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My Life With Major Depressive Disorder III - Lisa Velkoff
This post is part of a blog series called “My Life with…,” written by NUAM members regarding their experiences with mental disorder. The series will come in the form of weekly posts and one-time columns. This is part three of Lisa’s series: My Life with Major Depressive Disorder.
After having thought about it for a long time, I finally started therapy in the beginning of February. I’d never been before, and I was nervous as I walked into that first session. I’d started wondering if therapy would be a good idea more than a year before, based on a lot of things. I felt like I had things I needed to process (personal, relational, and family issues), I’d taken a class on psychopathology where we’d discussed the efficacy of therapy, and I’d finalized my commitment to psychology, as a major and as a career choice. Once I had firmly decided that I plan to get a doctoral degree in clinical psychology, I thought that it might be good for me to experience psychotherapy from the other side. And as a member and co-president of NU Active Minds, I’d spent a year advocating for mental health and encouraging people to feel safe entering psychotherapy. It was time for me to practice what I preach.
So as I said, I was anxious walking into that first session. No particular fears, just apprehension about a new experience. I walked out fifty minutes later feeling elated. This was going to be good. I could feel it already. I loved my therapist. She was warm and friendly, she asked the right questions and listened carefully, and we’d formulated some goals for therapy.
That first session, she asked me, after taking a family and personal health history, “what brings you into therapy?” I took a deep breath and started explaining my history with depression, and then suddenly my mouth had momentum. With the same kind of relief that comes after you’ve finished a big final exam, I told her about all the things that have added stress to my life over the past year or so. She listened calmly as I battled to find the right words to explain what I saw as my “crazy,” the name I’d given to my collective neuroses and stressors. I breathed out my anxiety about family tensions (which I won’t share here out of respect for privacy), my fear that relationships had changed while I’d studied abroad in the fall, my nervous apprehension for my post-graduation plans.
It was such a relief to just acknowledge, all at once, the things that had been claiming my mental and emotional energy. Having heard myself list them out, I thought for a moment “Lisa, you’ve got a lot to work through here.” My therapist expressed a similar thought, telling me that any one of my stressors might be reason to enter therapy, and that my entrance into therapy was well-warranted. I also felt some anxiety at seeing my laundry list of concerns laid out like that—how was I ever going to sort through it all? She reminded me that I’d already take the first brave step, just by being in her office.
I hadn’t been expecting therapy to be easy, and it hasn’t been. In my two months of weekly sessions, I’ve had to face some of my own most serious disappointments and struggles with myself. I’ve had to learn to acknowledge things that I don’t like about myself and the way I face relationships, but I’ve also learned strategies to help me foster more positive relationships with the people in my life and to change things that I think need changing.
I think the therapeutic relationship is a very special one. It’s a professional one, but given the situation, it’s also very personal. I feel supported by my therapist—she encourages me to recognize positive things about myself, cheerleads as I make small positive improvements each week, and helps me to set goals for more personal growth. There’s a definite freedom in the relationship—I’m lucky to feel so comfortable with her that I don’t worry about sharing things with her, like I might with some other people. I don’t expect unconditional approval—if I were to do something that isn’t good for me, I know she would say something about it. She’s already done that, remarking that it’s her job as a therapist to help me recognize when my behavior isn’t helping me. But I can expect unconditional support—even when things are tough, I know that she’s someone who will help me through to a better place.
I’m picking up on some of the things that I’ve noticed her doing that work, and I’m taking notes on these for my own future as a therapist: letting me speak something through alone without filling in my pauses—it’s often after I’ve stalled in the middle of a sentence that I say what I’m really thinking; relating to my own concerns with an analogous situation of her own, or with psychological studies or theories that might help; guiding me as I make decisions of my own.
In a psychology class I took in the winter, I remember that one of the readings was something written by a woman recovering from anorexia nervosa and who later went on to become a clinical social worker. She said that one of her mentors, when talking about the task of a therapist, said that “so much of our work is just sitting with people and holding their pain…Not taking it away, or trying to erase it, but acknowledging that it exists” (from the book Going Hungry: Writers on Desire, Self-denial, and Overcoming Anorexia, in the chapter “Little Fish in a Big Sea” by Sarah Haight, p. 194). It’s nice to have someone hold my pain while I think and cry about it, and I look forward to someday offering that same support to other people.
My Life With Major Depressive Disorder II - Lisa Velkoff
This post is part of a blog series called “My Life with…,” written by NUAM members regarding their experiences with mental disorder. The series will come in the form of weekly posts and one-time columns. This is part two of Lisa’s series: My Life with Major Depressive Disorder.
