Perspective: Depression from One Side of the Bed to the Other
My own story of depression, medication, and gaining a deeper insight into the stigmas and avoidance of mental health discussions and stress management in nursing. This is a driving force behind my commitment to bridging the gap between nursing and stress management without fear of retaliation by focusing on preventative health measures.As I have progressed in my career as a nurse I discovered a passion. Stress management. Stress management touches all aspects of our lives with increasing urgency. As we move forward each day we are expected to manage more, accept more, think more, and accommodate more. For more what do you ask? For more of everything. In our home lives we are expected to be Pinterest parents, cooks, home makers, and community leaders. At work we are expected to carry more patients, give ever increasing levels of customer service, contribute to shared governance, chart with legal precision, and still have compassion left for our patients. On Facebook we are expected to offer comfort to friends, get excited about petitions, try to get the best deals and sale prices on goods, and make sure we are sending back gifts in frivolous online games.
While one can say, "Well just stop doing X, Y, Z and you will be fine" have you ever stopped to ask yourself "Do I even know how to recognize that there is too much on my plate?"
Nursing and Stress Management
Prior to the birth of my first child, and while completing my undergraduate requirements, I started brewing a plan of stress management tailored for acute care hospital nurses. I chose this population because, well, I was one of those nurses. I knew the limitations, expectations, and resources available. I also knew the anxiety and stress that could come with it.
As I began formulating my plan I started asking questions of co-workers such as:
"Would you go to a group therapy session of all nurses?"
"Would you consider one- on-one counseling if it were available once or twice a month?"
"Would you want debriefing time after a traumatic patient event?"
Many of the responses were dismissive, uninterested, and withdrawn. I was surprised by this because I often found discussion to be a therapeutic route for myself, so I wondered "Where is the disconnect happening?"
I didn't realize it until I was hospitalized for a weekend during my first trimester of my second pregnancy for suicidal ideation.
From the Bed of the Depressed
In November of 2012 I went into my OB-GYN in tears. We had discussed Zoloft as a possibility for post-partum depression, which I had read can be much worse with two children. I knew I had PPD with my first, and was worried it would be worse this time around, so I wanted to be prepared. My tears and discussion of thoughts of swallowing Tide laundry pods because I was so miserable with morning sickness scared my practitioner and settled me in for three days in the High Risk Perinatal ward.
For three days I felt what others have felt when admitted for anything mentally related. I felt pitied, tip-toed around, and brushed off. Even though I had been cleared of all suicidal tendencies within hours of being admitted, I was still treated differently. During this time I was dehydrated from vomiting, anxious, and miserable. Most of these ailments were related to my morning sickness, which is notoriously bad.
When I was discharged that Sunday, I went home with a prescription of Zoloft. For two weeks I convalesced at my in-laws battling to find passion for my daughter again and to gain some reprieve from my nausea and anxiety. Thankfully, after getting to 100mg/day I was finally coming around. I found myself engaging with my daughter again, feeling less anxious, and feeling the ability to participate in my life again.
Shortly after my discharge I started therapy sessions with a psychologist who specialized in women's health issues and Eye Movement Desensitization Reprocessing (EMDR) therapies. EMDR is a treatment used primarily in Post-Traumatic Stress Disorder (PTSD) patients, but also has benefits for depression and anxiety. In a nutshell EMDR teaches you how to reprocess memories so that they no longer haunt or hold you back. I was skeptical of this approach, however after my first session I was a believer. The process of EMDR helped guide me down pathways I had never seen before in processing my anxiety.
Currently I have completed several sessions of EMDR, which has reduced anxiety over past circumstances, helped me develop new coping mechanisms, and is helping me wean off my Zoloft completely prior to delivery of my second child in May. So how does this all affect my perceptions of stress management in nursing?
Stress and Nursing
Mental health fears
After I was first prescribed Zoloft I was open with everyone about it, because it was helping tremendously. It felt amazing to feel like myself again, to be able to move, function, and love my life again. So when people asked about my pregnancy I would admit it was rough and that I was on Zoloft, but doing well. I was met with basically the same reaction from nearly everyone. Moderate discomfort.
