How can I tell someone I’m harming myself?

Opening up to someone about self-harm is a brave choice. It’s easy to feel alone or like no one else can understand what you’re dealing with. It can be scary to admit something that you may have kept secret for a while. Starting the conversation can be hard, but many people feel more supported after talking to someone about what they’re going through.

Find someone you can trust.

The person you choose to tell about self-harm plays an important role in your experience. Think about your reason for telling someone. If you are hoping to feel less alone, you may want to tell a close friend or peer. If you’re looking for help, a family member or other trusted adult (like a coach, teacher, or school guidance counselor) can help you figure out where to start. You can also confide in your doctor, therapist, or another healthcare professional.

Decide on the right time and place.

It’s also important to have this conversation in a safe space. Talking about self-harm is likely to bring up a lot of emotions, for both you and the other person. Find a private location—it may help to be somewhere that is comfortable and familiar to you. Timing matters, too. You should both be in a calm mood. You can also set a time in advance by letting them know you’d like to talk about something serious soon and asking when a good time would be.

That said, there will never be a “perfect” time or place. Don’t put off having this conversation forever simply out of fear of ruining a moment.

Do I have to do it in person?

No! This is your journey. You get to decide when and how you tell others. Many people feel more comfortable writing it down. You could write a letter or do it over text. If you’re okay with speaking but think looking at someone will be too difficult, give them a call.

Keep in mind that they may have a more concerned reaction if they can’t physically see you—their imagination may run wild about whether you are about to harm yourself in the moment. It may help to let them know upfront that you are safe (as long as that is true).

If you send a written message, waiting for their response can be nerve-wracking. Remember that there are lots of reasons someone might take a while to reply—it doesn’t mean they don’t care! It may help to first confirm that they have time to respond quickly. Instead of sending a long string of texts without a heads up, start by sending something like: “Hey, are you free for a bit? I want to talk to you about something important.”

What do I say?

The first sentence of a serious conversation is usually the toughest to get out. Even if you are going to talk in person, writing your thoughts down first can help you figure out what you want to say. You can tell them as much or as little as you want. Be honest about how you’re feeling and how they can support you.

People often want to problem-solve, so don’t be surprised if they try to jump into action quickly. For a lot of people, self-harm can be really scary. Their first reaction may be to tell you that you need to stop right away. They may assume that because you are harming yourself, you must also be suicidal. Let them know whether you are ready for their help or if you just need someone to listen for now. They may have questions—remember, what you share is up to you. They are likely asking to better understand, but you don’t have to answer anything that you aren’t comfortable with.

Asking for help can be scary, but it’s nothing to be ashamed of. It shows your strength and commitment to feeling better, even though it may feel impossible right now. Things can get better—and letting someone know what you are going through is often the first step in getting there.

I have trauma from racism

Racial trauma is a word that all of us should be a bit more familiar with because we all have some work to do. It’s all about the mental and emotional impacts that are a result of racial bias, racism, and hate crimes. This type of trauma may come from other people, or it can be experienced just by living in a racist system.

All of us are impacted by racial trauma, and it plays a huge role in your daily life (maybe even more than you realize). Melody Li, the founder of Inclusive Therapists, shared some thoughts and a few helpful reminders as you start doing the difficult work of racial trauma healing.

There are different layers of racial trauma

The historical — what happened to your people? How did you arrive here?  The intergenerational — how did that trauma then get passed down from generation to generation?  The personal — what are you experiencing now, in the day-to-day? And the systemic trauma — how is this system set up to keep you out and to keep you down? Resmaa Menakem writes about this idea in his book My Grandmother’s Hands.

Healing happens in the community

As you start looking at the layers of racial trauma and peel them back, it can be really painful. So do it in community. Find your people — the people that get you. Your people may or may not be your family of origin. Find people that you can tell your truth to and can share your experiences and microaggressions and they will believe you and validate you.

There can be celebration in the midst of healing

In the book, So You Want To Talk About Race, there’s a quote that more or less says that race is more than pain or oppression, but also culture and history. And so while you are doing this trauma healing work, while you are receiving care, connect with the joys, the vibrancy, the creativity of your culture and history. Don’t forget that part, because that’s all the awesome stuff that you get to keep. So there is the gratitude and the grief, and they can journey together.

We all need racial trauma healing — including white people

It just looks different for white people and for people whose ancestors may be oppressors or colonizers. White racial trauma goes deeper than just feelings of shame or outward violence or hatred. It’s thinking ‘how did my lineage get here?’ A lot of this work is demanded of by people of color, but this work is never demanded of white people. So they don’t know their lineage. They don’t know the story. They don’t know the original traumas that happened that really made their ancestors have to decide ‘do I maintain my heritage or do I choose power?’ People also need to ask: ‘How have my ancestors and lineage benefited from systems built to advance white bodies and keep the bodies of people of color oppressed? How did my people contribute to these injustices, directly (through genocide and land theft) or indirectly (through complacency and silence)?’

Racial trauma healing is going to be a process, with seasons of work or cycles of work

We can see that even in the Black Lives Matter movement that there are waves, that there are seasons. In each wave and each season of racial trauma, my desire for all of y’all is that you will gain deeper healing, but also brighter celebration of who you are.

What happens if I call the Suicide Prevention Lifeline?

Suicide is one of those incredibly difficult topics to talk about. If you’re having thoughts about suicide, it can feel like there’s no one to turn to that can actually understand what you’re going through. But the most important thing to remember is  suicide is preventable — even in those incredibly difficult moments, where it doesn’t seem like there’s another answer. 

That’s where The Suicide Prevention Lifeline comes in. The Lifeline is there to help calm you down and work to keep you safe in one of the most difficult moments in your life. But the idea of picking up the phone and talking to a stranger can feel, well, a little uncomfortable at first. And the unknown of what actually happens when you call may be a deciding factor in whether you pick up the phone.

Obviously, it’s going to look a little different for every person and every situation, but there are a few things that you can always expect, if you ever do need to give them a call. 

The Basics

It’s free and confidential

It can feel incredibly vulnerable to share all of the deepest and darkest thoughts going on in your head. But every call is confidential, and you can be totally anonymous, if you’d like. You can share as much or as little as you’d like about your experience, but it’s a safe space to share, without having to pay a thing. 

It’s offered in multiple languages

Language can be a huge barrier for a lot of people looking for crisis resources. But with the Lifeline, they’ll connect you with a translator. Just call the main line, and they will then connect you with a service that can translate calls in more than 150 languages.

Bonus: There’s an entire Spanish Language line you can reach at 1-888-628-9454.

You can call or chat

The Lifeline number is probably the first thing you think of. But sometimes having a full conversation over the phone can be a really scary step to take. So in those moments, if giving someone a call doesn’t feel like the right first step, you can use the Lifeline chat. 

It’s not only for suicide prevention

Just like with The Crisis Text Line, you can call for any serious crisis happening in your life. You don’t need to only be contemplating suicide to call the number. We all need emotional support, and we all have things come up in life that feels unmanageable on our own. (Sometimes we just need someone to talk to. In those cases, try out a warmline!) 

