Coping with Treatment-Resistant Depression: One Person’s Story

When Imadé Borha graduated with a masters in creative nonfiction writing from Columbia University in 2015, she figured the last thing she had to worry about was finding a job. It did not happen. “That was around the time of the first suicide attempt,” recalls Borha, 34, now a Durham, NC-based communications expert for a nonprofit.

“Career instability triggered a lot of my mental health issues,” she says. “Having to leave New York felt like a failure and not having a job” was traumatic.

Borha was first diagnosed with major depressive disorder in 2012. “It was a response to suicidal behavior and basically textbook depression,” she says. “The first time I tried to commit suicide, I realized that the three drugs I had taken hadn’t helped.”

According to Matthew Rudorfer, MD, psychiatrist and director of the Somatic Treatments and Psychopharmacology Program, treatment-resistant depression occurs when someone with a major depressive disorder has failed to respond to at least two antidepressant medications taken at the correct dosage for the prescribed time on National Institutes of Mental Health in Maryland.

“There are clearly many shades of major depression. … There is no ‘one-size-fits-all’ solution. Rather, the best clinical intervention for the person with [treatment-resistant depression] should be customized. A key goal of ongoing research is to improve the ability to assign patients the right treatment.”

A new diagnosis

In 2019, Borha was diagnosed with Borderline Personality Disorder (BPD), which involves mood swings, shaky self-esteem, impulsive behavior and trouble building relationships.

“Symptoms of BPD include extreme, intense emotions, which can be triggered by reactions such as feelings of abandonment or rejection,” she says. She feels she was turned down for jobs and other opportunities have brought her symptoms to the surface.

Amidst the mental turmoil, it took Borha a while to figure out just how much fear drove much of her thinking and acting. “If you’re highly suicidal, you really don’t have time to ask, ‘Do I have an anxiety problem?’ Over time, she tried the prescription anti-anxiety drug buspirone (BuSpar). It helped calm her mind. Along with dialectical behavioral therapy, her world came into focus.

Dialectical behavioral therapy combines weekly talk therapy with group training. It focuses on emotions and takes a balanced approach to accepting yourself and learning ways to make helpful changes. It was originally developed to treat BPD and women with suicidal tendencies, but it is now being used to treat other related problems as well.

“It helps people like me who have really big emotions to have skills or tools to regulate those emotions so our lives don’t look like chaos every day,” Borha says. Exercise — mostly high-intensity interval training — also helps her stay centered, she says.

Community is the key

“I really believe in this building [a mental health] Community will keep me alive, keeping my suicidal behavior and self-harm down,” Borha says. At the same time, she finds it difficult to build interpersonal relationships because she is afraid of abandonment and rejection. “I speak a lot, but when it comes to dealing with my current mental health on a day-to-day basis, it’s difficult. I have to be more vulnerable, put myself out there, just be honest with people.”

According to Borha, resistance to treatment for mental or emotional illness runs deep within the black community. “We are dealing with a situation where historically black people are punished for disclosing that they are sad, depressed or angry. They feel that their life may be in danger. That response resonates with their families and support systems.”

Borha says the mindset of keeping family issues under wraps is softening a bit. “Now, [Black people with mental issues] have a chance to find therapists and other resources.” However, she still sees barriers and racial bias around caregiving.

Through her website DepressedWhileBlack.com, Borha seeks to connect her followers with therapists who understand them. Right now, her Help Me Find A Therapist program is on hold while her team catches up on the backlog of requests.

Be your own explorer

“I think treatment-resistant depression is a big part of the suicide crisis,” Borha says. “If we can treat people who are struggling with this, we can save lives.”

The antidepressant esketamine (Spravato) is the only drug the FDA has approved specifically for treatment-resistant depression, although a number of other treatments and therapies may help and remain under investigation, Rudorfer says. Esketamine comes from ketamine. It is a nasal spray that needs to be administered and monitored by a healthcare provider.

Borha says she’s asked her insurance company to cover esketamine, but so far it’s a no-go. In the meantime, she continues to study and learn more about her condition.

“I would say research your symptoms because you can [need] a different diagnosis,” she says. “Then use that research to do self-advocacy. Tell your therapist or psychiatrist what else is there that they didn’t consider when making the diagnosis.”

And she says, “It’s okay to be wrong. … If psychiatrists can be wrong, I can be wrong. As patients, we have the right to experiment, to fail, and to try again. We have that right.”

“Just experiment, research and get started,” she says. “Stand up for yourself.”