Mind Shift

Depression entwined itself into Alex’s existence when they were 10, summoned by the roiling hormones of early puberty. They were overwhelmed, unable to understand how and why the world had been drained of its joy, its goodness, its hope. A writing exercise at primary school — Alex (not their real name) wrote about wanting to die — alerted the school to the force of the depression. Alex was referred to a doctor, who referred them to what was then called Child, Youth and Family and a counsellor. Alex’s parents offered well-meaning advice — just put one foot in front of the other — that paled in significance to the scale of the illness. “I was 11 when I made my first suicide attempts, because I just couldn’t comprehend [living] any more,” Alex remembers.

Doctors were unwilling to medicate someone so young, and Alex remembers “white-knuckling it” through their early teens. “But, you know, it was a nightmare. And I was a nightmare.” They would run away from home in the middle of the night, and self-harmed by sticking sewing pins into their flesh. “I would just walk around like a human pin cushion,” they say. “I became a pretty angry kid. I was pretty angry at how awful the world was to me.”

They discovered a passion for ballet, which bloomed into “an obsession”. The discipline it required gave Alex something to cling to, and, when they were about 15, they were prescribed fluoxetine, the common antidepressant also known as Prozac. It took away the “really, really bad lows” but still left Alex severely depressed as they negotiated the remainder of their teenage years, dropping out of high school in year 12, although Alex’s attendance record by that stage was so low they “practically hadn’t been there”.

They left home for ballet school in Christchurch. Full immersion in that world — training nine hours a day, six days a week — offered a respite. “This was just going to be my life, and I wouldn’t accept any other,” Alex says. “And for a while that helped.” But one day, training at a local gymnastics academy, they fell from a trampoline, “pulverising” the soft tissue of an ankle in the process. Alex knew instantly that all hope of a ballet career had been lost. “It was kind of like losing religion, losing God. I’d lost my thing… And nothing else was worth anything, and I had no idea how I was going to live.”

Alex hardly knows what came next. They know they moved back to Dunedin, squatting in various places around the city and hanging out with old friends. But the rest is buried beneath a haze of alcohol and whatever drugs came their way. “I was leaning on those things pretty hard. And I literally have no recollection of the following year.”

That fog only lifted after they were admitted to Wakari Hospital, suffering from “massive suicidal ideation”. “I was dissociating a lot, just doing a lot of extremely concerning things without realising. One of the oddest ones was sitting at my mirror and brushing my hair and then realising I had a knife to my own throat. It got to that sort of stage of mental health.” Worried friends delivered Alex to the hospital and didn’t leave until they were admitted. Alex was there for about a week, and when they were discharged it was under the aegis of a social worker and dependent on a benefit. That was “the level of functioning” they were capable of at the time. Alex cycled through the standard anti-depressants — fluoxetine again, citalopram, escitalopram. But this time “nothing worked”. One day in 2014, they mentioned to their social worker they had read an article about how successfully ketamine was being used against treatment-resistant depression in the United States. Frustrated by lack of progress with the established treatments, Alex “was intrigued by a completely different drug working in a completely different way”. By chance, that social worker had heard someone at the University of Otago was studying ketamine as a treatment for depression.