What If You Knew Depression as a Doctor + as a Patient | Dr. Deborah Serani | TEDxAdelphiUniversity


Translator: Nataliia Pysemska
Reviewer: Tanya Cushman I have mental illness. It’s taken me hours of talk therapy, months of trying to find
the right medication, and years to learn
how to live successfully with it. I’ve redefined how I think and feel and have learned what kinds of experience
and people to allow or limit in my life. Now at age 55, I’ve come to appreciate
the textures of my own mental illness and the wisdom that comes
from living within those margins. But there was a time
that I wasn’t so wise. A time when my mental illness
overwhelmed me. A time when, at age 19,
I reached for a handgun, ready to end my life. As a young girl, I didn’t know
I was depressed. I was just tired and tearful
a great deal of the time. And I just thought that everybody
felt that way as a kid. And teachers, friends, family – nobody really noticed
that I was depressed. Partly because clinical depression
wasn’t thought to exist in young children. And partly because I was a good kid
who didn’t need a lot of looking after and I knew how to put a smile
on my face to hide the pain. But as I got older,
my depression worsened. The tiredness and tearfulness morphed into an unshakable fatigue
and a looming despair. In college, I started skipping classes
because I was having trouble focusing. As things worsened, I stopped
going to school altogether, and stayed in my room,
and slept for hours at a time. Sometimes I didn’t know
if it was afternoon or morning, or if it was a Tuesday or a Thursday. And the fatigue was
just the tip of the iceberg. What bubbled beneath the surface were negative, corrosive
and menacing thoughts and feelings that completely overwhelmed me. “Dad’s gun is in the left-hand side
of his dresser drawer,” I told myself one morning. “When everybody leaves, go in and get it. Then go into the bathtub,
release the safety, make sure you closed
the shower curtains all the way.” It’s hard sometimes to hear myself
say those words out loud because I’m very lucky
that my suicide attempt was interrupted. I got immediate help
and began working with a psychologist who taught me about mental illness
and mood disorders, specifically the one
that I was struggling with, which was called “unipolar depression.” I learned how my own life story
and my own family’s genetics created this perfect storm
for my mental illness to hit. And not only did mental illness
stay in my family, it became something that I learned
to recognize and needed to maintain not only for myself
but for my loved ones as well. Psychotherapy not only saved my life, it changed my life, so much so that I decided
to become a psychologist myself and treat people who had
the very same mental illness that I did. My unique experiences
as being both a doctor and a patient offers me a perspective
that most people don’t have. I know what it’s like
to live with a mental illness. I know the shame that comes from feeling
betrayed by your own mind and body. I know what it feels like
to have to take medication and the awful side effects
that come with it, like weight gain, loss of libido, night sweats and hand tremors,
just to name a few. But a psychologist
doesn’t need to know firsthand what an experience is like
or what a disorder is like to help people heal. But my perspective,
personally living with depression, taught me things that clinical training
and education never could. So what if you knew depression
as both a doctor and a patient? Well, you would know these six things. As a doctor, I tell you
that stigma is alive and well no matter what you see, read or hear. Technology and science have advanced
the understanding of mental illness, but unfortunately, the general public still fears
those who live with mental illness. I know what it’s like to feel
the shame and the cold, hard stare. I’ve had a pharmacist tell me one time
when I went to fill my prescription, “Yes you mustn’t forget your Prozac;
there’s a full moon out tonight.” And mental illness stigma
is not just seen in the general public. There’s something called
“diagnostic overshadowing.” This is where healthcare professionals discriminate against people – children
and adults – who have mental illness. And as a result, these individuals
have undiagnosed physical disorders and are more likely to prematurely die
than the general population. So as a doctor, stigma still represents
one of the biggest wedges in getting well-being
for those who have mental illness. And we need to do more. As a doctor, I tell you, we’re not accessing the field
