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Ghost in a Body

Julie Hersh slid into her maroon Escalade early one Monday morning. With sports-buffed nails she fiddled with the CD player to find her favorite music—David Wilcox’s Hold It Up to the Light.

Her own mother and two children, ages 5 and 7, slept peacefully in the 10,000-square-foot manse she built with husband Ken, who had already left for work. She lingered over the baseball gloves beckoning on pegs—one for each family member. Soon, she thought, someone else will use her glove.

She backed out of her Preston Hollow garage just as if she was off to another errand or carpool or coffee with friends. But, this time, she detoured into a separate, less-used garage on the property. She watched as each panel of the door clicked down behind her. Then, she put her head on the steering wheel and left the engine running.

A striking woman, with angular looks resembling a Kennedy, who seemingly had it all—health, wealth and the perfect family—waited to die.

Suicide. Not a word bandied about at playdates. Yet, suicide is the 11th leading cause of death in the United States, according to Margie Wright, executive director of The Suicide and Crisis Center of North Texas. More than 33,000 people die at their own hands every year. Women, especially those ages 45 to 54, attempt suicide three times more often than men, reports Wright.

More importantly is why: Approximately 90 percent of suicides are attributable to one or more mental disorder, reveals Michael LaValle, a licensed psychologist who also sits on the board of the Mental Health America of Greater Dallas. And, because there is such a stigma attached to mental illness, many people, such as Julie, attempt to kill themselves rather than admit their feelings and seek help.

After nearly 90 minutes of waiting for death to descend, Julie emerged from her vehicle. A well-ventilated garage saved her from herself—and from her third attempt at suicide. She slammed the door, noticing “the same concrete, same brick, same unrelenting heat.”

‘This Isn’t a Real Problem’
Julie suffers from Major Depressive Disorder (MDD), a debilitating disease that strikes 21 million people annually, according Mental Health America.

Depression is the leading cause of disability in the U.S., reports the National Institute of Mental Health (NIMH). It’s more common in women than men—up to 25 percent of women will experience depression in their lifetime.

Despite its prevalence, only about half of Americans diagnosed with major depression receive treatment, reveals NIMH data.

Depression is ranked in terms of severity—mild, moderate or severe. It is often treated first with psychotherapy or a combination of therapy and one or more of the 20 FDA-approved antidepressant medications for more severe forms of depression, according to LaValle.

Julie weathered her first bout of depression during college during the ’70s—a time before doctors handed out “antidepressants like Tic Tacs,” she recalls. At the time, the bleak period lifted without medication or therapy.

But LaValle cautions, “Not getting professional help is an unnecessary risk, particularly if day-to-day functioning is impaired.”

Julie’s second stint with depression began about nine months after her first child was born, when she “gave birth to my first suicidal thoughts.”

According to Dr. Mustafa Husain, director of the Neuro Stimulation Research Lab at UT Southwestern Medical Center, there is a 50 percent chance one major depressive episode will lead to another. After two bouts, the risk goes up to 75 percent; three episodes and the odds of having a recurrence are 99 percent.

Julie started to experience symptoms based on the Hamilton Depression Rating Scale, a standard-yet-subjective diagnostic tool doctors use to measure (among many other criteria): weight fluctuations, sleep issues and loss of interest in activities. She describes feeling like “the walking dead, a ghost in a body once vibrant.”

Regardless, similar to most moms, she put her own health at the bottom of the to-do list and told herself, “I’m too busy. This isn’t a real problem.”

Friends noticed her weight loss and complemented her. She wanted to scream, “No, this is bad!” But, in a society, where image is everything, she took the praise instead of sharing the dark truth about her svelte frame.

As is the case for many who suffer from MDD, the stresses started piling up. In addition to her two children, Julie was also caring for Ken’s ailing grandparents. “My brain felt stuck in the gooey fluids of my day,” she relates in her recently published memoir, Struck by Living. “Someone always had a request for me. … After a while, I was disappointed to be so disappointing.”

The long days strung together like a delicate pearl necklace she might don at charity or business events—only they were laced with the tedium of motherhood: the repetition, the physical ache, the boredom. She says she began to think she was the only one psychologically devastated by a baby.
However, Julie was not diagnosed with postpartum depression. “I rarely talked about how I felt,” she writes. “My reactions seemed unhealthy to me, unfit for a good mother. So I did what I do best with unacceptable emotions. I buried them.”

Dr. Anna Brandon, a psychologist with the Women’s Mental Health Center at UT Southwestern Medical Center, estimates that up to 60 percent of women who suffer from postpartum depression never get help.

