In this post, I’m going to write about something that’s hard to talk about. I considered not covering this, because it’s taboo and I just want to gloss over it.
But then, part of the reason I have this blog, is to write about things that aren’t talked about enough. When I’ve written about sexual health – including herpes, genital warts and vaginismus – and mental health – e.g. trauma and grief – it’s partly because we should be talking about these things more, and all I can do is add one tiny voice.
That logic definitely applies to this.
I said in my last post that I felt really low over Christmas. But I didn’t say how low.
There’s one symptom of depression that has escalated quite quickly for me, over the last few weeks.
I now think that it’s caused, or at least, exacerbated by the contraceptive implant. That makes it easier to distance myself from it and write about it.
Basically, around Christmas, I started having some suicidal thoughts. Just to be clear, there is absolutely nothing to worry about. I’m certain I would never act on them so no one needs to worry about me.
The reasons I’d never act on them, no matter how bad things got, are
- the effect it would have on my family, and friends
- I always have hope that things can get better and I love life
- I don’t want to die, especially when I haven’t got a novel published yet
- I think I have pretty good genes and it would be a shame not to pass them on
- I’m agnostic and not sure what happens after you die.
It started a few days before Christmas, I think. At first, I got the odd image that came into my head, of myself having done it.
Every time, I just thought, Well, I’d never do that, and brushed it aside.
I guess I’ve been feeling miserable, and sometimes it felt nice to think about it, in an abstract way, because it was a way of imagining the feelings being gone.
The awful thing about suicide, is that it’s a permanent solution to a temporary problem. I think sometimes when people commit suicide, they don’t want to be dead forever, they just want to be dead for that moment, or that day, but their level of distress stopped them from thinking about the long term consequences the way they would normally.
Luckily, I didn’t feel that bad, so it would just cross my mind for a moment, and then I’d dismiss it.
Over the last couple of weeks, the frequency of the thoughts has increased, to the point where they come into my head throughout the day, and even though I still know I’d never take it any further, I’ve ended up thinking about it for ages sometimes. I’ve thought about how I would do it and things like that, in some detail.
Normally, if I haven’t got anything else to think about, like when I’m driving, or during a boring conversation, I think about sex, or the latest thing I’m sewing or writing, or the next bit of decorating I might do in my flat. Recently, it’s like my mind wanders onto suicide instead.
It came to a head, one morning this week, when I spent the whole journey to work thinking about what would happen at work, if I did do it. I was thinking about what they would say to my patients about where I had gone.
I realised this had got way out of hand.
I was making myself a cup of tea, when I got to the office and thought What the fuck is happening?
Then, it occurred to me.
Could this be caused by the contraceptive implant?
When I first got it, I read some horror stories online about people who had real problems with their mood after getting the implant.
The week after I got it, back in September, I had some major mood swings, but I put it down to other things.
One thing that makes me think it could be the implant, is that this feels completely different to other times in my life when I’ve felt like this, but not been on any hormonal contraception.
I have had thoughts like this in the past – when I was 16 and had depression and anorexia, and in the year after my ex-boyfriend died. Both times, it felt really different. Those times, it was something I gradually thought about at times when I was very, very upset (and still never acted on the thoughts). This time, it’s more like the thought compulsively comes into my head all the time.
Before, it was triggered by several different areas of my life becoming nightmarish, and feeling beaten down after months of hard times. This time, I’m really happy, and it it doesn’t make sense at all. I love my job, even though it’s hard sometimes. I love my flat and living in London. I have loads of friends and spend most of my time doing things I enjoy. I’m in this new relationship and, even though L-word-gate feels bad, overall, things are great and exciting.
Before, it felt like suicide was something my mind gradually wandered onto, when lost, during very hard times. This time, it feels like the thoughts are some bacteria or maggots that have got into my head.
I did a bit of research about the implant and depression or suicidal thoughts. I couldn’t find very much. I know that suicide is a very under-researched area of healthcare. I wrote an essay about suicide when I was studying for one of my qualifications, and wrote that suicide is one of the top 15 causes of death, but much less researched than other causes; there were only 60 randomised controlled trials into suicide, compared with 547 for liver disease and 1197 for high blood pressure.
Research into sexual health and contraception also seems to be neglected, despite it being medicine that half the population will consider using, when healthy and well, unlike most other types of medication. The lack of research and development could be because of the stigma of sex and contraception and the lack of focus on women’s health, due to the dominance of men in science and academia.
The top search result I found, was a journal article saying there was no evidence of a relationship between hormonal contraception and depression. The other top results were other publications, writing about this study.
