DR LIZ O’RIORDAN: A month before this photo was taken, I was on the brink of suicide after battling severe depression most of my life
I want to talk about something I’ve kept hidden for years. Even though I’ve shared every detail of my breast cancer journey – I’ve had it twice, and written about it extensively in The Mail on Sunday and on social media – shame and embarrassment stopped me revealing anything about this, until now.
When I started working on my memoir, Under The Knife, which is published this week, I realised it was time to finally tell the world that I’ve lived with severe depression for most of my life.
I was well aware that, in recent years, many high-profile people in showbiz and politics have been open about their mental health struggles, but I was scared to discuss my own, even to people I knew well. What would my patients think of me if they found out? Would my colleagues still trust me to do my job?
I’ve now retired from medical practice – radiotherapy treatment affected my left arm and I could no longer operate. I think it’s about time I told my story.
I’m doing so because I want other people in a similar position – and there are many of us – to know they are not alone. Help is available.
‘A month before this photo was taken, I was on the brink of suicide,’ says Dr Liz O’Riordan
My journey with depression started in my 20s, in my fourth year of medical school in Cardiff. My days were packed with lectures in pharmacology and pathology. The stress of revising was getting to me and everything seemed like a huge effort. Some days it was a struggle just to get out of bed.
I felt like I was living in a thick black cloud. I wasn’t sleeping well and my appetite disappeared. I’d start crying for no reason and pretend I had a migraine to avoid going out with friends.
After a few days the cloud would lift and I’d feel ready to face the world again. I’d borrow lecture notes from a friend, and life carried on as before. I thought this was normal. I thought everybody went through it.
A year later, working as a junior doctor, I spent some time in the psychiatry department, where I’d interview patients. I recognised the symptoms some were describing. Could I have depression?
I still had days where I felt very low, but I couldn’t hide in my room any more as the consultants monitored our attendance on the wards.
I forced myself to plaster a smile on my face and pretend that everything was fine. I told myself it was just the stress of the upcoming final exams. Everything would be OK once they were over.
READ MORE: ARE YOU DEPRESSED… OR ARE YOU SUFFERING FROM THE DREADED BURNOUT?
But that wasn’t the case. Working kept me going. I learned how to fake it on the wards. I would smile and pretend to be happy. In fact, I think when colleagues and friends saw me at my happiest, I was actually at my worst. I was so good at masking it.
However, the highs of the job brought terrible lows. The black days got closer and closer together. It finally dawned on me that I needed help.
My GP started me on antidepressants, and I hoped things would improve. They did, but I still had waves of depression that lasted for days.
I blamed it on my working life – 100-hour weeks with every third weekend on-call. Sleep was a luxury I rarely had.
I coped the only way I knew how – by ignoring texts from friends and never answering the phone when it rung.
One particularly bad weekend a friend knocked on my front door for ages as I stayed upstairs in bed, praying they would go away and leave me alone. And then it suddenly got a lot worse. I didn’t know it at the time, but the tablet I was on, Seroxat, also known as paroxetine, can have some pretty nasty, but rare, side effects.
I was becoming manic. I started spending money I didn’t have on things I didn’t need. Euphoric with lack of sleep after night shifts, I’d scour online shops. Parcels would arrive that I couldn’t remember ordering. My drinking got out of hand – I’d be the life and soul of the party, out drinking and dancing until three in the morning. Alcohol gave me confidence, made me feel invincible, but I didn’t know when to stop.
Eventually a close friend confronted me. ‘I think you might have a problem,’ she said. There was a long silence. She then recounted a toe-curling story about inappropriate comments I’d made to a male colleague the night before.
‘My journey with depression started in my 20s, in my fourth year of medical school in Cardiff… Some days it was a struggle just to get out of bed,’ (Pictured: A young Dr Liz O’Riordan)
‘You don’t remember, do you?’ she asked. ‘I’m worried you might have bipolar disorder.’ I didn’t know what to say. Tears started to fall and she put her arm around me for a hug. Maybe she was right. That terrified me.
It was hard enough coping in the male-dominated world of surgery, but with a mental illness on top?
I agreed to see my GP, and was referred to a psychiatrist.
I knew how to take a psychiatric history from a patient and how their appearance and body language are taken into account, but this was my first time being a real patient. I looked down at what I was wearing for the appointment, wondering if I’d worn the right clothes.
He told me to try to forget I was a doctor and answer his questions without thinking too much.
At the end of the consultation, he said I didn’t have bipolar disorder, but that the Seroxat might be causing the manic episodes.
It was a huge relief, but meant I had to come off antidepressants.
READ MORE: I WENT ON PROZAC FOR SIX MONTHS AND FELT LIKE A ZOMBIE – BUT WAS I REALLY DEPRESSED? JENNI MURRAY LIFTS THE LID ON STIGMA
That was horrific. It took six months, weaning myself off slowly by reducing the dose by a quarter of a tablet at a time. I felt jittery all the while. I was wired and anxious and it was just horrible. Back then, in 2002, withdrawal symptoms from antidepressants weren’t officially recognised. The NHS drugs watchdog, the National Institute for Health and Care Excellence (NICE), said they were ‘usually mild’ and lasted only a week.
It was only in 2019 that NICE concluded that patients should be warned that they could be severe and last longer in some people.
But I got there eventually and could think clearly for the first time in years.
I don’t regret taking antidepressants – at the time I hadn’t had a choice. Not much else was available and I needed them. I’d do the same again.
Also in 2002, at the age of 28, I left medicine behind for four years to do my PhD – in thyroid cancer – and I was learning how to handle my mood swings in a healthy manner.
