On being depressed in depression research

Estimated reading time: <10 minutes

Across from me, a research volunteer is telling me about their week. As I’m assessing whether they qualify for our study, I internally smile at just how much I’m relating to what they’re saying. But it’s only afterwards, when I score their responses and realise yeah, they definitely meet the criteria for major depressive disorder, that it hits me. Oh. I look back at my day, my week, my month. Here I am again.

Those are the times working in mental health research can really help, where my environment and my training hasten that sharp, sudden bit of perspective: I need to do something. 

Other times, it’s not so simple.  

I have deliberately crafted my life around my mental health. Thankfully, my longest and darkest spells were back in my teenage years, but I’m all too aware of how comfortably my mind finds falling into that place. I cannot afford to not be vigilant. As I write this, I realise I can’t even imagine what that would be like. I am mostly content – and my reputation as someone who celebrates joy and affection is not unfounded! – but only because I work hard to keep that peace.

I am strict about the hours I work and stricter yet about the company I keep. I spent years transforming my relationship with my body and now carefully curate the people and media I interact with to protect that. My phone is well stocked with habit trackers to catch me when routines start slipping; alarm bells ring when I can’t find the motivation to even brush my teeth. And when I say that walking everywhere keeps me sane, I say it lightly, but I mean it deeply. 

Most of these practices are things I’ve experimented with on my own, but knowing they’re supported by scientific evidence usually helps keep me on track. The literature on behavioural activation forcefully reminds me to keep moving and socialising when my mood dips. The clarity and simplicity of cognitive-behavioural frameworks nudge me out of avoidance when anxiety is holding me back. Part of what keeps the words of my psychologist ringing in my ear is how skillfully she could ground her advice in Acceptance and Compassion Therapy (ACT).

Inevitably, though, the practices I have so carefully cultivated sometimes falter, and I come crashing down. In that all-too-familiar darkness, my insight turns on me. I could write a great, well-referenced paper on all the reasons why I shouldn’t be lying in bed, staring into space, berating myself, but not only does that not stop me, it becomes a form of punishment. What the hell is wrong with me? I know exactly what will help and I’m just choosing to wallow. I tick off a checklist of cognitive biases – black-and-white thinking, jumping to conclusions, catastrophising – and yet every dark thought feels like incontrovertible fact. I’m fundamentally incapable of true connection with anyone. I’ll always be alone. I speak to myself in a way I would never speak to anyone else with depression, whether supporting them professionally or personally. Taking time off work is grossly indulgent – this misery is just a result of my weakness.

This dissonance between rational insight and what I feel to be true in every ounce of my being just makes me feel like I am going, very literally, insane. I can’t find a second of mindful detachment, can’t step back an inch, can’t let my feelings pass through me. I feel completely unrecognisable

When that mental shift happens, everything feels different. 

I’m plagued by questions about that distinction.

Is there a line between depression and those parts of life that are inherently difficult – struggles with motivation, the pain of self-criticism, occasional intense sadness? 

If there is a line, is it a question of severity, or does the experience transform into something new? 

Is my depression a part of me, or is it something separate and external that’s been imposed on me? 

Is everything I’m experiencing “normal”? Am I overreacting? 

Does answering any of these questions even matter?

It feels important. Not just scientifically or therapeutically. It feels important – no, utterly essential – to me. I desperately long for some perfect framework to help me understand it, understand myself, even just a little more. I know what my therapist would ask, and, no, Nicola, I’ve no idea what that framework would even look like. I still want one. 

In bed, I scroll Twitter, reading endless threads of academics debating these very questions. 

I resent every perspective I read. 

I resent colleagues discussing serotonin receptor mechanisms that could not feel more irrelevant right now. I resent the very notion that some equation in a computational neuroscience paper could possibly be helpful to me. I resent psychodynamic therapists ascribing meaning to the pain I know is meaningless – this isn’t an ‘opportunity for growth’ and I want it gone. I resent anti-psychiatrists claiming that the pain I’m feeling shouldn’t be pathologised – I’m desperate for this all-consuming virus to be wiped out. I resent the people arguing that how I feel is just a response to capitalism or oppression, as if solving those problems would even make a dent. I even resent threads of other people describing their depression in ways that I can’t relate to.  

By the time I reach “Top Five Tips for Well-Being”, I want to scream. 

