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treatment resistant depression

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Half Glass Full

by Heather Loeb

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Preface: A few weeks ago I fell into a depressive episode, the first since leaving The Menninger Clinic 5 years ago. During that 6-week stay, my medicine was changed, I did intensive therapy, took classes and started electroconvulsive therapy treatments. In the past couple of weeks, I’ve been irritable, fatigued, had a loss of appetite, had problems showering, been sleeping more, etc. A week ago I started a new medication that’s used off-label for treatment-resistant depression. It has been a very difficult time for me. 

I’ve been on my new medication for about a week now. I’ve read that it can start working as soon as a week, but won’t be completely effective until about 6 – 8 weeks. But the past two days have been good, and I feel excited and hopeful about what may come.

Earlier this week was challenging. I had two commitments at NAMI that I thought I could handle but at last minute (day before) I panicked, had an anxiety attack and knew I couldn’t make it. I didn’t know what to do until it just came to me — “I should ask for help.” You might think that should be an automatic thought, but I had never asked my friends at NAMI to help like me like that. I’ve asked one or two for help, but never said I was flailing and needed help now.

So I asked.

Within minutes, my NAMI commitments were covered, and grateful tears streamed down my face. I received supporting and kind texts telling me to rest and take care of myself.

The next day one of the Leadership Team members came to do a “wellness check.” She’s a dear friend and gently told me we needed to get organized when it came to covering my future events and presentations. I told her my original plan was not to do those things and focus on what I could do at home. Meetings and presentations are very overwhelming to me right now, and I certainly wanted help with that. So we made a plan, and I felt so relieved. Before I would put meetings or presentations on my calendar, thinking I’d be okay by then, but then I’d have anxiety attacks when it came time to go. This would prevent us from scrambling the day before or day of and prevent a lot of stress.

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I talked to most of the Leadership Team, and everybody has been so supportive. They want me well in time to go to the big NAMI Texas Conference Nov. 7 to Nov. 10. That gives me about a month. I feel like I can handle that, and that will give my medicine more time to work.

Even though I’ve had a couple good days this week, I’m still struggling with fatigue and taking showers. I also got on the scale today just to check, not thinking there’d be a big change, and I’ve lost 6 pounds since this depressive episode started. I’ve noticed it has been harder to eat, but I didn’t realize it was that bad. My doctor told me to stop losing weight, but I’m thinking he’d be understanding with everything that’s going on (maybe). So now I have one more thing to worry about, but I guess it’s better than me binge eating.

In other, positive news, I’m not napping so much during the day, even on the weekends. I’m gearing up to start walking on the treadmill in the mornings. I bought new workout clothes and (read Isla) updated my playlist (all Taylor Swift). I feel optimistic about taking care of myself, but I don’t want too excited because I know fatigue and apathy can take over anytime. But I want to stay positive. If I can just get 20 minutes of walking in each day, that’ll help stifle the depression big time. Oh, and I plan on going outside for some sunshine, too.

I’m going to do everything I’m able to get better. I just gotta strike while the iron’s hot. And it’s warming up.

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Let me preface this blog by stating these are my experiences only – not all depressed people are the same, nor do they experience depression/anxiety in the same way.

When I first wrote this blog I didn’t have a problem with the title but now I do. Labeling the following as “bad habits” implies to me that these actions can be prevented but these things are uncontrollable side effects of depression and anxiety.

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So let me say, “10 Things That (Almost) Every Depressed/Anxiety Person Does”

1. Cancels plans – I cancel plans a lot, and I feel really bad about it. When I’m feeling good I reach out to my loved ones and make plans but when the time comes my mood and demeanor have changed. It feels physically impossible to hang out, especially if it’s in public. My depression/anxiety is so unpredictable, and because of this, it makes it hard for me to maintain some friendships.

2. Sleeps too much – When I’m in a depressive episode I can’t get enough sleep. Mostly because I feel extreme fatigue, but I also don’t want to be awake much because it’s too much work. I get overwhelmed, and it’s painful to be awake, so I go to sleep early and take naps during the day. This is a problem because it can intensify things like obesity, headaches and backaches. You miss out on things, and it’s just not healthy. It’s definitely not a long-term coping strategy.

