After a lifetime of profound depression, 25 years of therapy and cycling through 18 antidepressants and mood stabilisers, Mr Hartman, then 46, had settled on a date and a plan to end it all. This clinical trial would be his last stab at salvation.

For 40 minutes, he sat in a hospital room as an IV drip delivered ketamine through his system. Several more hours passed before it occurred to him that all his thoughts of suicide had evaporated.

“My life will always be divided into the time before that first infusion and the time after,” Mr Hartman says today. “That sense of suffering and pain draining away. I was bewildered by the absence of pain.”

Ketamine, popularly known as the psychedelic club drug Special K, has been around since the early 1960s. It is a staple anaesthetic in emergency rooms, regularly used for children when they come in with broken bones and dislocated shoulders.

It’s an important tool in burn centres and veterinary medicine, as well as a notorious date-rape drug, known for its power quickly to numb and render someone immobile.

Since 2006, dozens of studies have reported that it can also reverse the kind of severe depression that traditional antidepressants often don’t touch. The momentum behind the drug has now reached the American Psychiatric Association (APA), which, according to members of a ketamine taskforce, seems headed towards a tacit endorsement of the drug for treatment-resistant depression.

Experts are calling it the most significant advance in mental health in more than half a century. They point to studies showing ketamine not only produces a rapid and robust antidepressant effect; it also puts a quick end to suicidal thinking.

Traditional antidepressants and mood stabilisers, by comparison, can take weeks or months to work. In 2010, a major study published in JAMA, the journal of the American Medical Association, reported that drugs in a leading class of antidepressants were no better than placebos for most depression.

A growing number of academic medical centres, including Yale University, the University of California at San Diego, the Mayo Clinic and the Cleveland Clinic, have begun offering ketamine treatments off-label for severe depression, as has Kaiser Permanente in Northern California.

“This is the next big thing in psychiatry,” says L. Alison McInnes, a San Francisco psychiatrist who over the past year has enrolled 58 severely depressed patients in Kaiser’s San Francisco clinic.

She says her long-term success rate of 60 per cent for people with treatment-resistant depression who try the drug has persuaded Kaiser to expand treatment to two other clinics in the Bay Area.

The excitement stems from the fact that it’s working for patients who have spent years cycling through antidepressants, mood stabilisers and various therapies.

“Psychiatry has run out of gas” in trying to help depressed patients for whom nothing has worked, she says.

“There is a significant number of people who don’t respond to antidepressants, and we’ve had nothing to offer them other than cognitive behaviour therapy, electroshock therapy and transcranial stimulation.”

Dr McInnes is a member of the APA’s ketamine taskforce, assigned to codify the protocol for how and when the drug will be given. She says she expects the APA to support the use of ketamine treatment early this year.

The guidelines, which follow the protocol used in the NIMH clinical trial involving Mr Hartman, call for six IV drips over a two-week period. The dosage is very low, about a 10th of the amount used in anaesthesia. And when it works, it does so within minutes or hours.

“It’s not subtle,” says Enrique Abreu, an anaesthesiologist from Portland, Oregon, who began treating depressed patients with it in 2012.

“It’s really obvious if it’s going to be effective. And the response rate is unbelievable. This drug is 75 per cent effective, which means that three-quarters of my patients do well. Nothing in medicine has those kind of numbers.”

So far, there is no evidence of addiction at the low dose in which infusions are delivered. Ketamine does, however, have one major limitation: its relief is temporary.

Clinical trials at NIMH have found that relapse usually occurs about a week after a single infusion.

Ketamine works differently from traditional antidepressants, which target the brain’s serotonin and noradrenalin systems. It blocks N-methyl-D-aspartate (NMDA), a receptor in the brain that is activated by glutamate, a neurotransmitter.

In excessive quantities, glutamate becomes an excitotoxin, meaning that it overstimulates brain cells.