I close Twitter.

I’ve had incredibly painful experiences, ones that have changed and moulded me, and have taken time and support to heal from, but this feels different. Even in the worst of those times, I was still me. I could always see some of the good in my life, feel the love of those around me, and have some insight into my emotions. I still fundamentally liked myself.

This feels… indescribably different. I feel alien to even myself. Everything I value in myself, anything remotely loveable or worthwhile, I feel robbed of. I am utterly sick of myself, and my self-absorption. I switch between feeling a deathly numbness and a despair that makes my chest burn. I have no clarity and don’t absorb anything sensible that is said to me. My pain grows and grows and I fear I will never emerge from under it. I feel completely trapped. When I try to reach out, I find a way to feel more alone. Kindness becomes only more evidence that the people who say they love me don’t know me, not really. 

I wonder how my research on negative bias – how a keyboard response to a facial expression – can possibly capture the cruelty of my own mind. 

I make a series of incredibly depressing google searches, with highlights including ‘movies about teenage social rejection’, hoping to feel understood. Everything feels irrelevant to me.

I turn to my default comfort watch, Grey’s Anatomy, and see De Luca suffer through a depressive episode. As his colleagues try to intervene and lift his spirits, he cries out that he would give up every life he’s ever saved to just not feel like this anymore. I cry with him. It makes me feel more seen than any academic paper ever has.

As I write this, I hope that it just might make someone else feel seen, in a way my academic work may never do. Each time I start questioning whether I’m really going to share something so vulnerable, that hope keeps me going. 

Talking openly about my own mental health has an extra weight to it. I worry that, in my moments of hopelessness, my lack of answers – as an “expert”- may feed the despair of others. I worry that this will be read not as my account of my experiences, but as a universal account of depression. Many of the people I love struggle with their mental health, and they all conceptualise it differently, wanting different forms of support, each as valid as the other. I worry that friends outside the field will take what I say as gospel, rather than one perspective among many.

I feel caught in the middle of the many ongoing battles in psychiatry. There are psychiatrists I respect, psychiatrists I love, psychiatrists who make me cringe, and psychiatrists who infuriate me (no, a few minutes of cheerful small talk doesn’t disqualify someone from having depression). Sometimes, those are the same people. In discussions about psychiatric diagnoses, medication, research trends, and NHS care, I take on different roles, trying to judge when to fiercely defend and when to aggressively criticise. 

Writing this, I feel more caught in the crossfire than ever. 

I worry about the response of my friends and colleagues within mental health. While I generally feel reassured of a level of understanding and validation, there’s a fear that I am particularly exposed in front of people who spend their life thinking about depression. I worry that I will become a case study, my behaviours monitored for symptoms. Oh god, I could be deemed a fraud. I think of other scientists reading this and worry that I should be adding citations. And there is an unfortunate reality that even those most qualified don’t always get it. I return from a period of sick leave for depression and get asked if I feel better – “what with all the bugs going around”. I don’t know what to say. It’s well-intended and I love my workplace and I know I have it better than most. I’m sure I’ve done the same thing. It’s still… tiring. 

Finally, I worry that what I’ve written will be picked apart or used to further some agenda, because this is not a clear-sighted critique. When I feel ‘well’ (what word should I even be using?) I can see the value of the same perspectives I resented while in the middle of it. I can feel a sliver of compassion for the very same parts of me I hated. Maybe that Amy isn’t quite so incomprehensible. But I honestly can’t tell if this is true insight, or if I’ve simply already forgotten just how sadistic my mind can be. 

I have no answers or conclusions or even suggestions. This is just one attempt to articulate one (thankfully temporary, if recurrent) experience.

Of course, the situation I find myself in is not a coincidence and you’ve heard it before. My story is that of countless others in this field: a depressed teen, wanting to help others like her, studies psychology. She worries that clinical work is too much for her own mental health and falls in love with research instead. 

Sometimes it feels like I’ve trapped myself. One day, after struggling to get out of bed, the journal club topic of the day is social isolation and it feels almost too much to bear. I wish I could laugh but can’t so I cry. I thank my lucky stars I’m watching on Zoom. 

