Dissecting Depression: The Background, the Battle, and the Breakthroughs

Dissecting Depression: The Background, the Battle, and the Breakthroughs

Episode 31

Helen Sneed: Welcome to Mental Health Hope and Recovery. I'm Helen Sneed.

Valerie Milburn: And I'm Valerie Milburn.

Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational stories of recovery. Our knowledge is up close and personal.

Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.

Helen Sneed: We live in recovery.

Valerie Milburn: So can you this podcast does not provide medical advice. The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers with any health related questions you may have.

Helen Sneed: Welcome to episode 31, the Great Abyss of Depression. The Background, the Battle and the Breakthroughs Part one. Valerie this has been something like going after the great white whale.

Valerie Milburn: It's. It's been a chore.

Helen Sneed: We have made quite an effort. It's just. The subject is just a behemoth. And I am so happy that we're here today to share what we've learned.

Valerie Milburn: I know. I was thinking about a text chain you and I had while we've been working on this and I sent you a text that said something like, how's it going? I've got a lot I'm working on over here. And you sent back. Yes, it's just too much much. This kind of sums up this been too much muchness. Yes. So we've got a lot for you. Yeah. We have much to offer with this episode, so I think we should start with the Fact that we set objectives for this because we had so much, we have so much we want to share. So what are our objectives?

Helen Sneed: Well, the thing that we're going to do because of this sort of voluminous amount of information is we are going to break this into two episodes about depression. And so we have our objectives for parts one and two. And today we're going to address our first two objectives. Basic background on depression and its phenomenal impact on the individual and society. And what is depression like? Through the words of great writers, we're.

Valerie Milburn: Also going to share our own journeys, adding our voices of experience and hope to today's topic.

Helen Sneed: Now, in our second episode, we'll explore treatment methods for the depressed person and support for families and caregivers and cutting edge treatment breakthroughs.

Valerie Milburn: Yes, and I'm really looking forward to sharing those cutting edge treatment breakthroughs next episode because we have found some really exciting, promising treatments that are happening now and more coming up in the future. So let's start with a definition about depression, and this one is from the American Psychiatric association, and it says that depression is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. And fortunately, depression is also treatable. Depression can lead to a variety of emotional and physical problems and basically

00:05:00

Valerie Milburn: decreases the ability to function. Now, the symptoms of depression can vary from mild to severe. And these symptoms are such things as feeling sad, basically having what we call a depressed mood and losing interest in pleasurable things that are usually enjoyable. There are often changes in appetite, thus gaining or losing weight. There trouble sleeping or just sleeping too much. And there's often low energy, just feeling tired all the time. I know feeling worthless or guilty is common because I experienced that. It's difficult to concentrate or to think clearly and it's really difficult to make decisions. A very serious it is, Helen, you and I know all about that.

Helen Sneed: Just parallel, you know.

Valerie Milburn: Yeah. And a very serious aspect of depression is there are thoughts of death or suicide. And, you know, I think these are the types of symptoms that many people associate with depression and they are the most common. But depression manifests in a variety of ways that I think people are less familiar with. And we're going to talk about that in a bit. But before that, let's look at a bit of background on the mental health disorder of depression. You know, one in six people will experience depression at some time in their life, and depression can occur at any time. But on average, it first appears in late teens to mid-20s. Women are more likely than Men to experience depression. And there is a high degree of what's called heritability. And that means that approximately 40% of people who have a first degree relative, and that means parents, children or siblings, 40% of those people will have depression. And now this is something I just recently learned, Helen. I learned it during this research and preparation for this episode that you and I were just talking about. I recently learned that about half of those who are diagnosed with a single episode of major depressive disorder will eventually relapse. And it is half. And also that the rate of relapse increases with each episode. And, you know, as I reflected on this, I saw that this is indeed how the course of my depression went, that my episodes of depression occurred closer and closer together as time went by. It's also important to know that depression has no prejudice. It's so common that it can affect anyone. So what causes depression? Well, there are several factors that can play a role. The first one is biochemistry. Differences in certain chemicals in the brain may contribute to depression. Another factor is genetics. Depression can run in families. But as we said in our episode on genetics, there's not a gene that determines a person will inherit a depressive disorder. Instead, a person can inherit a predisposition for depression. Personality is another factor. People with low self esteem who are easily overwhelmed by stress or who are generally pessimistic do appear to be more likely to experience depression. And the last is environmental factors. Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

Helen Sneed: Well, this is all grist for the mill. What I was interested in and want to tell about here is depression's phenomenal impact on society. The World Health Organization has ranked depression as the single largest contributor to global disability worldwide. This includes all mental and physical disabilities. Depression is number one. So let's look at depression's impact on the United states, our country. 17 million American adults had depression in 2019. Now, the center for Disease Control estimates that depression has more than tripled since the pandemic. So we're talking about a lot of people who are in trouble right now.

Valerie Milburn: Wow. Tripled. Tripled since the pandemic. That's amazing.