“Ketamine almost certainly modifies the function of synapses and circuits, turning certain circuits on and off,” explains Carlos Zarate, NIMH’s chief of neurobiology and treatment of mood disorders, who has led the research on ketamine.

“The result is a rapid antidepressant effect.”

A study published in the journal Science in 2010 suggested that ketamine restores brain function through a process called synaptogenesis.

Scientists at Yale University found that ketamine not only improved depression-like behaviour in rats but also promoted the growth of new synaptic connections between neurons in the brain.

Even a low-dose infusion can cause intense hallucinations. Patients often describe a kind of lucid dreaming or dissociative state in which they lose track of time and feel separated from their bodies. Many enjoy it; some don’t. But studies at NIMH and elsewhere suggest that the psychedelic experience may play a small but significant role in the drug’s efficacy.

“It’s one of the things that’s really striking,” says Steven Levine, a psychiatrist from Princeton, New Jersey, who estimates that he has treated 500 patients with ketamine since 2011.

“With depression, people often feel very isolated and disconnected. Ketamine seems to leave something indelible behind. People use remarkably similar language to describe their experience: ‘a sense of connection to other people’, ‘a greater sense of connection to the universe.’ ”

Although bladder problems and cognitive deficits have been reported among long-term ketamine abusers, none of these effects have been observed in low-dose clinical trials.

In addition to depression, the drug is being studied for its effectiveness in treating obsessive-compulsive disorder, post-traumatic stress disorder, extreme anxiety and Rett syndrome, a rare developmental disorder on the autism spectrum.

Fleeting remission effect

The drug’s fleeting remission effect has led many patients to seek booster infusions. Mr Hartman began his search before he even left his hospital room in Bethesda.

Four years ago, he couldn’t find a doctor in the Pacific Northwest willing to administer ketamine.

“At the time, psychiatrists hovered between wilful ignorance and outright opposition to it,” says Mr Hartman, whose depression began creeping back a few weeks after his return to Seattle.

It took nine months before he found an anaesthesiologist in New York who was treating patients with ketamine. Soon, he was flying back and forth across the country for bimonthly infusions.

Upon his request, he received the same dosage and routine he’d received in Bethesda: six infusions over two weeks. And with each return to New York, his relief seemed to last a little longer. These days, he says that his periods of remission between infusions often stretch to six months. He says he no longer takes any medication for depression besides ketamine.

“I don’t consider myself permanently cured, but now it’s something I can manage like diabetes or arthritis,” Mr Hartman says. “Before, it was completely unmanageable. It dominated my life and prevented me from functioning.”

In 2012, he helped found the Ketamine Advocacy Network, a group that vets ketamine clinics, advocates for insurance coverage and spreads the word about the drug.

And word has indeed spread. Ketamine clinics, typically operated by psychiatrists or anaesthesiologists, are popping up in major cities around the country.

Dr Levine, for one, is about to expand from New Jersey to Denver and Baltimore. Dr Abreu recently opened a second clinic in Seattle.

Depression is big business. An estimated 15.7 million adults in the United States experienced at least one major depressive episode in 2014, the NIMH says.

“There’s a great unmet need in depression,” says Gerard Sanacora, director of the Yale Depression Research Program.

“We think this is an extremely important treatment. The concern comes if people start using ketamine before CBT [cognitive behavioral therapy] or Prozac. Maybe someday it will be a first-line treatment. But we’re not there yet.”

‘More research needed’

Dr Sanacora says a lot more research is required. “It’s a medication that can have big changes in heart rate and blood pressure. There are so many unknowns, I’m not sure it should be used more widely until we understand its long-term benefits and risks.”

While a single dose of ketamine is cheaper than a $2 bottle of water, the cost to the consumer varies wildly, running from between $US500 and $US1500 per treatment. The drug itself is easily available in any pharmacy, and doctors are free to prescribe it – as with any medication approved by the Food and Drug Administration – for off-label use. Practitioners attribute the expense to medical monitoring of patients and IV equipment required during an infusion.

