Author’s Note

If I were to describe my relationship status with antidepressants, it would be: “It’s complicated.”

Like many people who are aware of the stigma surrounding medications for mental illness, I turned to antidepressants as a last resort, only after months of sadness, fatigue, and loss of interest in things I had previously been passionate about. I was in college and had started seeing a therapist, but it wasn’t helping. I desperately wanted to feel better. Even so, when my doctor first mentioned drugs, I almost didn’t take them. Aside from the possible side effects, it felt like taking medications was tantamount to admitting that I couldn’t handle things academically and socially.

In the end, my desire to feel better overpowered my shame.

The first pill I took left me with awful withdrawal headaches when I forgot a dose, so my psychiatrist switched me to a medication with a longer half-life, which ended up working well.

However, at that point in my life, I wasn’t ready for a relationship with a pharmaceutical. In a classic “it’s not you, it’s me” breakup, I stopped taking meds a few months after I started feeling less sad. I told myself that I didn’t want to become dependent on the meds, but really, it was that I couldn’t help worrying that being on drugs made me weak.

For almost a year, I did okay. I graduated and started a new job in a new city. I didn’t seek out a new therapist, partly because I seemed to be handling the ups and downs of my new life just fine, but mostly because therapy costs a lot of money and I was just getting used to the idea of disposable income.

Then, I had a down period that didn’t end.

I remember walking to work one day, crossing a busy intersection, and thinking that it wouldn’t be a bad thing if a car ran a red light and put me out of my misery.

Going on pills a second time was a lot like getting back together with an ex. It was a known quantity. My boyfriend at the time was also on drugs for anxiety, which made it doubly easy for me to restart; he was the first person in my life who freely admitted to being on psychiatric meds.

The funny thing is, even with a partner to help normalize mental illness, I still couldn’t get off my medications fast enough. This time, I told myself that the side effects weren’t worth it.

Two years later, after a long, slow decline during which I stubbornly told myself that I was doing fine, I finally acknowledged the severity of my unhappiness and restarted meds again.

I tried one more time to quit antidepressants after my internship year. I figured the worst part of residency was over (wrong). The fourth time I came back to medications, my psychiatrist told me that I might need to be on them for the rest of my life. “Your brain just needs the serotonin,” she said. And her matter-of-factness, combined with a burgeoning number of friends who had confided in me that they, too, were struggling and were taking medications, made me come to peace with the inevitable: Antidepressants and I were more than likely married for life.

What scares me most about how long it took for me to come to terms with needing medications is that I’m a doctor. I’ve read the literature. I know how prevalent depression and suicide are, and I’m aware of the medical guidelines that overwhelmingly support the responsible use of antidepressants. Sometimes I wonder: Why did it take me ten years to realize that taking medications does not make me a freak?

Part of the answer, of course, is that the medical community isn’t immune to the stigmatization of mental illness. I’ve seen countless doctors and nurses throw out casual comments about how a patient is “crazy,” or how a struggling physician is “going off his rocker.” The biggest compliment you can give a surgery resident is to tell them that they’ve done “strong work”; implicit in this statement is that they’re not just physically strong, but mentally so. When I cried during residency, I knew it was viewed by my colleagues not as a sign of compassion, but of weakness.

Another part of my struggle is cultural. I, like Jocelyn, was raised by immigrants from Asia. Mental illness was a subject of scandal. My grandmother spoke in hushed tones of a cousin, a girl, who died by suicide as a teenager. Making this tragedy even worse is that her father, my grand-uncle, was a psychiatrist.

In a culture where hard work and determination are considered panaceas for any ailment of the spirit, the silence regarding mental illness can be crushing. Studies show that Asian Americans are three times less likely to seek out mental health care than whites; when they do seek help, they’re more likely to drop out of treatment. They’re also more likely to consider and attempt suicide.

I’ve often felt that because I’ve never actively tried to harm myself that my depression wasn’t severe. It wasn’t until I was in my thirties that I first understood the concept of “passive” suicidal ideation, namely insidious thoughts like, Things would be easier if I were dead or, It would be a relief if I just didn’t wake up in the morning. A lot of people have the misconception that people with passive suicidal thoughts aren’t at the same risk for self-harm. In fact, recent studies have suggested that passive suicidal thoughts are just as important a clinical marker for suicide risk as having a plan to kill oneself.

If you have ever had suicidal thoughts, there are many hotlines staffed with people ready to help you through tough times:

• Crisis Text Line (Text HOME to 741741 from anywhere in the USA or to 686868 from anywhere in Canada, at any time)

• National Suicide Prevention Lifeline (Call 1-800-273-8255 from anywhere in the USA, at any time)

• The Trevor Project (Call 1-866-488-7386 from anywhere in the USA, at any time)

• For suicide hotlines by country: International Association for Suicide Prevention (https://www.iasp.info/resources/Crisis_Centres/)

Many people, however, hesitate to reach out to crisis resources, deeming their troubles to be “not that bad.” Depression, like any other thing in life, is a spectrum. For those in the wide gray area between wellness and crisis, there are a number of “warmlines” and other services:

• Mental Health America has free online screening tools to assess your mental health as well as links to many resources (https://screening.mentalhealthamerica.net/screening-tools)

• Substance Abuse and Mental Health Services Administration has a national helpline to guide you through treatment options (1-800-662-4357) as well as numerous other online resources (https://www.findtreatment.samhsa.gov/)

• The Anxiety and Depression Association of America (https://adaa.org) has high-quality information on mental illness topics, an online community, and a section with hundreds of personal stories of hope from community members

Finally, when people from diverse backgrounds seek out mental health care, they often struggle to find therapists who can relate to their unique cultural backgrounds. Resources like the Psychology Today website (www.psychologytoday.com) can help—the site is one of the most comprehensive directories of therapists and psychiatrists in the United States and Canada, searchable by a number of filters, including cultural sensitivity training and languages spoken.

At the lowest points in my depression, the loneliness seemed impenetrable. The purpose of this book is to break my own decades-long silence and show you that, if you feel the same way, you’re not alone.

You are not broken.

There is no shame in being who you are.

When you are ready to speak your truth, there will be people to listen.