Helen Sneed: Yeah. And here the impact just goes on and on. The National Institute of Health put together a

00:10:00

Helen Sneed: financial cost in the United States. What it does depression cost? $326 billion annually. Now that's 326 billion with a B. And this was pre pandemic. We don't have the numbers yet since the pandemic has evolved. Now here's something that you and I were really took us aback, I think. And was that of all this, these billions of dollars, hundreds of billions, only 11% of it comes from direct care for sick people. Now, Valerie, were you surprised by this?

Valerie Milburn: I really was. You know, if only 11% is spent on care, think about if more was spent on care, how many less hundreds of billions of dollars would be, would there be in the loss of the things you're going to talk about, productivity, you know, the long term health effects. If we were spending more on the up, upfront cost of care, you know.

Helen Sneed: That it's, it's only 11% is I, I find really just, just really, really unacceptable. It is now. Yeah. Now what you were talking about is that depression, it has these tentacles, they reach everywhere. It has a negative impact on health care costs, obviously education, productivity, social interactions, and a really increased suicide rate. Socioeconomic disparities are exacerbated by depression. Of course, given financial disparities, individuals from lower socioeconomic backgrounds often face undertreatment and inadequate support. So this can further perpetuate the cycle of poverty, suffering and inequality. It hits everybody and then there is the individual and family impact. And this is depression at the most personal level. And at this level, it can create crushing financial, emotional and physical burdens for families and caregivers.

Valerie Milburn: Yeah. I think about what it did to my husband and my family.

Helen Sneed: Yeah, yeah. And that's, and you know, that's. There are millions of stories like yours. You know, as we explore depression's grip on the individual, which we're going to look at more and more today, we find reduced quality of life, impaired functioning, great financial need and inescapable pain. Depression can completely disrupt family dynamics and contribute to conflicts and challenges within families. And I think one of the hardest things to accept is that depression's impact on just one person and one family can be a tragedy that lasts for years.

Valerie Milburn: Absolutely. And you and I are going to talk about that as we relay what we went through personally and how it impacted those around us. So as I mentioned earlier, there are different types of depression that depression manifests in different ways. And you know, you and I, Helen, want to share this information because we think this is not widely known, but there are different types. And you know, this was really brought home to me today when I had a conversation at lunch with a dear friend because she was fascinated when I shared with her about a type of depression I'm going to talk about, which is called persistent depression depression. She didn't know about this type of depression and she Said that learning about it as we talked shed light on so many things in her life. So I'm going to talk about that in a minute, but let's start with the big one, which is called major depressive disorder. And major depressive disorder has the type of symptoms I talked about earlier. Low mood, no energy, inability to feel pleasure, feelings of worthlessness and suicidal thinking. And major depressive disorder is characterized by being particularly, particularly severe and prolonged depression. And it has a serious effect on the overall quality of life and the overall ability to function. And those of us who have lived with it often describe it as crippling, debilitating, overwhelming, and devastating.

Helen Sneed: You know, one of the things that we have looked for, of course, using these, these, these dramatic words, hard hitting words, is how, how do you tell someone about what you're feeling? And with this, with major depression, I, I, the only way I know how to describe it is I prayed to die in my sleep. I just, I didn't want to exist anymore because, you know, I kept telling people the

00:15:00

Helen Sneed: pain is deadly, but you don't die.

Valerie Milburn: Yeah.

Helen Sneed: And it just went on and on and on.

Valerie Milburn: Yeah, I know that's a, it's a sad way to. It's a sad comment and a sad way to feel. But it, it's, it describes it. You know, it's like it's not the fear of dying, it's the fear of living. And it's, that's what major depression feels like. So persistent depression. Helen, you and I can also find words to describe that because we lived through it. And persistent depressive disorder is called pdd and it's also known as dysthymia or active depression. And Helen, you and I like to call it high functioning depression because sometimes with persistent depression there can be high functioning. And Helen, you described it as walking pneumonia, and that's a perfect analogy. And persistent depression was my first diagnosis, and it was called dysthymia. That was what was written on my chart. Dysthymia. And my depression was indeed persistent. My psychiatrist reminded me recently that one of the first things I said to him was, I just want to be happy. I had been depressed in this persistent way for so long that I thought it was going to be my normal forever. And that is indeed the first thing that's listed in the symptoms for persistent depressive disorder. That there's a low mood that is almost always present and that it feels like relief will never come. So there are other ways to describe it. The other symptoms are things like almost always feeling tired, regardless of how Much sleep you get. Often there's a feeling of being lazy, but it's really just the inability to summon any energy beyond what's necessary. You know, the minimum necessary. And it is possible to do everything you're supposed to do. But it always feels like a monumental effort. Feeling hopeless and crying a lot and engaging in social activities can be a monumental effort. So we can see that persistent depressive disorder symptoms are similar to those caused by major depression. They may seem rather less severe, but these symptoms persist most days for most of the day and last for two years or more. Many more years. Yeah, many more for you and me. So most people with persistent depression function almost normally, but struggle internally. And some people even manage to be, as we said, high functioning in the eyes of others. And many are very successful. You and I were, Helen, but in great pain internally. That was my journey. And yours too, Helen.

Helen Sneed: It was. And as I look back on it, I. Nothing was ever enough. Do you know what I mean? No success, no work, no relationship. I tried so hard, but nothing could vanquish the pain inside.