What to expect when you call in

1. You call 1-800-273-8255

So you’ve decided it’s time that you give them a call. First off, good for you. It’s incredibly hard to take that first step, but you deserve the help. Once you dial-in, you get an automatic message that gives you the option to switch to Spanish or to be transferred to the Veterans Crisis Line, if needed. 

2. You’re redirected to a local crisis center

It sounds like a complicated process, but don’t worry! This all usually happens within 30 seconds. The Suicide Prevention Lifeline is actually a huge network of crisis centers across the entire country. So your call is just sent to the center closest to you. That way whoever you speak with can understand the resources available to you in your actual community. 

3. You’re connected with a trained crisis worker

As quickly as possible, you’re connected with a trained staff member, professional, or volunteer. Everyone that answers your call has gone through the exact same training, so no matter what their title is, they can help you. 

4. You guide the conversation

This conversation is for you to talk through everything that you’re feeling. Yes, the person on the other side of the phone may ask a few questions to get things started, but you get to decide what you feel comfortable sharing. You can talk about anything. The call can also last for however long you want it to. There’s no script that’s followed, the crisis workers are truly just having a conversation with you and hoping that you can feel better. 

5. You can develop a safety plan and potential interventions

There may be a situation where thoughts about suicide just won’t leave your head — no matter how helpful a crisis counselor is. If you are still concerned about hurting yourself, you and the crisis worker will come up with a plan that feels right to you. In some cases, that means having a counselor come to your house, brainstorming family or friends that can help you, or scheduling another call to check-in with you later. In a situation that can feel overwhelming and stressful, they help put the control back into your hands to keep you safe and alive. 

6. In rare cases, the police may be called

We know that a lot of people may be scared to call the Lifeline because they are concerned about the police coming to their house. We absolutely understand that fear! It’s worth mentioning that less than 3% of calls ever actually require police intervention. Normally, the crisis worker does everything they can to de-escalate your suicidal thoughts and help you come up with a safety plan before they involve anyone else.

If you are feeling unsafe and concerned about interacting with the police, you can also check out this resource for alternatives to calling the police.

One of the most serious signs of a mental condition is thinking about suicide. You’re needed in this world, and suicide is not the answer. If you’re thinking about hurting yourself or others, safety needs to be your first priority. Call the Suicide Prevention Lifeline at 1-800-273-8255.

What is abuse?

In healthy relationships, people support each other and respect each other’s boundaries. But too often, people we should be able to trust take advantage of us.

The most obvious way people abuse each other is through physical violence. But more and more people are realizing that “abuse” can be so much more than that. There’s no simple definition of abuse that everyone uses—but there are a few common ideas that come up when people talk about abuse:

  • Exercising unfair power and control over another person that results in fear. People who are abused feel unsafe about their situation. They may feel fear of being hurt or attacked emotionally or physically. You can feel like you’re walking on eggshells because you don’t know if what you say or do is going to result in backlash.
  • Treating another person as an object. Abusive people don’t consider how their actions might be harmful to another person—or they simply don’t care. This could look like: treating you as their property, telling you how to feel, repeatedly telling you mean and hurtful words, diminishing your feelings or perspectives, or hitting you.
  • Twisting the relationship into something it shouldn’t be. There are certain things that are appropriate in some types of relationships but not others. For example, it’s appropriate for parents to lay down rules for their children to follow (assuming those rules are reasonable and enforced fairly). But it’s not okay for a boyfriend to do that to his girlfriend.

Who can be abusive? And who can be abused?

That’s simple: Anyone can be abusive. And anyone can be abused. It’s even possible for two people in a relationship to abuse each other at the same time.

That said, abuse is all about power and control—so it’s much easier to be abused by someone who has a lot of power and control over you. Because of this, there are certain relationships that are more likely to be abusive than others:

  • Men are more often the abusers, and women are more often the victims. In most societies, men make more money than women and have other privileges that women don’t. On average, they are also physically stronger.
  • Parents and children. Children are dependent on their parents, especially when they are very young. Sadly, many parents ignore their responsibility to nurture their children, and instead abuse the power they have over them.
  • People who are marginalized in society are more likely to be abused. People of color, LGBTQ+ folks, and people who are homeless or addicted to drugs or alcohol are more likely to be abused.

Because it’s easier to abuse someone when you have power over them, abusers often try to increase the amount of power they have in relationships. There are many ways they might do this:

  • Isolating you from other friends and family
  • Encouraging you to quit your job and depend on them financially
  • Putting you down, making you feel helpless and worthless
  • Making you doubt yourself
  • Encouraging you to use drugs and alcohol, which impair your judgment and make it harder to live independently

What does abuse do to people?

Being abused is a traumatic experience. Trauma has long-lasting effects on our mental health. People who feel abused may experience conditions like depression, anxiety, or PTSD.

In abusive relationships, there are communication patterns that include blaming the victim or diminishing the attacks. This can lead us to doubt ourselves or even reality. We may have trouble trusting our own feelings, trusting what others tell us are red flags, or knowing real and what isn’t.

Many people who have been abused blame themselves, thinking that the abuse wouldn’t have happened if only we hadn’t provoked the person. Or we might feel stupid for getting into an abusive relationship.

If you’ve been abused, it’s so important to realize that the abuse isn’t your fault. We all make mistakes and hurt each other, but there’s nothing you can do that would make it okay for another person to abuse you.

What if it’s someone I really love?

Actually, most abuse is committed by the people we love. They may even genuinely feel love for us. But love is not enough for a healthy relationship! Someone can love you very much and still hurt you deeply.

Abusive relationships are often very intense—and can be difficult to leave. Abusive relationships create dynamics where it is hard for any one person to leave the other. It may be hard to believe, but there is always a better alternative. You can find happiness and love with someone who also treats you with respect. And it’s better to be alone than to be with someone who abuses you.

What if the person isn’t doing it on purpose?

It doesn’t really matter whether someone is being abusive on purpose. They may have good intentions, or not realize what they’re doing. But at the end of the day, if what they are doing is causing physical or emotional harm to another person, it’s still abuse.

It can be really uncomfortable to label someone as an “abuser.” You might feel guilty about using that label. Just remember that your physical and emotional safety is more important than protecting their feelings. You don’t have to say it out loud to them! Just saying it to yourself can help you take it more seriously—and be motivated to make changes.

What should I do if I’m being abused?

Leaving an abusive situation can be a difficult process. Often, by the time you have made up your mind to leave, you are already in a situation where the person has a lot of power over you. You may not have a safe place to go if you leave. Take a deep breath and take things one step at a time. You don’t have to leave all at once. Keep these things in mind:

  • Remember: your safety comes first. When you are afraid to leave an abusive situation, it’s okay to lie to your abuser. It’s okay to sneak around. If there are children involved, it’s okay to take them with you. Do whatever it takes to keep yourself safe.
  • Reach out for help. This could come from a loved one, an anonymous hotline, or a shelter.
  • Create a safety plan. Do you have a safe place to go? Do you have cash? Do you have a phone the abuser can’t access? If you don’t have these things, what can you do to get them without tipping off your abuser?

The National Domestic Violence Hotline is a great resource for someone who is trying to leave an abusive situation—or anyone who wants help deciding what to do next. You can also take one of our mental health tests to get a sense of how abuse may be affecting your mental health. These resources are free and confidential!