“The first thing for women to understand is that it’s not rare,” stresses Brandon. “They are not incompetent or weak.”

‘Difficult to Diagnose’
Julie found the tradeoffs between motherhood and her promising career in sales to be “impossible.” Because of her husband’s tremendous success with his business, she reasoned that she didn’t need the income from her own employment. But, as he was “stretching his brain to new limits,” Julie was suffering from sleep deprivation, exhaustion and lack of intellectual stimulation. “My brain went into an idle state,” she notes.

And then there was the pressure to be supermom. “I ran faster, did more, took on volunteer projects and filled my schedule instead of saying ‘no’ to anyone,” explains Julie. The fast pace became her elixir and she also dabbled in reckless behavior (such as forcing her very young children to hike with her 5.5 miles up 1,581 feet)—all in an effort to breakthrough what she describes as “numbness.”

But soon she struggled to muster her mothering instincts and often found herself marooned behind the gates of her nine-bathroom home. She retreated from her friends, school, even exercise. Her son demanded to know: “What’s wrong with you?” She remembers looking at him and says, “My mouth moved but nothing came out.”

The first time she went to her physician to seek help, he told her that physically she was fine, suggesting, “We all have bad days. We have to force ourselves to keep going.” Except that Julie thought about killing herself at least three times a week.

Husain, who is also a professor of psychiatry and specializes in severe depression, cautions that MDD is “difficult to diagnose.” “We do not know exactly what causes major depressive disorder,” states Husain. It can be triggered by both psychological and biological (genetic) components. For Julie, depression runs in her family.

The critical symptoms he looks for are two to four weeks of an unshakable, sustained down feeling and an inability to enjoy life. The person will often express hopelessness, overwhelming guilt, a strong desire for isolation and a sense of being a burden to loved ones. LaValle adds that suicidal thoughts are common with MDD.

Brandon stresses that the most important thing to do, if you’re feeling any of these symptoms, is to confide in someone you trust and seek help. Of the women who come into her clinic and report depression symptoms, only 35 percent follow up on a referral for treatment.

Julie finally confessed some of her true feelings to her sister-in-law and that sparked a visit to a psychologist and a psychiatrist — and eventually five different prescriptions to treat the depression. Still, she found her condition hard to accept. “I was ashamed, humiliated that I needed drugs to prop me up for such an easy life. I didn’t need to work. I didn’t need to worry,” Julie allows.

But the meds didn’t seem to lift the mist that clouded her mind. That’s not unusual, according to the results of the nation’s largest clinical trial for depression, the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study. Because no one treatment is universally effective for everyone, many depressed patients do not experience relief from the initial treatment they receive.
Worse yet, “life went on despite my soul stoppage,” she submits.

Ken hired a nanny to help with the kids and the house and “everything I had dropped,” recounts Julie. Her friends and family kept close tabs on her and served as “substitute mothers” to her children. But, Ken “looked worn” and her son and daughter stopped coming to her with their needs. “They went to Ken. They knew I could no longer help them,” Julie details. “My children peered at me like an unwanted relative who entered their house.”

According to a 20-year study, published in the American Journal of Psychiatry in 2006, children of depressed parents suffered approximately triple the rate of anxiety disorders, major depression and substance abuse by their 30s. “Depression is infectious,” advises Husain. “It affects the whole family—not biologically in some cases—but being around a depressed person is very stressful.”

He adds, “Children need to understand that Mom is not well.”

Depression wears even the most enduring love and fealty to a fine tread, acknowledges Julie. But, Ken never gave up hope or support, even when Julie pushed him away (and suggested another more suitable wife for him).

“I saw her depression as a disease that could be treated,” explains Ken. “We had not run out of treatment options, so I was still hopeful. With two kids under the age of 8 at the time, my goal was to help get Julie better and preserve the family.”

‘Lightening Rod to Her Recovery’
Despite psychotherapy, antidepressants and constant support, it wasn’t enough to banish the thought from her mind that her husband and children would be better off without her.

During the course of six years and three suicide attempts, a voice taunted in her head: ‘You are not needed.’ She felt certain that, “with me gone, they can finally heal.”

Her family and doctors had a different plan: Electroconvulsive Therapy (ECT). According to Husain, an ECT expert, the procedure (also known as “shock therapy”) is a psychiatric treatment that involves sending a burst of electricity through the brain, causing a convulsion designed to bring the brain into balance.

Though controversial (and sensationalized in movies such as One Flew Over the Cuckoo’s Nest), Husain says ECT is a safe and effective treatment (even in pregnant women) for acute psychotic depression episodes in psychiatry today.