For comparison, when you tell someone you are on a new medication for any chronic or acute disease most people will show enthusiasm for you. Often praising the wonders of medication, telling you how glad they are that you are feeling better, or agreeing that maybe they should look into this option for themselves. This is not true of medications for mental wellness. The idea that you might be imbalanced somehow outweighs that you are working hard to manage both on a pharmaceutical and therapeutic level. While I was never swayed to silence my story by this reaction, it did make me understand why nurses are reluctant to seek stress-management options.
No nurse wants the stigma of weakness, vulnerability, or incompetence tagged to their credentials. We often think of being blamed first for drug diversion if we are on Xanax or Zoloft. We fear lawsuits if something goes wrong with a patient because we have been in therapy for depression. For me I had seen first-hand, from the bed, how those diagnosed with mental ailments were treated, and I understood all too well why most nurses I talked to cringed at even the thought of therapeutic conversations about work.
As my therapy, pregnancy, and time on Zoloft have come to end I have learned a valuable lesson, despite stigma, stress can be addressed without creating labels on the nurses participating. Getting to the root of stress related problems can help prevent occurrences of depression and pharmaceutical intervention; it just has to be presented in the preventative health arena.
From here on forward I am committed to bridging the gap between prevention and mental health awareness. I am committed to finding a way to let nurses recognize areas of stress and reduce them without being afraid of being labeled. My commitment starts with my own openness about my struggles and revelations, available here, in this story.Last edit by Joe V on Mar 22, '13
Tait is an acute care RN currently completing her MSN in Nursing Education.
Tait has '5' year(s) of experience and specializes in 'General Med/Surg, Complex Cardiac'. From 'Georgia'; 36 Years Old; Joined Jul '07; Posts: 2,595; Likes: 5,101.
Must Read Topics9Mar 22, '13 by VivaLasViejas, ASN, RN GuideThank you for adding your voice to the growing movement of nurses who are "coming out of the closet" with their mental health issues! It's the only way we can reduce the stigma and discrimination we face at the hands of our colleagues, supervisors, and Boards of Nursing. Well done!!6Mar 22, '13 by SleeepyRNThank you for sharing! I've read and enjoyed some of your other posts regarding this issue. When I was in nursing school, a classmate overheard another individual and I discuss my taking Lexapro. She said to me, I think people need to just work through their problems, not take pills to feel numb." It worried me knowing she was entering the healthcare field with this mentality. First, Lexapro does not numb my feelings. In nursing school I experienced 2 deaths in my family, and I grieved. However, I was able to grieve in a healthy way. Also, I was in counseling weekly for 4 years. I work/worked very hard to retrain my thought processes through depressive phases. However, no matter how much therapy I get, I will always have to take Lexapro because I have a chemical imbalance, not because I am not equipped to handle stress. Its sad that fellow nurses who should know better have this belief. I am suicidal when I don't take my Lexapro, no matter how much therapy I am getting. In fact 2 years ago I swallowed 120 mg xanax along with 2 full bottles of Lexapro. I wasn't trying to get attention. I was trying to die. When the xanax started kicking in, I vaguely remember getting a carving knife and trying to slit my wrists. Luckily I was too stupored to accomplish this. Apparently the knife was on the kitchen floor with blood when my husband got home.
Anyway, counseling helps me cope with things and live enough to function, but I need it in combination with Lexapro. Thank you for opening this discussion. I've gone a month again without taking my medication, and I'm starting to feel the effects. I've been laying in bed all day
I don't even want to go to the store. I keep thinking over and over and over that I'm useless and there is no point in my life.
I find myself wishing I didn't have family who would be devastated so I could just kill myself already. I continuously think "I just don't want to be alive." Very scary thoughts huh? So it ****** me off that a nurse who should know better can think "you shouldn't rely on meds, you need to learn how to deal."