of personal medicine the way we need to. In fact, it may be a phrase
that many of you are not even aware of, particularly genetic metabolism testing. Research tells us
that it takes up to 10 years for a person with depression to get
adequate treatment for their depression. Mostly it’s finding the right medications. But a test like this
can shave years and months and can turn into a week turnaround to find out the genetically designed
medications that will work best for you. Now, personalized medicine
is a field that offers enormous hope. But a lot of professionals
are unaware that it’s out there, and it’s called “genetic illiteracy.” And it’s something that a lot of health
professionals can’t really keep up with because there are
so many new breakthroughs when it comes to genetic sciences. But I’m here to tell you as a doctor that personalized medicine
and genetic metabolism testing should be done for every single person
who lives with a mental illness. As a doctor, I would tell you that the single
most important thing you can do if you live with someone
who has a mental illness or if you have mental illness yourself is to adhere to your treatment plan. Research says up to 80%
of individuals who have depression never reach recovery. That means they never feel better, let alone reach remission, which means
that depressive symptoms are gone. Now, consistency in dealing
with your treatment plan is not just showing up
for your therapy sessions or taking your medication. In my practice, it’s the biggest issue
that prevents people from feeling better. Consistency means taking
your medication every day – the same dose every day,
at the same time every day – and making sure that you get
your refills done on time so there’s no gaps in treatment. And consistency means not just going for psychotherapy sessions
because you’re not feeling good. You have to go when it’s a nice beach day or even if you don’t want
to or feel like talking. The idea of consistency
for any chronic illness is the key to well-being. In the field of real estate,
they have the mantra, “Location, location, location.” Well, in the field of mental illness
we need to talk about “Consistency, consistency, consistency.” Now as a patient – turn
my perspective towards that end – I would love for everybody
to just watch your words. Please don’t tell me to “buck up”
or “just try harder,” “be strong” or, you know, “Maybe
you’re just being a little lazy today.” You would never say those things
to somebody who has cancer or diabetes or muscular dystrophy. Depression is a real illness
with a neurobiological basis. And just like chemotherapy won’t help
somebody’s cancer be cured in one dose or insulin won’t regulate
somebody’s blood sugar forever, recovery from depression
is not going to get better from a dosage of medication
or a trial of psychotherapy sessions. Depression needs to be accepted
as a real illness. As a patient, I tell you
I need to know my triggers, and I ask that you respect them. So if you ask me to come out
with you for a drink, celebrate your latest promotion, or we’re going to go
out to the city, stay out late, and I say “no,” or I pass on watching
the latest tearjerker movie – it’s not that I don’t want to have fun. There’s a reason behind my noes. Drinking alcohol reduces
the effects of my medication. Staying out late will interfere
with my sleep architecture, and I need nine to ten hours a day. It just might be too overwhelming
emotionally for me to watch a really sad movie. So as a patient, I’m hopeful that you can understand
how invested I need to be in my self-care. And as a patient, I need to let you know that there’s a likelihood
that I may have a serious relapse. 70% of individuals
who have a depressive episode will have another one. And that statistic doubles to almost 90%
if you’ve had two episodes. So I need to know that you’ll know
what to do, who to call, where to go if I become suicidal
or dangerously depressed. This is called an emergency plan, and in it will contain
the names of my doctors, the names of the pharmacy,
the names of the local hospital. And if I go willingly, that’s terrific. But if I can’t go willingly,
you may have to call the police, dial 911, and you’ll have to deal
with me maybe being angry, telling you “I’m never
going to speak to you again.” But that really won’t matter,
because that’s the depression talking. Once I feel better, I’ll be so grateful
that you cared to look out for me. I’d be so grateful to be alive. Depression is a serious
but treatable illness. As a doctor, I’m here
to tell you there is hope. And as a patient, I’m here
to tell you there is healing. Thank you. (Applause)