There is no registry for tracking the number of patients being treated with ketamine for depression, the frequency of those treatments, dosage levels, follow-up care and adverse effects.

“We clearly need more standardisation in its use,” Dr Zarate says. “We still don’t know what the proper dose should be. We need to do more studies. It still, in my opinion, should be used predominantly in a research setting or a highly specialised clinic.”

As a drug once known almost exclusively to anaesthesiologists, ketamine now falls into a grey zone.

“Most anaesthesiologists don’t do mental health, and there’s no way a psychiatrist feels comfortable putting an IV in someone’s arm,” Dr Abreu says.

It’s a drug, in other words, that practically demands collaboration. Instead, it has set off a turf war. As the use of ketamine looks likely to grow, many psychiatrists say that use of ketamine for depression should be left to them.

“The bottom line is you’re treating depression,” says psychiatrist David Feifel, director of the centre for Advanced Treatment of Mood and Anxiety Disorders at the University of California at San Diego.

“And this isn’t garden-variety depression. The people coming in for ketamine are people who have the toughest, potentially most dangerous depressions. I think it’s a disaster if anaesthesiologists feel competent to monitor these patients. Many of them have bipolar disorder and are in danger of becoming manic. My question [to anaesthesiologists] is: ‘Do you feel comfortable that you can pick up mania?’ ”

But ketamine has flourished from the ground up and with little or no advertising. The demand has come primarily from patients and their families; Dr Zarate, for instance, says he receives “at least 100 emails a day” from patients.

Nearly every one of them wants to know where they can get it.

This article first appeared on ‘Sydney Morning Herald’ on 2 February 2016.

The study appears in the Journal of Gerontology: Social Sciences, and finds gender differences when long-married partners are asked about their marital relationship.

“The men don’t really want to talk about it or spend too much time thinking about it,” said Carr. “Men often don’t want to express vulnerable emotions, while women are much more comfortable expressing sadness or worry.”

The finding supports Carr’s belief that men and women have very different emotional reactions to the strain and support they experience in marriage. While talking about issues and offering support makes the wives — who traditionally feel responsible for sustaining the emotional climate of a marriage — feel good, this only frustrated the husbands surveyed.

“For women, getting a lot of support from their spouse is a positive experience,” said Carr. “Older men, however, may feel frustrated receiving lots of support from their wife, especially if it makes them feel helpless or less competent.”

In the study, 722 couples, married an average of 39 years, were asked how their marital experience and the reactions of their spouse affected them.

They responded to whether they could open up to their spouse if they needed to talk about their worries, whether their spouse appreciates them, understands the way they feel about things, argues with them, makes them feel tense, and gets on their nerves.

“Men who provide high levels of support to their wives may feel this frustration if they believe that they would rather be focusing their energies on another activity,” Carr said.

It may also have something to do with the age of the couples, with one spouse in the study having to be at least 60. Men of this generation may feel less competent if they need too much support from their wives, Carr said.

This article first appeared on ‘Psych Central’ on 27 October 2015.

The University of Michigan study found that there’s only one interaction that offers more rewarding feelings than Snapchat: face-to-face communication stole the show, once again.

Published online in Information, Communication & Society, the study seems to be one of the first known published findings on the matter of daily mood in relation to Snapchat. For those who have live under a rock for the past four years, Snapchat is the mobile app that made “ephemeral social media” popular.

In other words, there are some platforms that promote sharing content for a limited period of time (e.g., 10 or 20 seconds). For a lot of people, Snapchat only equals to that “sexting app,” as the description could surely hint to that.

But according to lead author Joseph Bayer, researcher at U-M, the study revealed that Snapchat seems to be the preferred social media for instant and spontaneous communication with close friends, one that often leads to goofy and enjoyable times.

