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Them: "How can we help?"
Me: "I don't know . . ."
The hardest part is I honestly don't know what will help.
This is a conversation I've had countless times over the last year. If only I had some sort of ailment that could be SEEN and FIXED . . . why can't it be a broken arm? A simple cast would "fix" the problem in just a matter of weeks.
With mental health, you read the books, you do the checklists, you take the meds, you attend counseling . . . but at any moment . . . around any corner . . . there it is - ready to crush your hope and happiness.
Each time you start a new medication you feel hopeful . . . "this time it will work"
And each time a new medication doesn't help, you feel a bit more hopeless . . . "maybe I am beyond repair"
A Silent Battle
They say mental health is a battle. It is.
And for many of us it is a lifelong battle.
And worse still, it is a silent battle - no one can SEE what you are going through.
And the worst part is that you begin to convince yourself that it has to be silent - that you shouldn't share your struggle - that perhaps you are "beyond repair" - that others will judge.
But it doesn't have to be silent.
In fact keeping it silent only allows your mind to go into darker and darker places.
You might not know what you need, you might not be able to fully articulate what you are feeling and thinking, you might think there is nothing that can be done - but please don't allow yourself to keep it all inside.
Start By Just Talking
At the risk of sounding naive or oversimplifying - a great place to start when you are suffering from depression is to just start talking.
Not sure what to say?
Normally I am not either - but here are some great prompts from the International Association for Suicide Prevention that you can send to a loved one to open the door:
When you get a chance can you contact me? I feel really alone and suicidal, and could use some support.
I don’t want to die, but I don't know how to live. Talking with you may help me feel safe. Are you free to talk?
This is really hard for me to say but I’m having painful thoughts and it might help to talk. Are you free?
I’m struggling right now and just need to talk to someone — can we chat?
when a friend/family/counselor said . . . this really helped
- taz - tell me all of them
- thank you so much for telling me
- amy texting
we have to normalize - these are sensitive things - but we have to begin the conversation
I can't relent . . . regardless of the thoughts, the feelings, the darkness - I refuse to relent.
I accept that this battle will never end. Life will change. I will have ups. I will have downs.
But this weight will be there and I can't give in.
988 Suicide and Crisis Lifeline
Allow chat, text, call
Just when I thought I was "fixed" . . . then the horrid depression monster came back with it's ugly claws and teeth ready to drag me back into depths of despair.
I had spent 2021 working up the courage to speak out about my depression (read below) and the beginning of 2022 adjusting to meds and trying to find normalcy in life with new diagnosis of Depression, OCD, Anxiety, and Bipolar Type II.
Then in the beginning of 2022 my life took a right turn.
To be completely transparent, I was going through a divorce while at the same time missing goals at NURSING.com . . . I felt like a failure.
Here I was, about to turn 40 and I felt like my life was crumbling around me and I was powerless to "fix" it.
I tried to power through, as I had tried to do in years past (read below), but I just couldn't fix everything no matter how much energy I tried to throw at it.
I let things continue as such but started exercising a bit more - I wasn't "well" but figured that since I was already on meds I should keep trying to "tough it out".
I kept up the same medication regimen that was prescribed in 2022 but soon realized that with the life changes - I was going to need help.
In early 2023 I finally made an appointment with a Mental Health NP - we reviewed my GAD-7 as well as my PHQ-9 scores (two tools used to measure Anxiety and Depression). My scores indicated a sharp raise in depression with a minor change in my anxiety.
Abilify (ARIPIPRAZOLE) 5mg daily was added. I had used Abilify in the past and so the thought was to add this in conjunction with Wellbutrin as a support for depression. No other medication changes were done and I continued with Lamotrigine and Gabapentin as therapy for Bipolar and Anxiety/OCD.
How Are Things Now?
Unfortunately, these medication changes have not seemed to help very much. I continue to have some days - or extended periods where I feel very low and struggle to get up and carry out with the day.
While I have not considered suicide, I have struggled to find purpose and motivation.