3. Isolates – As I mentioned earlier, when you’re depressed it’s so much effort to be awake and functioning. This includes socializing with family and friends. Even texting seems hard, so it’s easy to just withdraw but this too is dangerous. Feeling alone can increase feelings of depression — mainly loneliness and despair — which could lead to suicidal thoughts.

4. Neglects personal hygiene – Sadly, this is a huge problems for me. For a long time, I could only shower once a week. I also have trouble brushing my teeth. It seems silly because these tasks don’t seem hard but if you’re depressed, they’re an impossible task. I would feel gross, slovenly and even worse about myself.

5. Overuses drugs and alcohol – I abused my anxiety meds because I wanted to feel anything but the pain and discomfort depression and anxiety were making me feel. So I took pills to feel loopy and out of it. This obviously doesn’t aid in recovery of depression, and it can kill you. Using anything to numb the pain is dangerous, whether it’s prescription meds, drugs or alcohol. If you’re struggling with substance abuse, please reach out to your doctor.

6. Dissociates – I just wrote a blog abut this, check it out here. Dissociation is common to those who have depression. It’s one way the mind copes with too much stress or trauma. Experiences of dissociation last hours or days. That feeling that I’m detached from my body is why I like to binge eat or take pills — it’s just a feeling of escape. It doesn’t happen often with me, but I totally understand why.

7. Doesn’t eat enough or eats too much – I have Binge Eating Disorder, where I eat until I’m uncomfortably or painfully full but don’t purge. Overeating like that isn’t much different from me abusing medication — I just want to feel “good” for awhile. The problem with bingeing is that I only temporarily feel good. The aftermath and effects are terrible, but I seem to forget this when I’m bingeing.

8. Snaps at loved ones – Sometimes anxiety can manifest as anger or rage. I didn’t know that until recently. When I start snapping at my husband or yelling at the kids, I know it’s my “check engine” light coming on and I need to take a break or practice self-care.

9. Overthinks – This is called rumination, and it’s hard to stop. I’ll get a thought in my head or replay a scenario and think about it for hours, even days. It’s hard to control, and it causes me to feel shame and guilt. Believe me, I don’t need anymore of those.

10. Worries too much about the future – Sometimes I’ll get caught up on the future. I’ll worry excessively about it (and even ruminate), even though I know it’s irrational to do so. Mainly, I’ll think about finances or my husband dying. It’s unpleasant and just causes more anxiety. This is also hard to control.

Any others you can think of? Leave them in the comments.

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Dissociation

by Heather Loeb

Dissociation — I’m good at it. If you can be, I guess.

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Dissociation is when someone becomes disconnected from themselves or surroundings. According to WebMD, dissociating can temporarily alleviate overwhelming emotional experiences, such as traumatic memories. It can help reduce feelings of shame, anxiety or fear. It’s part of avoidance coping, when a person changes their behavior to avoid thinking about difficult things and intense feelings.

I have major depression, an anxiety disorder, avoidant personality disorder, binge eating disorder and trauma in my past. You could say that dissociation is my jam. I’ll be the first to admit that I avoid hard feelings and difficult situations.

In 2019, before I went to The Menninger Clinic, I used my anxiety meds to escape. I’d take more than I should just to escape. Escape what, I don’t know. Even now, after a stent in a mental hospital and vast behavioral changes, I still get the urge to escape. It drives me crazy that I can’t answer why.

I live a good life — better than most. And I love it. I love my family, I love my husband, I have a beautiful new house and my blog is taking me places I didn’t think possible.

Yet, after the kids are asleep and my daily chores done, I start to escape. I can feel it happening — I go into a haze, I feel my body relaxing and I just float. Sometimes I binge eat to escape and achieve the haziness. But, obviously, that’s not healthy. It could be worse, I could be swallowing pill after pill to get to that place. But I don’t.

I’ve tried exploring why I have the need to escape with my therapist, but honestly, I don’t remember the outcome of that, thanks to amnesia. I guess I’ll have to consult my notes on that one.

