I have struggled with crippling depression since I was, I don’t know, four? But it wasn’t until I was in the midst of cancer treatments that I came to terms with the fact that my life might just be better if I surrender to Big Pharma and take some goddamn antidepressants already.
As I was moving out of my serious cancer treatments into what they call “maintenance” because you go from trying not to die to maintaining your existence, my oncologist presented numerous options for keeping the cancer at bay. For my type of breast cancer, Tamoxifen is the most commonly prescribed option. Tamoxifen is a hormone blocker. It has numerous side effects, most commonly insomnia and weight gain. The typical prescription is one pill every day for five to ten years. When my oncologist, Dr. Nova, told me about Tamoxifen, I had already researched it ad nauseam.
“Will I gain weight?” I asked one afternoon in July 2018. I was still bald and wearing one of my larger post-baby/cancer dresses, my eyes leaking away from the chemo.
“Weight gain does happen in some women.”
“A lot of women.”
“It’s a side effect.”
“I absolutely will not take it if I gain weight. Period. I don’t care if that means I’ll die. I am fat right now. I hate being fat.”
My cheeks flush when I read this. Not because of the drama, but because of the shortsightedness and cruelty. Shortsighted because we are so much more than our bodies, a very difficult stance to take when you’re depressed and your body is killing you. Cruel because fat is such a vicious descriptor for any human to use against any other. At 5’5”, fat for me was weighing 147. My normal weight, my current weight, is 120. 147 is not fat. It’s just a bigger way of life that—for me—felt out of control and restrictive.
Dr. Nova’s face crumbled as she nodded to my one-year-old twins who were sitting in a stroller by my side playing with the large Q-tips that she had given them. “But Ivy, don’t you want to be around for your boys?”
Rational people often bring me to tears as did Dr. Nova in that office. Long story short, I took the Tamoxifen—am taking the Tamoxifen, will take the Tamoxifen for the next ten years—and haven’t gained an ounce. So that’s good. Interesting, accepting my fate with Tamoxifen had its own side effect: It forced a conversation about the depression that I have denied for many years.
“Ivy,” Dr. Nova said after I agreed to try Tamoxifen. “It’s not uncommon for cancer patients to also experience depression.”
“I’m not depressed,” I sobbed, making the two medical students who were crammed in the examining room wiggle discontentedly. “I just hate my life.”
A common side effect—if you can call it that—of Post Traumatic Stress Disorder (PTSD), which is a common side effect—if you can call it that—of cancer, is difficulty with emotional regulation. In fact, the challenges with emotional regulation experienced by those with PTSD can be so great that they can trigger a temporary diagnosis of borderline personality disorder. I am not a doctor, but I will say that from my cancer diagnosis in December 2017 until about oh, May or June of this year, my emotions were as erratic as a toddler’s. Unlike a toddler, it’s not acceptable for an adult to fling herself on the floor and kick her feet so violently that she spins in a circle. Metaphorically, I did this anyway.
The problem with the emotional dysregulation piece, is that it was one more excuse for not taking antidepressants. I thought, given the cancer, that my depression was temporary, that once I was done with cancer, it would clear up. But truth be told, I have been battling depression exactly twelve times as long as I battled cancer and I knew it. I just didn’t want to admit it. Before cancer, doctors tried, therapists pleaded and my loved ones begged for me to at least try an antidepressant. But I was too tough to have mental health issues, too strong to succumb to a stigmatized health issue that any ‘ol red blooded American gal might combat by pulling herself up by her bootstraps and forging ahead.
Eventually, Dr. Nova got me to try a non-SSRI antidepressant (I was opposed to the SSRI weight gain side effect) not because it would help me live a better life, but because she sold it to me as a non-anti-depressant. How fucked up is that? I finally get to a place in my life where I’m accepting that I might need to take a pill for the rest of my life to feel stable, but then decide to take it because I can hide what it’s for? This is the problem with talking about mental health. Opening up about the imperfections of our brain immediately gives others the impression that we are weak, unstable and unpredictable. I am not weak. I am sometimes unstable. I’m definitely unpredictable, but that’s just me.
Cancer forced me to address a lifelong struggle with depression for three reasons. One, because I knew that I’d have to take one pill (Tamoxifen) for at least the next ten years, I reasoned that I could possibly take another. Two, my oncologist promised that my anti-depressant could be filed away as fixing something else. Three, the sheer exhaustion from fighting a disease for so long made me say, “Enough. I’m sick of fighting to stay alive, I’m sick of fighting to feel normal. Do whatever you need to, but please, fix me.”
This is not an endorsement for antidepressants. Big Pharma is always a last resort for me. I don’t trust it, I think it’s incredibly corrupt, I hate that it further splices the divide between rich and poor in this country and I’ll do anything and everything to avoid coming in contact with it. But I had tried everything else—St. John’s root, not drinking, exercise, EMDR, everything—and none of it was enough to pull me out of the suicide troughs. Even though discussions surrounding mental illnesses have gotten infinitesimally louder, the shame of not being able to control your own brain is suffocating. At the risk of sounding like a PSA, if you or someone you know is suffering from depression or any of the many mental health diagnoses that we are aware of but don’t always talk about, please, at the very least, kindly and compassionately open the conversation about depression.