References

Runyan et al. (2002). Child abuse and neglect by parents and other caregivers. World Report on Violence and Health, World Health Organization. Retrieved from  https://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap3.pdf

Is my family dysfunctional?

A dysfunctional family is characterized by “conflict, misbehavior, or abuse” [1]. Relationships between family members are tense and can be filled with neglect, yelling, and screaming. You might feel forced to happily accept negative treatment.

There’s no open space to express your thoughts and feelings freely. You aren’t able to thrive and feel safe within your own family.

And that’s just the tip of the iceberg.

Signs of a Dysfunctional Family

No family acts the same—and all families experience some level of dysfunction. But there are some clear signs you can look for to indicate bigger problems:

Addiction

Addiction can lead to so many different unhealthy relationships among family members. ’12-Step’ programs, and even government-funded research studies, now recognize the effects addiction can have on the emotional health of a family – even from generation to generation [2].

Perfectionism

Expectations of perfection are wholly unrealistic—they just damage relationships. Families set themselves up for failure and anger by always expecting their kids or relatives to get everything right.

Expecting everything to be perfect puts a lot of pressure on everyone involved. Living with the knowledge you’ll never be good enough for your family’s jacked-up expectations can damage your emotional health in the long-term.

Abuse or neglect

Abuse indicates active harm like verbal, physical, or violence. Neglect is inactive harm, either physical or emotional: not feeding your child, or withholding love, interest, or attention.

Both abuse and neglect are extremely problematic. Families can get caught in cycles that normalize harmful treatment. Those who grow up in these families then go on to exhibit the same behaviors to their kids, causing a cycle of neglect or abuse [3].

Unpredictability and fear

It’s hard to establish trusting relationships when you live in constant uncertainty or fear.

If you’re never sure how your parents are going to respond, you’re constantly anticipating conflict and can’t express yourself honestly. Instead, you’re just waiting for their next criticisms.

You might even want to avoid things that should be enjoyable, like vacations or holidays.

Conditional love

Dysfunctional family members may be incredibly manipulative with their affection, giving love only when they want something out of you.

Withholding love makes you want to constantly please them, and doesn’t give you the chance to relax and be yourself.

Lack of boundaries

Examples of a lack of boundaries within the family include:

  • A controlling parent, who makes life decisions for you and ignores your opinions
  • An intimidating parent, who actively discourages you asserting yourself or even just speaking your mind
  • An older child taking on the role as parent.

No one has their own space. Nobody respects each others’ autonomy. Living like this can lead to unhealthy, codependent relationships later in your life.

Lack of intimacy

Your family doesn’t show many signs of closeness. There is no honest emotional support. Your relations are superficial, rather than emotionally available.

Relationships like these make it hard for you to be close with anyone, since you haven’t practiced doing so before.

Poor communication

There’s no sense of understanding between you and your family members, so you can’t voice your opinions. There’s always tension, and you don’t feel safe communicating with them.

No one talks about their problems and instead, everyone just sweeps issues under the rug [1].

And when it comes to planning, nobody respects each others’ time and preferences. There are no open lines of communication.

Understand how dysfunctional behavior affects you

If you recognize some of the signs of dysfunctional family behavior listed above, you may already recognize their effects on you. However, it can be a long process for some to see these signs.

Having low self-confidence or low self-esteem are examples of how your family can disrupt your life. Social anxiety and unexplained aches and pains can even be part of it.

It’s common for these traits to repeat themselves throughout generations. Your parents may have picked up on cues from their parents, which their parents picked up from their family. Many of us even grow up thinking that our dysfunctional families’ behavior is normal.

Do not despair: It is possible to break this cycle. The most powerful tool for breaking dysfunctional patterns is your own awareness and willingness to self-examine.

Dealing with a dysfunctional family

There are so many reasons for family members to act problematically—from finances, all the way to their past and how their family members treated them. It’s common for these traits to repeat themselves throughout generations. Your parents may have picked up on cues from their parents, which their parents picked up from their family. While none of this is your fault, you might still feel a personal burden.

It’s not your job to change your family. You can only take responsibility for yourself and your own actions.

Dysfunctional families follow certain patterns that suck you in and make it hard to move on. Setting boundaries with your family is one of the most important steps you can take to escape the negative effects. It also helps to find support outside your family.

Take a mental health test to see if you are experiencing mental health effects that may need to be addressed.

References

  1. Arora & Prakesh. (2018). Dysfunctional Family – Characteristics and Effects. Firstcry Parenting. Retrieved from https://parenting.firstcry.com/articles/dysfunctional-family-characteristics-and-tips-to-overcome-its-effects/?amp
  2. Center for Substance Abuse Treatment. (2004). Impact of Substance Abuse on Families. In Treatment Improvement Protocol (TIP) Series, No. 39. Substance Abuse and Mental Health Services Administration (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64258/
  3. Jaffee et al. (2013). Safe, Stable, Nurturing Relationships Break the Intergenerational Cycle of Abuse: A Prospective Nationally Representative Cohort of Children in the United Kingdom. Journal of Adolescent Health 53(4 0), S4-10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212819/

How can I set boundaries with my family?

When you grow up around unhealthy behaviors, it is normal to believe that this is just how families are and that you are destined to continue on this path. Two important steps to processing your emotions around your family and making better choices for your own mental wellness are:

1. Being able to notice/label dysfunctional behavior, and

2. Recognizing the stress, anxiety or other symptoms that behavior causes you.

It’s common for these traits to repeat themselves throughout generations. Your parents may have picked up on cues from their parents, which their parents picked up from their family [1].

Do not despair: It is possible to break this cycle. The most powerful tool for breaking dysfunctional patterns is your own awareness and willingness to self-examine.

Remember your needs are your own

Family members sometimes do not see their own dysfunction and the burden it causes others. They find it easier to accept toxic behavior in order to keep the family peace.

For example, a sibling might try to guilt you into visiting your aging parents, even if those parents were abusive to you. Your sibling may have also been abused, but views visiting as a duty—even if it causes them stress, anxiety and emotional pain.

You, on the other hand, might push against this. You know white-knuckling a family gathering helps nobody. And you see it’s not worth enduring the emotional pain.

Remember you’re not wrong, and resist the guilt. Different people have different value systems and ideas of family expectations. It is not your responsibility to live up to someone else’s ideals, especially when those ideals cause you direct emotional distress.

Setting boundaries with a dysfunctional family

Once you see that a family member’s guilt and anxiety is their own, it is easier to separate yourself from their expectations and just do what feels right to you. Setting your own boundaries becomes easier when you recognize that everyone’s boundaries can be different.

You cannot pour from an empty cup. If you do not take steps to ensure your own physical and mental wellbeing, you cannot adequately take care of others, no matter how much pressure is being put on you to do so.

What does it look like to set boundaries?

Brené Brown, an expert on shame and vulnerability, defines boundaries as “simply our lists of what’s okay and what’s not okay” [2].

Within a family setting, this might look like:

  • saying no to spending time with family members who make you uncomfortable
  • asking a substance-abusing relative to not use around you or your children, or
  • asking to finish speaking without being interrupted.

To be effective, boundaries must come with clear consequences. Let your family member know what the consequence will be if your boundary is crossed. (i.e. If you drink at my party, I will ask you to leave.) And follow through if they do cross your boundary.