At the same time, the Abilify has negatively impacted my sleep and increased my appetite. This has led to extreme exhaustion and weight gain.
In short, things are not optimal.
Just this weekend as I was flying home my anxiety spiked to a level so high that during my layover I nearly rented a car to drive the remaining 15 hours home vs getting back on a plane.
Ruminating thoughts continue although I have seen them decrease slightly over the last couple of weeks, this is a very welcomed outcome as rumination on negative thoughts can be tremendously terrifying and exhausting.
My current PHQ-9 is a 17 - indicating "moderately severe" depression. The main driver of the high score is driven by a score of "3" on the following items:
Little interest or pleasure in doing things
Trouble falling asleep, staying asleep, or sleeping too much
Feeling tired or having little energy
Bipolar II My mood has been stable - sadly it has been mostly depressive - I have not experienced mania or symptoms of mania. In all honesty, increased energy would be very welcomed at this point.
Clearly, I am not in an optimal state currently and something needs to be done.
Recently, I have started therapy. When I noticed the ruminating thoughts getting out of control and impacting my entire life I realized I needed someone to talk things through with urgently.
This has helped a bit with the OCD/Anxiety and I plan to continue this.
For depression, today, I have made an appointment to review my medications again with my Nurse Practitioner . . . something is off.
What I have learned is that as life changes - our mental health needs change.
Sadly, mental health is NOT a one-and-done type of thing and we must continually nurture it.
Where with diabetes, insulin will work today, tomorrow, and in 10 years to treat a patient . . . with mental health it is different. My needs will change as my life circumstances change. I can't start meds today and say "phew, at least I never have to think about that again".
I must keep my finger on the depression pulse at all times and adjust accordingly.
Conclusion (for now) - stop puffing your feathers
A farmer recently related a story to me of a time a hawk was attacking it's chickens.
By instinct the chickens fluffed out their chests to make themselves appear larger in an attempt to intimidate the hawk and deter the attack.
The farmer heard the commotion and ran outside - they picked up one of the chickens with it's chest fully puffed out. It was clearly hysterical and had fully extended itself. They were unable to calm the chicken and it continued to attempt to fluff it's chest out - instantly the chest cavity ruptured and the chicken died.
Our response to mental health is often the same.
We walk around with our chests puffed out trying to appear strong and invincible. We want those around us to think we are fine. We think this makes us look "strong".
Rather than speak and seek help, we keep puffing and puffing until the moment we break.
If that is you - please take this as an invitation to open up. Speak. Seek the help you deserve.
You do not need to suffer.
You deserve to be happy.
While I know this nursing journey is long, hard, and overwhelming . . . you do not need to suffer in silence.
Depression, anxiety, bipolar, and all mental health disorders LOVE silence.
In silence they can grow. They can control you.
On the contrary, they hate light. They hate you speaking up and seeking help - that is their biggest fear.
The main reason I share my story is to give you permission to share yours.
We love you and want you to know that you are NOT alone.
You CAN do this.
We are all in this together.
❤️ Happy Nursing!
-Jon Haws, RN
May is Mental Health Month so I wanted to provide an update on my original post in October 2021.
It has been about a year since I started on psychiatric medications for depression after receiving several diagnosis in April 2021:
OCD, Anxiety, and Bipolar Type II
I would be lying to insinuate that life has been perfect since starting medications. To do this, let me will talk through each element of my diagnosis and where things stand today.
At a high level I have only had 2-3 days that I was unable to get out of bed due to my mental health. This is a drastic improvement over 2020-2021.
I wouldn’t describe my mood as “happy” however, generally I am able to avoid those very dark moments.
While this improvement is welcomed – depression is still a big part of my life and the general battle continues. Depression feels like you are in a dark pit with a rope that is just too short to reach.
PERMA was developed by a Dr. Seligman from Penn State and is essentially “removing the disabling conditions is not the same as building the enabling conditions that make life most worth living.”
It stands for: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (hence PERMA™). Within this framework you try to identify and amplify your strengths and choose actions that will enhance those.
