The Truckee River wasn’t a softly babbling stream. The growl of its rapids mixed easily with the sounds of the park—if you were on the bridge standing over it, sometimes, it could drown out the playful yips of the dogs and the kids that chased after them.

In Reno, the sun was almost always out, illuminating the small white caps that bubbled as the Truckee flowed over the rocks beneath, racing its way off the Sierra Nevada that surrounded Lake Tahoe. It was pretty, the way it moved with abandon, like the river itself knew nothing would stop it in its path. I came down off the bridge to walk alongside it. I can see Gadget—her “go-go-Gadget” legs swiftly taking her on her always-jaunty stride ahead of me, until I told her to wait. She peered curiously at the yellow tubes coasting along the river, the limbs of the riders flailing as they rode down through the park.

I was not alone that afternoon, although it certainly felt like I was. It had felt like that for awhile, since moving 2,000+ miles from home, not meeting anyone I could connect with, and being unable to find any kind of good work, since the recession had hit Nevada much harder than it had here. Days felt endless, and sunset brought instant cold and sleeplessness, while my ex-husband rested peacefully next to me.

Darkness did not lift. I would drag myself out, hoping the sunshine would do something for my spirits, like it usually did. But tears always came, sometimes torrentially. Most of the time, torrentially. I was trying to ignore the wave of them building in my belly that afternoon, strolling alongside the river, watching.

As we came along to the underside of the bridge, two giant signs came into view, pinned underneath it. The warnings were clear: Wear lifejackets and stay in tubes. Strong currents and rocks create footholds. People had drowned here.

Oh.

That would work.

I could just jump in, right here, and—that would work.

It wasn’t the first time something came into my head that felt like it didn’t belong there. The kind of thought that felt like it came from somewhere else, some dark spot, but it was simple enough, blunt enough, that it made sense. I remember feeling sick, and refusing to let a single word slip from my mouth lest it get dissolved into sobs. And I didn’t know how to tell my ex-husband that evidently, I wanted to die, and my brain showed me a way to do it without me having to ask.

It has been a long, long time since Reno—it’s been what feels like three separate lifetimes. My marriage ended; my sweet Gadget gone over the Rainbow Bridge; promotions; developments; realizations; unbelievable traumas; highs that I thought would last much longer. But my cocktail of antidepressants//anti-anxiety meds and regular therapy has remained constant. And that afternoon in Reno is one of the biggest reasons why. It took a lot of work and a lot of time to feel okay, to learn how to combat racing thoughts and the ever-present Scumbag Brain.

Maybe I’d never be truly fine. Maybe that was just the hand I was genetically dealt. But I thought I was okay.

Fast foward a couple of years, and now, I’m in my early 40s. And I start to notice things. Excessive sadness in the two-ish weeks before my period. Numbness around things that hurt my feelings and a blink later, unbelievable rage. Some fixation on things I should have been able to move past.

Perimenopause, amiright? Maybe I needed bloodwork. Maybe it was my birth control pill—I’d switched to a progestin-only pill after I developed a blood clot after surgery, and maybe that was influencing this. So, to my GP and GYN I went. Full explanation of unstable moods in relation to my cycle. Two sets of bloodwork to check hormonal balances — turns out, yep, welcome to perimenopause, JD. Three sample boxes of a new BC pill that is designed to alleviate symptoms of PMDD, which evidently, I’ve had since I was a teenager. This should help. Give it the full three months to get into your system, okay?

Okay.

I do not know who I have been for the last month, but it assuredly is not me.

Wakeups at 3am and 5am. First sign that anxiety is dialed up a notch, for me. Literal trembling when reaching for my morning meds. Heart pounding madly against my ribs when going to the kitchen for coffee. “You’re okay. You’re okay. Everything is fine; there is nothing to be worried about right now.” But the usual mantra, the deep breaths that punctuate it, did nothing.

And then, the heaviness. The feeling that I only have one emotion, and it’s going to get so big that it swallows me whole. And then, it does.

“Guys? I don’t think I’m okay.” And I had ears attuned and eyes on me. Distractions in the form of happy hours, going to see cover bands, grabbing pizza. I’d laugh and forget about what was happening in my head. There was one night I laughed super-hard, danced with my sister-in-law, sang along loud, and when I got home, I cried so hard I couldn’t fall asleep.

But I just have to wait for this to kick in, right? It’s only been about three weeks. These meds are supposed to help regulate my mood. I’m sure they will. It’s just perimenopause. I have to be patient, right?

But patience only brought the type of blackness I hadn’t seen in years. Or thought in years. And suddenly, during one excessive bout of it, there it was.

Maybe now it’s time. Maybe you’ve always just been waiting for it to be time. Maybe now, it’s time.

So blunt. So simple. And it made so much sense. I’d thought it when I was watching a band a week or so earlier: Maybe I’m not going to beat this. Maybe it’s going to take me.

And maybe now, it’s time.

I realized I’d started buying food I’d be excited to eat, only to cook it and know there was no way I was going to eat it. A minor work snafu sent me stomping away from my computer, looking for something to punch. I cried all day, all night, or both. And when I wasn’t crying, all I was thinking about were things that hurt me way more than they should have. I was beside myself with thoughts of revenge. Awful things that had been said, done, just teeming in my decrepit brain. I literally screamed for it to just stop into the towels on the rack in my bathroom.