Being honest with family is sometimes easier said than done. Here are some tips to help create boundaries with dysfunctional family:

Ways to create boundaries with dysfunctional family

Take a break.

Spending time away from certain family members can help you identify where your stress is coming from and what you need to adjust in that relationship going forward.

Write it out.

Journaling can be an extremely effective tool for processing your emotions, identifying patterns and planning your next steps. Allow yourself to think about what you want from that person in your life and your relationship.

If you have to interact with a family member who causes you stress, it may help to write a letter saying everything you want to say to them. You do not have to send it! Just writing it all down can be cathartic. It can also help you plan what to want to say if you choose to have a serious conversation with them in the future.

Role play.

If you have made a decision to create boundaries with a family member but are afraid to take the next step, ask a trusted friend to play the role of the other party so you can rehearse your words. Rehearsing can reduce stress and discomfort when you are in the real situation, give an opportunity to plan what you will say and prepare for their reactions.

Use “I” Statements.

Focus on how their actions make you feel, rather than the other person being wrong. This can help keep communication lines open and lessen the chance of the other person becoming defensive.

Share with others who understand.

Friends can be a wonderful resource for venting and getting advice, but they will not always be able to identify with your struggle. Consider seeking advice from organizations devoted to specific issues, like Al-Anon, a volunteer-led group therapy option for friends and family of alcoholics.

You can also seek out help from peers going through the same issue at Supportiv. Their supportive chats are instant, anonymous, and available 24/7.

Seek professional help.

Try going to family or individual counseling. A professional therapist can help you identify dysfunctional family patterns you might not yet see and help you to create tools to set boundaries and lift yourself out of the situation at hand.

If you think your family relationships are impacting your mental health, take a mental health test online and keep exploring this site to learn more about managing your mental health.

References

  1. Jaffee et al. (2013). Safe, Stable, Nurturing Relationships Break the Intergenerational Cycle of Abuse: A Prospective Nationally Representative Cohort of Children in the United Kingdom. Journal of Adolescent Health 53(4 0), S4-10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212819/
  2. Brown. (2015). Rising Strong. Random House Publishing Group.

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For questions, contact CURESZ here: https://curesz.org/contact-us/

Is all trauma the same?

Everyone experiences trauma differently—even people who have gone through the same thing! But there are certain “categories” of trauma that can help you understand your own experiences, and how to heal from them.

Was my trauma really “bad enough” to affect me?

No one type of trauma is “worse” than another. You can even experience the same type of trauma—or even the same event—as someone else and have different reactions to it. If something hurts you, it hurts, and your natural emotional reaction is valid.

It can be helpful to think about “big ‘T’ trauma” and “little ‘t’ trauma.” Big ‘T’ trauma is what most people think of when it comes to traumatic events—things like physical or sexual abuse, terrorism, and catastrophic accidents.

Little ‘t’ trauma refers to events that might not be so obvious, but can still overwhelm our capacity to cope—things like your parents arguing a lot at home, or abruptly moving to a new town. Little ‘t’ traumas may sound less serious than big ‘T’ traumas, but they can build up and cause just as much distress as one big event.

Types of trauma

Trauma can show up in some unexpected ways. Here are some terms that can be helpful in making sense of what you’ve been through:

Acute trauma is a single overwhelming incident, like having a pet die or being the victim of a crime.

Chronic trauma (or complex trauma) is when something highly stressful happens over and over again, or lasts a long time. Often when people talk about complex trauma, it refers to going through abuse or severe neglect as a child [1]. It can also refer to other domestic violence or stress within your broader community. It occurs from repeated distressing experiences at the hands of someone you trust.

Insidious trauma happens to a group of people you are a part of—for example: racism, sexism, or homophobia [2]. Even if you haven’t noticed any incidents where you were specifically targeted, being a part of a marginalized community has a big impact on your mental health. “Insidious” means that this kind of trauma is usually subtle—you may not even realize it’s affected you!

Vicarious trauma (also called secondary trauma) results from seeing someone else’s trauma second-hand. It’s frequently experienced by helping professionals like social workers, therapists, and emergency room doctors. It can also happen if something traumatic has happened to someone close to you, like a friend or family member.

Mass trauma refers to an event or experience that impacts a larger community or society. This includes large-scale natural disasters, like hurricanes, as well as human-caused disasters (like war and terrorist attacks). These events usually involve property loss/damage, death, and general life disruption for almost everyone in the community.

Intergenerational trauma refers to when the effects of a trauma are passed down in a family [3]. For example, a grandmother who grew up in an abusive home may have learned to not show her emotions; even if the cycle of abuse is broken, her emotional distance can impact her grandchildren, great grandchildren, and so on.

Trauma can even alter a person’s DNA structure and gene expression, which can then be passed down to their biological children [4]. This can continue on for generations and generations.

Historical trauma refers to a mass trauma that is experienced over a long period of time (many years) by a specific cultural, racial, or ethnic group. This trauma usually spans multiple generations and includes things like genocide, slavery, colonialism, and war.

Like other forms of intergenerational trauma, historical trauma can be carried through a family’s DNA. It can also shape entire cultures [5].

Any type of trauma can have long-lasting effects on your mental health. It can cause conditions like depression, anxiety, and PTSD. These conditions are treatable, and you’re not alone! If you’ve been through something traumatic, it’s a good idea to take a mental health test and learn more about the ways your trauma may be affecting you.

References

  1. Cook et al. (2005). Complex Trauma in Children and Adolescents. Psychiatric Annals 35(5), pp. 390-398. Retrieved from https://doi.org/10.3928/00485713-20050501-05
  2. Dunn. (2005). Feminist Perspectives on Trauma. Women & Therapy 28(3-4). Retrieved from http://dx.doi.org/10.1300/J015v28n03_06
  3. Hill. (2018). Inter-generational Trauma: 6 Ways It Affects Families. Psych Central Blog. Retrieved from https://oie.duke.edu/inter-generational-trauma-6-ways-it-affects-families
  4. Henriques, M. (2019, March 26). Can the legacy of trauma be passed down the generations? BBC Future. https://www.bbc.com/future/article/20190326-what-is-epigenetics
  5. Clemmons, J. (2020, August 26). Black families have inherited trauma, but we can change that. Healthline. https://www.healthline.com/health/parenting/epigenetics-and-the-black-experience

Prairie Health

About this service

Medication is proven to help people with anxiety and depression recover, yet 50% of people prematurely discontinue their medication within 6 months. Why? Key reasons include side effects, limited patient communication and high cost.

Prairie Health provides adults with anxiety or depression hope of finding an effective treatment. After signing up, members receive a genetic test, which is proven to reduce the risk of side effects and can rule out bad medication options. Regular meetings with a psychiatrist and counselor ensure members stay on track, and Prairie delivers medication monthly. Members pay a low monthly rate, without dealing with the hassle of insurance.

Prairie Health is available in California to adults (age 18 or older).

Glimmer

About this service

https://weglimmer.com/

805-324-7813

Glimmer is a nation-wide safe space where LGBTQIA+, womxn-identifying, and QTBIPOC individuals can be connected to personalized and unique mental health services, cultivate sexual and creative expression, and indulge in a collection of LGBTQIA+ & womxn-made products tailored to them. Our goal is to increase access to personalized mental and sexual health services.

