I was trying so hard to make the smartest and safest choices around the pandemic. I was continually witnessing what seemed like everyone else making choices I’d given up for the sake of communal safety. Going on trips. Seeing family. I was isolated, hopeless, and deeply depressed. I remember thinking if this is how we’re going to be living now what’s the point? Throughout my entire life of mental illness I have never been suicidal. That stray thought floating through my mind was a huge red flag. This thought meant my depression was far worse than I had admitted. Spring happened, vaccines came, and I regained some of the things I’d lost. I visited my family out of state. Two of my best friends planned trips to visit me. I felt so much better, but I knew another winter was coming and I needed to be better prepared.
I joined Tiktok at the beginning of 2021, and if any of you are on that app you know the algorithm is very specific. Within probably a month it was showing me a whole lot of ADHD content. I related but still wrote it off as how everyone feels. In May Chris and I went on a vacation for our anniversary. During the trip my inattentive dissociation was in full swing. I was exhausted when we left, and constant one on one time with my partner was highlighting how difficult it was for me to stay present. When I was 11 or 12 my mom gave me a book about organization called “The Messies Manual.” What caught my attention was the ADD / ADHD checklist that Sandra Felton included. I very seriously brought it to my mom and told her I thought I had ADD because I fit all of these items. My mom told me those were things everyone experiences and I dropped it.
I’ve done enough inner child work at this point to know situations like this are sticking points for a reason. I also started piecing together all my seemingly unrelated behaviors, like obsession with five million hobbies, trouble with impulse control (ahem online shopping,) dissociation, and challenges with time management and what people often term “executive dysfunction.” It all fits. I decided I wanted to get evaluated for ADHD, and started looking for providers that could help.
Finding psychiatric practices that did ADHD evaluations and took my insurance was a nightmare, especially during a pandemic. Many of them weren’t taking new patients, didn’t return calls or emails, and those of you with mental illness or neurodivergence of any kind can empathize with how hard it is to make those calls and send those emails in the first place let alone follow up. I also work at a medical practice. The last thing I want to do on my off hours is make my own appointments and navigate health systems as a patient. But this is an important form of self care. It’s not sexy, it’s not fun, it’s not bubble baths and shopping sprees. I finally found a couple practices that were accepting new patients and took my insurance, but they required a referral from primary care which I also didn’t have.
If pandemic life has taught me anything, it’s that stepping up my self care includes my actual medical care. I needed a primary doctor anyway. My association with primary care offices though was the nurse asking me “do you really want that in your chart?” How could I find a primary doc who would understand the importance of mental health and not blow me off? How could I get over my own fear and ego to prioritize my mental health care enough to take a provider's time to discuss it?
I settled on searching for queer affirming practices, since mental health is a huge factor in LBGTQ+ community and affirming or queer providers generally understand the gravity of mental health challenges. I also want to patronize intersectional communities and businesses with my dollars (whether they’re insurance or not) so this was a great option. It’s been one of the best choices I’ve made for my health and mental health. If you’re in CT, the doctors and staff at Anchor Health Initiative are amazing. I had my first visit with a nurse practitioner via telehealth. She included a depression and anxiety screening in that visit and then someone from the referral department reached out with a full list of psychiatrists and therapists for me to pick from that took my insurance. I also went for basic blood work which I hadn’t done in years, and set up an appointment for an in person physical. I called Liv Well Behavioral Health from the list the folks at Anchor sent me, filled out copious intake questionnaires, and finally established care with Dr. Carter.
Every step on this path has felt so affirming.
Affirming that my mental health actually matters, enough to take time, energy, and money to support. Affirming that my mental health matters enough to take the time of healthcare providers. Affirming that these healthcare providers are happy to support me.
It turns out Dr. Carter was far more concerned with my chronic anxiety, depression, and trauma scores than she was with possible ADHD. Your trauma scores are pretty high, did you know that? I shift my eyes and say Yeah I figured. Dr. Carter ordered genetic testing for me to see how my body metabolizes different medications. She spent time educating me about how different kinds of psych meds work. When my results came in, she took almost a full hour to go over what they meant and how she read them with me. Then the moment of truth came. She suggested Celexa.
Even after all this, I was anxious about trying it. I had the results in my email saying it was a great match for me. I had an experienced provider supporting me and it was still scary. I started an introductory dose on 12/30/21. The ski boot effect wore off after about a week because it wasn’t a therapeutic dose. But it was enough to give me hope that I could actually feel and function better. The trial went great, and I started my therapeutic dose 2/2/22. My mental health work is far from done. I still have trauma to address. We still need to talk about ADHD. But ADHD has a lot of crossover of presentation with anxiety, which my prescription is addressing.
I feel so much better. I know this is the beginning of my journey, that the effectiveness of meds ebb and flow. This is not everyone's experience. I was afraid of having to try multiple different meds to find one that worked for me. I was afraid of so many side effects that are possible with SSRI’s and other psych meds. I’m not minimizing the struggle that many people go through, or saying meds are for everyone, but I’m saying that it can be worth it. Sometimes it works out. I am also incredibly lucky to be in a state that has awesome options for both physical and mental health care. One of my friends also uses Cerebral and loves them.
I know this is long, but I wanted to share my whole story, because our mental health journeys are really complex and layered. We talk about stigma a lot, but not how it comes at us from all sides. From family, sometimes religious structures, cultures of origin, and even our own medical communities. I had to deal with my own personal blocks to taking meds too.
Up until starting meds, the idea of taking something felt like giving up or quitting. But actually starting meds felt like unclenching my hands from a steering wheel as a storm clears. I’m still driving, but I can see better. I can breathe.