I know dissociating isn’t a good long-term solution. I know that I need to face my problems, my demons. But it’s so much easier to just melt away from the world — go to a place where my problems aren’t so heavy. Because the truth is depression sucks. Especially mine. Because I have treatment-resistant major depression, most medicines don’t work. I’ve had to resort to doing electroconvulsive therapy (ECT), where electric currents are passed to my brain, triggering a seizure. Somehow, and they don’t really know why, it’s like a hard reset to the brain. Depression is kept at bay, temporarily at least for me. I go every eight weeks to get a treatment, but some people can go years or are cured after the initial treatments. I’ve had more than 20 treatments, which kind of makes me sad. Sad because I have to go through so much to feel somewhat normal. But at the same time, those treatments have allowed me to live happily at times and spend quality time with my husband and kids. I’ll always be grateful for that.

But the pain is always there. The anxiety lingers. The trauma from my past is still there. I guess we have our answer on why I yearn to escape. The pain is just so deep and unrelenting, no matter how hard I try to put on a happy face.

I think (almost) everyone dissociates from time to time to cope. Some things are too big, too overwhelming. And that’s OK. But it scares me just how much I want to escape. At this rate, I’ll never face my demons, but I know they’re there…waiting.

I know that at some point I’ll have to push through — force myself to discover why my pain runs so deep and discover how to heal myself. And I keep waiting to wake up one day and be different, to be the person who faces their problems head on, but that doesn’t just happen. You have to decide to make changes, take baby steps and harness your strength to do the hard things.

And while that sounds great, and I almost feel optimistic I could actually do that, it’s just overwhelming.

So, maybe tomorrow then.

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Retrograde Amnesia

by Heather Loeb
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As many of you know, I have retrograde amnesia, caused by the many ECT treatments I’ve had to do in order to obtain relief from my depression. For the record, I must have these treatments — my depression is treatment resistant, meaning that most medications can’t help alleviate my symptoms. Not much does except the ECTs, which I started in 2019.

During a treatment, I’m anesthetized and electric currents are sent through electrodes that are placed on my forehead, inducing a seizure. It’s not known exactly how the treatments help; I’ve always looked at it as a hard reset of my stubborn brain.

I would be lying if I said I don’t mind the treatments — I actually hate them, because over time I’ve developed a phobia of the anesthesia. And it’s definitely bothersome that I can’t remember some things. My memory loss goes back years, decades even, and it’s very hard to retain information even now. It’s also pretty embarrassing. I’ve forgotten who some people are, their names and how I know them. And when I say I have amnesia, I’m met with blank stares. And then I have to explain ECTs, which sounds unbelievable if you’re not used to it.

When I do try to recall something, I see only a gray wall where the memory once resided. Things aren’t just fuzzy — they’re just not there most of the time.

This must sound awful, but there is one good thing about my memory loss: the memory loss.

That’s not a typo.

I’ve suffered for decades with major depressive disorder, an anxiety disorder and a personality disorder and it’s unbelievably painful. But, just like I can’t remember who I ran into at the grocery store last week, I also can’t remember the most painful, darkest moments of my depression. I only know about it from my husband’s or best friend’s account of it. Or previous blogs.

Even with the ECT treatments, I still suffer with depression, just on a much lighter scale. I’m glad I can’t remember every time I couldn’t get out of bed or every time the pain was so deep that I wanted to end my life. Because if I sit and dwell on just how bad it was or can be, then I might forget that I do want to live — and live happily.

I don’t know if that makes much sense, but I do know that I (likely) will be struggling with depression and anxiety for the rest of my life. That thought alone makes me sad, and I can see how that thought can make me — and others — lose their faith in life and just put their suffering to an end. Mental illness can be so lonely when you’re in such pain all the time. And people still don’t understand it; the stigma of having a mental disorder is still there, too. So, if you do know someone who struggles, please be more understanding and empathetic. It’s just so lonely.

Even if I have to go under anesthesia and have electric currents sent through my brain every eight weeks, it’s not so bad. Not compared to the reality I was living without the treatments.

I just have to remember to take notes anytime I’m awake.

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The Camera Adds 10 Pounds

by Heather Loeb

This weekend I’ve eagerly awaited the arrival of our annual family photos. This year we opted to do them inside our new home, so I’ve been dying to see how they turn out.

I’ve also been dreading the new photos. It’s no secret that I’ve gained almost 20 pounds since the onset of the pandemic, but that doesn’t mean it’s any easier to see, especially in our family photos.

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I know it’s been hard on everyone, and a lot of people have gained weight. I know that I should love myself no matter what. I hear others say that I’m beautiful no matter what, but my anxiety and eating disorders speak louder. They always have.