We hope to take away the “hard parts” of accessing comprehensive and affirming sexual health, mental health, sex education, and physical health services. Glimmer members can also explore inclusive education, virtual events, shops, and art. Not only will this give Glimmer Members the ability to find the right wellness professional, but also engage with a community that helps them feel powerful, loved, and understood.

Glimmer Verified Wellness professionals go through a rigorous process to be matched via our site. We only want to refer professionals who are informed, affirming, collaborative, and have experience working with diverse populations. Not looking for a psychologist or licensed mental health professional? We are open to non-traditional healers, practitioners, coaches, and more. We recognize that traditional mental health treatments are not for everyone, so if there is a need, we are here for it!

How fast do mental health meds work?

There are many different types of mental health meds, and they all work on different time scales. Let’s look at a few different types of medications and their differences:

As needed

Some medications do not need to be taken regularly. They are taken “as needed.” (Doctors will sometimes call these PRN, which stands for “as needed” in Latin.)

These are generally taken for a very specific purpose—for example, to help you sleep, or to stop a panic attack. They last anywhere from a few hours to a few days. Sometimes these are safe to take every day, but others should be used sparingly. Your doctor will tell you how often you can take a medication like this. It all depends on what kind of medication it is, and how high of a dose you are taking.

Examples include:

Medications that need to be taken daily

Some medications take some time to build up in your system. They need to be taken every day for a few weeks before you will feel the full effect. These medications usually treat long-term conditions with a variety of symptoms, like depression or bipolar disorder. Unlike as-needed medications, you can’t take an antidepressant only on days when you feel extra depressed.

It’s best to take these medications at the same time every day. It’s easier to remember that way. Plus, some medications might keep you up if you take them right before bed, or make you sleepy if you take them in the morning. Some should be taken with food. Others should be taken on an empty stomach. Ask your doctor what time of day is best.

Examples include:

Immediate release vs. extended release

Usually when you take a pill, the whole pill is dissolved in your stomach and is absorbed into your body fairly quickly. This is called immediate release. You will feel the positive effects more quickly—but it can also make side effects worse. The medication will also wear off more quickly. Sometimes, you may need to take multiple doses throughout the day.

Some medications are available in an extended release form. The pill is designed to dissolve slowly instead of all at once. There are a couple advantages to this: First, you don’t have to take them as often. It’s easier to remember to take one pill in the morning than to remember to take it 3 times throughout the day! It can also help you feel more stable throughout the day. On the other hand, it won’t take effect as quickly.

Most medications are immediate release by default. The extended release form will usually have an abbreviation at the end to tell you that it is extended release—something like ER or XR for “extended release,” or SR for “sustained release.” For example, Adderall comes in an extended release form called “Adderall XR.”

(Sometimes you might also see “IR,” which stands for “immediate release.”)

Some medications are also available as long-acting injectables. Instead of taking a pill every day, you go into the doctor’s office every few weeks to receive an infusion. The medication is slowly released in your body until your next appointment.

Starting new medications—and stopping them

When your doctor prescribes a new medication, they are going off what they know about how a medication usually works. But everybody’s brain and body are different. A new medication may hit you faster than most people—or it might take longer to feel the effects. You may need to have the dosage adjusted.

Sometimes you’ll feel side effects right away, but it will take a few weeks to feel the positive effects. Other times the side effects will only last a few days and then wear off once your body adjusts.

Some medications have withdrawal effects when you stop taking them. With some medications, you’ll feel withdrawals if you skip a single day. With others, you can afford to forget to take them every once in a while.

If you want to stop taking something, it’s best to talk to your doctor first. Your doctor can help you reduce the dosage gradually, which will reduce withdrawal symptoms. (You can often do this by cutting your tablets in half for a few weeks, then into fourths for a few more weeks.)

There’s always some trial and error involved in finding the right medication (or combination of meds). Check out this article to learn how to make the process easier.

How do I find the right medication for my mental health?

It would be really nice if there was one perfect medication for every mental health concern. “Depressed? Just take Happy PillsTM!” Unfortunately, it doesn’t really work that way.

There are many different types of medications, and they all work differently. On top of that, everybody’s brain is different. So is each person’s mental health. The same medication may affect you one way, but have a totally different effect on me!

There’s always some trial and error involved in finding the right medication (or combination of meds). But we do have a pretty good understanding of how certain medications work, and what factors might make them more or less helpful.

Why do medications work differently for different people?

There are many reasons why medications affect people differently.

By far the most important factor overall is which mental health condition you are experiencing. The treatments for PTSD are very different from the treatments for ADHD. (Although some meds do treat multiple different conditions.) Mental health conditions are often misdiagnosed, so getting this right is really important!

Some of the other things that affect the way meds work:

  • Your genes: The DNA we inherit from our parents determines lots of things about our brains and body. It’s not just the color of your eyes or the shape of your nose—your genes affect things like which meds will work, how quickly they’ll work, and which side effects you’ll be most sensitive to.
  • Allergies: Just like foods, animals, and plants, you can be allergic to medications. Allergies can show up as a rash, hives, a fever, or even anaphylaxis (think of people who have to use an epi-pen when they get stung by a bee).
  • Weight: Sometimes, a person who weighs more needs more of the same medication to get the same effect. Some medications are stored in fat cells, and may stick around longer if you have more body fat. [1]
  • Age: As people get older, they often become more sensitive to medications. [2]
  • Other medications: Medications don’t just interact with your body—they can also interact with each other! [2] For example, some painkillers (like ibuprofen) can increase the levels of lithium in your body. Many people take lithium as a mood stabilizer. Taking lithium and ibuprofen together can be dangerous.
  • Other substances: Caffeine, alcohol, tobacco, and recreational drugs can all interact with medications. [3][4][5] Be careful with these substances while you are trying a new medication. For example, some medications make it so that the same amount of alcohol can get you drunk much more quickly.
  • Food: When you take a medication with food, it usually takes longer for your body to absorb it. That can be good or bad—some medications should be taken with food, while others should be taken on an empty stomach. Medications can also interact with certain foods, the same way meds can interact with each other. Some medications have a special diet you have to follow while you are taking them. [6]
  • Drinking water: Some medications can cause dehydration. Make sure you drink plenty of water when you use any of these substances.
  • Taking your meds consistently. There are some medications that you can take as-needed—for example, if you’re experiencing a panic attack. But most mental health meds need to be taken every day. It will often take at least a few weeks to see an improvement. If you skip days or suddenly stop taking a medication, you can experience withdrawals. Ask your doctor about the best way to take your meds—and what to do if you decide to stop taking them.

This infographic goes into more detail on why medications work differently for different people.

What can I do to make this process easier?