Bayer’s team enrolled in the study 154 college students who had and used smartphones. The researchers used a method called “experience sampling” – one that measures the way people feel, think, and behave on a day-to-day basis – as to have an understanding on what made the participants feel well.

In order to do that, researchers would text them the same survey at random times six times a day. The phase of gathering data went on for two weeks, in which the participants were asked to answer the same five questions:

How negative or positive do you feel right now? How did your most recent interaction occur? How pleasant or unpleasant was your most recent interaction? Within that interaction, how supportive or unsupportive was that person to you? How close are you to that person?

Researchers discovered that no other social media interaction was associated with such high levels of positive emotions as Snapchat – and Facebook scored significantly lower than others. One of the reasons behind this statistic is that Snapchat involved reduced “self-presentational” concerns, meaning that users did not have to worry if they looked conceited or ugly in their Stories.

Facebook is better known for sharing “perfect” moments – such as newborns, engagements and graduations – while Snapchat offers users a separate environment where the small moments are equally appreciated.

This article first appeared on ‘Mirror Daily’ on 21 October 2015.

Over 35 per cent had experienced some form of mental health issue and more than 80 per cent knew a close friend or relative with similar experiences. Nearly three in ten said they had been discriminated against or knew someone who had, for mental health problems. And while most said they would be happy to talk about their mental health problems at church, seven in ten said their churches offered no resources to deal with it.

Previous research by ComRes showed that mental health issues account for nearly 25 per cent of the disease quota in Britain yet attracts just 11 per cent of NHS spending.

A recent BBC story stated that universities are facing a 10 per cent rise in demand for counselling services from students, with recorded mental health cases having risen from 8,000 to 18,000 between 2008 and 2012.

The online research was conducted via Christian Research’s panel of around 17,000 practising Christians across the UK, with 1,275 responding between 5 and 7 October.

“This is a clear sign that churches need to provide a more supportive space for their congregations to explore these issues,” said Maddy Fry, the researcher behind the study.

Earlier this year the UK’s largest Christian disability charity, Livability, joined forces with Premier Mind and Soul to create new resource to help churches better understand people with mental health needs in their congregations.

Christian Today reported that Katharine Welby-Roberts, an associate at Livability and the Archbishop of Canterbury’s daughter, who has spoken publicly regarding her struggles with depression, said: “As anti-stigma campaigns, such as Time to Change, begin to see societal attitudes towards mental health change, the Church has begun to recognise the need to better support people with mental health needs in their congregations.” She said that churches wanted to support people with mental health problems, but did not know how. “This can often lead to isolation or people leaving the Church because they feel misunderstood or not catered for. I believe the Church is a key untapped local resource which can support people with mental health needs.”

This article first appeared on ‘Christian Today’ on 15 October 2015.

Last year in the Northern Territory, 86% of those in prison and 96% of those in juvenile detention were Indigenous. In Western Australia, Indigenous people account for only 3% of the population, but 40% of prisoners.

It is unacceptable to ignore the intellectual capacity of a person facing the court and it’s vital to ensure that youth put behind bars have been properly assessed before sentencing. This is particularly important for Australians affected by fetal alcohol spectrum disorders (FASD). These occur throughout society and in high levels in some Indigenous communities.

The capacity to screen for prenatal alcohol exposure – as well as to diagnose FASD – must urgently be increased. This echoes recent calls by Perth Children’s Court magistrate Catherine Crawford for clinicians to assess children and youth before sentencing, so the court understands their cognitive limitations.

Cognitive limitations

Fetal alcohol spectrum disorders are a group of preventable conditions resulting from exposure to alcohol in the womb. Alcohol readily crosses the mother’s placenta, entering the circulation of the developing fetus with devastating effects.

Significantly, it can disrupt brain development and that of other organs, causing lifelong problems. These include developmental delay, intellectual and memory impairment, as well as a range of behavioural, emotional and mental health disorders.

