Jane Chin’s website was one of the first in the mental health field I discovered, and I’ve been so impressed with the prolific work she does with Chinspirations.com–which includes 18 (that’s right!) of her own blogs, and, more specifically, with Jane’s Mental Health Source Page.

She created her website in 1998 when she was a patient and receiving treatment for clinical depression, and it’s purpose is to share depression, bipolar disorder, and mental health-related information from a personal point of view. With a Bachelor of Science (B.S.) in Microbiology from Cornell University and a Doctorate (Ph.D.) in Cancer Biochemistry at Roswell Park Cancer Institute/University of Buffalo in Buffalo, New York, she spent over a decade of her professional life in healthcare research and business. Most of her experience has been in the pharmaceutical industry.

In 2004, Jane became an entrepreneur (self-employed) with her site and by providing medical affairs advisory and consulting services to biopharmaceutical companies. A significant amount of her work is with field medical affairs, especially medical science liaisons or MSLs. She was a columnist for Pharmaceutical Representative magazine and is Founder and President of the Medical Science Liaison Institute.

What this means: it took a very long time for me to write her bio and go through her site. OMG!

Alas, here are my questions for Jane.

1) Wow, Jane. You know a lot. And do a lot. And you’re not on any medication. So let’s start there. I’m always intrigued (and jealous) of people who have gone off their medication successfully. As someone diagnosed with Bipolar II, I tend to think I’m a life-timer. And it’s only been a year and a half since I was ordering off of a psych-ward menu. But I’m always curious … how do you think you know when or if you can go off your meds?

When I was first receiving treatment for depression in 1998, I was adamant about “going off after one year”. This was both for medication therapy and psychotherapy. As a result, I was a very compliant patient – I took the meds when and how I was supposed to, and I made every therapy session count. You can say I was a very motivated patient. I chose a “one year” mark partly for a logistical and naive reason: I was planning on moving to the west coast to join my husband after completing my doctorate on the east coast. I calculated that this may be a year out, and I wanted to be “fixed” by the time I moved out west.

However, I also realized that I would be willing to go off the treatment plan with the blessing of both the psychiatrist and psychologist, who would be clinically assessing my progress. There was really no “weaning off” psychotherapy – I stopped when I was ready to move to the west coast. With medication, I was carefully weaned off with decreasing doses of the antidepressant and made sure that my depression remained at bay. I was willing to change my mind and return to the dose that worked if at any time I experienced any deterioration, because I had worked too hard to get to where I was to jeopardize it because of stubbornness.

2) You mention as your sanity tools some of the same staples of my twelve-step depression program for recovery from depression: enough sleep, eating well, staying active, forming strong personal and social relationships. Any other secrets you use to stay out of the danger zone?

The most important secret is to know myself physically and emotionally. This means how I responded to certain situations and what may be the “threshold” negative stimuli that I must be careful not to cross. Not getting enough sleep, not exercising for too many days at a time, not eating regularly or well, or not having enough human interactions are examples of stressors for me.

Many of us assume that we should know ourselves best, but I’ve found that I had let myself run on autopilot for years without realizing when my condition was deteriorating. It’s a bit like looking at yourself in the mirror everyday and assuming that you look the same from day to day. The changes may be so minute that we don’t realize we’re spiraling downward until we’ve hit rock bottom. In retrospect, that was what happened with me. Once I began to recognize some “danger signs” specific for me, I could manage the situation before it got out of control.

3) You consider yourself “in remission” which means that you keep a vigilant watch on your mental health. What did you do in 2001 when you relapsed? I mean, do you continue to work, just at a slower pace, and wait to feel better on your own? What if the depression doesn’t lift on its own?

To tell you the truth, I became complacent when I first started working, and did a lousy job at “keeping watch” over my mental health. Hence, I ignored those stressors I previously talked about until it was too late. Once I recognized that my depression had relapsed, I called the insurance company for network healthcare providers. I did not want to “wait things out” to see if I would get better on my own. I’m a big risk-taker where entrepreneurialism is concerned, but managing depression was not something I take risks with. Thus the simple answer to your question, “What if the depression doesn’t lift on its own” was, “I didn’t want to wait and find out”! I had already been down that road years ago.

I made appointments as soon as possible with both a psychiatrist and a psychologist. I was fully prepared to resume both treatment modalities because I saw the value in combining these, and this strategy worked for me before. I requested a different antidepressant because I had a lot of side effects with one I was taking in 1998. I tried 3 different kinds of antidepressants but did not find one that I could tolerate. I experienced severe dizziness or sleepiness, which would interfere with my work. I ultimately decided to go with psychotherapy treatment alone because my symptoms were improving.

4) Your log of experiences as you received treatment for depression was raw and real. I so recognize the desperation, when you wrote this:

I don’t feel like going to lab. I don’t care if I graduate. I don’t care if I don’t eat. I don’t care if I’m alive. I wish I was never born so I don’t have to think about dying more and more. Cried almost all day yesterday. Also thought about ending things because I don’t feel that life is worth the pain I bear anymore. Been thinking of the steps. Plans have become more realistic. I just don’t want to live in my skin anymore. The last time I had these thoughts was right before I started the depakote. Had letters written but they aren’t very good. What can a person say to ANYONE knowing she wants to leave them all because she can’t stand the pain anymore?

What would you say to your reader who is in that place right now? What would be your most important message to her?

I’d say, “This will pass. Hold onto yourself.” My husband and I were in a long distance marriage while I finished graduate school so he could not be my voice of reason when I was in a dark place. He wanted to find a way for me to help myself when I was caught off-guard by mood changes. My husband asked me to write “IT WILL PASS” on a post-it note and put that note in a place where I will see it often. The note went to the corner of my computer screen.