Oh. I thought.
However, when I read further, I realised it wasn’t so clear. This was a literature review, where they looked at all the studies into progesterone-contraception and depression. There were only 26 studies, which, again highlights the lack of research into contraception and mental health, especially as 1 in 4 women on the pill report it negatively affecting their mental health.
This study has been widely reported as disproving any suggestions that hormonal contraception causes depression. However, firstly, they only included studies published before September 2016, and two very relevant studies came out just after this cut-off, showing the opposite.
Secondly, the relationship between contraception and mood is likely to be very complicated, because some women take hormonal contraception to help with the mood symptoms of pre-menstrual syndrome. One study showed that women on progesterone-only medication showed worse functioning, but women on combined contraception (oestrogen and progesterone) were less depressed than women on no hormonal contraception.
It’s very difficult to do randomised controlled trials about contraception and mood, because it would be unethical to give a control group a placebo instead of contraception. One of the only ways of researching this is to look at patterns in data we already have. However, even if there are no difference in large groups of women on different contraception, it doesn’t mean that the contraception has no effect on their mood. It seems more likely that it has strong, opposite effects, in different situations.
Also, some of the studies in this systematic review did demonstrate a relationship between depression and contraception.
Also, there’s a saying in science that “absence of proof is not proof of absence”. Looking at a handful of studies and saying they don’t demonstrate a significant relationship might be more of a reflection of the lack of research rather than the lack of a relationship.
One of the next things I found when I was researching was this article, in the Independent, from November 2018, published alongside a BBC documentary about hormonal contraception and depression and suicide. This article referred to two recent Danish studies, which looked at a huge body of medical records in Denmark, and explored correlations between contraception use and mental health. One found that women on hormonal contraception were more likely to be prescribed antidepressants, and the other found that women on hormonal contraception were more likely to attempt suicide.
The Independent article described how the link between depression and contraception was being addressed in the UK, compared to other countries (such as Denmark, where the studies took place). It suggested the NHS isn’t doing enough to make women aware of the risks, and monitor how hormonal contraception affects mood. I think that’s a valid concern.
These studies were into hormonal/progesterone contraception as a whole, rather than just the implant. I’ve been on two different combined pills, and found one had no impact on my mood, and the other was unbearable and I stopped it after 3 weeks. On the contraceptive injection, I used to have a couple of days of weird sadness when it was wearing off, but that decreased over time.
It doesn’t seem like there’s enough research into contraception and mood as a whole, let alone comparing individual types of contraception.
I’m planning to get the implant removed, as I don’t like this. In fairness to the implant, I was already feeling emotional the week that I got it, so I know some of how I’m feeling is just me or my situation. I know that L-word-gate is tapping into insecurities that have been buried for a long time, which isn’t the implant’s fault. However, I think the implant is amplifying emotions that are already there, to an unbearable level of intensity.
On an unrelated note, I have enjoyed not having painful periods, while I’ve had the implant. However, I’ve had light bleeding on and off the whole time. One of the times, I bled for nearly a whole month. I’m so sick of constantly staining underwear and bedding by unexpectedly bleeding. Additionally, the blood and menstrual products are giving me vagina eczema. Sometimes being a woman is bollocks.
On some of the forums where I read horror stories about the implant, part of the horror was the difficulties that people had getting their implants removed. Some people found healthcare professionals were reluctant to take them out. Most side effects get better after 3-6 months, so they like people to persevere to see if that will happen, especially as the implant is expensive to the NHS. I’ve been on the implant for 4 months, and this has got worse and worse, so I hope it won’t be an issue.
On that day when I felt like enough was enough, with the suicidal thoughts, I decided to text one of my friends about how I was feeling. I thought my friend Tess would be a good first port of call, as she’s told me she’s had suicidal thoughts in the past.
At lunchtime, I wrote her a text saying how I felt, but felt unsure about pressing send.
Then, at the end of the day, when I was walking out of work, I did send it. Funnily enough, as I was walking to where I parked my car, I nearly bumped into a former patient, who was walking the opposite way, as I was looking at my phone.
We had a quick chat about she was doing, and it made me laugh to myself, as I bet you’d never think that, if you bump into your therapist, they are in the middle of texting a friend about feeling suicidal.
Even though Tess was still at work, she replied straight away, saying she’d call me when she finished work.
I already felt better, just for telling someone.
A bit later on, we spoke on the phone. It felt like such a relief.
She said that when she felt suicidal, a few years ago, it was because she felt like nothing could change that would make her happy, even if she won the lottery.
“Is that how you feel?” she asked.