We’ve all seen those commercials for Zoloft on TV—the ones with that weird blob-thing (is it an egg? a rock?) that seems to be capital D Depression. It oozes around sadly for a while in its depressed ooblecky-ness, and then (after a brief explanation of how SSRIs work) magically starts bouncing around, chasing after butterflies and enjoying the company of other limbless blobs.
Zoloft is only one of many SSRIs (selective serotonin reuptake inhibitors), which some statistics say are the most prescribed drugs in America. Other common SSRIs are Prozac, Paxil, and Lexapro, and they’re a class of drugs that have come to mostly replace MAOIs, one of the first antidepressant medications. MAOIs have some pretty severe side effects and can limit what a person can eat and what other medications they can take, so when SSRIs appeared and were shown to have fewer side effects, psychiatrists (and patients) were relieved.
Which isn’t to say that SSRIs don’t have side effects. They do. One of the most serious of which is increased suicidal ideation in children and teens. Most researchers agree that antidepressants should not be the only form of treatment for a person with depression—they should be used alongside psychotherapy (usually cognitive behavioral therapy, CBT) to help a patient out of depression.
That’s not the path I went. My psychiatrist suggested therapy, but I was too scared at the time to face the challenge of therapy, so for six years, I treated my depression exclusively with Zoloft. We’d chosen that one because it had worked for my mother.
It was such a relief to start taking those little blue pills. One and a half, 75 milligrams, and I felt like myself again. Well, sort of myself. Myself with odd dreams, and insomnia. I still didn’t feel motivated to get myself to my dance classes. I was happy to not fall into helpless tears every day, but I didn’t feel like any of my emotions were as strong as they’d once been. Why didn’t I have that flying-high, I’m-a-teenager-and-I’ve-got-the-whole-world-at-my-feet delight anymore? Why couldn’t I cry when I watched sad movies that used to make me weep, like My Girl or A Walk to Remember? It felt like, if my normal emotional range had stretched from -10 to +10, and while I was depressed that went as low as -20, suddenly it only went from something like -6.5 to +6.5. I didn’t like losing my emotions. I wanted to stop feeling depressed, not to feel numb.
But those weren’t terrible side effects. I could live with those, if it helped me to be myself. I didn’t have problems with nausea or fatigue or tremors, and the sexual side effects were no concern at 15. It was better to be a little emotionally foggy than depressed.
I’ve always been ambivalent about taking medication. At first, I really hated the idea that I had to depend on medication just to function normally and feel like myself. It felt unfair. More than once, I’d stop cold turkey, on my own decision and not guided by my psychiatrist. My depression would always show up again within days. Not necessarily the agonizing sadness and tears, but irritability (snapping and my family and friends for the smallest things), even worse insomnia (lying in bed for several hours, unable to sleep), and anxiety (I’d suddenly realize that I’d been gnawing on my fingernails and cuticles) came back. So I’d always end up back on the medication, knowing that it helped me to function while still hating it.
My most recent attempt at going off the medication was in December. I studied abroad this fall and had enough Zoloft for the semester, but my psychiatrist had closed her practice by the time I got back. I had nobody to provide me with a prescription, and I decided to try going it alone. I did well for a few months (during which time I started therapy, something I’d been thinking about for a while) but mid-February, the symptoms started coming back. I was irritable. I was grumpy and tired (I could nap a whole weekend afternoon away). My fingernails were chewed raw. I tried to fight it, thinking that I could just will myself not to be depressed, but I was. I knew it when I’d look at my to-do list and burst into tears, feeling terrified by the challenge and crippled by my anxiety.
My therapist referred me to a new psychiatrist, who, after a very thorough intake interview, prescribed me Wellbutrin. It’s not an SSRI; it works differently in the brain, on norepinephrine, dopamine, and serotonin. It doesn’t cause weight gain like SSRIs can, fewer people report emotional numbing, and, as they’re more than thrilled to say on their website, it does not have the same sexual side effects and may in fact be effective in treating sexual dysfunction. They’re still figuring this drug out, but they know it has been effective in treating depression, and I’m hoping this might be a better solution.
I’m still working through my ambivalence about medication. I know it’s effective and I’ve seen it work in myself, but my ultimate goal still remains that someday, I’ll be living without antidepressants.
My Life With Major Depressive Disorder I - Lisa Velkoff
This post is part of a blog series called “My Life with…,” written by NUAM members regarding their experiences with mental disorder. The series will come in the form of weekly posts and one-time columns. This is part one of Lisa’s series: My Life with Major Depressive Disorder.
