Editor’s note: This story discusses recovery from depression. If you or people you know are at risk of self-harm, the National Suicide Prevention Lifeline provides 24-hour support at 1-800-273-8255.
Heather Armstrong can recall the precise moment that she “just sort of went off a cliff.”
Armstrong's deepest bout of depression, she says, started when she downloaded her training program for the Boston Marathon, inviting months of exhaustion and hunger.
Or was it the moment three weeks later, when a boyfriend’s comment triggered her lifelong anxieties about body image? But could that be traced back to the remarks she says she heard relentlessly growing up, about "what a beautiful woman looks like?” Of course, she only agreed to the marathon while mourning the death of her dog, whose health took a nosedive after Armstrong’s divorce.
The “why” of depression has flummoxed Armstrong since she rose to international fame blogging about it in the early 2000s on her immensely popular website, dooce.com — where, incidentally, she had announced she would be taking a break just a few months before her mental health deteriorated in 2015.
Now Armstrong is back with a new story: How, in a few short years, the “Queen of the Mommy Bloggers” went from superstar influencer to a hospital gurney, hoping doctors could cure her depression by almost — almost — granting her wish to die.
Armstrong’s memoir, “The Valedictorian of Being Dead: The True Story of Dying Ten Times to Live,” recounts the experimental treatments during which doctors at the University of Utah repeatedly administered high doses of anesthesia to nearly flatline the Salt Lake City author and “reboot” her brain.
The treatments produced “abrupt” positive results in Armstrong’s case, her doctors say. Now Armstrong hopes her outcome will supply not just hope, but also relief to depression patients for whom the unanswerable “why” of the illness has made it hard to justify their suffering to others. Depression can’t be chalked up to a character flaw, personal weakness, or failure to cope, Armstrong says, if it can be cured on a gurney.
“It was very validating in the sense that I had been so sick, and my brain had been so diseased it had convinced me that life was not worth living,” Armstrong said in an interview at her home in Federal Heights. “Suddenly a day after the treatment I was like, ‘How? How could I have possibly gotten there?’”
‘I guess I’ll feel this way forever’
The events in the book begin in spring 2017, about two years after Armstrong dialed back her blog sponsorships and took up speaking engagements and consulting. Costs mounted and income was irregular, Armstrong said, so she began working full-time in web branding for an animal welfare nonprofit.
She also had full custody of her two young daughters following her highly publicized divorce in 2012 from Jon Armstrong, who cofounded the family’s online business and had been characterized in the blog as the sturdy straight man foil to Dooce’s neurotic screwball.
And she was training to guide a sight-impaired runner in the Boston Marathon, following a rigorous workout schedule on a vegan, gluten-free diet that left her chronically tired, famished and fixated on her weight. Armstrong blamed her despair on the physical exhaustion and stress of training.
“A lot of times, there’s no explanation for why we are so depressed,” Armstrong said. “There’s no explanation why we’re so sad and sorrowful and hopeless. And so I thought, ‘Oh, well, I have a reason. The reason is this marathon.’ And so when it was over, I was like, ‘I’m gonna be fine.’ And then I didn’t have that reason anymore. Which was like, ‘Well, then … what is it? What is wrong with me? I guess I’ll feel this way forever.’
The day-to-day pressures of parenting and work magnified into insurmountable agonies until Armstrong would wake up each morning and “gasp for breath as my anxiety set fire to every molecule in my body,” she wrote in her book. Routine power struggles with the kids landed her in her closet, weeping on phone calls to her mother. Text messages from work came with piercing nausea.
And, frighteningly, she no longer was responding to antidepressants that had helped her in the past.
That put Armstrong among the more than 5 million Americans who suffer from treatment-resistant depression — about a third of all depression patients, said anesthesiologist Scott Tadler with University of Utah Health.
It also made her a perfect candidate for a study Tadler and a team of researchers were conducting: Could using the anesthesia propofol to reduce brain activity to almost nothing bring relief to depression patients who aren’t helped by traditional medications?