Because we just moved in, a couple of our bathrooms don’t have mirrors hung yet. At first it was annoying but now I’m relieved I don’t have to look in the mirror. It doesn’t matter how much positive self talk I spew — I just don’t like what I see. My weight is tied to my confidence, and sadly, my self worth. Right now, it feels like I’m worth nothing.

The family photos will just confirm what I’ve already been telling myself: I’m ugly, fat and unworthy.

Except, here’s the thing — my daughter is watching. And listening. If I admit these truths aloud, she will for sure hear them. And my voice will become her inner voice. My actions will becomes hers as well, and I’ll be damned if she cultivates this ugly self-hate that’s just rotting my worth and self-esteem.

I’ve talked about this before, many times. I have to change the way I talk to myself, treat myself. I’m raising kids, but really my goal— and what all our goals should be — is to raise healthy adults. I don’t know much about that, but I have my missteps to guide me.

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The first thing I’m going to do is post the family photos — no matter what they look like. I’ll frame a couple in my house, not just because I’m trying to set a good example, but because damn, that’s what I look like now. This is what my family looks like after nine months of a deadly pandemic. We have survived, and even if I survived in a way that led to tighter clothes and an expanding waistline, I’ve survived. And that’s all that matters.

I want to thank Jennifer Stewart for capturing out family in our new loving home. I want to thank my body for supporting me during this time. I want to say that I do love myself and I’ll try harder to love it no matter my size. They say the camera adds 10 pounds, but maybe it’s time I stopped buying into that.

That I stop buying into diet culture and equating being then to being happy. I need to be happy now, instead of waiting until I’m a certain weight. Fuck that.

I’m going to be happy now, because both my daughter and son are watching. And that’s OK that they’re watching — it’s OK that they see me struggle, and even when I’m sad, but they’ll also see the fight in me, the determination and my grit. I’m all for them seeing me as human, because I am — just a perfectly imperfect human. That’s all we can be.

Edit: Our family photos were not available at the time of publication. I will add them in once I receive them.

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The past couple days have been hard. I’ve been extremely fatigued, irritable and I’ve fallen back on some unhealthy coping skills, such as binge eating. I don’t know why, but I’m just exhausted. It hurts to move.

Tomorrow I get another ECT, so maybe it’ll reset my brain and I’ll get back on track. Things were going well up until a couple days ago. I have a lot to look forward to.

We leave for San Antonio in just an hour. We’re staying the night in a hotel so we can get to the hospital bright and early. I know they help, but I really don’t like ECTs. Not a fun time for me.

Please think good thoughts and send light my way.

Here’s to next week. Hoping y’all have a good one, too.

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Me with my Going to Therapy is Cool shirt

“You need to think positively.”

“You need fresh air and sunshine.”

“You’re lazy.”

I’ve heard all three of these statements in regards to my depression, and even though they are NOT TRUE, they make me feel such a sense of shame.

Shame (for me) is that awful feeling I get in the pit of my belly; it’s surrounded by humiliation and I feel less than. Unloved. Like something is seriously wrong with me. And really, there’s not a single thing to be ashamed of when you’re mentally ill. I didn’t give myself depression, or anxiety, or even avoidant personality disorder. But here I am 20-plus years into my diagnosis still feeling the occasional prong of shame and guilt.

When I was first diagnosed, I kept it a secret. I was embarrassed and didn’t want to admit to my family and most friends that I was flawed. I didn’t see anyone in my family struggling, so it felt like I was the only one suffering. And when I went to a psychiatric facility last year? Holy shit, was I embarrassed. But if going to the “mental hospital” is the worst thing people can say about me, then let them say it, scream it if they want.

There’s nothing wrong with seeking help, whether it be for a mental illness or diabetes. Taking care of myself enables me to take care of my two young children and husband, and to be there for my friends. To live a life I’m proud of. Ain’t no shame in that.

Far too many people suffer in silence and that’s so dangerous. There needs to be a shift — a societal shift of acceptance, understanding and no judgement. Why there is still a stigma surrounding depression and other mental illness is beyond me. The stigma that people perpetuate is what’s flawed. Not me. Not anyone else.

