When Depression Recurs

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Reader’s Question

I am a 25-year-old female. I was quiet and introverted as a child, and was picked on a lot and bullied for most of my adolescence, due to a physical disability I have. I didn’t have many friends.

As a child, I was always a straight-A student, but depression sort of changed everything. My performance slid, and I became yet another mediocre student. I started self-harming at the age of 12, and it became an everyday routine when I was 15 (at that time also, I started experiencing migraines pretty often) and at 16, I attempted suicide. I did get it treated and have been on medication (Prozac).

I didn’t stop self-harming entirely, however. I did go for a few years without it, but now sometimes, I go back to it for a few months before stopping again. I am not sure if this relates to personal relationships. My love life has been rather painful — I’m prone to being led on, and I was in a verbally abusive relationship for two-and-half years. I rarely get asked out on dates, or when I do, they never show up. I do have more friends now than I did before, but I find it hard to relate to them or open up my feelings; I fear that people will judge me. I don’t open up to my family either, for the same reasons. My dad and I have a rather strained relationship — he tends to blame me for a lot of things, and compare me to other kids who perform better in school. He also doesn’t acknowledge that I was depressed or mentally ill — he thinks it had something to do with possession and the supernatural.

Lately, I have been noticing changes in my behaviour. I get irritated easily, I am tired all the time, I frequently have sleepless nights, and my appetite is inconsistent. I cry often, and tend to hide in my room every day. I have also been having migraines a lot, I haven’t been performing well at university, and none of the activities I used to enjoy spark any enthusiasm for me. Everything sounds so familiar. It reminds me of how I was ten years ago. I am afraid that it is happening to me again. I don’t have any suicidal tendencies like before, but I have been trying to fend off thoughts about self-harming. I am dodging the idea of seeing a doctor about it, as I’m afraid that what I am fearing is actually true. But at the same time, I cannot stand living this way. It’s tiring. I would like know what happiness feels like, but happiness seems to move further and further away from me. I’m losing trust in people, and I have no motivation to carry on and finish up my final year, either.

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I feel very trapped and I don’t know what to do.

Psychologist’s Reply

It sounds as if you have been working very hard to keep the depression at bay, but it has come back. Major Depressive Disorder (if that was indeed your diagnosis) is, unfortunately, an illness that often has recurrent episodes. The symptoms you describe (irritability, insomnia, loss of appetite, crying frequently, loss of interest in activities and relationships, exhaustion, difficulty concentrating, headaches, and most importantly, thoughts of self-harm) point to a depressive episode. Depression clouds our thinking and often our ability to make good choices or see things without a negative lens. Although it may feel terrifying to seek help and acknowledge that the depression has returned, you are right in recognizing that it may bring you relief from the symptoms you have described.

Because you mention being a student at university, I encourage you to reach out to the counseling services that may exist on campus. You didn’t mention if your previous treatment included therapy, or only medication. A large body of research supports improvement in depressive symptoms following a course (usually 8 — 12 sessions) of cognitive behavioral therapy or interpersonal therapy. If you have accommodations for a physical disability, someone at your school’s disabilities and accommodations office can likely help get you to the right services on campus. It is possible that a psychiatrist visit may also be useful to evaluate your medication and help determine if a course other than Prozac might be more effective for you. If finishing the semester is difficult, you may be eligible to take a medical leave of absence or take “incomplete” grades in your courses until you are able to improve with the help of therapy and perhaps medication. Someone in your university’s counseling services office can help sort that out with you.

As an adult, you have the right to seek treatment without consulting your family, or sharing any information about your illness with your father. It sounds as if he is not the best source of emotional support for you right now. Many cultural, religious, generational, or other factors can influence people’s beliefs about depression or other mental health issues. That must be difficult, to have a parent who is unable to acknowledge and support treatment for your depression. Finding your support through a mental health professional, understanding friends, and perhaps others in your situation may be the most helpful system for you right now. If it’s difficult to talk with your friends about it, rely on the space that a weekly counseling session can provide, and reserve your time with friends for the activities you enjoy together.

Because you have a history of self-harm and a suicide attempt, your increased thoughts of self-harm is concerning. If you cannot get to the counseling center for some reason, and find yourself thinking about suicide or harming yourself, please call a crisis hotline (such as the numbers listed on NHS Choices in the UK or 1-800-273-TALK in the US) to talk to someone who can help until you are able to see a mental health professional. As you experienced with your depression when you were younger, these symptoms are temporary, and you will likely find healthy relief from them with the right treatment.

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