Valerie Milburn: Right?

Helen Sneed: It just went on and on and on. And so I was always in a state of dissatisfaction because I could just, you know, I could get no comfort and no relief.

Valerie Milburn: Right. It's exactly, it just persistent, just no matter what, just a persistent ongoing depression. So the last one, well, no, there's a couple others. But the big one that I really also want to focus on is what's called agitated depression. But because it manifests in a way that is often unrecognizable, even to the person who's going through it. And this type of depression doesn't manifest as feeling lethargic or slowed down as in other types of depression. Agitated depression causes insomnia, feelings of emptiness and severe agitation and irritability. There's like this strong feeling of being uncomfortable all the time. And there's anger. A very common symptom of agitated depression is anger, often the primary symptom. And experiencing anger alongside depression can make it difficult to pursue treatment. And this is because anger is not always recognized as a symptom of depression. This was true for me. I didn't recognize my mood when I was having this agitated depression. I didn't recognize that mood as depression.

Helen Sneed: And you know, one of the first definitions of depression I heard that really hit home is that depression is anger turned inward.

Valerie Milburn: Yeah, I've heard that.

Helen Sneed: But I was full of anger. But of course would

00:20:00

Helen Sneed: pathologically afraid of expressing it. But I. I just have have seen that to be true in my own experience for years and years.

Valerie Milburn: Yeah, I wish I'd heard that definition earlier. And also I think one of the reasons I didn't recognize my anger is I was so afraid of anger because I didn't ever see anger growing up. I saw rage and hysteria, but no anger. So I couldn't identify it. I didn't know what to do with it. I just, you know, didn't definitely didn't see it as depression. I just thought I was p***** off all the time and had so much trouble with anger anyway, so. But this was happening after my mother's death and I didn't make the connection between, you know, her death and depression and. But I was having anger outburst over the most inconsequential things. And so, you know, one day I was looking at the thermostat, the air conditioner thermostat at my house and I had set it at one thing and my husband had moved it to another. And I just blew up like, what are you doing? I wanted it here. And you ended there. Just this outrageous explosion of anger. And a couple days like you, this is not me. I'm just, I'm so easygoing and sweet all the time. So a couple days later I was driving to my sponsors ranch to spend a couple days with her and my husband called me on the way there and said, you know, honey, and he pointed this out to me, these outbursts that have been going on. And he said, I really want you to talk to your sponsor about it because I think this is a thing that. So I was of course p***** off when he said that. But my sponsor is a psychiatric nurse as well as my sponsor of, you know, two decades. And so I did talk to her about it and she asked me about other symptoms, helped me recognize what was really going on. And I, you know, talked to my psychiatrist about it and it brings on the point that it's important to pursue treatment with agitated depression because people with agitated depression may be more likely to be in danger of self injury and suicidal thoughts and attempts. So it's important. Agitated depression needs to be addressed. So the last two types of depression that I wanted to talk about are called seasonal affective disorder and catatonic depression. Seasonal affective disorder is known as sad and it's a type of depression that's related to changes in seasons. It usually begins and ends about the same time every year. Most people with seasonal affective disorder have symptoms that start in the fall and continue into the winter months. And this saps energy and causes moodiness and it has to do with, you know, the changes in the light. And one of the treatments is light therapy. These symptoms often resolve during the spring and summer months. And the last thing I wanted to talk about is catatonic depression. Catatonic depression is diagnosed when someone shares the symptoms of both major depressive disorder that I talked about and then catatonia. And the symptoms of catatonia include a state of near unconsciousness or insensibility or things like rigidity of the body or even loss of speech.

Helen Sneed: Yes, I am. When we first talked about this, it's the first time I told you that I had. I'd been diagnosed with catatonic depression at one point in my treatment, and I had never heard of it, you know, and I thought my doctor was sort of, you know, just exaggerating or something. But I'll tell you, I had reached a point where I would sit in therapy, I would not move a muscle, and I would stare at the rug, and I wouldn't say a word. I. I couldn't move and I couldn't say a word. And I swear I memorized that d*** rug. Over time, it. I did not feel empty inside. I felt like all this turmoil, but I felt as if I had sort of a carapace, you know, this, this, this, you know, shell over me that kept anything from. From. From getting to me anymore. I just was catatonic. And it was, to me, my final inability to coexist as a human being. I guess that's what it is, is that it's just. It's a withdrawal from the human race.

Valerie Milburn: Yeah, I didn't know that, Helen, until we talked the other day about it. And that is.

Helen Sneed: Yeah, it's a. It's. It's sort of hard to describe. It's really pretty dreadful. But, yeah, I think that. Valerie, I really am grateful to you for going over all of this, because there are these nuances and these different kinds of depression, and I think that I've kind of had all of them at one time or another. But I'm curious about one other relationship, and that's with substance abuse, because it seems to me like substance abuse is an old partner of depression.