But then, another day, not long after, I realise I feel… okay. I don’t know why, or how long it will last. A week or so later, I think I actually feel happy. And there’s no neat narrative to where I am now, but maybe I’ve found some solace. When my head is dark and I loathe the part of me that led me there, I desperately wish I had a magic wand, to be free of it – screw all the philosophy about meaning in the suffering or the empathy it provides, I’ll gladly sacrifice that. Truly. But, as things lighten, I can just about see something. I see my day-to-day research in a subtly altered light, see with striking, personal clarity the way that an ambiguous face can appear terrifyingly critical. And, emerging, I can see how what I fear – never being free of that darkness – grounds me, teaches me, and motivates me to keep going. How it keeps me connected to the people I’m trying to help. Maybe this is what keeps alight, year after year, the flame that drove me into this field. And in lieu of a magic wand, these frayed threads of silver linings, offering a little peace, will have to do.

The start of a new decade….

I haven’t written something reflective in a while, so buckle up, this is a long one! 

It feels quite incredible looking at how much in my life has changed since 2010.

For one thing, I got my BSc, MSc and PhD! Three graduation ceremonies, with my family there every step of the way. And then a post-doc in Oxford (which still feels surreal at times…). I published papers! I learnt to code! I presented at conferences! I won awards! I taught undergrad students! There’s a million things I could beat myself up about, but right now I’m just gonna take a moment to celebrate all those achievements, most of which 20 year old me could not have imagined.

I left a relationship that was holding me back in so so many ways – from finding any peace with myself, to just generally growing as a person. I was so trapped and I couldn’t see it because I couldn’t see out of the confines of that relationship. I healed from all the damage that relationship did – not quickly and I don’t think fully until the last few years. I learnt to have much higher standards for the people in my life. I met Laurie – the most important person in my life – and I could write a whole novel about his impact on me. He has challenged the way I think, while giving me the space to be exactly who I am and grow as a person, and ultimately made me an immeasurably better person. He is someone I feel completely safe with and completely free with. I respect and trust and love him beyond words.

We’ve had a tonne of shit thrown at us – a lot is current and awful – but we’re stronger than ever, and when the time is right I cannot wait to marry him, in our own unique way.

(Bonus – his parents are incredible people!)

I’ve kept some of the very best friends I had from before 2010 – particularly my Sussex girls (wifey, Sarah, Turk, Henny) and Laura. I’ve watched them all grow into even more amazing people – and cried a ridiculous amount as one of them got married.

I’ve made some incredible new friends. Roberta, Aaron, Alex, Rita… You are all so special to me in different ways.

I started doing audio recordings on WhatsApp, to stay in touch with friends who I craved more of, and that has brightened my days immeasurably. I’ve got much better at being vulnerable and reaching out when I’m struggling.

And I’ve met so many many other wonderful people! Far too many to list.

I’ve also been deeply and horribly betrayed by people who I thought were my friends. And honestly, I’m still not really healed from that. That’s a work in progress. But the excellent friends I do have renewed my faith in people and I wholeheartedly trust in their loyalty and love.

I’ve spent so many happy times with my family – on holidays, over meals, at our infamous Gillespie summer parties – and every year I grow more and more thankful that I was lucky enough to be born into this amazing family. 

I worked on a psychiatric intensive care unit.

I successfully helped lead campaigns against staff redundancies.

I moved house 6 times… One time due to arson (buy me a drink and I’ll tell you the story)

I lived in London, despite previously thinking I had zero desire to. And stayed in just the one flat for 4 years! And lived with some of the best (and worst…) housemates.

I dyed my hair for the first time! And then about a hundred times after that, finally settling on red hair, and I love it.

I was fortunate enough to travel to a tonne of new places – Porto, Stockholm, Copenhagen, Toronto, Las Vegas, Los Angeles, San Diego, Barcelona, Paris, Jerusalem, Rome, Florence, Berlin, Dublin, Edinburgh…. 

I danced a lot, hosted a lot of parties, went to a lot of bars, and did a lot of tequila shots…

I’ve eaten some of the most incredible food – some of which, I cooked!