50 comments

  1. Wow- what an incredible presentation. I am SO very proud of your strength and courage to overcome and achieve so much! I love you !!!!! #2 : )

  2. Nice talk. I learned what it might take for me to start getting better. The commitment is daunting. But the payoff… it would feel so good 🙂

  3. Thank you, Deborah, for sharing the absolute best lecture on suffering and coping with chronic UniPolar Disorder that I've experienced online!
    Your patients and students are incredibly fortunate individuals.
    PLEASE continue to educate the public, therapists, counselors and physicians, en masse, globally! Best wishes! 🙂

  4. Great talk about hard truths. My experience with depression has been life-changing too. Ending the stigma is such a key point in the fight against mental illnesses! What you're doing, reaching out to talk about this, to explain it to people, is so important. Thank you.

  5. Wow thank you so much Dr. Serani! 💐 I am so inspired by your TEDx Talk. I'm beginning to feel and see that my purpose and calling is to go back to school for my Master's Degree so I can help others who suffer from depression, anxiety, trauma and ptsd like me. I love knowing that I'm not alone in my struggle, 😊 and I love knowing that it's not my fault. 😉 The first time I learned it wasn't my fault was when I watch "Good Will Hunting" with Robin Williams 18 years ago. I needed to know it wasn't my fault…and nobody ever told me that. Speaking out boldly and educating those around us, our communities, country, and the world is the only way to break free from the stigma and teach us how to help one another. 💞 The internet is such a blessing, and so are you! Thank you again and I hope to cross paths with you someday.
    Warmly,
    Sunshine

  6. Fantastic! Thank you SO much! Your description of what your teenage episode was like mirrors my own (except the suicide attempt part). So much of this deeply resonated with me. We must share this far and wide and end the stigma! Keep up the great work Dr. Serani! You are a huge blessing! <3

  7. I can't metabolize anti depression medication and no doctor I met knew that this exists. I only knew because my brother was genetically tested for that and told me about it. it scares me that this is't known because it's like poisoning yourself when you haven't found a right medication after years and years

  8. how do we find a doctor locally that does this testing? What is the testing called? My son needs this so badly and I think I do also.

  9. This resonates within myself.. Because it's even worse when I'm still a medical student.. everything you said makes so much sense.. Thank you..

  10. Thank you for this talk. This was the video I was looking for. I'll be a psychologist soon and I understand you 100% . There is a lot of stigma specially if you work in health care. as a patient myself there is stigma too so there is pretty much stigma everywhere.

  11. Guess what? The stigma around diabetes is still strong and people are often confused between type 1 and type 2. The stigma is common for both types (which sort of lets us relate to each other (type 1 to a type 2) on a deeper level than the illness itself). The worst thing is, people often think that its all an act for "attention". I have received comments like "Just get over it already!" , "Oh god, not again." The thing is, people don't really get it unless they have been through it themselves. The stares I get when I inject my insulin at a public place, the words "This will cure u, trust me", the blame game, it's all still there and people do say those words.

    P.S Type 1 diabetic with Hypothyroidism (19 yrs old, diagnosed at 2) and living in a country where all that matters is your image in the society.
    When u try to share it with the people you trust and they turn it down by saying "Stop being so negative." , it makes it even worse. I'm at the point where I can't feel anything. Its just dark and empty. Nothing to live and hope for. Tried 14 times to kill myself and failed which makes me feel even more disappointed.

  12. Thank you so much for this. It's nice to have a medical professional who understands from personal experience. Kudos to you for overcoming your depression. Your video has inspired me to try my hardest to do the same.

  13. I been suffering from anxiety since 5 years ago. I feel sad that I feel so hopeless at this moment. The past 5 years I been through so many situations that caused "this dark side"… I am a kind hearted person. I try my best to be there for my family and friends if I am able to. I lost my mother to cancer 12 years ago. I can not believe I am fighting for my life now. I stay alive for my love ones. I already feel dead inside. Everyday is just struggling with pain. I know how and why I got this way. The medicine I take is to help me function just a little. How long can I hold on? I really feel alone too because it seem like no one experience this in my life. They love me but they don't understand 100%. I feel scare… what if I give up or turn insane….