“No, actually, it isn’t! Actually, I am happy. I feel happy all the time. It doesn’t make any sense!”
I started telling her about what my mood had been like, over the week.
On Monday, I felt back to my old self again, after Christmas. Finally writing that blog post about Christmas felt like a weight had been lifted, as well as reading people’s comments. I had been dreading Monday, as I had quite complex or difficult patients back to back all day, but loads of my sessions went really well and it was a good day.
Then, on Monday, I spoke to Andrew on the phone and some of the demons came back. This time, after I spoke to him, I thought I’m definitely going to break up with him.
What had happened, was that he has an exam in March, which he needs to pass if he wants to move forward with his career in a certain way, in the next five years. He took it before and passed with flying colours, but now it’s expired.
A few days ago, the way he started talking about this exam, it reminded me of when he had that job interview, last summer. He seemed to get things completely out of proportion and had a total meltdown about preparing for it, and it was the first time I got really pissed off with him and questioned our relationship, as he completely neglected it.
Last time, it only lasted a week. I had already been thinking, what if it gets like that again? I can’t handle two months of that, especially feeling so fragile at the moment.
Then, when we were chatting on Monday night, I asked when we would see each other again. It transpired we were both free on Tuesday night, as my plans had got cancelled, and he wasn’t working.
However, he said, “I’d prefer to do some revision.”
I was annoyed because we see each other so rarely, because of his shifts and living on opposite sides of London. It feels like we have to make the most of every opportunity to see each other, otherwise we’d never see each other, and even then, it tends to be a maximum of twice a week, and really, I’d prefer it to be more.
It was annoying that we were both free, but he was not seeing me so he could revise for an exam which is not for TWO MONTHS.
I didn’t tell him how I felt then, even though it was obvious I was pissed off. I just said good night.
I expected that, from his point of view, it seemed unfair because it wasn’t like we ever had plans on that Tuesday night, and the exam is important.
However, from my point of view, it wasn’t really about that one night, but it made me anxious about what the next two months would be like and our precarious relationship. It also made me feel frustrated because his urge to revise so early seems to be because of his perfectionism, rather than a genuine necessity. In all the years I’ve done SATs, GCSEs, A-levels, exams every year for my degree, exams for post-graduate qualifications, I’ve never started revising two months beforehand. Surely you’d forget the stuff you revised at the start, by the time the exam came around? Frankly, I find it a bit swotty and Hermione Grainger-ish.
Since I’ve had the implant, another problem is the intensity of my emotions and how quickly they escalate, leading to more reckless decision-making. I think some of the thoughts of ending the relationship have come from this. I guess the feelings seem so intense, I consider doing anything to make them stop, even if it’s totally irrational.
So, I got off the phone and felt livid, and decided I was probably going to end things with him.
By Tuesday evening, I had calmed down and thought I probably didn’t want to end things but I didn’t want to talk to him. I had already gone to sleep when he tried to phone me (I’ve actually been ill with yet again bout of flu, and I’ve been in bed the last two days).
It was Wednesday evening, when I was on the phone to Tess.
I had told her that I definitely didn’t think I would act on the suicidal thoughts. In my job, I assess suicide risk every day. One of the things we ask people is to rate how likely they would be to attempt suicide, and we get them to rate it out of 10, where 10 would be that they would definitely do it in the next few days, and 0 is that they definitely wouldn’t ever do it.
“Even now, I’m still definitely a 0, it’s just the frequency of the thoughts that’s the problem.” I told her. We also discussed how, of course, I knew exactly what I would do if it got worse, as I’m used to making safety plans with people every day. I know all the different places people can get support with suicidal thoughts.
I told her about my annoyance with the Andrew’s two months of revision and she understood, and we discussed whether I should stay with him.
For some reason, we got onto talking about Andrew and how he had wanted to meet my parents at Christmas, but it hadn’t worked out.
“So, they said they wouldn’t be in London til 6pm…” I was saying.
I paused for a moment, as I thought I heard someone coming into my flat.
I then thought it was probably just my neighbours going into their own flat. It’s weird because the walls in this building are very sound-proof, but the front door is not. When my neighbours are in the hallway, I can hear them as clearly as if they were in my flat, but as soon as they close their own door, I don’t hear a peep.
“Anyway, they weren’t going to get here until 6pm, so I said to him that…” I stopped again.
I could definitely hear a noise.
It WAS inside the flat.
Someone was in my flat!
It sounded like someone was slowly walking down the hall, from the front door.
My heart was thudding as I got off the sofa and tiptoed across the living room.
What the FUCK!
Is it a burglar?!