Perhaps most importantly, a key thing I’ve learnt is the importance of the relationship you have with yourself – the importance of truly genuinely having an authentic compassionate love for yourself, even when you’re not fulfilling your goals – even when you’re totally fucking up. I am more at peace with myself than ever before – with who I am, what I need, my body, my strengths, my weaknesses. I’ve got a lot better at prioritising myself and what I need, and investing time in myself – and not in people who don’t deserve my energy. I am so far from perfect, but I deserve the very best I can give myself, the same way I strive to give the very best of myself to others. I don’t do either of those things perfectly either, but we are all works in progress. And deserve joy throughout that journey.

So what do I want, going forward into this next decade?

I want to keep being vulnerable, and push it even further. I want to get better at reaching out, even when I have nothing to give. I want to be wary about isolating myself when I get overwhelmed, while respecting that sometimes that is truly what I need to just focus on myself. I’d like to carve out the time and money to do some explorative therapy.

I want to continue having very high standards for the people in my life – while working to better understand when to have a zero tolerance approach, and when to leave space for growth and forgiveness. I want to keep finding joy and love in all the wonderful relationships that I have, and putting the very best of myself into keeping those relationships going. I want to keep expressing my appreciation for all the awesomeness that they bring to my life.

I want to keep learning and growing as a person. I want to keep experiencing new things, in all realms.

I’ve become so much more at peace with my body and have an infinitely healthier relationship with food than I could have ever imagined ten years ago. However, I don’t always take the time to feed myself regularly with nourishing food, and I want to prioritise that more – and what is nourishing to me, may not be nourishing to you! And that’s okay! I want to continue learning about what feeds me best, letting go of any toxic concepts from diet culture. I want to take time for lunch breaks. Every. Day. (Why does this feel like the hardest goal on this list to achieve??)

I also want to continue reducing the meat and other animal products I eat, and continue shifting the animal products I do buy to ones from more ethical sources – while balancing what is pragmatic for Laurie’s physical health and my mental health when restricting food.

I have loved discovering yoga and a morning swimming routine, and want to make time for that, in ways that serve me. I want to make sure I’m never letting my body hold me back from entering spaces I want to be in – particularly, I want to try some of the physical activities that I avoid because of fear of judgement. Strength training maybe? Dancing maybe? I want to keep challenging everyone’s ideas about fat women! I want to be even more vocal about it!

I want to burn the nice candles, use the fancy body wash, wear the expensive perfume – every day because life is short!

I want to wear more colour again. And push myself out of my clothing comfort zone even more!

I’m proud to say I’ve read 59 books this year! And I want to keep finding time for reading, and taking trips by myself to read, because I adore it. I considered setting goals to read certain types of books more – but fuck that, I’ll read what I enjoy! If I want something different, something challenging, something longer… I’ll read it. And if I want to read an exploration of complicated unlikeable characters, I’ll damn well read that. I will however stick to the strict rule set by my friend of not buying a new book until I’ve read three.

I don’t want to worry about whether people will like what I have to say, to worry about if expressing things that are important to me will make someone not like me. I want to continue speaking my mind more. Especially when it really matters.

I want to prioritise some boring but necessary adult things. I want to get savings. Day-to-day budgeting is fine, but I want be financially prepared for the unpredictability of life – so I need to get better at not taking an all-or-nothing approach to treating myself (I can buy one nice new dress when I get paid, not a bag full of bargains!). I don’t want to waste money on transport, when walking helps keep me sane.

But I also want to spend money on amazing experiences with amazing people, sometimes impulsively, because otherwise… what’s the point?

I want to look after my eye health and not wear contact lenses every hour of the day! I want to get on the flossing so I keep getting metaphorical gold stars from the dentist!

Rather annoyingly, I’ve discovered that I actually do pretty well going to bed early and getting up early. Ugh, how boring. So I want to give in to those early nights. (But also, suffer the consequences of those wonderful unplanned late nights).

I want to keep cooking delicious feasts for the people I love – every weekend that I’m home, ideally.

I want to stop drinking alcoholic drinks that I don’t really want, just because the social context dictates it.

Career wise… I would love to be gaining my own research funding by the end of the decade. But ultimately, I just want to be doing worthwhile science. That means being ambitious and driven, thinking of important questions and how we can answer them, and doing good work and getting it out there. It does not mean publishing for the sake of it, rushing projects and lowering my standards. I want to take the time to do some science really well, rather than take on to many projects and do them all poorly – for the sake of my sanity as well as the science! I want to take the time to read more of the great work out there being done, and learn from it – I want to find a way of prioritising this that works for me. I want to look at my publication list and be proud of the quality, not the quantity. And look at my achievements more broadly – how I’ve contributed to a lab, how I’ve taught, how I’ve mentored, how I’ve been a good colleagues, what skills I’ve developed, what attitudes I’ve changed. If doing all of that takes me up the career ladder, fantastic. If not, it wasn’t mean to be. If I’m in a job, doing worthwhile interesting work, with great colleagues and where my skills are being put to use – I’ll be satisfied.