Valerie Milburn: Yeah, it. It is. And I'm familiar with this relationship between depression and substance abuse because I live with both depression and substance use disorders. The bottom line for me is that I had to treat and I have to continue to take care of continuously both my mental illness and my substance use disorder at the same time. I like to say that I can't be sane if I'M not sober and I can't be sober if I'm not sane. But here's what the research shows. 20% of those with the major depressive episode in the past year also have a substance use disorder diagnosis. And this is what we call a dual diagnosis. Depression and substance use disorders can exacerbate one another and additionally the presence of one significantly, significantly increases the risk of developing the other, but definitely can live in recovery with both. A testimonial to that. I've been sober for 23 years and stable, you know, without serious mental health issues now for 20, almost 23. So it can be done. Both can be conquered.

Helen Sneed: It can be done because I know you.

Valerie Milburn: Yeah.

Helen Sneed: Now, one of the things also that we have just kept running into in our research is the incredible importance and impact of early diagnosis and early treatment with depression. Now, I think it's widely known that U.S. teenagers and young adults are in an enormous mental health crisis. This began before the pandemic and has been exacerbated by it greatly. The Census Bureau survey found that 50% of adults aged 18 to 24 reported anxiety and depression symptoms in 2023. That is 50%.

Valerie Milburn: 50%.

Helen Sneed: Yeah, 50%. And I bet it's underreported. So, okay, so what's going on? Right? What is causing this? Well, many young people have come of age in this era of pandemic related school closures and, you know, the remote work and job and income loss. And of course, this also leads to increasing difficulty accessing treatment because if you don't have a job, you can't pay for treatment or you don't have insurance. Now, the National Institute of Mental Health looked at younger at the kids and what's going on with them, and it's disturbing. Four million adolescents had at least one major depressive episode in 2020, and almost 60% of them received no treatment. Oh, yeah, that's pretty hard to look at. Now the prevalence breaking it down is that it's higher among adolescent females. They're at 25% compared to males at 9%. But you know, 9% is almost 10. That's very high.

Valerie Milburn: Yeah.

Helen Sneed: And here's a really, really one that'll keep you up at night. By 2021, 30%, 30% of teenage girls had seriously considered suicide.

Valerie Milburn: So it really hits me hard, Helen. I mean, I've got tears. It's hard.

Helen Sneed: It's hard.

Valerie Milburn: So hard.

Helen Sneed: You know, you just think of those girls and what their resources they have to turn to when they feel that terrible now. So here are Some of the reasons why this early diagnosis and treatment are so critical to begin with, you get improved outcomes. Timely identification and intervention can help prevent the worsening of symptoms, it reduce the risk of complications, it reduces the threat of suicide and improves overall prognosis for the future. Now, early treatment also can increase the chances of achieving full remission and reducing the duration and severity of severity of depressive depressive episodes.

Valerie Milburn: And that's the good news. Look what can happen for the good if we diagnose if you just get.

Helen Sneed: In there early and again, look at these kids and young adults to just get to them and stop it now, right now. Valerie there's this other really major point and this is something about depression that I know surprised both of us. Yes, it's called chronicity. And depression has the potential to become a chronic and recurrent condition if left untreated or undertreated. The really scary thing is it begins to take on a life of its own and it begins to sort of just self generate so that one depressive episode is followed by another, is followed by another. By identifying and treating depression early,

00:30:00

Helen Sneed: it's possible to prevent this development of chronicity. Now, early intervention can interrupt the cycle of depressive episodes and it reduces the risk of relapse and it can provide individuals with effective strategies to manage their symptoms, you know, to get some sense of control over it and to prevent future episodes, which is the whole point. So this early intervention can save lives, prevent suffering, reduce the need for money and resources to treat a person with chronic depression over years.

Helen Sneed: Now, as we know and as we've said, describing depression can be almost impossible. But one thing's certain. Many great writers have suffered from depression and recovered. So we decided to use their words to help explain what depression is like. Now, the first come from the great writer William Styron. He said, the pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain. Now, Ned Betsini put it differently. He said, I didn't want to wake up. I was having a much better time asleep. And that's really sad. It was almost like a reverse nightmare. Like you wake up from a nightmare and you're so relieved. Well, I woke up into a nightmare. And here's something from Kay Redfield Jamison, who's written so brilliantly on the subject. Depression affects not only mood, but the nature and content of thought as well. Thinking processes almost always slow down, and decisiveness is replaced by indecision and rumination. The ability to concentrate is usually greatly impaired, and thought and action become difficult, if not impossible. Finally, I think the most telling and succinct definition of depression comes from Abraham Lincoln, who said, if there is a place worse than h***, I am in it.

Valerie Milburn: The quote by Abraham Lincoln always hit me really hard because I think people did not know for a long time what kind of depression he lived with. There's just a lot in these words of, you know, gifted writers. But, Helen, you're a gifted writer. Well, you have a wonderful way of sharing your story, and I know a lot about your story because we know each other really well. But I love the way you tell it, and I know it offers a lot of hope for our listeners. And your story offers hope because despite the incredibly long battle you had with depression, you now live in recovery. So can you talk about what it was like in the beginning, like how your depression began?