It didn’t sound like they’d forced their way in, so I mentally scrolled through people who had keys.
My friend Nelson had a key, but he moved out before Christmas and gave his key back. The builder gave his key back when he finished.
Who is it! How did they get in!
Am I about to get attacked!
Oh my god oh my god oh my god…
I felt shaky as I walked towards the doorway, still carrying my phone.
“OH!” I cried out, when I saw who it was.
It wasn’t a burglar!
It was Andrew!
With a massive bunch of flowers.
For a moment, I had completely forgotten that I gave him Nelson’s key, a few weeks ago.
I hung up on Tess for a moment, and said, “I thought you were a burglar!”
“Sorry, I just wanted to see you!”
We hugged, and then I quickly called Tess back, and explained what had happened.
“I’m so pleased. Go and have a nice evening!” She said.
“I’m sorry I didn’t talk to you yesterday,” I started to say to Andrew.
“No, I’m sorry! I shouldn’t have made you feel second-best or neglected,” Andrew said.
I was supposed to be having dinner with my friend Ruth, but she had kind of stood me up earlier, otherwise I would have been out.
“I knew you might be out, so I was just going to leave the flowers and a note,” he said.
I was so pleasantly surprised that he was apologising for making me feel neglected, without me having to explain anything. The flowers were also a lovely and relevant surprise. A few weeks ago, we were in the supermarket and I was considering buying myself some flowers, as it’s a new thing I’ve started doing sometimes. I told him I like lilies and I noticed out loud that he hadn’t bought me flowers yet.
He had bought a nice bouquet of roses and lilies.
As soon as I saw him, I knew I should tell him about the suicidal thoughts.
He said was really supportive. He was keen for me to do practical things like telling my GP and the counsellor from Occupational Health, but I didn’t want to do that. Weirdly, the stigma about mental health can be worse for mental health professionals. I didn’t want anyone in a professional capacity to know. However, we both agreed I would get the implant taken out as soon as possible.
It felt like a really special evening. I told him how lucky I am to have him.
He couldn’t stay over as he had to be in court early the next morning, but we had a few hours of just talking, and having dinner and then hugging in bed. He thought I wouldn’t be in the mood for sex but we managed to fit some in before he needed to run for the last train home.
I was leaning towards not writing this post, as suicide is such a heavy-going topic. However, by complete coincidence, this week at work, I had to do online training about suicide and it made me think differently.
This training is actually aimed at normal members of the public, rather than healthcare professionals, and it’s about how to recognise the signs and how to bring it up with people. I thought it was quite good, and it reminded me that the most dangerous thing about suicidal thoughts is that we find them so hard to talk. If one blog post puts a tiny hairline crack in the huge wall of stigma, it’s a risk I’ll uncomfortably take by writing about my own experience.
Please do have a look at the Zero Suicide Alliance training, it takes about 30 minutes.
I know two people who died by suicide, and it’s such a massive waste of life, that’s one of reasons I’d never act on my thoughts.
One person was a close friend of my Mum’s and a friend of the family, who died when I was 13.
The other was a girl I knew from school, and then we later worked together, in a nursing home. She went on to be a journalist and died at the age of 29.
I want to end by quoting something from a podcast, which I heard recently. It’s from ‘Griefcast‘, which is a podcast in which comedians talk about their experiences of bereavement.
There’s an episode with the Irish comedian Aisling Bea, which is really good. In 2017, Aisling wrote an article in the Guardian about how her father committed suicide when she was 3. It’s an absolutely amazing, heartbreaking article you should definitely read.
In the podcast, there’s a bit where she says some things that perfectly sum it up:
“So many people are afraid to talk to anyone, because they think someone will get upset. But if you don’t get upset, living in a state of almost upset… if you don’t talk to your wife, because you think, telling her that you are down, and don’t feel like living anymore is upsetting, and will upset her, you will live in a state of upsettedness, which is like living with your shoulders up around your ears, it’s stress, and you will get more unwell. If you get upset, then you can start to work to get better. If you never get upset or upset someone, you’re going to stay in that paralysis and numb state for a long time and it will catch up with you in the end…”
“…allow a space where your husband can get upset, and if they tell you that they don’t want to live or are really struggling, that is not a comment on your worth as a wife or a girlfriend or a partner… It’s just that something inside’s broken and needs fixing… you are worth fixing.”
It’s so true, because just talking to one friend – in fact, even before we spoke, just having that text saying, “I’ll call you in an hour,” made the reality of what I’d been contemplating seem much more real, and it made the hopelessness seem more unreal.
I know it was going to be OK.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at befrienders.org