Hello, blogosphere! My name is Lisa Velkoff and I am a junior at Northwestern University. I’m majoring in Psychology and English, I’m 21 years old, and my spirit animal is a koala because I love hugs and they look like they’re always hugging. A week after my 15th birthday, I was diagnosed with major depressive disorder. It was the beginning of March in my freshman year of high school, and it felt like the end of the world.
I’d like to start by explaining, clearly and clinically, what depression is. I know we’ve all received a lot of messages about depression, but after my diagnosis, I got a little obsessed with knowing about this condition I had, and it seemed to matter a lot that I know all that I could about it. Major Depressive Disorder falls within the category of Mood Disorders in the DSM-IV-TR, an umbrella that includes bipolar disorder, dysthymic disorder, and cyclothymic disorder.
This diagnosis demands the presence of at least one major depressive episode, which includes elements beyond depressed mood, such as fatigue, significant changes in weight, loss of interest in once-pleasurable activities, and psychomotor agitation or retardation. Symptoms must have been present for at least two weeks and cause clinically significant distress in the patient. Over the course of his or her lifetime, 5-12% of men and 10-25% of women will experience MDD (clearly, women are about twice as likely as men to receive this diagnosis). Among first-degree relatives, MDD is 1.5-3 times more common than among the general population, and approximately 50-60% of individuals who have one Major Depressive Episode are expected to have a second.
So here we are, all on the same page about what a diagnosis of Major Depressive Disorder means. But that tells very little about my life with depression, which is the point of this blog. So here’s what my first depressive episode looked like.
It was the fall of my freshman year of high school when things started getting bad. At first, it wasn’t huge things—I gained some weight, but that could be explained by puberty. I was tired often, but who wouldn’t be, having to wake up at 6am to get to school by 7:30? I was irritable and I snapped at my family members, but I was fourteen and supposed to be angst-y. I found that I didn’t have the energy to get to my classes at the dance studio in the evenings, even though I’d just started dancing on pointe and felt over-the-moon proud of myself. That was hard to explain—I’d taken my first dance class when I was two, and it was hugely important to me. And I was also crying a lot. More than I’d ever cried in my life. The smallest thing would make me burst into tears, out of sadness or anger or frustration or just feeling overwhelmed by the task of living. At the worst point, I would find myself bawling in my room for hours every day—those kind of tears that make it hard to breathe and make your throat sore and give you the feeling that you’re going to throw up because you’ve wept out all the tears you can and your body just needs to rid itself of the horrible feelings inside.
I knew I was depressed. At some point, I knew that my daily agony wasn’t the way adolescence was supposed to be, and that I was suffering more than I should have to. But I didn’t say anything to anyone. I felt terrified by the idea—my mother had been depressed often and was taking Zoloft. I didn’t want to take medication, and I didn’t want to admit that my mood had somehow gotten out of my control. I didn’t want to have to see a psychiatrist. I didn’t want anything to change, and it felt like maybe, if I just kept quiet about it, the problem would just go away. Finally, the day after my fifteenth birthday, my mother came home from work and found me curled in a ball on my bed, sobs ripping through me. She said to me that she thought I was depressed (my mother is a clinical psychologist) and wanted to take me to the doctor. I agreed, relieved that it didn’t have to be my choice, and thankful that she saw and understood what was happening to me.
We went to my pediatrician (it felt so wrong and unfair that someone still seeing a pediatrician should have to deal with something as adult as depression) who referred us to a psychiatrist who worked with adolescents.
At my first appointment with her, I sat on the couch with my mother and answered a barrage of questions while she took notes on her clipboard. “Lisa, have you been feeling sad lately?” “Are you experiencing any psychomotor agitation or retardation?” “Do you feel sluggish or uninterested in things you used to love?” “Do you find yourself thinking about suicide?” “Are you constantly worried or anxious?”
My mother contributed answers that I didn’t know about family history, and gave her perspective on what my months of suffering had looked like from outside. My psychiatrist talked with me about my treatment options: psychotherapy, medication, or a combination of the two. I remember being scared at the prospect of being in therapy, so I said that I felt like medication would be a safe bet, considering that it had been effective with my mother. I walked out of her office with a prescription for Zoloft, which I started taking the next day.
That was six years ago. I, my depression, and my methods of treatment have changed since then. I’ve learned a lot about myself and about depression and I feel like sharing my experiences here will be therapeutic for me. I hope as well that it might help someone else to understand and learn to deal with depression.