Mood changes are like waves. When you’re right in the middle of a big trough, you’re caught up in the depths of the abyss. It can be very difficult to believe that things can get better. Sometimes you stay in the abyss for a long time. You may have to make a choice to hang onto yourself while you ride out the storm.

I remember at one point I was in such a dark place that I was lying on the floor and fantasizing about a morbid alternative. After a long time of wallowing in this morbidity, I heard a voice say “Get Up” and I realized it was my voice. I just kept saying “Get Up”, over and over to myself until I finally sat up on the floor. This was an example of hanging onto myself even when a part of me wanted to quit and give up. It was my act of defiance – I didn’t want to “be beaten” by depression.

There was another time when I was online in a mental health chat room. Someone sent me an instant message; he needed to talk. His wife went out for a short while and he was alone. He had bipolar disorder, was on an antidepressant but no mood stabilizer, the doctor was not answering his calls, and he was eyeing razor blades. That was what he told me over instant message. I asked him to get a phone book to look up the suicide hotline number. I told him that I’d get a phone book and look at the suicide hotline so we would be doing something “together”. Even though this was a total stranger, I felt helpless and panicked that he might hurt himself. I wanted to keep him engaged online until his wife got back. She returned and sent me an instant message to let me know she was back. This incident gave me a glimpse of what it’s like to be on the other side – be the loved one or friend of someone who suffers from a mental illness and runs the risk of hurting himself or herself. It made me understand what my husband must go through whenever I plunge into dangerous depths.

I like a phrase from Sarah MacLaughlin’s song, “Hold On” – “Hold onto yourself, for this is going to hurt like hell.” The song is not about depression, but that phrase resonated with me. It does hurt like hell, but hold onto yourself. You are worth fighting for.

5) I love this paragraph in your bio:

I consider each day that I wake up a blessing. Sometimes I’m glad when I’m having a “boring day” because I remember what a ‘dark, depressed day’ felt like. Because of my experiences with depression, I have learned to be thankful for the extraordinary things and the ordinary things. I am thankful to my extraordinary husband who supported me through the worst of times, and to visitors on this site who share their personal stories with me. I am thankful to the mundane things that remind me I am still alive; the weather, leaves that need to be raked in garden, picking up the mail. These are gifts that depression has given me.

I can really, really relate to it. But here’s a dilemma we’ve had on many of the message boards of Beyond Blue: Should you fake gratitude when you don’t really feel that way? I mean, is it okay to whine and gripe on the days that you and your inner demons are fighting so hard that you can’t do much else?

Faking doesn’t work for me. I can’t advocate faking gratitude if I can’t even do it. Faking is a form of resistance and takes a lot of energy – mentally, emotionally, physically, spiritually. That energy may be better spent in a couple of different ways: one, look for the smallest things you can genuinely feel grateful for; two, accept that you’re going through one of those days where the demons are having a party in your head. Your mission is to get through the day, one moment at a time.

It’s important to talk about what’s going on with someone who understands, instead of keeping things pent up inside. That said, whining and griping continuously won’t help you feel better, either. I suggest putting a time limit on whining and griping, maybe frame the situation in a matter-of-fact way and break things down as specifically as possible. For example, “What this person did really bothered me. I feel as if the whole world is out to take advantage of me.” Then you take each piece of that information and work through it. You don’t need to feel completely “OK” in order to feel like you’re moving forward. You just deal with it the best that you know how, and give yourself credit for each little step forward. If a step forward meant you got dressed and went to get the mail instead of shutting yourself in your room, pat yourself on the back for this step forward.

I find that when I stop pretending to be someone I’m not, it frees me up to work with who I am. I can be easily stressed and high-strung. If I force myself to be laid back and mellow, I’m going to get frustrated because I won’t “get there”. That’s just not who I am.

6) Can you tell me a little bit about your community on your site? Beliefnet just launched its community on Monday. Do you feel that this is the support group of the future? No more Big Books and bad coffee?

I consider my website a personal one and I occasionally invite people to participate through my blog carnival. It is not the same format as the community that Beliefnet just launched. I’m grateful that I still have an attentive audience after almost 10 years. The web has allowed many who otherwise feel isolated from depression gain support and understanding. There are different approaches to encouraging people who experience depression and bipolar disorder to seek help and know they are never alone. Today, books, online forums, personal blogs or websites are among the options we have for support and information.

7) One last question. Your husband sounds as supportive and incredible as mine. But we are lucky. What would you tell a person with a spouse that just doesn’t get it?

My husband understood that there is a biochemical basis for depression. This helped me, because a big hurdle in relationships where one person suffers from depression is when the partner does not separate the illness from the person, or interprets that person’s behavior as a fundamental character flaw instead of an episodic occurrence. When I asked him how he came to this understanding, he said that I educated him about it. I had forgotten that I did! To his credit, he read about depression and bipolar disorder on his own as well.

If a person’s spouse or partner is open to information, he or she may find it helpful to look at websites or books written from the partner’s or spouse’s point of view. This at least prevents the partner or spouse from self-blaming because no quick-fix is possible. The partners and spouses may also realize that they are not alone and that other people have gone through the same struggles they are going through. Receiving validation for their frustration is important because it can encourage partners and spouses to in turn validate what their loved ones are experiencing instead of denying or trivializing it. Support for spouses and partners in the relationship is critical when riding through the storm of depression or bipolar disorder.