The whole trial-and-error process can be frustrating. But there are some things you can do to make it easier:

  • Find a treatment team you trust. Some doctors are better than others. Some doctors are great, but don’t know much about mental health. Try to see someone who specializes in mental health. And talk to a therapist if you can—they’ll spend a lot more time with you than a doctor will. That can help with getting the right diagnosis. (Plus, meds usually work better if you’re also in therapy!) If you’re not sure about something your doctor has told you, get a second opinion.
  • Ask for recommendations. If you have friends or family members who have experienced similar mental health challenges, ask them about the meds they’ve tried. Of course, your experiences may be very different from theirs. But it’s nice to have a starting point. There are also online support groups where people can talk about their experiences with medication.
  • Keep a medication journal. This can be as detailed as you want—if you have the time and energy to track your mood every day, that’s perfect. But if all you can do is write down the meds you’ve taken in the past and anything you remember about how they made you feel, that’s a great start. Some things to keep track of: your mood, your sleep, and any side effects.
  • Get your genes looked at, if you can. Your genes can give some clues about how medications will affect you. You doctor can order a DNA test—kind of like 23andme, but for medications! These tests can’t tell you exactly which medication is going to work best, but they can give your doctor an idea of which medications might be more promising—and which ones to avoid. Check out this article for more information on genetic testing for mental health meds.

Above all, be patient and don’t give up! Your mental health is worth it. And remember: medications are just one of the many ways to treat mental health conditions.

References

  1. Le. (2020). Drug Distribution. Merck Manual: Consumer Version. Retrieved from https://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-distribution
  2. Demler. (2012). Psychiatric Drug-Drug Interactions: A Refresher. US Pharmacist 37(11), pp. HS16-HS19. Retrieved from https://www.uspharmacist.com/article/psychiatric-drug-drug-interactions-a-refresher
  3. Donovan & DeVane. (2001). A primer on caffeine pharmacology and its drug interactions in clinical psychopharmacology. Psychopharmacological Bulletin 35(3), pp. 30-48. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12397877/
  4. Chan & Anderson. (2014). Pharmacokinetic and Pharmacodynamic Drug Interactions with Ethanol (Alcohol). Clinical Pharmacokinetics 53, pp. 1115-1136. Retrieved from https://doi.org/10.1007/s40262-014-0190-x
  5. Desai et al. (2001). Smoking in patients receiving psychotropic medications: a pharmacokinetic perspective. CNS Drugs 15(6), pp. 469-94. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11524025/
  6. Bushra et al. (2011). Food-Drug Interactions. Oman Medical Journal 26(2), pp. 77-83. Retrieved from https://dx.doi.org/10.5001%2Fomj.2011.21

I can’t get over things that happened in the past


It can be frustrating to realize that things that happened in the past are still affecting you. You might think, “That happened years ago! I thought I was over it. Why am I still feeling or act this way?”

Our past trauma can have such long-lasting impacts. At times it can feel like you will never recover from it. That leads to feeling discouraged. Often people feel scared to talk about the effects, because it makes them feel ashamed.

The truth is, it’s normal to have trouble moving past the things that have happened to us. Nothing is wrong with you—you’re just learning how to cope with challenging feelings!

Your feelings and experiences are valid

We often question our own perceptions or experiences. Sometimes while you are going through something, it doesn’t seem like that big a deal. Calling it “trauma” might feel like overkill—but trauma comes in all shapes and sizes! Anything that has a lasting emotional impact can be traumatic.

You may have tried to talk to someone who didn’t take your experiences seriously. But other people don’t get to define your past or how you deal with it. All that matters is what you experienced, and how it affected you.

How our past continues to affect us

Trauma has lasting effects on the brain. It can become difficult to feel fully alive in the present moment. When we are not living in the moment, we are reliving the past—or fearful of what might happen in the future.

Our experiences also shape our beliefs about ourselves. We like to feel like we’re in control… So when something happens that’s outside of our control, it’s often easier to blame ourselves. We become overly critical of ourselves. We think, “If only I had been stronger, this wouldn’t have happened to me.” We end up feeling like the problem is with us, when really the problem is what has happened to us.

While you are working through your trauma, you are likely very alert and ready to protect yourself in any situation. You may not trust others—or trust them too easily. You might have some triggers—situations that remind you of the past, or bring up feelings or behaviors that make you feel stuck.

Things that happen in our past can have a lasting effect on our mental health. If your thoughts, feelings, or behaviors are interfering with your daily life, it’s possible that your trauma has led to a mental health condition like PTSD, anxiety, or depression.

How to heal and move on

To move on from the past, it’s important to create a strong foundation for healing. Here are some steps to start your journey:

  • Give yourself some credit. If you’ve realized there’s a problem, you’re halfway to solving it! Rather than asking “what’s wrong with me?” consider “how is it that I keep going even though I have faced such scary situations?”
  • Get support. Try to find a friend or family member who understands. You can look for a support group online or in person. It can also be helpful to have a therapist that helps you heal.
  • Be easy on yourself. Whatever you are feeling is normal to feel. Many other people have had the feelings you are having. If you don’t believe that, you can search online for stories of people who have had similar experiences. And the more you begin to open up to trusted people, the more you will realize that you’re not alone!
  • Take one situation at a time. Rather than trying to solve your whole life, start with the specific issue that has gotten you upset. Identify what’s triggering you. Is it something you can avoid? Or do you need to talk it out with someone? Do you need to work up the courage to face it?
  • Remember it’s a process. You will take positive steps forward, and you will also take steps backward. You are moving forward overall… Don’t rush it! It takes what it takes.

Remember: Just by reading this, you’re taking your first steps toward facing your past. That’s such a brave thing to do, and you should be proud of yourself!

Experiencing abuse in an LGBTQ+ relationship

Abusive partners in LGBTQIA* relationships—Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual—use the same tactics to gain control of their partners as abusers in heterosexual relationships. Just like abuse in heterosexual relationships, abuse in LGBTQIA* relationships can be physical, sexual, emotional or even financial. And while the epidemic of abuse does not discriminate, it’s also important to acknowledge the unique challenges some victims might face given their identity.

Abusive partners in LGBTQIA* relationships sometimes use societal factors to maintain control over their partner. Also, when trying to leave an abusive relationship or access help and resources, LGBTQIA* victims face an added layer of complexity.

Homophobia and transphobia make it harder to speak out

Many victims of dating and sexual violence feel scared or apprehensive to come forward or report the crimes against them because they fear that they won’t be believed or become outcasts in their community. This fear is amplified among queer and trans folks, who have to also wonder if they will face discrimination and prejudice—especially when the assumption is that sexual and relationship violence only occurs in situations with male perpetrators and female victims.

Moreover, abusive partners in LGBTQIA* relationships may try to use their partner’s sexuality or identity to shame them and exert power over them. They do this by calling them names, playing on gender insecurities, or pressuring their victim sexually. Abusers will often try to establish these behaviors as “normal” for LGBTQIA* relationships to disguise their intention to control you.

Threatening to “out” someone

Threatening to reveal a person’s sexual orientation or gender identity is a common tactic used by an abuser. While some people are comfortable going public with their gender identity or sexual orientation, others may not feel safe or encouraged to do so. Whether it’s telling an employer, a family member, coach or friend – no person should ever threaten to disclose personal information about their partner without their consent.

Pressure to seem like the perfect couple

People of marginalized groups may feel as though they need to maintain a façade of perfection in order to be accepted by their peers or family. They may try to overcompensate for any predisposed stigma that people have against their group to protect the image of all its members.

For example, a lesbian individual may be seeking acceptance of her relationship from her friends. She may hide her partner’s abuse so that her friends do not form a negative perception of all lesbians.