My Life with Schizoaffective Disorder IV - Katie Sanford
This post is part of a blog series called “My Life with…,” written by NUAM members regarding their experiences with mental disorder. The series will come in the form of weekly posts and one-time columns. This is part four of Katie’s series: My Life with Schizoaffective Disorder.
I did it! That’s right! I danced for 30 hours and I survived! I’m pleased to say, I haven’t been the slightest bit manic, depressed, or psychotic. I’ve been sore, and happy, and that’s about it. And Dance Marathon was nowhere near as hard as I was expecting!
I had been expecting to get tired every time I took one of my meds that usually makes me drowsy, but I didn’t. In fact, I only took 3 halves of Adderall the whole time, and I didn’t take the first until 4am. I was expecting to go through half the bottle. Probably largely thanks to the Adderall, I never truly hit a wall or crashed. I watched most other people get to a point where they were dragging and wanted to go home, but not me (or the amazing Paula, that girl’s got energy despite being sick!). I felt most tired when we laid down with our feet up on break after block 5, but once I got up, I was fine. Other than sore feet and knees, I felt really good while we were dancing. Whenever they stopped us to talk, I could feel the pain throbbing, but once we got dancing again, I was fine.
My boyfriend was a godsend, bringing my duct tape when my backpack ripped, icy hot when my knees started to hurt, deodorant when I ran out, and always bringing a smile and a kiss. Oh, and especially for picking me up in his car when it was over and basically waiting on me hand and foot one Sunday. I couldn’t have done it without him, that’s for sure.
It was a truly moving experience, listening to the kids and families supported by the B+ Foundation speak to us, and knowing that somewhere in Norris, the finance committee was counting up all the money that we had spent months raising and that would soon go to such a good cause. I don’t know how many times I started to cry, though I never fully burst into tears. I was pleased we were helping the Evanston Community Foundation, too, and I loved hearing their stories. It’s nice to know we are helping on a local level. And when they revealed the final amount we had raised, it was overwhelming. I couldn’t believe I was a part of something that had done that. I felt a bond with everybody there, not just the wonderful people I had been dancing with. It was one of the best feelings I’ve ever felt. I always knew DM was something that every Northwestern student should do at least once, but now I truly understand why. There’s nothing else quite like it. I was proud to have done it, and, though I had originally thought that this would be my only year dancing and that I would go back to just being on committees next year, it was so much easier than I had expected, so, who knows, maybe I’ve got another year of dancing in me.
At the very least, I’ll always have the pictures and the memories, and yes, it’s true, I did accidentally rub toothpaste all over my legs because I thought it was Icy Hot since I didn’t look at the tube that I pulled out of my bag and had forgotten that there was even toothpaste in there to begin with. I’ve even got a picture of it. But, hey, it was a long night and day and night again, so I think I’m allowed to have done something stupid.
So thank you to all the friends, family, committee members, dancers, and everyone else who made my first time as a dancer so unforgettably wonderful. I appreciate it from the bottom of my heart.
On another note, I saw my psychiatrist this week, and he said he was very proud of me, not just for making it through DM, but for speaking up about my illness. Not only am I promoting a positive image of mental health, which I love, but it’s also a sort of therapy for me. For example, I am in intro to drawing, and for my final project, I took a risk and drew some hallucinations that I’ve had. It was a risk because I was worried it might bring up unpleasant memories, but also because I had to explain it to the class, and, the thing is, the people I usually tell about my disorder are either close to me or psych majors who are interested in mental health. It was really scary to tell all these virtual strangers about it without having any idea how they felt about mental illness. But you know what, it was a really good experience. Drawing it didn’t stir anything up, it was actually more like putting it to rest. By making them just a picture, it was like an assurance that they weren’t real and couldn’t hurt me. Like I had the control over them, not the other way around. And the class was really cool with it and seemed to like it, as did my professor. It was a good reminder of why I take risks like this, because, though they are scary at first, they usually turn out really well. So I guess that’s my advice to you right now, take a risk. It may very well turn out better than you think it will!
My Life with Dysthymia II - Celeste Mora
This post is part of a blog series called “My Life with…,” written by NUAM members regarding their experiences with mental disorder. The series will come in the form of weekly posts and one-time columns. This is part three of Celeste’s series: My Life with Dysthymia.