I was fine for a while. I married Dermot, a surgeon who’d once been my boss. But the first year of our marriage was stressful, as I’d spend the working week at the Royal Marsden Hospital in London, before going back to our home in Suffolk at weekends.
I probably had low-level depression then. Dermot knew I was a bit down, and knew about my history, but I didn’t think I was ill again.
As soon as I found a consultant job, somewhere nearer to home, we both thought it would get easier.
That finally happened in 2013, when I was 39. But instead of getting better, things got worse.
I’d imagined that reaching the pinnacle of my career would give me authority in the operating theatre, with my own ladies to look after and a chance to develop my skills as a reconstructive breast surgeon.
‘Even in theatre, where I felt most in control, the camaraderie with my regular team ended when some were assigned elsewhere’
But it wasn’t at all like that. Suddenly I realised how hard it was to treat cancer patients. I’d either be telling them they had cancer, that their cancer had come back or that they needed more surgery. I felt like I was just making them cry.
I started to dread going into work. I began to question my own judgment about how to manage patients, if colleagues had different opinions. I increasingly struggled to get my voice across and became less and less confident.
Even in theatre, where I felt most in control, the camaraderie with my regular team ended when some were assigned elsewhere.
I was having nightmares plagued with anxiety about sitting exams I hadn’t revised for and my teeth falling out. When my alarm went off in the mornings, I’d try to find an excuse not to go to work. But I always went.
Then, one day towards the end of 2014, seeing a pile of work papers stacked on the kitchen worktop, I felt my heart stop. I remember this sense of panic as I briefly thought about doing something to end the pain I was in. I barricaded myself in my bedroom, away from anything I could use to hurt myself, and was lucky enough to get an emergency appointment with my GP the next day.
I told him I was fine, that I just needed another antidepressant. He told me I wasn’t fine. He was right.
With a bit of gentle probing, a floodgate opened and I told him everything. He handed me a prescription for a different antidepressant, citalopram, which has fewer side effects and is easier to withdraw from, and signed me off work for a month.
But overwhelmingly, I felt guilty and embarrassed. I’d been a consultant for less than two years and already I ‘couldn’t cope with the job’. I had a wonderful husband, a stable income, a loving family. There were millions of people in far worse situations, and I felt I’d let everyone down – including my patients. I’d failed at life.
Of course, I now know that’s not true. And I’m not the only person to feel like that. Research shows people with depression commonly feel guilt and shame.
READ MORE: DEMANDS FOR FLAWED STUDY THAT CASTS DOUBT ON ANTI-DEPRESSANTS TO BE AXED
Dermot had no idea how I’d been feeling. I hadn’t wanted to bother him. I genuinely hadn’t thought I was that ill – I’m good at putting on a mask. When I told him I’d felt suicidal, I could see the look of pain in his eyes. My friends and family were angry: they thought I’d been lying to them, pretending I was OK. But that wasn’t true. I just hadn’t recognised what was going on.
The antidepressants kicked in without any issues, and I was lucky to be able to see a therapist through work in a matter of weeks. If I’d relied on normal NHS channels, the waiting list would have been nine months. That’s a very long time for someone who’s thought about ending their life.
I couldn’t believe it. If I’d been diagnosed with breast cancer, which we rightly see as life-threatening, I would be treated within a month. But severe mental health problems, which can be fatal, too, meant waiting nearly a year for professional help.
As things improved I made a ‘safety plan’ using a website called Staying Safe. This involves writing down the things which make you happy and the numbers of people to call if you start to struggle. You can download the plan on to your phone, so it’s there if you need it.
After a month, I went back to work. But it was far too soon. Just eight months later, I fell apart again. About half of people with depression relapse – a risk which increases with every new episode. The trigger for me was finding out a patient was taking legal action against the Trust because of complications following surgery I had carried out. I took it personally, starting to doubt my skills again.
My mood darkened and I thought of ending my life once more. I was terrified of actually doing it, but too scared to carry on living. But sitting in my car in the hospital car park, the tears rolling down my face, I visualised Dermot finding me, and realised I couldn’t do that to him. A part of me was clinging to the hope of a happier future.
I spoke to the medical director and had another five months at home. Apart from the guilt I felt admitting to everyone that I was broken again, I also felt guilty at the moments of joy while I was on sick leave.
Treatment for depression involves doing the things that make you happy. I had more therapy, took up gardening, went to the beach with the dog, read a book in the park, started making my own clothes and began singing with the local Rock Choir. But I’d feel like I wasn’t supposed to be enjoying myself. I’d think: ‘What if one of my patients sees me smiling?’
I had to remember it was my brain recovering, not my body.
My psychologist kept reminding me that the depression and the guilt wasn’t my fault. That I was just sick, even if the treatment would take a long time – perhaps a lifetime. She helped me see that the mask I used to hide my true feelings had to go. I had to learn to let my loved-ones in, and let Dermot have the pleasure of helping me for a change.
I started looking forward to waking up in the morning and seeing what each new day would bring.
In April 2015, I went back to work. It was nerve-racking, but my colleagues were amazing.
Then, three months later, I was diagnosed with breast cancer. That’s another story.
My life has been extraordinarily challenging at times, but I’m in a good place now and I’ve learned some important lessons.
I never realised how much people love me. There are so many people I can call who would drop everything to help me.
I’ve realised my mental health is a rollercoaster and that, while my cancer might not come back, my depression will.
I’ve got better at asking for help and looking after myself. But I’m not ashamed of depression. It’s part of me, and that’s OK.
- Adapted from Under The Knife: Life Lessons From The Operating Theatre by Liz O’Riordan, to be published by Unbound on July 6 at £12.99. To order a copy for £11.69 (offer valid to 15/07/23; UK p&p free on orders over £25), visit mailshop.co.uk/books or call 020 3176 2937.
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