Putting it out there – I’d love to contribute to some work on hormonal contraception and mental health. Because coming off the implant earlier this year has had such a hugely positive influence on my mental health that I almost can’t believe it, and I know I’m not alone in that.

I want to make sure I’m not perpetuating an ideal of being busy and overworked, however unintentional. I want to keep posting about the breaks I take. I want to reclaim my evenings, because working late messes up my sleep, meals, exercise, and time for loved ones – and I don’t mind sacrificing the odd weekend to do so. That works better for me. But I also should probably delegate more, let go of some things from my to-do list, and say no to more things that are asked of me.

I want to continue being more pro-active in taking time for my mental health. I want to make sure I’m taking enough quiet time whether that’s structured mindfulness, or just not having a podcast constantly on the go. I want to make sure I’m saying no to social invitations, when I need to prioritise myself. It’s okay to miss out or reschedule sometimes. I know I need a lot of structure – so many lists – and taking the time to stay on top of that is worthwhile. I want to carve out a little bit of time each day to think about what will best serve me, whether it’s a lazy evening, some disciplined work or a wild night out – maybe via a chat with a friend, maybe via a minute to myself.

I’ve really enjoyed developing a skincare routine and finding a look that works for me. And I do want to perfect the shade of hair dye I used and the curly girl method…. But otherwise, I want to let go of any other goals around how I look. I just simply don’t care enough. If I moisturise my legs more, save up for microblading, get smooth feet for once in my life or if I don’t…. *shrug*

Finally, I want to imminently do a big overhaul of my social media. I want to unfollow anyone who is just draining my time and energy. I’ve gradually posted less and less on Facebook and I’ll probably continue to do so – except for the occasional reflective or thoughtful posting, about myself or issues I think matter. I’d like to do that more. I spend far too much time scrolling on Twitter, without any clear gain so I want to make it work better for me – I want to shift to primarily using Twitter for academic things, limit my time, and either engage with discussion or log off. Instagram, I’ve gone through phases of posting more or less, and actually I kind of miss when I posted more. For a few years it was a lovely catalogue of memories  (my phone photo gallery is a mess of way too much irrelevant shit)and then I felt slightly self-conscious about how much I posted, so I cut down to something more “curated”. Fuck that. I’m bringing back the random selfies and food pictures.

I thought about whether to add standard goals like owning a house, or some bucket-list experiences etc. But honestly – is that what will make the decade feel like a success? I’m sure there’ll be a tonne of other awesome things I achieve and experience, tonnes of tweaks to my life I make, and I’ll celebrate them as they come – but I’m not striving for them.

This, right here, is what’s important to me.

(Oh, and – of course – I’d like to blog more. But let’s see.)

What I’ve been reading in 2018 (January to June)

Something slightly different – a round up of my reviews for books I’ve read in the first half of this year, highlighting my top recommendations and one my favourite genres – books with young, supposedly “unlikeable” female protagonists in messy relationships!

(For those of you who already religiously follow my goodreads reviews, this post will be pretty redundant! For those who would like to religiously follow me on good reviews, find me here! I’ll also do another round up at the end of 2018, for the second half of the year.)

My Top Recommendations

her body and other partieswhen i hit youeat uppublicly shamedlullaby


A Friendly Overview of “Biological Predictors of Clozapine Response: A Systematic Review” – Part 2

This is the second blog providing a “friendly overview” of a systematic review I co-authored on biological predictors of clozapine response, which has recently been published in Frontiers Psychiatry. In the first, I explained why predicting response to clozapine is important and gave a brief explainer of what systematic reviews are. In this one, I’ll explain how we conducted our review, and the key messages from our findings.

Obviously you can find all of the detail in the paper itself, but this is primarily aimed at non-scientists or people outside of the field. If anyone is interested in more detail of a particular aspect, I’ll happily write a follow up on certain aspects or answer questions in the comments/on Twitter!