Hello everyone! I hope the last week of classes finds you all happy and healthy! This week I’ve decided to discuss why I no longer take antidepressants. Let me preface my opinions on antidepressants by saying that I think they are a wonderful invention. There are many people living with dysthymia who feel more like themselves on antidepressants, and for some people, they are a godsend. Also, despite my poor experiences with psychiatrists, allow me to say that psychiatry is a noble profession, and I know many people who are helped by it. Also, what I am about to say only pertains to my own condition and life. If any of you are considering antidepressants, do not let my story deter you.
And with that, let me tell you why antidepressants do not work for me.
I was first put on Lexapro when I was a junior in high school. At this point, my therapist thought I had major depression, and the drug was simply a means to make me feel better for a time. I was personally thrilled with the idea of taking one pill a day and feeling the happiness I saw in others. Sadly, antidepressants do not work for several weeks, and when they do, they have different effects for different people. My teenage brain did not understand this, so when I started taking the little white pills, I was troubled when I didn’t turn into that girl from Clueless instantly. When the antidepressants did kick in a few weeks later, I started feeling both relief and side effects. I did feel more motivated, and I had fewer days per week where I cried for hours on end. I also felt foggy and found that I was unable to cry, even when I felt sad at appropriate times (like watching The Notebook or losing a pet). I was not thrilled with this side effect, but I figured that I would mellow at some point and the ability to cry would return.
Sadly, I never regained the ability to cry, and I started feeling hungry. To this day, I have never felt as hungry as I did on Lexapro. It started as a nibbling feeling, but soon spiraled into a gnawing hunger that I could only relieve by eating ungodly amounts of food. Even then, I was never truly full. For a girl who has struggled with her weight since she could walk, I was not thrilled at the 20 pounds I gained in a summer. Luckily, at this point my bout of therapy was helping me work through some issues, and I felt well enough to try to taper off the Lexapro after having been on it for around 8 months. A word to the wise, if you ever decide to go off antidepressants, taper off exactly as your doctor prescribes. I quit Lexapro almost cold-turkey the first time, and the withdrawals were intense. Suddenly I was crying all the time, and had weird moments of panic that I couldn’t explain. By the time I was headed to college, though, I had made it through most of the withdrawals and was feeling good.
I will explain in a later post about my freshman year at NU, but for now I will just say that it was not at all healthy. I tried to party my way out of depression, but only felt worse afterwards. This culminated in the scene I described in my last post, where I was sent home on “medical leave” and eventually sent to psychiatrist. The psychiatrist talked to me for probably 5 minutes, and although she was nice, she did not really listen to my objections to Lexapro. Instead, she prescribed a higher dose, thinking that it would alleviate some of the side effects, and sent me on my merry way. I was not pleased, but I had hit rock bottom at this point, so I didn’t have much of a choice.
My second round with Lexapro showed what it could really do in the side effect department. I was foggier than before, still had trouble crying at appropriate moments, and the hunger came back. Or, to be more accurate, the hunger multiplied. This time, I tried to go back to the psychiatrist to explain these problems, and she responded by putting me on Topamax. Topamax is an older antidepressant that isn’t usually prescribed anymore, and with good reason. I had to take the drug before bed because one of the symptoms is fatigue, and not 5 minutes after consuming the pill, I would be knocked out. It did help me feel less hungry, but it also made me high. I do not mean “high” in a cute, “dude where’s my car” kind of way. I was so dizzy that I once fell over doing yoga—when I was in child’s pose. I also could not focus in class and would often lose my place in the middle of a sentence. The worst side effect of my side-effect-reducer, though, was the tingly hands and feet. I still deal with this from time to time today (even though I have been off of Topamax for almost 2 years now), and it feels like my hands and feet have just woken up from being “asleep” combined with a stabbing-with-a-needle kind of sensation. This really isn’t pleasant on a day-to-day basis.
Eventually, I had hit my limit with attempting antidepressant side-effect control. I told my therapist that I was going off the drugs, and since I had made significant progress at the time, she approved. I am proud to say that I have been off antidepressants for almost 2 years now, and I have never felt more alive. While I do still struggle with motivation, having “down” days, and crying whenever I feel strong emotion, I feel that these symptoms are much better than the side effects I get from drugs. I work very hard every day to keep myself healthy without drugs, and that often includes going to therapists and other psychological professionals to talk things out. Also, I have found that going to bed early and waking up early helps my mood considerably.
While I would like to say that I will go back on antidepressants at some point in my life, I doubt that I will ever return to them. I have found that having a good support system and a therapist on call works much better to keep me stable in the long run than some bottle of life-saving pills. I have made a choice not to go back to antidepressants, and so far, it has paid off.