‘I saw the fear in her eyes’
It’s not the first time doctors have used anesthesia to treat depression. The Food and Drug Administration last month approved a version of ketamine for depression treatment, and researchers at Yale last week announced a similar, and possibly safer drug mimicked the effects of ketamine in tests on mice.
But ketamine, which is taken in a low-dose inhaler spray, has only shown short-term effects, Tadler said — “if you're lucky, a week or two.”
Previous research at the U. indicated deep levels of other types of anesthesia could come closer to replicating the effects of electroshock therapy (ECT), which is considered the most effective treatment for depression, said Brian Mickey, associate professor of psychiatry at University of Utah Health and the lead researcher on the pilot study on propofol.
It’s not clear why ECT improves mood disorders, Mickey said — “which is kind of surprising, for a treatment that's been around for so long and has been so effective.”
There might be similarities between the seizure effect of electroshock therapy and the suppressed brain activity from anesthesia. But, Mickey said, “when we do ECT or propofol treatment like that, there's so many things that change in the brain, it's not always clear which things are responsible” for the mood improvement.
Although it’s effective, many patients are reluctant to try electroshock therapy due to cognitive side effects and its scary depictions in popular media, Tadler said: “Think of ‘One Flew Over the Cuckoo’s Nest.’”
Propofol isn’t associated with cognitive side effects — but general anesthesia taken in doses far beyond what is used in surgery, to produce something close to brain death, isn’t a fear-free proposal, even though Mickey assures patients that the technique is safe. Armstrong had signed up for at least 10 treatments, each with 15 minutes of heavily suppressed brain activity. These took place two or three times per week.
In her book, Armstrong describes hallucinating in the first treatment, possibly a reaction to fentanyl, which she was given to prevent a headache (which she experienced anyway). She reprints pages from the journal of her mother, who watched each of Armstrong’s 10 treatments and described the first:
“I doubt anyone could fully comprehend my dread as I saw the fear in her eyes a second before she went under. I watched at the foot of her bed as they shoved the breathing tube into her throat and started the oxygen to keep her alive,” the journal entry read.
But throughout the treatments, Armstrong said, she was not seriously afraid of dying or suffering side effects, even though she describes extreme fatigue following the early sessions. There was only one fear: That it might not work.
‘A switch being flipped’
In Mickey’s report, published in the International Journal of Neuropsychopharmacology, a graph shows the progress of the 10 depressed subjects in the pilot study.
Armstrong said it is easy to pick out her line: It’s the dark green one, the one that has the highest score for depression symptoms at the beginning of the trial, and the lowest score at the end.
“She really improved, probably the most abrupt,” Mickey confirmed. “Kind of like a switch being flipped.”
Six of the ten subjects had at least a 50 percent reduction in their scores — the criteria for their depression being considered “responsive” to the treatment, the study found.
For Armstrong, by far the most significant improvement was after the fifth treatment. “It was thrilling,” she said. “I wanted to dance naked in the streets.”
The degree of improvement for the six who responded was unusual, Mickey said.
“This is larger than the effect you would see with an antidepressant, typically,” he said. “Seeing this improvement within a couple of weeks [is a] relatively fast improvement.”
During the five treatments that remained, Armstrong said, “I was really afraid it was going to reverse.” But since the final round, Armstrong hasn’t experienced any recurrence of the hopelessness she felt before the treatment, she said.
More important, she added, she hasn’t felt any lurking apprehension that her depression might be returning — something that followed her through her recovery from postpartum depression, which she had chronicled on her blog years earlier.
“Now when I have a bad day, I can recognize it’ll be better tomorrow,” she said. “The difference is so stark. … It gave me back the ability for my medication to work, and to think about things rationally and determine solutions to problems.”
Of the six who responded to the propofol treatments, five saw the results continue for at least three months, Mickey said.
‘A time of great discovery’
As Armstrong reflects on the situational factors that may have worsened her depression, there are always more pieces to the puzzle — more “stray dominoes in the sequence that led to that gurney,” she writes. The marathon training may have been the biggest persistent stress, but it’s never just one thing when a mind is biologically predisposed to depression. There was grief over the dog that died. A job that required being glued to a phone at all hours. Kids being kids. And trying Utah’s dating scene as an over-40, divorced mother of two.
