Against the odds (with a 50% chance of relapse within 1-2 years, according to the Institute for Quality and Efficiency in Health Care1) and against the recommendations of my mental health team, I tapered off psychiatric medication and stayed well — well, mostly. Let me put it this way: I have managed to avoid another admission to an acute psychiatric hospital ward, since my last encounter with psychiatry which was about three years ago. It hasn’t exactly been a straight path, and I wouldn’t encourage anyone to make a decision about discontinuing antidepressants (or any long-term medication) without consulting a health professional or without support in developing a robust alternative health and well-being plan.
Here follows a brief look into my rollercoaster journey of recovery, returning to work, having my trauma re-triggered, finding a way through, and finally living well. It no longer matters that I have not remained entirely symptom free. The fact that I have had further experiences of altered perception is no longer relevant. What does matter is that, despite having experienced distress again, I was kind enough to myself in allowing and claiming some space to heal.
Starting work again was interesting. After my first day back, last year, I did not make it home. We were being evacuated due to fires near our house. The noise from the helicopters was triggering for me. The first ‘warning signs’ started with me becoming noise sensitive and feeling unsafe and monitored, like I did while being an inpatient. During that time, a helicopter had flown above the ‘caged’ unit, peering down on us patients like identifying wild animals waiting to be darted, with us not knowing whether we would ever be set free. So I got scared again with these traumatic memories erupting. I was back in the cage (in my head) and I couldn’t get out, the fires were getting closer, and I needed help again.
Despite the timing being right for my return to work — my youngest at the time had just started school, and I felt I needed another challenge — once again I found myself in a place where things were getting on top of me. I was hardly coping. What was different was that I recognised this and took steps to act. I knew what to focus on instead and continued to access people who would validate my experience. I had some clearer ideas by then of what I needed to try to do to get better and I would be able to tell others what I needed.
After a distressed phone call to Healthline, in desperation I briefly restarted the antipsychotic medication that I had left in the cupboard. I took them for two days and felt side effects that further triggered bad inpatient memories, so I decided to abandon it. My throat was extremely sore and I would do anything to make it stop, so I stopped the meds.
This stop/start fashion wasn’t meaningless. I remember clearly thinking, “I’m done. I’m not putting myself through this again.” I was encouraged by the Healthline worker to see my GP and do the basics: keep drinking water, try to breathe and remove yourself from the situation if you can (which was very useful advice). I wasn’t going to settle for the side effects of a marginally better than placebo treatment again. So I continued to do the basic stuff: rest, drink water and breathe. Mostly these things worked. It was that simple, initially. That of course being a short-term strategy, but effective for survival, I also went to see the GP as advised — who, aware of my history of reacting adversely, was appropriately hesitant to put me on antidepressants. I asked about Circadin (prolonged-release melatonin) and within a couple of days my healthy sleep rhythms returned. They also referred me to brief intervention counselling.
Following hopeful inspiration and continuing to draw on all my supports, I started to recognise my needs (for quiet, space, and a little bit of solitude). I found healing in discussing my unresolved past with a helpful mental health professional through the programme I was referred to. I remained active in raising awareness about mental health issues and kept checking in on my life priorities.
I connected with other affirming people, which included a friend (with lived experience of depression and trauma) who provided social and practical support, and my employer, who also was well informed about trauma.
I meditated, did restorative yoga (gifted from a friend who knew of my previous distress), and grew in confidence as I learned how to really look after myself. I started saying “No,” guilt free. I accepted help… and helped others… but not compulsively. Self-compassion remained my priority. I started paying mindful attention to the state of me — whatever it was at the time — and focussed on what I needed to do to keep on living well. I got to the point where, dare I say, I was flourishing at times.
Shortly after this I was back at work again, feeling as if I was really making a difference in people’s lives. Then I got pregnant. I wanted to complete my family while living healthily, but I was fearful of what could happen again as I was told by psychiatrists that I was high risk for severe depression in the future. I realised that I needed to remain the one in charge of my future. I had to take responsibility for ensuring it didn’t happen again.