Anyway, I'm very open with my psychiatrist and my husband about these feelings and thoughts nowadays. Because I know when the Lexapro kicks in again, I love life and don't want to miss any of it. So, I'm off to finally refill my Lexapro. Thanks again for the post.Last edit by SleeepyRN on Mar 22, '134Mar 22, '13 by Blue Roses, ASNThank you for your article. I also had issues with depression and anxiety, mostly due to the conditions at my former job. I would have panic attacks daily, and I was generally miserable. After about six months of it and an ER visit due to heart palpitations and dizziness that wouldn't go away, I went to see my doctor. She was very kind and understanding, and gave me a script for Lexapro. I also left my job soon after that. I am in a better job now, and my anxiety is well controlled sofar with the Lexapro. I also have a very good support system behind me, and people I care about who also care about me. I know i wouldn't have gotten through it without a few nurse friends and my fiance. One thing I've learned from it is that a nurse is often only as good as the support system behind her. I'm happy to be recovering.5Mar 22, '13 by VivaLasViejas, ASN, RN GuideYou know, sometimes it takes experiencing---and then being diagnosed with---a mental health problem before one "gets it".
I don't know if it's karma or what, but I used to be very leery of patients with MH diagnoses and now...well, y'all know what I'm up against. I'm also one of the three people at my assisted living community who decide on admissions, and in fact have said "No" to prospective residents with a history of psychiatric disorders. Part of it had to do with a resident we had for about 18 months who had schizophrenia, factitious disorder, and a history of ETOH abuse among other things, and let me tell you, the dude was a hot mess. It would take a week to describe what he put us through.......most of what I know about psych, I learned from trying to keep him from killing himself. So yes, I've been really cautious when it comes to residents with mental health concerns.
But it wasn't until I landed on a psychiatrist's couch myself that my attitude changed. Not too long into treatment, it occurred to me that people might think I was a "crazy person" with my nasty diagnosis and a need for multiple medications to manage it, and that upset me greatly. So it wasn't too far of a reach for me to realize that EVERYONE deserves a chance.......by my old standards, I wouldn't even be admitted to my own facility. After all, nobody wants a resident in their building who's anxious, asthmatic, alcoholic, hypertensive, diabetic AND bipolar.
I salute people with these debilitating illnesses who put their reputations and their privacy on the line to show the world that not all mentally ill people are "crazy" or scary. Although I don't think celebrities are the best spokespersons for the reality of living day-to-day with depression and other MIs, they do tend to put the spotlight on a particular condition that often "legitimizes" it, as well as serving as role models for others. I know it helped me when actress Catherine Zeta-Jones "came out" with her bipolar II a couple of years ago; Jane Pauley is another source of inspiration. (Unlike we lesser mortals, however, they never seem to gain weight on antipsychotics.) It's when MI is romanticized that I have an issue with it, because it is anything BUT glamorous to fall asleep at the skatepark while your grandkids are attempting to master the "ollie" in a concrete bowl, or to spend a thousand bucks at Wal-Mart, or to be too agitated to sit through a staff meeting without being disruptive (and yes, I've done all of the above).
Tait, you have brought a very common, but very serious illness to the forefront in a forum which reaches many nurses who suffer from it. Thank you for being an advocate.......we haven't a single nurse to waste.3Mar 22, '13 by RN58186You are so right that until one experiences it, one does not "get it" about mental illness. I thought I did. I was wrong. I have been on meds and in therapy for well over 10 years. I have three suicide attempts to my name. For me like for Sleepy RN, I meant to die. I have been certified more times than I can count, and have had more than 15 mental health admissions. I have never hidden my struggle with depression and will be honest with anyone who asks. My management has historically been less than supportive, while my peers at work are awesome. Today I am the healthiest (mentally) that I have been in many years. I still see my psychiatrist weekly and still take multiple meds. That's okay - I am functioning. I am safe to be at work and can trust my clinical judgement. I know that I am a good nurse. I just happen to be a good nurse who battles depression. I am currently working on a Master's degree in Theology, and am doing my final project on the church's response to mental illness. Because that is another area where there should be a lot more support than there is. Thanks for writing this and reminding everyone what it is like to be the one in the bed. It helps to know others understand.3Mar 23, '13 by BCgradnurse, MSN, RN, NP GuideGreat article, Tait. It is hard for those who haven't experienced MI to know what it's like. It's not something we can snap out of just by sheer will. I also had post partum depression twice, and was subsequently diagnosed with Major Depressive Disorder. I understand the desire to just check out of life, emotionally and physically. I don't think I would have survived without medication. My experience has given me a greater understanding of those who struggle with these illnesses.