Helen Sneed: Yes. My depression began in the last century. It is as old as I am. In fact, I've been depressed for all of my life, except for the past 10 years. My first memory is of depression. This feeling would come over me so terrible that I couldn't think of one thing in the world that would ever make me happy again. And all I knew to do

00:35:00

Helen Sneed: was sit perfectly still with my eyes closed, not moving a muscle until it passed. But how long did these spells last? I don't know. I was only Four.

Valerie Milburn: Four, Four. That's really, that's so hard to think about, how painful that must have been because at 4, you, it's like you said, how long did they last? How did you even know what was happening?

Helen Sneed: I didn't know. And, and you know, it was just the whole, that period of my life due to this childhood trauma. I have very few memories before the age of eight. But I do know I believed I was so dirty and low I should live in the barn with the animals. And this was my core belief, this self hatred so deep that it never wavered over decades. And I told no one of these things. It's hard to believe, but I was already contemplating suicide. Now when I was nine, we moved and I discovered humor and even the adults loved it. And you can bet that I stayed funny for the rest of my life because humor allowed me to build a double life, what I have called, you know, a footbridge over the sewer. And despite the h*** of my inner life, I kept it all inside and functioned very well in the outside world. I mean, I adored people as much as I feared them.

Valerie Milburn: You have stayed funny. And I'm curious, did your double life hold up as you got older?

Helen Sneed: Oh, Valerie. Through middle school and high school, I solidified my double life. I was outgoing, popular, smart, active in clubs, in the school theater and everything else. And people thought I had a brilliant future ahead. When I was 16, I became anorexic and lost £40, all done through starving myself. And everyone thought I looked beautiful. Now I also had a stellar college career in most respects and had the prizes to prove it again. Great things were expected of me, and when I graduated from college, though I fell apart almost immediately. For 16 years the structure and people in school had kept me functioning. And without them, I went into a debilitating major depression, my first that lasted for two years. I was flattened, stayed in bed, gained a lot of weight, and no one could understand what had happened to me, but no action was taken. Now, somehow in a manic burst, I left Texas and moved to New York City. To this day, I don't know how I did it, but I flourished there with many friends and a passion for the theater and the city itself. And the self hatred and negative thoughts never let up. They were just this integral part of who I was, and I thought this was normal and justified. I was fat, lazy and lovable, hadn't lived up to my potential, deserved any bad thing that happened to me, and I had great difficulty regulating my life. Job searches, finding an apartment, making decisions were so hard they often didn't get done. Now, another thing is I starved myself and lost 90 pounds and became intensely anorexic, which went on for quite some time. Now, other symptoms were mood swings with the hideous racing thoughts, migraines, starving or binging terror, and this pathological fear of showing anger. And these things grew and grew as the years went by, you know, the.

Valerie Milburn: Anger growing and growing, and all of those symptoms growing and growing must have been, you know, a thing that thought, you know, had you think about treatment and did you seek treatment at that point?

Helen Sneed: Well, I guess treatment sought me, really. The official, I guess onset was in 1981, and it began one morning with a panic attack so severe my roommates took me to the Mount Sinai emergency room. And I had no idea. It's like a shroud dropped over me. I was convinced I was dying, and they sent me home from the hospital. But this began weeks of intense lability each day. Morning panic attacks, deep depression, gradual improvement at night and the same the next day. So after my third trip to the emergency room, the staff referred me to a psychiatrist. And this was my first. And this was my first foray into treatment. And she stacked on many, many drugs. This was what was done in those days. They were kind of in love with the little black bag. And so I changed doctors, but was so debilitated that she sent me back to Texas. And there I continued to deteriorate until it was awful. I could no longer read a book or drive a car or sign my name.

00:40:00

Helen Sneed: And this inevitably led to my first suicide attempt and hospitalization for six weeks. Now, my diagnosis was manic depression, and some of the meds seemed to make me even worse. What followed was one of the most profound experiences of my life. I went into a private psychiatric hospital in another city and was an inpatient for 15 months.

Valerie Milburn: 15 months. That's a long stay.

Helen Sneed: A year and three months.

Valerie Milburn: Yeah.

Helen Sneed: With no tweezers. My doctor there changed my diagnosis to depression and anorexia, and he took me off all medications. And the withdrawal lasted for over a month and was excruciating. Now, typically the old double life. I became a leader on the unit and tried to help my fellow patients who became treasured friends. And I never admitted to my strong suicidal desires or showed any anger because suicide patrol and physical restraints scared me to death. I always hated the hospital, but it kept me from killing myself. And I loved the people in it. They were my salvation. And when I was discharged, I was working. But there was no transition plan of any kind except for therapy twice a week. And again I fell apart. And frankly, I was worse off than when I was hospitalized. Gradually, I was put on more and more medication, but it never addressed the core depression. I would spend hours weeping on the floor of my apartment, unable to move. But I had many friends and was able to work and dated a number of the city's bachelors. And during that time, unfortunately, my psychiatrist initiated a sexual relationship that was last to last for six years. And I never told a soul.

Valerie Milburn: I don't know, Helen, with such a fragile state, you were already in when that started. I mean, how did you survive that relationship?