Depression is not a matter of smart and dumb, weak or strong. But it is a matter of life and death sometimes. And the silence surrounding mental illness only widens the gap between those suffering and the help they need. Shame about it feeds anxiety and low esteem. Anxiety feeds depression and depression feeds risky behaviors, drug/alcohol abuse or suicidal ideation. It’s an awful cycle and it’s very hard to break, especially if you can’t afford psychotherapy, medication or doctors’ visits.

It’s overwhelming to have depression, to say the least. It’s OK to stay in bed all day (to an extent), it’s OK to cry. Being angry about it is OK. Whatever emotion you choose, just know that depression can be treatable. You can live with depression. You can be happy. Some of us will work harder than others at it — also OK. Be proud that you are a fighter, I know I am.

I will continue to fight my disease until I die. I will be a voice for those who can’t speak. I will help normalize depression and there sure as hell no shame in that.

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urlMy 5-year-old daughter is sensitive and she can be anxious – she’s her mother’s daughter, for sure. When she does get anxious I try to calm her down with deep breathing and I started repeating one mantra over and over – you can do hard things. Does it help her? Maybe but it definitely helps me.

It’s so simple but it hits me deep in my core. My depression (and anxiety) just crushes me, the weight of it feels so heavy that I can’t move. But the thing is, I can do hard things.

In the past five years I’ve given birth to two kids who are 23 months apart. I’ve battled postpartum depression. I went to a mental hospital for six weeks. I started ECT therapy and have had more than 20 treatments – that’s 20 times under anesthesia and 20+ seizures. I have been suicidal many times but I’ve clawed my way back to me. I’m proudly scrappy.

I will have depression forever, and I’m sure there will be dark days ahead but I can do hard things. That’s the mindset and philosophy I want to pass down to Isla (and Eli).

I try my best to hide my depressed self from the kids but I know it seeps through at times. I just hope they remember how strong I am and how much I love them. I hope they never really know how sad I can be. I want them to know I have a big heart and big emotions, and that’s ok. That they are cut from the same cloth, that they can tap into their grit and resolve.

It’s easy to give in to depression, to the despair and apathy that accompanies it. What’s not easy is to do it in front of your kids. They’re always there, watching and imitating. While it’s scary to think I could have another depressive episode, I know I can get through it. I can fight. I can overcome.

I can do hard things. And so can you.

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One-year Anniversary

by Heather Loeb

A year ago this month I went to the Menninger Clinic for inpatient psychiatric care for six long weeks. The months leading up to my trip to Houston weren’t good ones. I was emotional, suicidal and so damn sad. I had been labeled with treatment resistant depression, thus none of my meds were working. I also had tried TMS and ketamine infusion treatments but it didn’t lighten my load at all.

I was scared. Mostly because I feared I wouldn’t be around to watch my kids grow up. My husband, therapist and psychiatrist all agreed Menninger was the next step. After going over my history, meds and different treatments, I was told I was a prime candidate for ECT (electroconvulsive therapy). It took weeks for me to wean off all my meds – an antidepressant, antipsychotic, benzodiazepines, anti seizure meds and Ambien.

While I was weaning off my meds, I underwent psychiatric testing and went to classes about how to deal with mental illness. I also had to go to the classes on addiction because I wasn’t great at taking the prescribed benzodiazepine the way I was supposed to, to put it mildly. When we weren’t taking classes, we were required to do therapy and meet with psychiatrists. The classes – and the teachers – were all very helpful. My diagnoses are Major Depressive Disorder, Generalized Anxiety Disorder, Dysthymia and Avoidant Personality Disorder.

I became close with a couple of patients who were in the same boat asI was. I still talk to them; sometimes it seems like they’re the only ones who understand what I went through since they were right there with me.

The facility was nice. It should be for how expensive it was, but hey, it did save my life. What stuck with me is that there were not rods to hang your clothes on, no drawers and no shower curtain rod – nothing a patient could try to hang himself from. At night we could shut our doors but the staff did checks every 15 minutes. The whole night. Every door leading outside was locked so patients couldn’t leave. We couldn’t have our phones but they offered cell phones for patients to use. We also had access to computers where all social media sites were blocked. It was a hard adjustment but it kind of made me feel safe, cocooned really. The girls had one wing, boys another and we all shared one common area with couches and a TV. On the weekends, we did movie nights and ordered food from outside the facility. Although it was scary and heart wrenching to be away from my family, I felt supported by the friends I made and never felt alone, despite my depression and anxiety.

