MHM Magazine

Issue 2 | 2023 | MENTAL HEALTH MATTERS | 27 MHM Being diagnosed with major depression as a student in 1996 was a relief after many years of struggle and not having a name for the ‘black dog’ I lived with. On top of the depression, I also had trichotillomania (compulsively pulling my hair out). Being a nursing student with depression was tough, but my university was supportive by providing psychiatric help. On qualifying as a registered nurse I thrived in working in emergency medical situations. I was extremely active in the specialty and studied further to develop my skills. I volunteered in the emergency medical services and enjoyed the adrenaline-rush at the time. In the years that followed however, the depressive episodes persisted (and the volunteering reduced). I was prescribed various antidepressants – which I took with limited success. 2012 saw the first of many admissions to a psychiatric clinic as well as multiple suicide attempts through overdoses. After the first admission in 2012 and exhaustion of my Prescribed Minimum Benefits in that year, I was transferred to a government psychiatric facility for the first time. Again, because of lack of funds (exhaustion of benefits), I was admitted to the same government facility in subsequent years. Several depressive episodes later, I’d been prescribed various antidepressants, antiepileptics, mood stabilisers and antipsychotics (augmentations). Unfortunately, my treating psychiatrists had to change for various reasons which didn’t help the situation. I was fortunate though to be able to see a psychologist, (and pastoral counsellor in later years) who supported me through the difficult times. 2015 was an extremely difficult year. At that stage I was a nurse educator and had been placed on extended sick leave after being referred to yet another psychiatrist and clinic for Electroconvulsive Therapy (ECT). Managing this difficult depression has been challenging over the years. Electroconvulsive therapy has helped me many times, but it has had some negative effects with resultant memory loss. Eventually my treating psychiatrist identified the problem as “treatment resistant depression (TRD)”. One definition of treatment resistant depression reads that it “typically refers to inadequate response to at least one antidepressant trial of adequate doses and duration.” By the time this diagnosis was made, I had, in a period of 19 years been on so many medications, I’d lost count. It’s tough living with TRD – or, as some refer to it - “difficult to treat depression”. The depression has caused me to isolate myself, feel anxious, extremely inadequate and made me want to die on multiple occasions. My family have suffered through multiple absences while I was hospitalised, as well as through several overdose attempts. Also living with a depressed mother, wife and daughter has not been easy on my family. The financial burden this has placed on our family is often something I feel very guilty about. One extremely difficult aspect of living with TRD is that of funding treatment. Medical aid PMBs (Prescribed Minimum Benefits) are so limited that funding treatment is an extremely costly affair. The past few years have seen at least one (and two per year more recently) admissions to a psychiatric facility that depletes my psychiatric benefits for the year and so further admissions, ECTs, ketamine treatments, psychiatrists’ and psychologists’ visits are all paid for by myself. I am fortunate that most medications are funded, though. Unfortunately, the major depression that I was living with during my professional years took its toll and eventually I was too ill to carry on working. It was then that I was declared unfit to work and I entered the world of workplace disability after a lengthy six months of assessment and processing. It was a major disappointment for myself – I was a professional woman, loved my work and specialised in an area where there was a dire shortage of nurses. I often still regret this course of events. My depression has probably worsened since the termination of my working career. I have been hospitalised at least annually in the past few years (some years, twice) with episodes of TRD. I am blessed with both a caring psychiatrist and psychologist who have stood alongside me during very difficult times. My family have also TREATMENT RESISTANT DEPRESSION LIVING WITH... By Jean Augustyn