When Imadé Borha graduated from Columbia University in 2015 with a master’s degree in creative nonfiction writing, she thought the last thing she would have to worry about was finding a job. It didn’t happen. “That was around the time of the first suicide attempt,” recalls Borha, 34, now a communications professional based in Durham, North Carolina, for a nonprofit organization.

“Professional instability was triggering a lot of the mental health issues I had,” he says. “I felt like a failure having to leave New York and not have a job” was traumatic.

Borha was first diagnosed with major depressive disorder in 2012. “It was in response to suicidal behavior and basically textbook depression,” he says. “When I had the first suicide attempt, that’s when I realized that the three medications I had taken hadn’t helped.”

Treatment-resistant depression occurs when someone with major depressive disorder has not responded to at least two antidepressants taken at the correct dosage for the prescribed time, according to Matthew Rudorfer, MD, psychiatrist and head of the somatic treatments and psychopharmacology program. at the National Institute of Mental Health in Potomac, MD.

“Clearly there are many nuances of major depression… There is no one-size-fits-all solution. Rather, the best clinical intervention for the person with [treatment-resistant depression] It must be personalized to the individual. “A primary goal of ongoing research is to improve the ability to match patients to appropriate treatment.”

A new diagnosis

In 2019, Borha was diagnosed with borderline personality disorder (BPD), which causes mood swings, an unstable sense of self, impulsive behavior, and problems forming relationships.

“BPD symptoms include extreme, intense emotions that can be triggered by reactions such as a feeling of abandonment or rejection,” she says. She feels that rejection of jobs and other opportunities caused her symptoms to come to the surface.

Amid the mental turmoil, it took a while for Borha to discover how much anxiety was driving much of his thoughts and actions. “When you’re very suicidal, you don’t really have time to ask, ‘Do I have an anxiety problem?’ “Eventually, she tried the prescription anti-anxiety drug buspirone (BuSpar). She helped calm her mind. Along with dialectical behavioral therapy, her world began to become clearer.

Dialectical behavior therapy combines weekly talk therapy with group skills training. It focuses on emotions and takes a balanced approach to accepting yourself and learning ways to make helpful changes. It was first developed to treat BPD and suicidal women, but is now also used to treat other related problems.

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

Community is key

“I firmly believe that building [a mental health] “The community will keep me alive, keep my suicidal behavior and my self-harm down,” Borha says. At the same time, she finds it difficult to build interpersonal relationships due to her fear of abandonment and rejection. “I talk a lot, but when it comes to daily interaction about my current mental health, it’s difficult. I need to be more vulnerable, put myself out there and be honest with people.”

Borha says resistance to seeking treatment for mental or emotional conditions runs deep in the Black community. “We’re dealing with a situation where historically, when Black people reveal that they are sad, depressed or angry, they will be punished. They feel like their lives may be in danger. That response resonates through their families and support systems.”

Borha says the mentality of keeping problems in the family a secret is relaxing a bit. “Now, [Black people with mental issues] “I have the opportunity to find therapists and other resources.” But he still sees obstacles and racial biases related to care.

Through his website, DepressedWhileBlack.com, Borha tries to connect his followers with therapists who understand them. Right now, her Help Me Find a Therapist program is on pause while his team catches up on the backlog of applications.

Be your own researcher

“I think treatment-resistant depression is a big part of the suicide crisis,” Borha says. “If we can treat people who have struggled with it, we can save lives.”

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

Borha says he asked his insurance to cover esketamine, but so far it hasn’t. In the meantime, she continues to study and learn more about her condition.

“I would say investigate your symptoms, because you can [need] a different diagnosis,” he says. “Then use that research to advocate for yourself. “Tell your therapist or psychiatrist what else there is that they haven’t considered when it comes to the diagnosis.”

And he says: “It’s okay to make mistakes… If psychiatrists can make mistakes, I can make mistakes. As patients, we have the right to experiment, fail, and try again. We have that right.”

“Just experiment, research and do it,” he says. “Advocate for yourself.”