Thanks so much for charing your experiences. Best wishes to you!3Mar 23, '13 by CharlieChaseThis article is amazing, thanks for sharing! It takes a very strong individual to be open about personal experiences with mental health related issues. I am about to graduate in May with the intention of working on a psychiatric unit, and have been worried about the very things that were touched on in this article. I refuse to believe that personal struggles make an individual incompetent or weak, but at the same level it is hard not to feel like a hypocrite when you are on some of the same medications as your patients. That being said, if a nurse were a type 1 diabetic on insulin would they still be embarrassed to be on the same medication as a patient?4Mar 23, '13 by lovingtheunlovedI've had six psychiatric hospitalizations for depression. I live in a small town, so it's never a secret when I go in. I'm pretty open about it, partly because everyone knows about it anyway, but partly because I want to help destigmatize the issue. Just like a patient with diabetes, you take your meds, you modify your lifestyle, but sometimes those things don't work and you end up in the hospital. Fortunately, I'm doing really well right now. I've had to overcome the fear of what others will think and ask for help when I need it, whether it's calling my psychiatrist or telling my boss I'm overwhelmed and need to back off on my workload a little bit. Mental illness, when treated, doesn't make someone incompetant. I'm a good nurse. Even depressed. But I'm a better nurse well.3Mar 24, '13 by VivaLasViejas, ASN, RN GuideQuote from lovingtheunlovedTHAT'S the hardest thing in the world for me to do---it's not that I worry so much about what people will think, it's the asking-for-help part. It absolutely galls me to have to ask for ANYTHING.......my parents were never responsive to my emotional needs when I was growing up, so I became self-reliant to a fault. They met my physical needs more than adequately; I didn't lack for food, clothes, or toys. But I still see myself as weak, and it kills my soul when I have to depend on the kindness of others for such basic things as validation.......a sense of belonging.........even sanity.I've had to overcome the fear of what others will think and ask for help when I need it, whether it's calling my psychiatrist or telling my boss I'm overwhelmed and need to back off on my workload a little bit.3Mar 27, '13 by novelideas86I really enjoyed reading your article. Mental health is very important to me. I have had issues of my own with depression. I've been managing fairly well lately, however, the struggle I have had, and the struggle I have seen others go through has really affected the direction I want for my nursing career. I admit that I am one of those people who isn't the quickest to discuss my mental health issues with people I am not close to (and it took me a while to be able to talk about it even with people I am close with, and then only because I felt it would help them to know they aren't alone) because I am so keenly aware of the stigma attached to any kind of imbalance. I want to empower people to reach out for help if they need it, and I also feel that preventative measures aren't encouraged enough. I wish you the best of luck with your commitment to stress management for acute care nurses.1Apr 14, '13 by sail81Thank you for sharing this! I too suffer from depression and anxiety. Actually having been having lots of flare ups lately. It seems when I have down time it's the worst, I can't get "started" everything takes so much effort. I am on Prozac and also take Gabapentin for anxiety in the luteal phase of my cycle. Depression sucks and there is no other way to put it. People who have not had depression have a heard time understanding just how bad it can be. I know it's bad when I start contemplating what the purpose of life is---it's nice to know I am not the only one who struggles. The silver lining in being a nurse with this ailment is we can see everyone has some hardship---some just cover it up better than others. Thank you for sharing!