HIV status can be a tactic for manipulation

While HIV/AIDS impacts people of all gender identities and sexual orientations, we know that queer and trans folks are disproportionately affected by the virus. It is never okay for a partner to threaten to reveal anything about your medical condition without your consent, or to prevent you from accessing proper medical treatment. In some extreme cases, an abusive partner who is HIV+ will threaten to infect a partner if they decide to leave the relationship. They may also claim that they will die or become more ill if their partner breaks up with them. Manipulation, threats and making you feel guilty are never okay in any relationship.

If you or someone you know may be experiencing relationship abuse, please do not hesitate to consult these resources:

  • The Anti-Violence Project: AVP operates a free bilingual (English/Spanish), 24-hour, 365-day-a-year crisis intervention hotline that is staffed by trained volunteers and our professional counselor/advocates to offer support to LGBTQ & HIV-affected victims and survivors of any type of violence. Call 212-714-1141
  • The National Domestic Violence Hotline: Signs of LGBTQ Relationship Abuse. Their 24-hour hotline number is 1-800-799-7233
  • The One Love Foundation has a variety of resources, including lots of information about what healthy and unhealthy relationships look like.

My coping skills aren’t working anymore

We all have coping skills that we rely on to feel better during tough times. If your go-to techniques just aren’t working anymore, you’re not alone.

It’s frustrating and scary to hit a wall with your coping skills—but it’s also normal. It would be so nice if we could just pick one set of coping skills and use them forever. But the truth is, that rarely works. We learn and grow. We adapt to new situations. That’s not a bad thing! You can mourn the loss of some coping skills, while also finding opportunities to learn new ones.

Why did my coping skills stop working?

You may have heard that different things work for different people. But different things also work for the same person at different times. Anything that changes our thoughts, emotions, or situations can change the way our coping skills work.

Some of those changes are personal: You break up with someone. You move to a new place. Your body develops a tolerance for your antidepressants, and they’re not as effective as they used to be. But there are also things that affect society as a whole—especially right now!

Other changes affect millions of people all at once. Right now, a global pandemic is raging. People are waking up to racial tensions and injustices that many have ignored for a long time. The stakes in world events seem higher than ever. This is a unique time! Pretty much everyone is experiencing some of the same issues at the same time—and they all affect our mental health in similar ways.

At the same time, some of your coping skills may not be available right now. Working out at the gym, getting dinner at your favorite restaurant, or visiting family might not be options. Other strategies, like journaling or video chatting a friend, are doable—but you may find that they suddenly don’t work as well as they used to.

Learning new coping skills—and giving old ones a second chance

There’s a flip side to all this change: strategies that haven’t worked in the past may work now! Whenever you hit a wall with your coping strategies, you can add more. This might seem overwhelming if you feel like you’ve tried it all. But remember, the situation you’re coping with right now is different from ones you’ve coped with in the past. It’s only natural that your coping skills will change, too.

If you tried meditating a few years ago and didn’t find it helpful, think about giving it another chance. The same goes for skills like breath work, yoga, spending time outside, practicing gratitude, and any other coping strategy. Small things can and do help in the long run, like sticking to a routine and setting boundaries for yourself.

Coping skills during COVID-19

During the time of social distancing, it’s more important than ever to find support from other people. While constant video calls can be exhausting, you might benefit from a vulnerable and honest conversation with a trusted friend or family member. Many of us are going through similar challenges. Hearing that others are right there with you is powerful.

You may also want to learn more about practicing self-compassion and acceptance. It’s okay to acknowledge that you’re reaching your limit—even if that means you have no more energy to call a friend, or that you’re losing your patience with your family. Constantly pushing yourself to “be fine” often adds more stress and frustration. There isn’t one right way to deal with life right now—times are tough, and circumstances are beyond your control.

It’s important to not give up or assume that all hope is lost. You may not be able to eliminate negative feelings… but you can learn how to manage your emotions in a healthy way. Mental wellness takes effort, especially in the face of distressing external circumstances.

You can find more tips for maintaining your mental health during COVID-19 on our Wellness & Coping Skills page.

I’m finding myself without support during coronavirus

Social distancing has caused people to feel like they don’t have a support system there to help them. Particularly during the height of coronavirus, feelings of isolation and loneliness can bring themselves to the forefront of daily life. It is important to know that you are not alone, and that there are things you can do to mitigate these feelings.

Use coping skills

It’s okay to feel lonely or isolated during these times. If these emotions are making you feel more anxious or depressed, think about the coping skills you have available. These might include:

Find ways to let your emotions out in a healthy way. Burying your emotions isn’t a good long-term solution—sooner or later, they’ll come out anyway!

Find ways to have human connection each day

Having to physically distance and isolate yourself from people can make you feel disconnected from your support system. However, it just means that you might have to find other ways to create that human connection. Call family members or friends when feelings of isolation set in, or make weekly virtual plans to eat together, talk, or watch a movie together. Ensuring that you have some social interaction each day—even if virtually—can help you to recreate the environment and support system that you had before coronavirus and social distancing were in effect.

Join online communities

If you need more connection with others or resources for mental health, joining online communities can be a good way to find both. Through these communities, you can find people from all over the world who may be experiencing or have experienced the same feelings and emotions that you are. This is an excellent way to gain support from others while also learning new information about topics that you may be interested in.

Osmind offers an online patient community for people with treatment-resistant mental health disorders, their mental health providers, and those passionate about innovative mental health treatments.

Most importantly, take care of yourself. Eat what will make you happy. Choose to disengage from technology if you aren’t feeling it. Work out if it makes you feel good and you have the ability to. Quarantining at home has created a whole host of new and sometimes terrifying experiences and emotions. Just getting through it is an immense accomplishment!

Can ketamine treat depression?

Ketamine is a medication that has mainly been used for anesthesia and pain management. In recent years, researchers have found that lower doses of ketamine can also be used to help with severe or treatment-resistant depression. While it has not yet been approved by the FDA, some doctors have begun to prescribe ketamine treatment to their patients.

How does ketamine treatment work?

Most antidepressants come in the form of a pill, which you take daily at home. Ketamine is a bit different—it’s given to you directly by a medical professional. There are two ways to receive ketamine:

  • Through a series of injections (this is called the ketamine infusion model)
  • At the beginning of a therapy session (the ketamine-assisted psychotherapy model)

The ketamine infusion model involves patients receiving a standard dose (typically 0.5mg/kg over 40 minutes) of ketamine through an IV. Usually, patients will undergo an “induction phase” and a “maintenance phase.” The induction phase is the first one to two weeks of treatment, where patients will receive two to three ketamine infusions each week. The maintenance phase is the period after in which patients return as needed for more infusions. Patient moods are tracked over time using validated depression scales to determine when is best to get another infusion. Osmind provides software for doctors to help monitor their patients.

The ketamine-assisted psychotherapy model involves both ketamine and psychotherapy. The patient receives ketamine as a needle injection, a lozenge, or a spray into their nose. After they take the ketamine, a mental health professional (psychiatrist, therapist, psychologist, etc.) will give them psychotherapy. Occasionally, patients may also be prescribed ketamine to administer at home as well. These appointments may last as long as three hours.