People with FASD can suffer from attention-deficit hyperactivity disorders (ADHD), communication disorders, poor impulse control, disobedience and hostility issues, and learning difficulties.

They often struggle to distinguish right from wrong and fail to learn from mistakes. Few with FASD will live and work independently. Many have mental health and substance misuse problems.

It is no surprise that many also come in contact with the law. An adolescent living with a FASD in Canada or the United States, for instance, is estimated to have a 19 times higher risk of incarceration than someone without a FASD.

Despite this, the condition remains poorly recognised and few obtain a diagnosis prior to offending. Offenders with FASD are often poor witnesses and fail to understand why they have been detained. Unable to negotiate the justice system, they are adversely influenced by others and often enter a cycle of re-offending.

FASD and the justice system

Rosie Fulton, a 21-year-old Aboriginal woman with FASD and significant intellectual impairment, was arrested last year after stealing and crashing a car. Declared unfit to stand trial, Rosie was sent to Western Australia’s Kalgoorlie Prison for lack of alternative accommodation.

She stayed in jail for 21 months with no trial or conviction. Only after her story broke, mounting pressure on the health ministers of Western Australia and the Northern Territory led to Rosie being transferred to supervised community accommodation close to her family in Alice Springs.

In Australia, we don’t know how many people deemed “unfit to plead” are in prison and how many have cognitive impairment, as we lack recent data regarding rates of FASD in prisons. US studies suggest up to 60% of young people with FASD will at some time enter the juvenile justice system.

Another study, conducted in a forensic mental health facility in Canada, showed 23% of resident youth had one type of FASD. This figure may be higher in vulnerable Australian populations, particularly in some remote regions where alcohol use in pregnancy is prevalent.

The economic impact of incarcerating people with FASD is huge. In Canada, the direct cost to the correctional system between 2011 and 2012 was CAD$17.5 million for youth and CAD$356.2 million for adults.

Screening for FASD

Diagnosing FASD is a challenge because as children get older, a firm history of prenatal alcohol exposure may be elusive. With age, the characteristic facial features (small eye openings, a thin upper lip and flat philtrum, the area between the upper lip and base of the nose) of fetal alcohol syndrome – a subset of FASD – diminish, and growth deficits correct.

Thorough assessment by a physician, a psychologist and, if necessary, allied health professionals, can identify impairments required for a FASD diagnosis, whether fetal alcohol syndrome or a neuro-developmental disorder associated with prenatal alcohol exposure. Such impairments can be in IQ, communication, memory, motor and executive function, and other areas.

In Canada, youth probation officers are using a tool for screening young offenders for FASD, and identifying the need for referral and assessment.

Another tool for health professionals with accompanying guidelines for assessing and diagnosing people with FASD is being developed in Australia. This will standardise the diagnostic approach.

Tools such as these are necessary to increase screening and diagnostic capacity in the justice and health systems. If a diagnosis is known, the associated behavioural and cognitive deficits can be taken into account when considering the reliability of evidence given by an offender, the supervision required in detention, and the sentence.

Appropriate care

There has been a call for better legal support for people with vulnerabilities in their journey through the criminal justice system. Consideration should be given to the defence of diminished responsibility in conditions such as FASD.

And alternative models of care need to be found to avoid imprisonment of those unable to plead. As identified in the case of Rosie Fulton, this poses a significant challenge, particularly in remote Australia where alternative accommodation is not readily available and would be costly to establish.

But prison is far more costly. In Canada, the justice system accounts for 40% of the total costs of FASD (including health and education). And Australia’s Senate inquiry on justice reinvestment heard that the estimated cost of detaining a juvenile offender in New South Wales in 2010–11 was much higher ($A652 per day) than the cost of supervision in the community ($A16.73 per day).

To end the cycle of re-offending, we urgently need evidence-based strategies to ensure offenders with FASD are recognised early and receive the care they deserve.

This article first appeared on ‘The Conversation’ on 13 October 2015.