Helen Sneed: Well, to this day I'm not sure because it was wrenching. But finally, geography cured me again. I got a break and I moved back to New York City, which I had wanted to do the whole time. And it was in another manic burst. So I hit the ground running, determined to prove that I was more than a mental patient. I got high profile jobs at the national and international level. My outer life was full of many friends and opportunities. Now, treatment at the time was therapy twice a week and a ton of medications tried. Over the years, My depression still remained drug resistant. Now I proved myself for almost 20 years highly functional in public. And my private life consisted of depression, anorexia, suicidal ideation, weeping, reading in bed, and almost total isolation. So inside, I was full of festering secrets in this, you know, sickness. And I felt that I lived apart from the rest of humanity, that I wasn't really fully human anymore. So after 20 years of this double life, I sought a second opinion. And I learned that my depression was not typical in its unrelenting longevity. It came to light also that I had PTSD based on childhood trauma. So I went to a trauma expert and she told me that she didn't think I would live much longer without specialized treatment. She was afraid I would kill myself. Well, I let her persuade me to quit my job and go into full time treatment. It's the biggest mistake of my long life. I went overnight from being a leader in my field to being a full time mental patient. And the minute I quit my job, I began cutting viciously and often.

Valerie Milburn: Whoa. At this point, she sent you into full time treatment, so you must have been seeking all sorts of treatment and desperate. What kind of treatment did you have at this point?

Helen Sneed: A lot. I had group therapy, individual therapy. As I say, much, much medication, DBT training, emdr, body work, intensive outpatient programs. But in spite of all this, I went steadily downhill. For five years, I completely ceased to function you see, my entire identity in life now centered around multiple mental illnesses. I had five diagnoses, Clinical depression, bipolar disorder, anorexia, post traumatic stress disorder, and borderline personality disorder. I had lost everything. I was financially wiped out, massively medicated, and my illnesses were still drug resistant. I was told that my condition was severe and chronic. My symptoms included suicide attempts and cutting daily for long

00:45:00

Helen Sneed: periods of time. My revered doctor, whom I had followed blindly, told me I was hopelessly sick, I would never recover, I would never work again. And her contempt and betrayal shocked me. I looked at her and said, I will devote the rest of my life to proving you wrong.

Valerie Milburn: And you did. And I have so much admiration for that. What I was thinking about as I was listening to you tell your story, and like I said, I know your story is something that we have learned a lot about as we've particularly pursued our knowledge about the cutting edge treatments coming up. And that's basically that your depression was, as you've described, treatment resistant. And you were, you know, you talked about all the different types of treatment and that it didn't work. And there's so much hope now for treatment resistant depression and, and that, you know, maybe you wouldn't have had to suffer that way if the things that we know now had been in effect then. And I think it's, that's sad for that and it's promising for the future, don't you think?

Helen Sneed: Oh, I think that the, the, the future is, is, is so exciting. And as we've mentioned, it's very close. I mean, some of these things are almost upon us. These great, great advances.

Valerie Milburn: Yes. Yeah, some of them are here. You're right. Some of them are here.

Helen Sneed: Yeah.

Valerie Milburn: I'm going to talk about a couple of them. So I wish, yeah, sorry, I, I wish we had, you know, what's the song? If I wish I had known then what I know now.

Helen Sneed: Yeah, well, it's, you know, again, I always say I can accept everything about my illness, but I want my years back.

Valerie Milburn: Right.

Helen Sneed: And not going to get them.

Valerie Milburn: Right.

Helen Sneed: So anyway, Valerie, now our stories are similar in some ways, but you really have had your own course in dealing with depression over very, very intense, long years. And I think there's great value in our hearing it because of the way that you handled yourself over all that time. And so I would like to just start you off telling your story with, you know, the basic questions. When was the onset and what were your symptoms?

Valerie Milburn: Well, like you, mine began young, not quite as young, but my journey with depression began the Summer after sixth grade, I was sexually assaulted just before school let out that year and I told no one. My family moved to a new town early that summer and our neighborhood was kind of isolated. There weren't many kids my age, was months before school was going to start. And looking back on it, knowing what I know now about trauma, I can only imagine what shaped that isolated, trauma stricken 12 year old self, what shape that I was in that summer.

Helen Sneed: It's tragic to think about it.

Valerie Milburn: Yeah, it's really sad but you know, it manifested with symptoms such as a lot of weight loss, I had a lot of stomach problems, I withdrew. I had been a really outgoing kid, I withdrew. I had behavior changes and one of them was the Monday after the assault happened. I showed up in class as a different kid. I had gone basically from teacher's pet to a loud and mouthy kid. And the other thing I was doing was writing a lot of dark poetry. I remember a line that will stay with me forever and it was kill me or make me something more. I was a 12 year old. I also remember walking around in the dark at night. I don't know what my parents were doing in the neighborhood where I was, where they were building all those new houses and walking through those half built houses. And my symptoms were pretty severe. The physical symptoms led to doctor's visits which led to my diagnosis of depression.

Helen Sneed: So you did get the diagnosis. So what, what was the response of those, those people in your life that.

Valerie Milburn: Were around you like not enough? No early diagnosis and treatment? Well, early diagnosis but no treatment. My parents response was to move me from a large public school that fall to a small private school. And one of the lack of reactions that really has stuck with me over the years is that my teacher that Monday morning or that kid that started, you know, behaving differently in class after I just came in, changed. He didn't respond at all to a kid who just really changed overnight.