  14. im sorry but western philosophies are absolute crap when it comes to mental illness. medication does not help. i promise you your body is much smarter than you think. if you are feeling tired, disinterested, lethargic, and experience a loss of appetite, it is not because you need drugs in your body. that is nothing more than symptom treatment. if you feel tired, and experience a loss of appetite, consider listening to your body for once rather than resisting these messages. try water fasting and meditation. you will be shocked. depression is a call for your mind and body to rest. if you give it what it wants, youll be amazed.

  15. I wish I could find a doctor like you. Trying to find someone who is understanding and not condescending.

  16. I wish I could find some help of this quality but my family isnt supportive and sort of hates me for my depressive ways. I've sought help at a local fred clinic but they can only give me drugs, not therapy. do to my stupid choices and ruining my life by turning to alcohol to deal with this illness I didn't know I had at a young age im a loser who works at a warehouse, so I cant afford therapy. I'm at the point where suicide seems like the best option for me. It's been a 28 year downward spiral and I can't see any reason it will get better. In fact its only gotten worse these past 5 years.

    I don't know why I typed this. guess I just needed to get it off my chest.

  17. I've suffered from depression since I was 8. I'm 40 and still have not found the right drug combination that stops my daily struggle and suffering. I'm glad you've found a way to treat your depression successfully. One day I hope to before it's too late.

  18. I was clinically depressed my whole life. In high school I also skipped and stopped going to school and sleeping all of the time. And I had to drop out because of being absent and not being able to focus. I was not able to get help since my dad was bi-polar and that is where the focus was. I could write a book about what I have been through. I did go back to school and finished a teaching degree. I still struggle and probably should be on meds, but feel that makes me seem weak. I also, have a lot of fears and now that my mom is dying of a brain disease I am super depressed and anxious. I never heard of the personalized medicine. Wow. Wish I could be tested for this.

  19. thank you from the bottom of my heart …your talk made me realize I need to understand my illness better and love myself more.

  20. I failed an attempt, i still feel ire to the people "saving" me, it was
    not the depression talking. i still very much like to die, it hard work working up to that.

  21. JESUS loves you very much, he died for you and If you will BELIEVE in him you will be Saved and have everlasting life Jesus give hope , JESUS gives second chances He that will call upon the name of the Lord will be Saved Come to JESUS as you are and he will welcome you with open arms

  22. This really made me feel better. It defined what i am going through. And i must try harder to be consistent with my meds the same time everyday. This is one of the ways to stay mentally healthy and stable. Thank you this is a wonderful talk. .

  23. Dear Dr. Serani, your talk is so inspiring and compassionate and needs to be circulated everywhere!

    Battling with depression and emotional dysregulation myself and that too in India, its first of all very hard to find the right combination of therapy and medical supervision especially the kind of personalised genetic testing that you talk about which would make life so much easier and simpler for patients here.

    On the stigma front, its a relief in a way to even know that stigma also exists in North America and other parts of the world because here, people never ever want to talk about therapy in connection to themselves, forget about taking medication (which means something is *really wrong with you and that you can't possibly be a functioning or dependable individual).

    If you have any connections or suggestions in India, please do share. Thank you again!!

  24. Great presentation! I totaly agree regarding the stigma of mental illnesses. A week ago my mood was dangerously low. I then decided to write a story about my feelings and thoughts. I wanted other people to know what I feel when I'm on a very low point. I published the story on my weblog and then shared the link of it on Facebook.

    The days following I got a lot of reactions from friends and family to my story. It affected them greatly and it made some of them even cry. I was overwhelmed by these warm reactions! Because of that story I do not need to put a mask on with the people who read it. That feels so good! Be open and honest to your loved ones regarding your illness.

  25. I had undiagnosed hypothyroidism for years because my doctor always told me the symptoms were just about my depression. Now I'm medicated for it thank goodness. It is a life long illness and I could've had it untreated for the rest of my life if I hadn't been so insistent with the doctors.

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