I have an appointment coming up with my psychiatric nurse practitioner, and that means my thoughts frequently settle on the effectiveness of my mental health treatment. By now, I’m familiar with the questions she’ll likely ask me, but somehow the answers never come easily. Determining how I feel is not something I’m very good at, although I’ve gotten better at it. This time, I’ll attempt to describe the seemingly endless plateau of “meh” on which my mood currently resides. I have occasional dips into the dark chasm of “really bad,” but for the most part, things are ok. But as I decided after I was released from the hospital, I’m not settling for “ok” this time. I want to feel great, exuberant, joyful, even- happy. Happy would be good.

At this point, it seems like I’m running out of viable mental health treatment options that come in pill form. I was told I was a candidate for and encouraged to try Electroconvulsive Therapy (ECT) while in the hospital (a treatment that has changed immensely since it first began). My mother’s worried googling turned up IV ketamine as a promising treatment that my psych NP also encouraged. I knew people in my partial hospitalization program that moved on to do Transcranial Magnetic Stimulation (TMS). These are all safe treatments that, if they work, can change your life for the better. So, why am I so resistant to the idea?

I think it comes down to acceptance. When I first became depressed, it took me a long time to get to a place where I felt comfortable taking antidepressants. I clung to (and sometimes still do) the idea that if I just tried harder, all my problems would be solved. This is because, like many of us, I’m way too hard on myself. But it’s also because it was scary to fully accept that I have an illness that can’t be overcome through sheer force of will; a fact that my biochemical imbalance predetermines. On one hand, taking responsibility for your mental health is an important part of managing it. On the other, there’s an element of frightening imposition that comes with accepting that the very fact of your diagnosis is out of your control. I carry my depression around with me- not by choice or through lack of effort, but because its complex tangle of symptoms, neurological effects, and genetic alterations are not things I can leave behind.

Despite coming to terms with the apparent chronic nature of my depressive episodes and the fact that right now, I need antidepressants, I see this next step in mental health treatment options as Phase Two of my personal acceptance hurdle. It was tough to accept that I needed antidepressants, and now it’s tough to accept that I may benefit from another level of psychiatric treatment. I like to mull things over for a very long time, so until or if I decide to make that leap, I’m just considering it.