00:50:00

Valerie Milburn: I had been this wonderful, outgoing, straight A student who was pleasant and helpful and suddenly I was assertive and loud and disrespectful and my grades dropped. I mean there was only a month left in school, but I don't know, no reaction from him. Looking back on it was kind of inappropriate, but I, I kept going after that diagnosis and being put into a smaller school, I. It was that active, persistent, but you know, high functioning depression that we talked about. But high functioning is not full functioning. But I did excel in middle school. I excelled both in grades and in sports and I made those friends I needed Carried that into high school. High school. I was freshman class favorite, national honor society, sports boyfriends, had a job in high school. I bought my first car at age 16. But I had already found drugs and alcohol and my use, drug use rapidly accelerated and everything changed. I started living two lives, although I was continuing to excel. I was high. I had a life of drugs going on behind the mask of perfection. I did manage to graduate from high school in three years. I moved to Austin. I got into the University of Texas School of Business as an out of state student at age 17. I was completely self supporting all the way through college. Made good grades, prestigious internships, stable, important employment to support myself. I was capable, competent, confident and impaired by drugs and alcohol.

Helen Sneed: You know, we're also brilliant in hindsight. But looking back on it, what do you think the relationship was exactly between your drug and alcohol abuse and your mental health issues?

Valerie Milburn: Well, I know why I kept using drugs. When I was introduced to them the summer after eighth grade, it was an excellent form of self medic medication. The marijuana calmed the anxiety, the alcohol made me outgoing and funny. But it didn't work for long. I am an addict. One thing is interesting though. Such heavy drug and alcohol use during high school and college made it such that I can't identify if it was depression and mania or if it was alcohol abuse and my addiction to speed. I mean, I would stay up for days and have symptoms of mania, but I was snorting methamphetamine. So was it mania or was it speed? And then I would crash for a few days. And yes, there were classic symptoms of depression, but was this, you know, up and down this that I was going through the bipolar disorder or the substance use disorder? And I would say both because I eventually was correctly diagnosed with bipolar disorder.

Helen Sneed: Well, it's interesting because you weren't diagnosed with bipolar disorder until you were your 30s, right?

Valerie Milburn: Right.

Helen Sneed: So what was happening for you between college and getting your diagnosis?

Valerie Milburn: Well, after college, I got married right after college, when I was 23. And I was not abusing drugs then and I was only drinking socially and I was completely clean and sober during both my pregnancies, which were early in my marriage. But that depression crept in as I built a very stressful, successful career in my late 20s. And stress is not my friend. So I would withdraw. I would tell myself I had the flu. I had the flu a lot. I called in sick all the time. I retreated from reality. The depression immobilized me. I mean, at age 30, I know I was 30 because it was my son's third birthday party, I missed it. I was too depressed to get out of bed for my son's birthday party. And, you know, around this time, the pure manic episodes began. And I say pure because I hadn't taken speed in years by that point. So I know it was mania, but Helen, it wasn't the mania that took me down. The mania was productive. It was the depression that was, as we have said, debilitating. And I was using about five different substances to change the way I felt. And thus with the stress and the depression, I had my breakdown, as I've talked about, at age 34. And I mean, I literally broke, I stopped functioning, I lost my job, I had seven psychiatric hospitalizations, I did attempt suicide, and I ended up living in a sober house away, away from my family.

Helen Sneed: Well, what about the depression symptoms that, that, that you've been mentioning? What, what did, what did depression

00:55:00

Helen Sneed: look like for you at this point?

Valerie Milburn: Well, those symptoms that we've been talking about were in full force. I had a constant low mood, I mean really low days and days of not getting out of bed, not showering, barely eating. The activities I usually enjoyed brought me no pleasure if I was even able to do them. I felt so guilty about not being part of my family, about not being able to work, that made me feel worthless. I was just immobilized, you know, immobilized, obviously. No energy, I couldn't concentrate. And I thought about suicide often. And as I said, I did attempt it. And then with all the depression, just to make things interesting, I'd have a manic episode. But I fought my way to recovery. And you know, in recovery I do still face depression. That's the interesting thing about depression, it just comes and goes. You know, even in recovery I have low days and. But now I know that it's a low day and I know it won't last. And I'm not scared of those low days. I use all my tools, self care, mindfulness, exercise, using my support system. I rely on my sponsor a lot because she says wise things like it's a pajama day, take care of yourself, you'll be better, things will be better tomorrow. But if things aren't better in three or four days, I'm on the phone with my psychiatrist. We monitor it together from there and we take appropriate action. Now I have had three bouts of full on depression in recovery and one was due to a very success, very stressful work environment. The one that was agitated depression was after my mother's death that I talked about. And the other was at the beginning of the pandemic. And they each manifested differently. The first one was just classic major depressive disorder and it was work related again, it was surrounded by a lot of stress. I was in a relatively new career of being a teacher. It was triggered by witnessing two really violent events at the school where I was teaching. It brought up old trauma issues and it was characterized by those classic symptoms. I couldn't concentrate, I was overwhelmed all the time, and I had to go part time at work. I just couldn't function. So that was major depressive disorder, classic symptoms. And the other one was the agitated depression. And then the other one was just a scary depression, the one that started at the beginning of the pandemic because I couldn't figure out what was going on. And you know, as we all know, the whole situation was foreign because it was a pandemic. We never been there before. And this one felt like the old depression might be returning because I couldn't shake it. And it kept getting worse. And that was what was so scary. And then one morning, Helen, I had that thought. That is terrifying for me. How am I going to get through this day? I called my psychiatrist that morning. You know, you would have done the same thing. So my psychiatrist and I put together a multifaceted plan. I followed the plan. I fought my way out of that depression. I did it. I fought my way back.

