In October of my second year of my PhD program I found myself waiting in an exam room at the student health center wondering if I was being melodramatic about how terrible everything felt. I was, objectively, a successful second year psychology graduate student. I had proposed my Masters, taught an undergraduate lab, and secured funding for the next three years via a supplemental grant, but I had never in my life felt worse about myself or my future. I had lost any motivation to work in the area I was studying or academia in general and wanted to quit nearly every day. I struggled to communicate my needs with my advisor, who was so enthusiastic about his work that he didn’t seem to notice my struggling. I was increasingly having trouble getting out of bed because of the dread I felt about what my day held – even on weekends. I had started avoiding my roommates, whom I loved, and instead I was spending hours not really watching TV on my laptop alone. I had started going home every day and getting into bed and hoping I’d fall asleep until my alarm went off the next day.

It took the death of my grandmother and the acute grieving that accompanied that to finally convince myself to make an appointment to see a doctor. I assumed I’d see a doctor and be put on medication, an idea that scared me if I was being perfectly honest. Despite my training in psychology and neuroscience, I worried that taking medication meant that I was unable to “deal with things” and that I’d be dependent on it to function.

A visit to the doctor

I had no idea at the time, but the doctor I was waiting to meet was an absolute dynamo of a woman who would become a source of support and encouragement for the rest of my time in graduate school. Within minutes of coming into the room, she had laid out a multi-pronged action plan and had almost convinced me that we really could fix things (something I couldn’t convince myself of). We would try medication, but, as she explained, we’d increase my dose very slowly and have frequent appointments to assess how things were going. She listened to and validated my concerns about medication and explained that she was worried enough about my mental state that she felt it would be prudent; ultimately, I agreed with her, but the autonomy to make the final decision was something I was very grateful for and had not experienced much as a graduate student. Therapy was the other big aspect of her plan and before I left, she had arranged for my intake appointment with a therapist she had worked with before and felt was a good match. She also ordered bloodwork – I had always experienced on again/off again anemia and before graduate school I’d been without health insurance because I was supporting myself with two part-time jobs.

With the wonderful gift that is hindsight, I can say that from that day on things did start to improve, which was something that at the time felt impossible. I was officially diagnosed with major depression and anxiety.

I’ve always been quite anxious and believe that in my case, the depression arose from the massive increase in anxiety and the overwhelming imposter syndrome I encountered in graduate school.

I started taking a selective serotonin reuptake inhibitor (SSRI) that day (more on that shortly). My bloodwork came back the next day showing that I was severely Vitamin D deficient and anemic, both of which were likely contributing to my fatigue and perhaps even the depression (there is evidence that Vitamin D deficiency and depression are correlated, but more research is needed to understand this relationship). My doctor treated both deficiencies aggressively and after years of keeping an eye on my bloodwork, we decided it was best if I take both iron and Vitamin D daily.

My medication and therapy journey

The SSRI I started after my appointment is a first-line treatment for depression and anxiety and for some, it can take up to six weeks to improve depression symptoms. It is, however, important to keep in mind that not everyone responds to SSRIs and many people need to try multiple types of medication before finding the right one. I was fortunate in that I started to feel noticeably different after about a week, which coincided with my first dosage increase. I remember very clearly making my bed and realizing that for the first time in months I wasn’t worrying in the background: I was just focusing on what I was doing.

It was like someone had turned down the volume on my constant, all-encompassing anxiety – it was such a drastic change from how I had been feeling that it was initially a little frightening.

My experience with SSRIs was positive overall and I credit them with helping jump-start my recovery, but it wasn’t all roses. I did experience side effects from the SSRIs, some of which got better over time, like the night sweats, and some of which did not, like the vivid dreams that persisted even after I stopped taking SSRIs. If I could give anyone starting an SSRI a piece of advice, it would be to talk openly with your doctor about the process and how you are feeling (and if you don’t feel comfortable talking with them, perhaps consider getting a second opinion). I also experienced certain side effects that are “reportedly rare” for women (I say reportedly rare because I found many women in patient-centered online forums reporting these issues but who had been ignored by their doctors). My doctor not only took my concerns seriously, she decided we should try a different SSRI, which resolved the issue almost immediately.

While medication without a doubt played a role in my recovery, I know that therapy was the most beneficial aspect of my treatment and was what ultimately helped me overcome my depression and learn to manage my anxiety during graduate school. I come from a family that views therapy with distrust and, at the time, I felt immense stigma about going to therapy since other graduate students didn’t seem to need to do this to cope (little did I know that many, many of us were in therapy and just not talking about it because of the overall stigma in academia!). I saw my therapist every week until I moved across the country after graduation. If I could still see her virtually, I absolutely would. Therapy allowed me a safe space to talk about how isolated I felt as a first-generation college student in a highly competitive grad program, it helped me process the death of and grieving for the family members I had lost, and it helped me grow immensely as a person, which is why I continued to go to therapy after my depression had lifted.

My therapist helped me to see my anxiety as a part of me and something that had been and could be useful, but that could also deceive me and needed to be managed, especially during times of high stress.

Therapy was especially useful in giving me tools to navigate the unique environment of graduate school, which in my experience was not the most encouraging or welcoming.

I learned to stand up for myself and place boundaries. Perhaps most important, going to therapy allowed me to build the necessary trust in myself to pick my own path, which ultimately lead me to industry, despite pressure from others and my program.

For me, one of the hardest parts of depression was the hopelessness it caused. Before I started therapy and medication, I knew something was wrong and I one hundred percent believed it was permanent. The feeling that I wasn’t good enough or smart enough to be in a PhD program was inescapable, and I thought I’d always hold the dread, anxiety, and deep despair that landed me in the exam room at the student health center. When I made that appointment, I felt with deep conviction that my only option was to accept that I was wasting my time as a graduate student and that I should quit before they kicked me out. As a health psychologist, I know that research shows most depression stems from a combination of environmental and individual factors, including elements outside of our control (e.g., genetic predisposition), but I was unable to apply that knowledge myself. I will forever be grateful that my doctor and therapist were so thoughtful and thorough in treating me, both as a patient and as a person.

Graduate school was one of the hardest periods of my life and I know now that many graduate students experience the same struggles as I did.

I wish I had known that before I started my PhD because maybe it would have changed the impact the stress had on me, but unfortunately, I can’t go back: all I can do is talk openly about what I experienced and encourage others to do the same if they feel comfortable doing so. Academia is not an easy place to exist: it can be isolating, competitive, unrelenting, and let’s be honest, it can be very mean. If you are struggling or know someone that is, don’t wait to get help. It can get better. Nothing is worth it at the expense of your mental health.

Lea earned her PhD from the University of Pittsburgh in Biological and Health Psychology. During her graduate study, she participated in an internship at UPMC Health Plan working on a digital behavior change app. Following the completion of her degree, Lea relocated to Seattle and now works as a research scientist on the Governance and Ethics team at Sage Bionetworks, a non-profit organization focused on developing and applying open practices to data-driven research for the advancement of human health. Lea is passionate about open science, data governance, digital health, social determinants of health, all things food, the ocean, and music.