When it was time to start ECT I don’t remember being scared, although it sounds scary to me now. I had three treatments a week for three weeks before starting a maintenance phase. At first, I got awful headaches after each treatment but those eventually subsided. By far, the worst side effect of the ECTs is the memory loss. Usually, it only affects patients around the time of treatment, meaning you might forget things that happened the day of treatment. But lucky me, my memory loss goes back years. I’ve forgotten people’s names, and sometimes, entire people. I still can’t remember how I met the majority of my Facebook friends. My short term memory has taken a hit, too. I can’t figure out how and what my brain is actually going to remember.

But as bad as memory loss sucks, the ECTs saved my life. And for that, I’m grateful. I relish in spending time with my kids and watching them grow. David and I enjoy each other more now, too. My mental illness takes a toll on him and I’m very thankful for his patience, love and support.

I won’t lie – there have been dark days in the past year and it hasn’t always been easy. My brain is not reliable and I have to remember during anxiety attacks or depressive episodes that it lies. It tells me I’m not good enough, that I should want to die, that there’s no way out. I ride out the pain best I can and turn to my support system – my doctor, therapist, best friends, parents and then to more ECT treatments. It’s not a perfect system but here I am.

I somehow learned when I was young that having mental illness made you weak, but after my experience I know that’s not true. It couldn’t be further than the truth but the stigma surrounding depression is certainly real. I could have easily overdosed on my meds or died any other way by suicide, but it was strength that saved me and what keeps me going now. I’ve been battling my brain for a long time – decades even – and I know I have more to go but I’m proud of the work I’ve done.

My brain has betrayed me (many times) but my dear, hardworking heart never will. Thank you to all who have supported me.

If you are suffering from depression and need help, the National Alliance on Mental Illness visit www.nami.org

If you are suicidal, please call the Suicide Lifeline at 1-800-273-8255.

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Fight Like Hell

by Heather Loeb

I write a lot about having depression and reaching out to get support but it has come to my attention that when I’m the one struggling I don’t reach out often. Maybe to my mom, husband and best friend but with everyone else I put on a happy face while inside it feels like I’m dying. I think it’s important I talk about the dark while I’m in it.

It started a couple weeks ago. I wasn’t being honest with myself about how things were going. I happen to have a therapy appointment and one with my psychiatrist that week so I let it all hang out. It felt good to come clean and it was decided I would get an ECT treatment ASAP. I scheduled it for next Friday so in the meantime I made an impromptu visit to my parents’ lake house. The kids were dying to get out of the house and I figured it would do me good as well. While the kids had a blast, I didn’t fare as well. I can remember one night eating steak with my parents and I was staring at the bright pink steak knife that cut the steak so well. I wondered how it would feel down my arms. Later, I told my mom to just hide the knives.

I decided to chat on the suicide lifeline messaging system. The lady was asking my history and as I told her that I had major depressive disorder, anxiety, I’ve done ECTs, been to a psychiatric facility, etc. She the said, “Wow, you’re a fighter.” Though I know it’s the truth, it’s not something I’ve heard a lot through my life. I’ve heard I’m lazy, that I’m basically useless, but not a fighter.

But I fight everyday. For my kids, my husband, my family, my amazing friends who support me no matter how depressed I am or how unwashed my hair is. And I know sometimes I’ll fall back on the idea that being mentally ill makes you weak, but I can’t stress enough how that’s total and utter bullshit. And then I’ll remember that I’m a Phoenix rising from the ashes, that I’ll regenerate and will continue to be born again. Because I’m a fighter and I will continue to fight like hell, even though it sucks, even though it’s hard, even though it tires my soul. If anything, I need to show my children that there are many ways to be strong. And that it’s ok if you’re different than others. It’s even ok if you need to go to a mental health hospital. And that self care is a necessity and doesn’t make you selfish. I’ve tried pouring from an empty cup and it got me nowhere (technically it got me to the mental hospital) so even though my journey is a messy one, my kids can still appreciate it one day. I hope.

If you need help, I highly recommend either calling the National Suicide Lifeline or using their chat function. Call them at 1-800-273-8255

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