Home Gesundheit Umgang mit behandlungsresistenter Depression: Die Geschichte einer Person

Umgang mit behandlungsresistenter Depression: Die Geschichte einer Person

von NFI Redaktion

After completing her Master’s in Creative Nonfiction Writing at Columbia University in 2015, Imadé Borha thought she wouldn’t have to worry about finding a job. But that wasn’t the case. „That was around the time of the first suicide attempt,“ recalls Borha, now 34 and working as a communications professional for a non-profit organization in Durham, North Carolina.

„Career instability was the trigger for many of my mental health issues,“ she says. „It felt like a failure to have to leave New York and not have a job.“ Borha was first diagnosed with severe depressive disorder in 2012. „This was a response to suicidal behavior, basically a textbook depression,“ she says. „When I had the first suicide attempt, I realized that the three medications I had taken had not helped.“

According to Dr. Matthew Rudorfer, a psychiatrist and head of the Program for Somatic Treatments and Psychopharmacology at the National Institute of Mental Health in Potomac, MD, treatment-resistant depression occurs when someone with severe depressive disorder has not responded to at least two antidepressants taken in the right dosage for the prescribed period. „There are clearly many shades of severe depression… There is no ‚one-size-fits-all‘ solution, but rather the best clinical intervention for the individual suffering from it. Treatment-resistant depression should be tailored to the individual. A key goal of ongoing research is to improve the ability to provide the right treatment to patients.“

A New Diagnosis

In 2019, Borha was diagnosed with Borderline Personality Disorder (BPD), which leads to mood swings, unstable self-esteem, impulsive behavior, and difficulties in building relationships. „The symptoms of Borderline Personality Disorder include extreme, intense emotions triggered by reactions such as feelings of abandonment or rejection,“ she says. She feels that rejection of jobs and other opportunities brings out her symptoms.

Amidst the mental turmoil, it took a while for Borha to realize how much her thinking and actions were driven by fears. „When you’re at high risk of suicide, you really don’t have time to ask, ‚Do I have an anxiety problem?'“ Over time, she tried the prescription anti-anxiety medication Buspirone (BuSpar). It helped calm her mind. Along with dialectical behavior therapy, her world increasingly came into focus.

Dialectical behavior therapy combines weekly talk therapy with group skills training. It focuses on emotions and takes a balanced approach to self-acceptance and learning ways to make helpful changes. It was originally developed to treat BPD and women with suicidal tendencies, but is now used for treatment of other related issues as well.

„It helps people like me who have really intense emotions to have skills or tools to regulate those emotions so our lives don’t look like chaos every day,“ says Borha. Exercise, especially high-intensity interval training, also helps her stay focused, she says.

Community is Key

„I firmly believe in this building [a mental health] ‚The community will keep me alive, keep my suicidal behavior and self-harm low‘,“ says Borha. Yet, she finds it difficult to build interpersonal relationships because of her fear of abandonment and rejection. „I talk a lot, but when it comes to dealing with my current mental health on a day-to-day basis, it’s tough. I have to be more vulnerable, show myself out there, just be honest with people.“

Borha says that the resistance to seeking treatment for mental or emotional illnesses in the black community is deeply rooted. „We’re dealing with a situation where black people have been punished in the past for revealing that they are sad, depressed, or angry. They feel like their lives might be in danger. This reaction echoes in their families and support systems.“

Borha says the attitude of keeping problems in the family secret is loosening up a bit. „Now, [Black people with mental issues] have a chance to find therapists and other resources.“ But she still sees obstacles and racist biases related to care.

Through her website DepressedWhileBlack.com, Borha tries to connect her followers with therapists who understand them. Currently, her „Help Me Find a Therapist“ program is on hold as her team catches up on the backlog of requests.

The antidepressant Esketamine (Spravato) is the only nasal spray medication approved by the FDA specifically for treatment-resistant depression, although a number of other treatments and therapies can help and continue to be studied, says Rudorfer. Esketamine comes from Ketamine. It is a nasal spray that must be administered and monitored by a doctor.

Borha says she has asked her insurance to cover the cost of Esketamine, but so far it has been a no-go. Meanwhile, she continues to study and learn more about her condition.

„I would say, research your symptoms, because that can lead you to a different diagnosis,“ she says. „Then use that research to advocate for yourself. Tell your therapist or psychiatrist what else there is that they haven’t considered in the diagnosis.“

And she says, „It’s okay to be wrong… If psychiatrists can be wrong, I can be wrong. As patients, we have the right to experiment, fail, and try again. We have that right.“ „Just experiment, research, and take action,“ she says. „Empower yourself.“


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