I utilized this framework to create my resolutions for the New Year and then used a goal tracking app to keep track of my progress.
I put these two together because I have realized how entangled they are.
Generally, intense feelings of anxiety have subsided.
I still have moments – especially at night – when anxiety starts to build and I begin to focus on my anxious thoughts.
As far as medications go, Gabapentine is the main agent on board for anxiety. When I was feeling most anxious, I would take it in the mornings and evenings. When I start to feel anxious, it feels like someone is squeezing my chest – with it continually and progressively getting tighter and tighter.
For me, Gabapentine seemed to mostly help with symptom management. After about an hour or so the tightness in my chest would begin to subside.
Most of my anxiety tends to be work focused so outside of medications, I have tried to disconnect myself a bit from work. Specifically, I stopped checking emails and messages at nights and on weekends so that my mind can rest a bit and focus on my family and home.
Bipolar Type II
To be honest . . . I personally haven’t done much to address the Bipolar outside of taking the medications. I’ve noticed a considerable difference in mood variability and so has my family.
Personally, I’ve missed the “highs” that come along with Bipolar . . . but I am happy to see the lows gone.
[2021 Orignal Post]
In this post, I’m going to open up with you about my mental health journey – including some of my darkest moments – and where I am today.
A day for global mental health education, awareness and advocacy against social stigma. source
So in light of that . . . I believe strongly that the stigma around mental health needs to vanish. It is so often the stigma that keeps many of us silent. As nurses we KNOW and we are taught to put aside the stigma, but when the mental health demons invade our lives, we to become silent and often avoid seeking the help we need.
My Darkest Moments
For a good part of my adult life I’ve suffered with depression (spoiler alert – there’s more to it) but for many of those years I was one who kept telling myself I could muscle through it or that I was smart enough to overcome it alone. I was wrong.
I want to share with you two of my darkest moments as well as where I am now – hopefully helping those who need help and/or are afraid to seek the help they need.
2017 – 2018
In 2017 I began taking Lexapro for what I thought at the time was just anxiety. Things rolled along ok for a few months and then in 2018, an enormous cloud of depression hit me. I was missing work 2-3 times per week. When I did go to work I would come home after and go straight to bed. Finding the energy to even get out of bed was near impossible.
Things began to spiral from there and I very vividly remember “rock bottom”. One night I went into my closet and suicidal thoughts crept in – I reached for a belt and even put it around my neck for a moment. At that point, I broke down. The thought of my children saved my life.
It is so hard to share this – and I’m not sure how it will be taken – but my mental health was so broken at that point that I saw no way out. That was one of the scariest moments of my life and I’ve never forgotten that moment. Even to this day it still terrifies me.
It was then I realized that Lexapro can intensify suicidal thoughts so I came off of it but failed to get further help – these dark ideas left and although depression. continued off and on – I continued on. Still keeping so much inside.
2020 – 2021
Toward the end of 2020 I new, more intensified cloud of depression began to roll over me. Around the end of October I began to feel as though my muscles were replaced with sand bags. My mind became foggy to the point of having no mental clarity. All enjoyment had been sucked out of life.
Then, the anxiety began to come back as well.
I remember nights laying on the floor in front of the fireplace just trying to get my heart to calm down – trying to focus my mind on anything positive – to no avail. I was engulfed in a constant feeling of impending doom while at the same time depressed to a state of being incapacitated.
And still . . . I was afraid to open up and get help.
On October 22, 2020, I sent an email out to the NURSING Family to share my current state as a beacon of hope for those who were also struggling. I was flooded with messages of support and many more messages from nurses and nursing students who were also struggling.
I would like to say that at this point I went and got help . . . I did not.
This state only began to intensify from October 2020 until about April 2021.
At that point, I was inches away from being broken.
I asked my wife to make me a mental health appointment at a nearby clinic (I was feeling too ashamed to admit my need) – luckily I was able to get in that day.