What is ketamine treatment like?

Ketamine treatment can differ across people. Most people will experience a gentle floating feeling with some mild hallucinations. Patients can experience different feelings or experiences during two separate infusions. For example, they may see colors during one infusion, and think about people in their lives during the next. Side effects of this treatment may include hallucinations, dizziness or dissociation (feeling disconnected from your own mind or body), but these usually only occur after the session and stop fairly quickly after.

Osmind provides an online community and care platform for patients with treatment-resistant mental health disorders, their mental health providers, and people interested in FDA-approved psychedelic medicine. They also have treatment guides and patient interviews that may help.

How can I decide what type of ketamine treatment is best?

There is no evidence to show that one model is the superior model of treatment. It might be helpful for you to talk to your doctor and consider the following to decide which ketamine treatment will be best for you:

  • Do you want to do psychotherapy?
  • Is one treatment more convenient for you and your schedule?
  • How much does each treatment cost? Are you willing and able to pay more for one treatment?

Ketamine is also available in another form, called esketamine.

Can esketamine treat depression?

Esketamine is a type of ketamine that has originally been used as a general anesthetic. Recently, it was approved by the FDA for use as a medication for treatment resistant depression (TRD). It is the first FDA-approved psychedelic medicine and the second drug approved to treat TRD.

What is esketamine treatment like?

Esketamine must be administered as a nasal spray in a Janssen-certified clinic. In order to receive esketamine, patients must also be taking another antidepressant. Patients will self-administer the nasal spray under supervision of a provider and be monitored for at least two hours after they administer the spray. After two hours pass, patients must be driven home.

This treatment is split up into two phases: the induction period and the maintenance period. The induction period is the first four weeks of treatment where patients receive esketamine two times each week. After four weeks have passed, the provider will evaluate the patient’s progress. Should the patient need to continue treatment, they will administer esketamine once a week in the clinic. Nine weeks after the patient has started treatment, the provider will adjust the esketamine frequency to what best fits the patient’s needs.

How do I choose between ketamine and esketamine treatment?

Esketamine treatment has more regulation than ketamine treatment because it is an FDA-approved medicine for TRD. It can also have different effects than ketamine treatment. It is important to talk with your provider to see whether ketamine or esketamine is a better fit.

Osmind has patient guides as well as interviews with people who have undergone ketamine treatment that can help to give you a better idea of what treatment might look like.

Several factors can be important when deciding what is best for you.

  • Cost is a very large factor to consider because ketamine treatments are generally out-of-pocket cash payments for treatment. These can cost in the thousands of dollars for the equivalent “induction phase.” Esketamine may be partially covered by insurance because it is FDA-approved for TRD. Check with your insurance plan and provider to see how much esketamine may cost for you.
  • Type of treatment is also important to consider. Esketamine treatment does not include psychotherapy, whereas ketamine treatment can. If you want to combine your therapy and medication appointments, ketamine treatment may be preferable for you.
  • While ketamine is an FDA-approved anesthetic, it is prescribed off-label for mood disorders such as major depressive disorder and TRD. It has not undergone formal FDA efficacy and safety studies for these conditions. However, real-world studies point to the effectiveness of this treatment for depression (e.g. American Journal of Psychiatry study).

I’m afraid of losing someone

Few things in life are scarier than the thought of losing a loved one. On some level, most of us realize that everything comes to an end. We usually do our best not to think about it.

But some things can bring it to the front of our minds—for example, when someone we love gets sick. Or during a major crisis like a natural disaster… or a global pandemic. Sometimes it’s on our minds simply because we’ve lost someone before. When we feel depressed or anxious, our minds can become fixated on negative thoughts like this.

Fear and anxiety often come from uncertainty. There are some things we can never know for sure: What will happen to my loved ones, and when? What will happen to me if I lose them? We can’t see the future. But there are things we can do to manage our fear and anxiety about it.

Understand that you’re not alone

It’s totally normal to fear losing someone. The fear of loss is something everyone has experienced at one time or another.

And if worse comes to worst and you do lose someone, you can make it through this. Humans are incredibly resilient. We bounce back! People have been suffering from grief and loss—and overcoming it—for as long as we’ve existed.

Finding someone you can talk to about your fears can make a huge difference. If you don’t have a trusted friend or family member, try finding an online support group or talking to a therapist.

Focus on what you can control

One way to cope with fear is to think about whether there’s anything you can reasonably do to control the situation. If there is, do it. If there isn’t, try to let it go. Once you’ve done all you can, worrying about it more won’t do any good—it will only wear you out.

The coronavirus pandemic is a good example. If you’re worried about a loved one getting sick, what can you reasonably do? You can wear a mask to avoid spreading the virus. You can avoid traveling except when necessary. You can encourage your loved ones to do the same.

What you can’t do is control other people’s behavior. You can’t force other people to wear a mask—but you can avoid spending time around people who aren’t being careful.

There are certain things that give us the illusion of control. Washing your hands after you touch things in public is a good way to prevent the spread of illness—but washing your hands 10 times more often won’t make you 10 times safer. Worrying and obsessing over the virus also won’t help.

You can try a journaling activity to determine what you can and can’t control: Write down what you’re afraid might happen. Then, make a list of all the things you can and can’t control about the situation. Letting go of what you can’t control is easier said than done, but you can learn to do it by practicing.

Making meaning out of fear and loss

Our emotions help us make sense of the world around us. Even painful emotions like fear and grief have an important purpose.

Fear can motivate us to do what we can to keep ourselves and our loved ones safe. Thinking about future losses can help us to appreciate what we still have.

Many people are able to find comfort in their belief systems. Some people believe that our loved ones live on after death, and we will see them again. Others believe that a piece of them lives on within us. For some people, this life is the only one we get, and that’s what makes it beautiful and valuable. If you’re not sure what you believe, that’s ok too—learning to live with uncertainty can be good for your mental health!

We wish we could guarantee you that you won’t lose your loved one. It’s heartbreaking to say, but losing people is a part of life. But you’re surrounded by people who understand that fear and have overcome it. And that can be a source of hope

Alternatives to calling the police in a crisis

About this service

dontcallthepolice.com is a database of vetted resources that can be used as alternatives to calling the police or 911, broken down by city. We provide information about resources in the areas of housing, mental health, domestic violence & sexual assault, LGBTQ+, youth, elders, crime, and substance use.

We focus our listings on organizations that provide emergency or crisis services, or can provide immediate assistance to callers, in order to best address reasons that people may otherwise call the police. dontcallthepolice.com is a streamlined, user-friendly, centralized access point for alternatives to police.

There is no charge to access dontcallthepolice.com.

We do not collect or keep any data about users who access dontcallthepolice.com.

dontcallthepolice.com provides resources that can be used in many of the situations that may otherwise involve police – however, these resources are not meant to address every plausible situation, only to provide the services described. If you are in immediate danger and feel safe doing so, call 911. We vet all of our resources for their policies as to law enforcement involvement and do our best to only include resources that limit law enforcement involvement to the fullest extent possible – however, many of the people working at these organizations are mandatory reporters and subject to state and federal laws, so may contact or involve law enforcement in the case of child abuse, abuse of a vulnerable adult, or if they determine there is an imminent risk of violence.