This story discusses suicide. If you or someone you know is at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for additional resources.
This fall, fans of “This Is Us” have seen a different side to Toby, Kate Pearson's new husband. The ordinarily happy, go-lucky guy is off of his antidepressant medications — and trying desperately to hold it together for Kate, but he's failing.
Last week, we saw him weep after learning Kate (played by Chrissy Metz) was pregnant. In the episode this week, he struggled to shower and get dressed. On social media, viewers shared their reactions: Watching him made them feel less alone.
“So many people can so relate with this scene!” one woman posted on Twitter.
Another Twitter user urged people who don't know how to treat those with mental illnesses to tune into the show immediately.
The reason fans related to Toby’s experience with depression so much? It’s accurate.
“Feeling kind of worse, or having (an) emotional outburst when you are suppressing your emotions — that can happen to human beings in general,” Dr. Sophie Lazarus, a clinical psychologist at the Ohio State University's Wexner Medical Center in Columbus, told TODAY. “Folks who are depressed tend to feel more down, more irritable and have trouble concentrating.”
The show is embracing Toby's struggles, and it's not depicting depression or mental issues as a stereotype.
"The writers are portraying real people with mental vulnerabilities," Dr. Ken Duckworth, medical director of the National Alliance of Mental Illness (NAMI) told TODAY. "You care about the characters and I think their psychiatric vulnerability is part of who they are but doesn’t define them."
For Toby (played by Chris Sullivan) there are a few things at play. He stopped taking his medication because he thought it would impact his sperm, since he and Kate were undergoing in vitro fertilization (IVF) to try to conceive. But there’s no evidence that antidepressants have an effect on sperm.
“There’s nothing about sperm that I know of, but libido and erectile issues are things that come up with any antidepressant medication,” said Dr. Desmond Oathes, an assistant professor in the Department of Psychiatry at the University of Pennsylvania in Philadelphia.
Antidepressants take anywhere from four to six weeks to start working and sometimes it feels like symptoms become worse before they get better. This could be a reason some stop taking their medication.
“Depressed people have stressful lives, it might get worse (after they start medication),” Oathes said.
Most people dislike their antidepressant medications because they make people “feel like they are in a bit of a cloud,” he explained.
But stopping medication without a doctor's help can make it challenging for treatments to work in the future.
“Going on and off medication unsupervised is ineffective and can lead to mood instability,” Lazarus said.
Some people even experience antidepressant discontinuation syndrome or have withdrawal symptoms, which include flu-like symptoms, anxiety, trouble sleeping and a return of the depression.
"Don't stop your meds fast," Duckworth said. "Don’t make radical changes on your own without communicating and staying in touch with your provider."
Toby’s instinct to suppress his feelings throughout his life and eschew help is something experts see all too often.
“It is almost 100 percent that people with depression have strong feelings that they should be able to take care of it themselves,” Oathes explained. "The stigma associated with asking for help is that they’re weak."
Lazarus said depression also isolates people.
“Depression tends to cause more internalization, feeling down or not sharing because they think that people don’t care or want to help,” she said.
On top of it, people with depression often find it difficult to care for themselves, engage in normal activities or enjoy things they once did. And, like Toby, they might struggle to get out of bed or overeat. They might not sleep or eat enough, too.
“Some people have depression and continue to look like they are doing well. More people than not tend to isolate and that tends to exacerbate the depression,” Lazarus said.
Sometimes people confuse episodic depression — for example, feeling sad about a divorce or a death of a loved one — with depressive disorder. While people often recover from smaller bouts of depression without much intervention, people with depressive disorders often require medication and psychotherapy to help them.
The experts agree, that people should seek help if they feel depressed or notice their moods or interests change.
“It often takes people a long time to realize that there is something clinically wrong with them,” Lazarus said.
People can and should help their loved ones with depression — even if they don't understand exactly what is occurring.
"You can support loved ones by helping them to get treatment, listening and not judging," Dr. Susan Albers, psychologist at the Cleveland Clinic in Ohio, told TODAY via email. "They are often in great pain and distress."
If people have thoughts of hurting themselves or killing themselves they should seek help. And, Oathes stressed that you should always speak up if you fear loved ones are at risk of hurting or killing themselves.
“Don’t be afraid to say something,” he said. “It doesn’t make people more likely to kill themselves. In fact, it is quite the opposite.”