The Government also said it would not force resource companies to acknowledge their workforce is vulnerable to suicide.

It was responding to a parliamentary committee report on the impact of FIFO work practices on mental health, prompted by nine publicised suicide cases that triggered the inquiry last year.

The committee found in June that FIFO operations could lead to a “heightened risk of mental health issues” but a lack of accurate, accessible data made it impossible to establish suicide levels among any specific working group.

In its response tabled in parliament, the Government supported 15 of the committee’s recommendations, noted 14 and partially supported one.

Mines Minister Bill Marmion said it supported recommendations around gathering more data on the mental health impacts of fly-in, fly-out work.

“One of the things that actually surprised me is the report didn’t come with any data at all,” Mr Marmion said.

“So you can’t compare the mining industry with any other industry.

“We recognise the cohort of people that work in the mining industry are a vulnerable cohort: male and in the age group that mainly they pick up.”

The Government’s response said it has funded the development of a case management system for the Office of the Coroner for 2016-17.

That would create a single, searchable database of suicides for specific occupations, including FIFO workers.

But it would not force mining groups to acknowledge “their workforce is vulnerable to suicide”, noting FIFO work was a potential suicide factor in conjunction with other life stressors such as mental illness and alcohol and drug use.

No mental health code of practice just for mining industry

The Government will invite the Mental Health Commission and the Mining Industry Advisory Committee to work on strengthening existing codes of practice instead of creating a new one for FIFO workers.

“We’re looking at it but we already have codes of practice, a general code of practice,” Mr Marmion said.

“We’ve just got to make sure the current codes are reviewed and, you know, it’s a doubling up.”

The committee recommended a code of practice for FIFO workers address rostering issues, “with the aim of encouraging even-time rosters, and rosters that support mental health and wellbeing such as two weeks on, one week off”.

The Government said “some anecdotal evidence supports this recommendation, while other anecdotal evidence indicates some workers prefer the financial benefits of longer rosters”.

It said existing codes of practice would be reviewed to ensure they addressed the impact of fatigue.

The Government said it would also do more work on recommendations around mental health training programs, “mental health literacy” for FIFO workers and their families, and policies to manage suicide or suicide attempts.

Unions condemn Government for ‘abandoning FIFO workers’

Chamber of Minerals and Energy (CME) acting chief executive Nicole Roocke welcomed the Government’s response.

“We consider the approach to refer the matters to things like the the Mining Industry Advisory Committee and the Mental Health Commission will see action happen on the specific recommendations,” Ms Roocke said.

The chamber also supported the move to review existing codes of practice.

“CME doesn’t support the development of an additional code of practice to specifically address these concerns and these issues,” Ms Roocke said.

“What we do support is looking at existing codes of practice, whether these be looking at [re]working ours, or looking at the other breadth of codes of practice that do exist.”

The Australian Manufacturing Workers Union, the Construction Forestry, Mining and Energy Union, and the Electrical Trades Union said they were most concerned about the refusal to establish a FIFO Code of Practice.

“It underpins the integrity of all the other recommendations, and without it, weakens the 14 recommendations that the Government has agreed to,” CFMEU State Secretary Mick Buchan said.

“The mental health and well being of workers should always come first and we will continue to campaign to improve this work practice for the benefit of FIFO workers and their families.”

This article first appeared on ‘ABC’ on 13 October 2015.

The suicide of another police officer on Monday, who is also understood to have suffered from mental illness yet was armed with a service revolver, is expected to intensify pressure on Chief Commissioner Graham Ashton to act.

Force command has been accused of being slow to react to the increasingly erratic behaviour of several officers, who were deemed fit to work and permitted to carry firearms.

A Victoria Police spokeswoman said the force had strict policies to the ability of members to carry personal firearms which take into account, health, wellbeing and welfare issues.

“Members are monitored very closely in relation to carrying a firearm. We are not complacent and continually review these policies to ensure they remain robust, and we look for opportunities to improve,” the spokeswoman said.