I took walks, listening to a funny audiobook I was enjoying, only to stand on the apron of the driveway, shaking, thinking I didn’t want to go back inside. I tried to remind myself I didn’t have to think any awful thought that popped into my head, and it was like something inside me responded with pure derision.

I didn’t want to write, because all I could write about was how fucking terrible I felt, and I was exhausted enough by just having to think about it. I don’t remember the last time I even started writing a poem. Inspiration is as dead as I feel.

“I don’t know what’s happening. I don’t know how to stop this,” I said to my therapist. “I feel like an unmedicated teenager. I don’t remember the last time I felt this bad.” He told me I needed to speak to my medication management team to see if there was another antidepressant or something else I could use while I waited for this BC pill to “kick in.”

I looked forward to my weekly video calls with Kelly, only to burst into sobs five minutes in, explaining that the things I was thinking were so bad that I couldn’t even say them out loud.

“But you don’t really want to do them,” she assured me. “There’s part of you that’s still in there that is never going to let this win.” And that’s when I said it.

“But I don’t actually know. These horrible things… I don’t know where they come from, but they just make so much sense. It feels like…when I was living in Reno.”

I made an emergency appointment with my mental health nurse practitioner the next day.

Here’s the thing: I’m not sure anybody is ever really looking out for us, as women. Not that medical professionals don’t want to help, but there are a lot of things that get glossed over when we start describing symptoms they’ve all heard before. Case in point: When I first sought out BC options, I told my previous GYN that I was nervous, because I have mood disorders. The original pill I took was amazing, and I was so sad to switch to progestin-only pills when I developed the blood clot.

Here’s what no one told me before the NPs I saw: Progestin-only pills have a tendency to cause depression and anxiety. There is a very high chance they’ll make it worse if you already have a history of them. I didn’t learn this until two years after I’d been taking them—and thinking about it, my moods have consistently declined over this two-year period. Maybe it makes a little more sense why I can’t seem to get over things that wouldn’t “normally” bother me this much. Maybe it’s no surprise that things started feeling significantly worse when lower hormonal levels from perimenopause kicked in.

Nobody told me to watch for symptoms of worsening depression. The only thing I was told was to wait it out, especially once they saw the lower hormonal levels. It was my MH NP who literally ordered me to stop taking the BC pills that day. “Your [psych] meds have been working for 10 years,” she said. “You’ve done great on them. There’s no reason they’d just stop working now. This is coming from the birth control. You can’t wait another month and a half to see if it maybe gets better.”

At her behest, I made an emergency appointment with my GYN, and—yet again—met with a NP who seemed to know much more about BC options and mental health issues surrounding perimenopause than any other doctors I’ve seen. She was able to advise me about different options and helped me pick some new things that I’m going to be trying out in the next few weeks. “We’re going to get you better,” she said, just before she left the exam room.

Nurses save lives, man. For real. Unsung heroes, every single one of them.

Tomorrow marks two full weeks of being off hormonal BC. I’m definitely not fine or even okay yet, but it is “better.” I’ve cried only about once per day, as opposed to all day long. I can focus more during work. I’ve been hungry enough to eat. I’m still very frustrated at the amount of thought I’m putting into people and things who don’t deserve it, but at least I’m not screaming into the void begging it to stop. I still spend too much time alone, but I’ve stopped sentencing myself to it as some sort of unforeseen prophecy. And the things I don’t want to say out loud? They’ve shrunken down to just murmurs, sometimes barely audible, and they’ve stopped making sense.

This has been the worst I have felt in more than 20 years. And I was just going to try to stick it out, as if that was any kind of treatment plan. Well, it’s perimenopause, and like, all bets are off during that, right? Turns out, maybe not so much. Turns out, women need more advocates and more information about what happens to us as we get older. I literally cannot believe how bad things got, and how I had no idea it was about to happen.

What this has done is encouraged me to do a little more digging. Some recent research showed me that multiple women who have a history of GAD and MDD had their symptoms explode when taking this same BC pill. They explained “buckets of sadness” they lived in every day, with no reprieve from reliable remedies. So many talked about how they felt like someone else, and that their actual selves fell further and further away from them. It did not get better for any of them until they stopped. Most of them said they didn’t feel back to normal until at least a month later.

I’m definitely not the most patient person, especially about myself. These two weeks have felt endless, like those days in Reno, but at least “sticking it out” at this point is already helping me see signs of improvement.

But I can’t reiterate enough how important it is to be honest. Even when you think you have everything under control. Even when you think you have someone in your corner already. Especially when you don’t want to say things out loud. It is terrifying to not feel in control of your own thoughts, to not know who’s voice you’re hearing. We’re taught, as women, that we’re just “emotional,” as if that’s some kind of explanation, as if that’s something we need to learn how to wrangle—as if it’s actually possible. It isn’t always—especially when you’re being led down a route that’s going to bring you to a cliff that crumbles underneath you. There’s a huge difference between patience during a rough time and full-on suffering. It’s okay to admit when you can’t see it.

And just for the record, Kelly was right. There is still very much a part of me that wants to win.