I remember parking at the clinic and walking in – feeling like a broken man. How was I able to let my mental health get away from me? I thought.
The Physician Assistant walked me into the exam room and asked: What’s going on?
At that moment, I broke down.
I told her that I couldn’t keep going on like this trying to overcome it all with brute force. I admitted that I needed help and I needed it bad.
Her response floored me: “Thank you for telling me that. That you would trust me enough to share that means a lot.”
A sense of relief hit me immediately as if I was confessing a crime and had been granted clemency.
That’s it I thought. This whole time I’d been bottling this up – here she was empathetic – not even judging me in the slightest. After making sure that I wasn’t thinking of harming myself or others. She let me know that she wanted to get me in the Mental Health NP – but that I wouldn’t be able to see her until the next day. The wait seemed endless.
The next day, I shared my whole story.
The NP listened with deep concern before telling me her diagnosis: OCD, Anxiety, and Bipolar Type II.
I wan’t entirely surprised by any of that and was able to identify moments in my life that would have pointed me toward that much sooner. She provided a ray of light and we began discussing treatment.
What’s unique about mental health is that there is no lab value you can draw . . . it’s not like running an EKG and diagnosing a myocardial infarction on the spot. The fact that it can’t be seen and that no one talks about it also leads to much of the stigma that surrounds it, I believe.
I started on four different medications to help with anxiety and bipolar – as well as to aid with sleeping.
The medication I was prescribed for depression made an immediate impact – but it also led me to almost a permanent state of hypomania. My mind wouldn’t stop and I was unable to sleep. As someone who has experienced hypomania in waves – I really enjoy that state – but this was never ending.
We adjusted meds . . . and then . . .
Like so many, I thought I could taper down my doses and I didn’t want to continue getting help.
That was a bad idea (of course).
Within a few weeks of stopping meds – my mental health deteriorated. I remained suffering in that state for about a month before returning for help. Meds were adjusted and over the last 2 months or so I’ve been in a much better state.
What Helped Me
Meds weren’t the only thing that helped me of course. Over the past year I’ve been trying to add in many things. Here are a few things I’ve tried:
Meditation: just a short 10 minute meditation in the morning
Reading: I love reading and I mixed in a few books on mental health
Exercise: trying to walk 10,000 steps a day really give me a daily goal to work toward
Diet: through diet I was able to lose many of the pounds that crept on between 2017-2020
Painting: watercoloring (I’m no good at it) helped my mind escape the anxiety for short periods
Journal: writing three things I’m thankful for each night
Talking: telling family and friends helps to get it out in the open and stop hiding
When all of those combined were not able to “kick the depression” I knew I needed more help. Medication has been a tremendous help for me and has given me the boost I need to continue healthy habits, get out of bed, and face the day.
There is so much more to my journey and I could talk about it forever. The darkest part of it lasted a few months – but it felt like several lifetimes. Time stood still and it felt like endless suffering that I was incapable of escaping.
You CAN Do This!
I know some of you reading this are suffering in silence. I know you might be scared to seek the help you need. I understand that fear – but you are not alone. There is compassionate help available for you.
The pain, the loneliness, the fear, the exhaustion, the self hate that comes along with mental health creates a personal hell and it can be very scary.
I once heard depression described as being stuck in a well with no way out. Even in your best moments, you are still just hanging on to the sides of the well knowing you will fall back down.
Please seek out help.
Your story and your journey will be very different from mine and what helps you will be different than what helped me . . . I know that.
But by sharing my story, I want to encourage you to seek help.
If you are in a dark moment right now it will feel like it will never end – it will.
Let me just leave you by saying there is light on the other side and you can get to that other side. Please don’t judge yourself or feel weak for this. As a nurse you would NEVER say to a patient “stop having a heart attack!” – be kind to yourself. It is okay to struggle with mental health – YOU ARE NOT ALONE.
We love you ❤️
-Jon Haws, RN, BSN, CCRN Alumnus
If you are thinking of hurting yourself please call the suicide hotline: 800-273-8255