Senior Constable Tim Baker, 44, is understood to have suffered serious mental health issues for almost a decade before he killed Vlado Micetic during a routine intercept in Windsor in 2013. He was charged with one count of murder last week, after shooting Mr Micetic three times in the chest and claiming he acted in self-defence.

Mr Baker took extended leave on several occasions because of his illness, and was only allowed to resume work after approval from a Victoria Police psychiatrist.

But less than a year before the shooting, it is believed Mr Baker was involved in a serious altercation with another officer during Operational Safety Tactics and Training that should have set off alarms, according to colleagues of the accused man.

During firearms training, an instructor placed a hand on Mr Baker to assist with his stance. According to a source, Mr Baker responded: “take your hands off me or I’ll f…ing kill you”.

Two former colleagues have expressed serious concern that Mr Baker was subsequently issued with a gun and permitted to work alone.

“He should not have been operational and he definitely should not have been working by himself. It’s a failure of the department and Tim’s supervisors, they’re the ones who should also be held accountable for this tragedy,” said a former colleague.

Another officer, who worked briefly with Mr Baker, said his mental health issues were widely known and he had received professional help.

Police Association secretary Ron Iddles refused to discuss Mr Baker’s case, but said more than 200 officers had gone on sick leave over the past year because of depression and post-traumatic stress.

As Victoria Police force grapples with the issue of mental health and an entrenched history of “suffering in silence”, Mr Iddles urged more members to seek help when they were unable to cope with the demands of the job.

The state coroner is presently investigating at least four police suicides, including the death of an information technology specialist at the Victoria Police Centre in June, who did not carry a weapon as part of his daily duties, but was issued with a gun by the transit safety division.

The man shot himself at a Rosanna primary school, where his estranged partner is believed to have worked.

A senior police officer said the man should never have been given the weapon .

“The force hasn’t always been great at dealing with (the) mental health or stability of its people. Obviously the job’s stressful and people handle it different ways, and there’s definitely some coppers who shouldn’t have guns.”

A Victoria Police spokeswoman said the force had appointed Deakin University to assist with a workplace analysis, while also undertaking an internal review of the welfare work and support it provides to officers.

“The Chief Commissioner has commissioned an external review to look at what more Victoria Police can do to best manage the issues surrounding mental health to ensure that going forward we deal with these issues in the best way possible,” the spokeswoman said.

This article first appeared on ‘The Age’ on 13 October 2015.

I remember I had asked to leave class early that day. I probably stood at the top of those stairs for about 10 minutes. I kept picturing myself wearing a cast in my arm and having to stay home for a week. I moved back and forth trying to figure out where the best place to fall from would be to cause just enough harm. Ultimately, those 10 minutes turned to seconds and the school bell rang. My chance had gone away.

I brushed off what I had tried to do. I didn’t think it was a big deal. I wanted to hurt myself to get out of having to go to school. Wanting to not go to school was not anything unusual for someone at that age. The extent to which I was was willing to go to was.

I wasn’t used to admitting I was struggling. I had always been a perfectionist who had a close group of friends, did great in school, and was truly happy with life. Having a mental illness was nothing I ever pictured having to deal with.

The thing is, mental illness is like cancer. You don’t know when it’s coming.

So when it does, you have to admit you have a problem. I would have probably been able to prevent what happened my first semester of college had I sought help for the insecurities I was having. Feelings are not a phase.

While I had forgotten about what happened my junior year of high school it ultimately came back to haunt me my first semester of college. I wasn’t used to being away from the perfect life I was used to having back home. I was diagnosed with depression after seeking help from a therapist in late September of 2011. I was advised to start taking medication but for personal beliefs refused to do so. However, the weekly sessions I began having with my therapist began to really make a difference.

While I continued to see here for about 9 months, I ultimately regret the need to hide the fact that I was seeing her. The stigma with mental illness is that if you’re dealing with it you’re either crazy. And truth be told, the people who think this way are the ones who should call themselves crazy.