Helen Sneed: Oh, you are really an inspiration. I mean, the thing that gets me is you have endured so much and yet you found the strength to fight back each time, even at your lowest ebbs. And I, I can't tell you how much I respect that and, and envy it because, you know, with depression, a lot of the time people just quit. And you really maybe miss your son's birthday party, but you were also fighting all that time. And, you know, this is a good place to bring us to the close of our first episode on depression. I like ending with Valerie's fighting words. As we've all seen, you know, depression is so potent, ruthless and unrelenting, it makes an indelible mark on the very fabric of our society, not to mention on the individual who has it and those who love and care for them. So what can be done about it? Well, you know, actually a great deal now that we've explored the disorder in its many manifestations. In part two, we will fully examine treatment methods for the individual with depression and support for families and caregivers. For despite its virulence, depression is highly treatable. And Valerie, I don't think enough people know this, right. That it really is highly treatable. With adequate treatment, 70 to 80% may achieve a significant reduction in their symptoms.

Valerie Milburn: Right.

Helen Sneed: And

01:00:00

Helen Sneed: from the cutting edge in this part 2, we will describe the phenomenal breakthroughs and results in research and treatment that create hope for us all and for the future.

Valerie Milburn: Yes.

Helen Sneed: So I think this has been a really, really, for me, a fascinating, you know, exploration of depression. And now, which happens at the end of every podcast that we have episode. Valerie will lead us in a mindfulness exercise.

Valerie Milburn: I will do that. We will close, as Helen said, with our traditional mindfulness exercise. And what is mindfulness? I always give a definition. Mindfulness is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's thoughts, feelings and bodily sensations without judgment. Today's exercise is called Easing the Mind and it's a way of building a gentler relationship with our thoughts. I don't know about you, but my mind doesn't always do what I want it to. But practicing mindfulness helps us respond gently to our thoughts. Let's get mindful. We will begin, as always, with our diaphragmatic breathing. If you're walking or driving, please adapt this mindfulness exercise in such a way that it works in your current surroundings. If you can find a comfortable seated position, try closing your eyes. If it's safe to do so, we will take three diaphragmatic breaths. I usually start with about 10 diaphragmatic breaths for my mindfulness and meditation practice. Let's breathe. Inhale through your nose, expanding an imaginary balloon in your stomach. Hold your breath. Exhale through your mouth, pulling your stomach in as you do so. Take another breath. Inhale through your nose. Expand that imaginary balloon. Exhale through your mouth, pulling your stomach all the way in. Drop your shoulders. One more inhale. Exhale. Continue with this deep, regular breathing. Begin offering your mind a few phrases of loving kindness with the intention of building a gentler relationship with your thoughts. You can use the phrases may my mind be at ease and may I be at ease with my mind. May my mind be at ease and may I be at ease with my mind. Continue repeating these phrases, May my mind be at ease. May I be at ease with my mind. Use the phrases in your head as the object of your awareness. Try to hear the words in your head and connect with the meaning of the phrase. When you notice the mind is agitated or anxious or overacted, use a one word note. Note, thinking or anxious. Whatever is present, just note it Then return to your phrases. May my mind be at ease. May I be at ease with my mind. Let's spend the next 30 seconds repeating your phrases. Remember to be gentle, not forcing or straining to concentrate. Just repeat your phrases. Enjoy the next 30 seconds of mindfulness.

Helen Sneed: It.

Valerie Milburn: If your eyes are closed, please open them and gently bring yourself back to your surroundings. May this exercise bring you gentle thoughts. Thank you for doing this mindfulness exercise with me.

Helen Sneed: Well, that was wonderful, Valerie. And thank you for the first peace and tranquility I've had today.

Valerie Milburn: You're welcome.

Helen Sneed: Okay. And to you, our listeners, we are so grateful that you were with us. People ask us what they can do to spread the word about mental health, hope and recovery. We would be so grateful if you'd post a review wherever you access your podcast and mention us on social media, too. We want to reach more people. And don't forget to visit and refer people to our new website, mentalhealthhopeandrecovery.com it's the place to find all our episodes and to leave us a message. We would love to hear from you and value your opinions. Please join us for our next episode, the Great Abyss of Depression. The Background the Battle and the Breakthroughs, Part two. We have some incredible information to give you, including treatment methods, ideas for families and caregivers, and the astonishing breakthroughs in treating depression. Until then, we leave you with our favorite word. Onward.