TW: Suicidal thoughts

Courtney N. loves being a schoolteacher. She gets excited about going back to school, like it’s New Year’s Eve. So, when she had to take a leave from her job because of debilitating anxiety it caused even more emotional stress.

Courtney had been struggling with anxiety since she graduated from college more than a decade ago. Medication managed it mostly well, most of the time. After a surgery, she found that her medication was no longer working to keep her anxiety in check.  A new provider suggested putting her on an SSRI. While she had her concerns, she tried the medication.

Here’s what Courtney said about that experience:

“After switching meds, I could not sleep at all, and I was actively suicidal. I tried everything to feel better—mushrooms, reiki, acupuncture. I changed my diet. I exercised. I gave up caffeine and alcohol. Nothing helped. I could not continue my work as a teacher, so I took advantage of the Family and Medical Leave Act to try and get myself well. Even with a loving family, a loving fiancé, and being surrounded with loving people, I felt everything slipping through my fingers.

I had two separate in-patient hospitalizations, and one intensive outpatient stint… By this point I was on 6 or 7 different medications and was still not better.”

Courtney had been administered the GeneSight test at some point during her crisis, but the results were never reviewed with her. The GeneSight test analyzes how a person’s genes may affect outcomes with certain medications and this type of testing exists for commonly prescribed medications used to treat depression, anxiety, ADHD, and other mental health conditions. This type of testing provides clinicians with information about which medications may require dose adjustments, may be less likely to work, or may have an increased risk of side effects based on a person’s genetic makeup.

When her new clinician offered a GeneSight test, Courtney remembered that she had done one and requested the results. After her new clinician reviewed her results, Courtney’s clinician informed her that an SSRI may not have been a good option for her. Courtney is a fast metabolizer, meaning that some medications may not stay in her system long enough to be effective.

Courtney’s provider prescribed a new medication and after some time, Courtney began to feel like herself again and she was finally able to return to her job.

As Courtney gets ready for a new school year, we checked in with her to see how she is doing and what advice she has for others struggling with their mental health.

Myriad: Courtney, thank you so much for taking time to catch up with us. What have you been doing during your school break?

CN: I’m working at a summer camp. For me, keeping a schedule is a component of maintaining my positive mental health.

Myriad: How are you feeling?

CN: I am great!

Myriad: How do you mentally prepare yourself for a new school year?

CN: As an English teacher, reading for pleasure is a big part of preparing for a new school year. Additionally, I spend time with colleagues collaborating for next year.

Myriad: What are you most excited about?

CN: I’m most excited about sharing my love of reading and learning with more students. I was awarded a grant in the spring so I will be able to teach more diverse texts in my classroom this year.

Myriad: How do you encourage your students—and their parents–to prepare mentally for a new school year?

CN: I think parents and students should remember that we all deserve grace. We’re all human, so we will all make mistakes or need some help. It’s not only okay, but it’s important to seek out that help if it’s needed.

Myriad: After what you have been through, is there anything that worries you?

CN: My biggest worry is a relapse in my mental health. However, I do have a team of people, professionally and personally, who I can turn to if this ever becomes more than a worry.

Today, Courtney sometimes wonders what might have been: “What would have happened if I hadn’t taken the GeneSight test? How could my clinician have known about my particular gene-drug interactions? ? How long would it have taken to get to where I am today?”

Here she makes a good and important point: Some providers only have a small window of time to spend with each of their patients; if they prescribe an antidepressant, patients may have to take it for several weeks to see how it works, and then come back. If it doesn’t help, they may need to be slowly weaned off before they can start the process again with something else. “That trial-and-error takes so long,” Courtney says, “but what do you do in between that for someone?”

She also stresses the importance of being an advocate for yourself. “When you’re struggling with mental health, it is hard, because you know your body, but to get someone to listen and spend the time to understand is all so difficult,” Courtney says. “Ultimately, you need to be the one to make the choices that benefit you,” she adds, “and having all the tools at your disposal can help you and your healthcare provider make the best decisions.”