So, after sharing my pregnancy news at work, a colleague told me about a nutrient trial (for pregnant women) and I wanted to participate as I read about the research with other groups of people including those affected by earthquake trauma. I was motivated to try anything that didn’t mean having to put up with side effects. I figured meds were not that great of a treatment, at least for me, and I needed to find alternatives. In saying this I acknowledge that for 40-60% of people with depression, meds are claimed to be effective… that is, up to 20% more effective than placebo. What I’m suggesting though is that for the remaining 40% who do not feel well on antidepressants, there is a need for health professionals to be proactive about identifying and suggesting other options, especially if medication did not make a difference and if becoming or remaining medication-free is a goal of the individual.
Once I was on the nutrients, there was an improvement in my ‘ratings’ on the mood questionnaires and interviews I took part in monthly. Less distress… further spaced-apart “episodes” that I became quicker to recover from, and generally better-regulated emotions. This was hard to trust, initially. My thoughts were still very negative and I would catch myself regularly ruminating on what I had been told: that I just couldn’t expect myself to ‘recover’ and stay well without meds, that the stats were against me… that is wasn’t possible.
My newly improved state started to make sense after I reviewed my hospital notes again — this time with a nutrition lens on. They found low potassium, which I learned impacts brain functioning and therefore could contribute to psychosis. I was eventually treated for the low potassium during my admission, but I wonder why they did not start there. I often questioned whether I would have needed invasive ‘treatments’ at all had they first enabled me to gain optimal nutrition, enough rest and time to meaningfully connect with the people around me. So I kept at it, continued the trial which was open label by that stage, and continued my yoga routine, gratitude journaling, meaningful work, spending time with my family, preparing for the birth, and working out a plan to manage on a practical level which resulted in the decision to enlist the help of an au pair. The brain fog started to clear and without it, problem solving and decision making became a lot easier.
By the time my baby was born earlier this year, I was elated. I was a third time beginner… yet I was wiser. I had another chance to grow in my competence and capacity to maintain a well state through another significant life change.
I chose to continue to take the nutrients and learned to accept offers of help from a supportive community of strong people, mostly mothers, around me. My thoughts started to change — I’d be able to see the funny side of things, draw on times when things were good and ask myself how I could best continue to support myself and my family.
Since coming off meds and learning to live well, I have few regrets… and can continue to learn from the ones I do have. I have organised my life in such a way so that I can have some child-free time: i.e. solitude, a basic human need I had expected myself to go without in the past (and a need that remains unmet for so many other parents). I’m not expecting myself to be “independent” though. To raise my children well, I need to be interdependent, maintain an equal relationship with my husband and care for myself. I realised no one was meant to do this alone. Finally my relationships are healthy. Love is healing my broken heart. I continue to inquire internally about ways to be kind to myself and others. About what I need to do that would further support me on this journey of working on my parenting and other relationships, growing in confidence and living a life that is meaningful. I regularly review who I can connect with to support my well-being and who I need to stay away from.
Connecting with those with lived experience, and being open about it, really helped. Before I started sharing my story, I was oblivious as to how many of us were struggling, or have struggled at one point or another in our lives. We share suffering as part of the human experience. It is unfair that women (I think especially mothers) are significantly more burdened than men, though, and the gender gap in depression continues to exist.2 It is unfair that the “go to” treatment excludes a significant proportion of people who experience depression. The mental health system needs to embrace innovative ways of viewing and treating what is termed “mental illness.” I am hopeful that the mental health inquiry here in New Zealand will build momentum for service providers to reflect on recent research — for example the effects of nutrition on mental health, and Open Dialogue — and change their focus to include using depression subtyping.3 This theory posits that different types of depression exist, depending on the cause. One size clearly does not fit all. Longer term solutions are possible, and should be made available to enable a shift from alleviating ‘symptoms’ to enabling healing.
Coming off meds was difficult. It was a long, slow journey to begin with, and starting out I needed to connect with people who have been able to do this successfully and who offered support. One thing I will say is: it can be done, and it’s good to have someone to help.
This time when helicopters are flying overhead, I point and show it to my son, saying: “Look, there’s a helicopter.” Somewhat to my own surprise, but nonetheless convincingly, my lips are daring to shape: “Mommy’s no longer scared. It’s just a helicopter, and it’s okay.”
- Depression: How effective are antidepressants? Institute for Quality and Efficiency in Healthcare, Informed Health Online. ↩
- McKay, S. The woman’s brain book: The neuroscience of health, hormones and happiness. Hachette Australia, 2018. ↩
- Rantala, MJ, Luoto, S, Krams, I & Karlsson, H. Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions. Brain, Behavior, and Immunity. 2018/3. ↩