A Friendly Overview of “Biological Predictors of Clozapine Response: A Systematic Review” – Part 1

After (too many…) years, a systematic review I co-authored on biological predictors of clozapine response has recently been published in Frontiers Psychiatry, so I’m going to do two posts giving a “friendly overview” of the paper. In this one, I’ll outline why predicting response to clozapine is important and give a brief explainer of what systematic reviews are. In the second, I’ll explain how we conducted our review, and the key messages from our findings.

Obviously you can find all of the detail in the paper itself, but this is primarily aimed at non-scientists or people outside of the field. If anyone is interested in more detail about a particular aspect, I’ll happily write a follow up on certain aspects or answer questions in the comments/on Twitter!


Writing a PhD thesis – “words of wisdom”

For those of you doing PhDs, whether your thesis submission is a few years away or a few months away, I thought I’d pass on some “wisdom” about the whole process (most of which is just how to avoid my mistakes…!) – from planning to mindset to little technical things. I read a lot of advice which sounded great but seemed very idealistic and sometimes just scared me – I’m hoping this is a bit more grounded and reassuring. Some of these tips may be broadly useful to other projects or pieces of academic work or writing, but it is quite focused on writing a PhD thesis, which I found a very different process to any previous academic writing  – partly just due to the length!


Slow cooker BBQ brisket recipe

Firstly I’ll say that compared to my last recipe, this is a lot more relaxed. It’s my favourite kind of chuck-it-in-a-pot dish with lots that you can personalise; you can improvise and use whatever looks good in your cupboard, and nothing is too essential that if you realise you’ve run out it’s a disaster (well, other than the brisket). So if the technique of my cherry pie seemed a bit intense, don’t worry, most of my recipes will be more like this…


Genetics, epigenetics and DNA methylation – an intro (Part 1)

I’ve wanted to write an intro to “epigenetics” for a while, because when I was trying to learn about it for the first time, I found most things fell into two camps: either mainstream press with lots of hype but not much detail or jargon-filled explanations aimed at hardcore biologists with lots of prior genetics knowledge. As someone who started my PhD with little understanding of genetics, it took me quite a while to piece together information with enough detail to properly understand all the terms but not so much detail that my brain felt like melting. I wished there had been one resource which talked me through at least the basic ideas from start to finish, without assuming a tonne of knowledge beforehand – and so that’s the aim of this series of posts! For people new to genetics, this will be a crash course in all the key things to know. I will use some of the jargon so that you can learn the words, but try not to get bogged down in it – you don’t need to remember it all and I will try to explain everything as I go. Leave me a comment if I need to explain something further! For people familiar with genetics, this will probably cover a lot of old ground and you might want to just skim it then read the extra resources at the end!

So… let’s start with the hype!


Cherry pie recipe – based on Serious Eats

So, my fiance had been hinting about cherry pie for… years but pastry is something I have no real experience with and it’s always scared me a bit. But over Valentine’s week I wanted to do something special, so I hunted down these recipes on Serious Eats, adapted them slightly and I was really happy with the results (if we forget about the fact the crust slightly burnt…). This may well be the most elaborate recipe I post because it’s pastry BUT (for pastry) it’s pretty relaxed which I like – expect the rest of my recipes to be more low key.


The unspoken concept of “true scientists”

There is often this unspoken concept of the “true scientist” : the person who is wholly dedicated to their science. Science is all they talk about and they never take a day off. They eat, sleep, breathe science and it isn’t “work” for them because it’s their passion, their life’s mission. They’d never resent working late because it’s all they want to do. They’d move across the world to do their research – there’s no sacrifice too big to pursue their thirst for science. They’re also probably a white middle-class straight guy – but that’s a story for another blog post…

Now, I love doing psychiatric research – I frequently feel ridiculously lucky to get to do the work I do and genuinely can’t imagine a more rewarding or exciting career. And yes, I definitely get swept up in analysing new data or reading around an area that I want to try to get to the bottom of and I will happily spend an evening chatting away about my work. And yes, when necessary, work takes over and I don’t have space or time for much else (apologies to everyone I ignored during the last month of my PhD!). But, science isn’t my whole life – I spend a lot of time thinking about other things and doing other things!