While getting the right combination of drugs to work can take six to eight weeks, ECT delivers results quickly. “When life is on the line,” such as in an acutely suicidal person like Julie, “ECT is the answer,” Husain counsels.

Over the last decade, there has been an increase in the use of ECT, although its use has stirred passions over the years. Husain calls it the “abortion issue of psychiatry.” In fact, in the state of Texas, ECT is banned on children under the age of 17.

There are risks: the patient must be put under general anesthesia and it can cause memory problems. Contrary to belief, the treatment does not involve shock as defined by medicine and the patient’s body does not violently convulse. It’s not painful, though Julie details feeling sore, as well as forgetful, after the treatments. Doctors recommend a patient complete at least six ECT therapies to see improvement.

For Julie, it was the lightening rod to her recovery. “My life didn’t magically realign, but I no longer felt I deserved a death sentence,” she notes of her treatments at Zale Lipshy University Hospital (on the UT Southwestern University Hospital campus in Dallas). “ECT, primitive as it seems, saved my life.”

Is it a cure? No, stresses Husain. “Depression is a chronic disease. You can treat it, not kill it,” he insists. Once a person is out of the dangerous zone, the usual course of treatment is to resume medications to keep the person stable.

‘You Never Get Over It’
There is only limited information about how to successfully treat people with depression, according to STAR*D (which was conducted at UT Southwestern, in addition to 40 other medical centers in an effort to determine the effectiveness of different therapies for people with “treatment-resistant” MDD). For 70 percent of patients, an antidepressant is not enough to trigger remission.

Bill Bond, of Dallas, knows the stats too well. His wife Ann, a stay at home mom, who suffered from MDD for 20 years, succumbed to suicide on her fifth attempt. Her first episode of severe depression occurred after the birth of their third child. Over the years, Ann tried a combination of psychotherapy, drugs and ECT. “Northing worked,” according to Bond.

Bond recalls his wife saying to him, “I have everything in the world. I don’t understand why I feel this way.” Yet, because her repeated suicide attempts increased the risk that she would ultimately succeed, Bond concedes, “We all knew Ann was going to take her life.”

The energetic father of three, who “walked on egg shells” as he feared the unpredictable nature of his wife’s mind, found Ann’s body in their home after an overdose. “You never get over it,” he shares softly. Bond, who has gone through the Suicide Crisis Center’s SOS program (Survivors of Suicide), notes that none of his grown children have struggled with depression—though they are well aware of the signs and risks having lived through their mother’s illness.

But life is not the same now that his children are having kids who will never know their grandma. “My kids miss having their mother,” he offers simply.

“The urge to commit suicide is not logical and can’t be explained or cured by things that seem to be the right ingredients for the perfect life,” urges Julie. “Depression is a matter of life, electricity and chemistry that we have yet to understand.”

Husain adds, “You can see a broken bone or cancer, but you can’t see or measure depression.” Too many times a patient starts to feel good and is tempted to abort medicines and even psychotherapy. But Husain emphasizes that this is a very real illness (not a passing mood or character flaw that you can “snap out of”) and requires ongoing treatment. And, even then, the odds of beating persistent depression diminish as more treatment strategies are needed, according to STAR*D.

‘What’s the Big Deal?’
Julie learned the hard way that MDD is an unrelenting illness—similar to diabetes. Like many others, Julie went off her medication (wrongly thinking she shouldn’t need drugs if she is “spiritually whole”) and drifted back into crisis.

Her son Andrew, then 12, knew something was awry in his mother. He asked her if the depression had returned. Embarrassed, she replied: “Yes, I’m sorry.” He reassured her and encouraged her to go back in for ECT and to take her medicine.

“What’s the big deal [about seeking treatment]?” she remembers him saying. “Kids don’t have the same cultural hang ups that we do,” relays Julie. “Why couldn’t I see my depression like that, as a disease to be addressed?”

Both Husain and Brandon advise patients to seek early treatment when they start to experience symptoms of depression and to apply preventative measures, such as getting enough sleep (critical for a new mother), eating healthy and exercising. “Be proactive about your health. You are worth this,” stresses Brandon. “A depressed mom is impaired.”

Will Julie’s suicidal thoughts return? She knows the odds are in favor of it. But she has adjusted her lifestyle to limit stress as part of her recovery. She’s also rekindled a close relationship with her children (now teens) completed her childhood dream of writing a book and running a marathon, and now serves as board president of the Dallas Children’s Theater, among other nonprofit involvement (though she’s more apt to say “no” these days).

This time she is armed with the treatment, wisdom and acceptance she needs to survive. And, most importantly: hope.

“I choose to live,” she affirms.