And there were stresses tied to the roller coaster of professional success in a career that hadn’t really existed before her.
Armstrong was one of the first internet celebrities to shed the caveat “internet.” She had parlayed her blog into a slot on the New York Times bestseller list and a contract with HGTV. Her Twitter following was well over a million. She was the first personal blogger to monetize the medium, and three years after she was fired for blogging about her workplace, the blog was a lucrative family business — though Armstrong won’t say how lucrative.
Over time the content shifted. The first post on Dooce, in 2001, began: “I should probably shoplift something before I die.” That was followed by years of often frank and profanity-laced observations from daily life, ranging from vulnerable to irreverent to bizarre, peppered with grainy, slice-of-life snapshots. After a decade or so, meticulously posed portraits filled the site. Shopping guides for apparel and home furnishings eventually crept in, as revenue from advertising from tanked.
The profession Armstrong had pioneered — writing candid personal stories online for ad revenue — had morphed into a tiring infomercial-machine for “content sponsors” who only want their brand attached to images of a perfect life.
“I call it the Pinterestification of the internet: where nothing is messy, your kids are never shown with food on their face, the clothes are always pressed, and they’re running through Central Park with a happy face,” Armstrong said. “And it’s not wrong. People making money this way is not a bad thing. That’s great you can make money putting Old Navy clothes on your kid and going to Central Park and taking pictures of them. That’s not what I signed up to do.”
In 2015, Armstrong’s kids started objecting when household plans were built around product placement, and Armstrong began posting more sporadically. She still produced some sponsored content, but the blog was no longer her family’s central source of income. The business model she innovated was upended, and that led to a loss of community as the first generation of mommy bloggers drifted into the background, she said.
It also brought about anxiety as to the lasting value of what Armstrong had built.
“It was kind of devastating because what happened was, brands caught on to the fact that, ‘Oh, these women who are nobodies have created an industry and we need to get in on it,’” Armstrong said. “So they wove their way in, and then they started dictating the entire thing. … The community around voices and stories just really isn’t there anymore. It’s about the pretty picture.”
That also worries Armstrong for younger women and girls, whose aspirations are being shaped by a bombardment of flawless images manufactured by influencers. Armstrong recalled a social media event last year where she saw at least four families being followed by hired photographers to document their days in the most attractive light possible.
“Commenters say, ‘This is exactly how I want to be,’ and it’s like, ohhh, man. That’s really hard. Especially for my 15-year-old. That’s a really, really, really hard standard when you have a professional photographer following you everywhere.”
It’s maybe fitting that Armstrong’s next writing project reverts to the most conventional medium: a single narrative, printed in ink on bound pieces of paper.
After the propofol treatments proved successful, Armstrong quit her marketing job and moved to Paris to write during the summer months when her daughters live with their dad.
Now, she says, she plans to focus on mental health advocacy and suicide prevention, especially in Utah, where suicide rates are exceptionally high.
“I’ve dedicated my life to writing this book,” Armstrong said. “I really believe in the team that helped me, I believe in the study, I believe in the science.”
She also says she wants to get the word out about Mickey’s study. The team is beginning a larger, double-blind study of propofol and recruited the first of 24 subjects last week, Mickey said. Further results likely will be available in two to three years, he said. To learn more or to support the study, visit https://medicine.utah.edu/psychiatry/research/labs/mickey-lab/current-studies.php.
To Utahns suffering from seemingly incurable depression, Tadley pleaded: “Don't give up hope.”
“This is a time of great discovery in our understanding of depression and its treatment,” he said.
Hear more about ’The Valedictorian of Being Dead’
Heather Armstrong and anesthesiologist Scott Tadler will speak about her book and treatment at a ticketed event at 7 p.m. on Saturday, April 27, at The King’s English Bookshop, 1151 S. 1500 East, Salt Lake City. Visit kingsenglish.com for details about tickets.