One of my favorite songs says it best: “It’s ok not to be ok.” Jessie J sings this in her song “Who You Are.”

And what she goes on to say is really what I hope to show you through this personal essay. She sings “When we realize this, life is more content.”

While my family members knew I was attending therapy, my friends didn’t. Every time I was in therapy or attending group counseling I lied and said I was somewhere else. I was ashamed.

The fact that I was hiding a big part of my life became even more apparent when I was interviewing for a scholarship and came face to face with a work colleague who was part of the panel. In the essay I had discussed my battle with depression. I did the interview in peace but came out in tears.

He was the first person outside my family, more than one year after I had stopped being treated by a therapist, who had found about about my depression. I intended to keep it this way.

I finally felt the need not to so during my senior year of college. One of my best friends opened up to me about his struggle with depression not knowing about my own struggle. I was hesitant to admit it to it but finally chose to do so.

He was the first person who actually made talking about depression feel normal and continues to be the only person who makes I can have that type of conversation with. I’m happy to have found that support but am sad that there has only been one person who I can receive this type of support from.

While we may not all feel comfortable talking about depression we need to be willing to open our hearts and our minds to having the conversation about depression.

That is why I openly wrote admitted to my battle with depression on Facebook a few months before my college graduation. Soon after, four more people opened up to me about their own struggles with depression.

As a professional writer I have openly blogged about my story and have raised awareness with organizations like To Write Love on Her Arms and Mental Health America. That is not enough though.

You might think that because I worked with organizations that are in the mental health space that I should and could have treated my own depression. The thing is that even though I learned about how the things I was feeling were not OK, I couldn’t stop them.

You can have everything in the world or nothing at all and are still not be immune to facing a mental illness.

I have a mother who has survived multiple battles with cancer, a father who’s an amputee, come from a very low socioeconomic background, and have phased other health battles. But none of those experiences ever made me depressed. It was the things that I didn’t think much about in life that did.

After more and more people began to know about my own struggle, I began to feel in my own skin. While some people have looked at me differently and at times might not say things about it as respectfully as I wish they did, that’s ok. Depression is not the most easiest thing to wear, but when you’re finally able to wear it in public, life becomes 100 percent easier.

Follow Ingrid Vasquez on Twitter: www.twitter.com/ingridtweets_

This article first appeared on ‘Huffington Post’ on 13 October 2015.

Bipolar disorder is a mental illness that causes severe mood swings. The symptoms are often difficult to spot among children and teens because others mistake it for the normal ups and downs that every kid goes through. It is estimated that about 3.4 million American kids and teens experience the early onset of bipolar disorder, according to the American Academy of Child and Adolescent Psychiatry.

Current treatments for bipolar disorder include lithium and psychotherapy. However, lithium medication is often prescribed to adults only as mood stabilizers. While there are many studies on lithium use in adults, only a few tested its effectiveness and safety on children.

The participants were given a standard dose for the first four weeks before gradually increasing it to a maximum dose for the remaining weeks. The researchers assessed the participants’ moods using the standard tools used for bipolar disorder. They also listed the side effects of the drug on the participants.

The analysis showed that those who took lithium showed a significant improvement compared to those who were under the placebo. Almost half of them scored either “very much improved” or “much improved” compared to only 21 percent of those who were under the placebo. Some of the side effects include weight gain and reduced kidney and thyroid function, the authors wrote in a press release.

“Until this study, there was no data to support the use of lithium in the treatment of youth with bipolar disorder,” said Dr. Victor Fornari, director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y., to HealthDay News. “This study provides evidence to support the efficacy and benefit of lithium in the treatment of children with bipolar disorder in a manic state.”

The researchers plan to continue their study to determine whether lithium can be used on children long term.

This article first appeared on ‘HNGN’ on 12 October 2015.