For World Mental Health Day, two sisters (one a doctor of 34, one a writer of 29) had a conversation about depression and about the impact of the 34-year-old’s suicide attempt a few years ago. They wished to remain anonymous.

Younger sister: How would you describe your mental health?

Older sister: I think my mental health is good at the moment. I am on a regular anti-depressant and my mood seems good. I guess I’m a lot more aware of my mental health these days so I make an effort to talk about things that I’m worried about.

Younger sister: How would you describe my mental health?

Older sister: I think you are up and down. You are definitely not sick but I wouldn’t describe you as mentally very healthy. You seem either highly strung or overcompensating the last few times I’ve seen you. It’s been a long time since I’ve seen you truly relaxed. That said, you have a highly stressful job and I think this is a normal reaction to that. How do you feel?

Younger sister: I think I’m on the right medication (low-level anti-depressants) and that helps me sleep which makes a massive difference. When I can’t sleep consistently then I tend to get low and then that can tip over into something more serious. I do feel quite low quite often but I never know if that’s a mental health issue, or just normal. When do you think low mood tips over into depression?

Older sister: It’s a really good question. I guess when low mood is persistent. I think the medical diagnosis says two weeks of constant low mood with other symptoms like poor sleep, lack of concentration, suicidal thoughts, weight loss or appetite loss. I got really frightened a few weeks ago as I woke up feeling really low and was scared the depression had come back.

Younger sister: Frightened is an interesting word to use. Can you describe that feeling?

Older sister: I’m frightened of getting depressed again. Specifically, of the feeling of worthlessness and hopelessness. Although I’m well now and I guess it took being that ill to get the help I needed, I don’t think I could ever say I’m glad it happened because it was so painful to go through, sort of like being stabbed repeatedly in the chest. It physically hurt.

Younger sister: For the benefit of people reading this conversation, what happened two years ago was you tried very hard to kill yourself and by some miracle at the last minute, dad found you and then six hours of resus later you were alive but in a coma. Then there was about a year where you were really unwell after that. I find it hard even writing “you tried to kill yourself” and reminding you of it because you’re so much better now and I don’t want to upset you.

Older sister: I don’t find it upsetting at all. I think a lot of people (my friends, family, work colleagues) worry about that. It is what happened. It had become so painful being alive at that point that I decided to die.

Younger sister: You were very angry at times after you’d woken up because you didn’t want to be here – that was so hard to take as your sister.

Older sister: I don’t remember that but I’m sorry. It must have been horrible to watch. What was it like for you?

Younger sister: Awful. The worst time of my life. I tried to convince you that life was worth living for days. It’s hard to be that compelling.

Older sister: What did I say?

Younger sister: You just cried. And looked down. As if you were broken in pieces.

Older sister: I felt broken in pieces.

Younger sister: When you were coming out of the coma you were so delirious that you kicked me and punched a nurse because you were so confused. Apparently that’s normal for a person coming out of a coma. You woke up and your brain wasn’t quite right yet and you were so confused and you had a tube in your mouth so you couldn’t speak and you panicked, and thought everyone was trying to kill you. I don’t think you recognised any of us.

Older sister: I don't remember anything of the first few days after I woke up from the coma. I remember you were there and friends came to visit but I think my memory starts about a day before I went home from hospital. There's about a week that's just blank. I know my boss came to visit. I have no idea what I said to him!

Younger sister: I don’t think you remember this but I helped you shower when you were in hospital because you were too weak to walk to the bathroom or stand up in the shower. It was the first and only time I’ve seen you naked. I couldn’t believe how thin you were, there was nothing of you.

Older sister: I think I'd lost about two stone by that point. I could see all my bones. When I got severely depressed, my appetite just disappeared. I'd eat and get full really quickly. It was so stupid in retrospect – I knew I was ill but I thought it was something physical, I didn't connect it to how I was feeling mentally, even though as a doctor I'm trained to know these symptoms.

Younger sister: How was it when you started therapy, after the suicide attempt?

Older sister: Hard. Really hard. I got a bit better after I got out of hospital and I just didn’t want to think about how things were before. I wanted to feel better, not drag up the past and everything that had happened. She [my therapist] made me go back and it was really painful.

I’m interested in how the rest of our family reacted. Dad doesn’t want to talk about it and mum seems to have pretended it didn’t happen. What do you think?

Younger sister: Dad finds it too distressing because he found you and was in the ambulance with you when your heart kept stopping so he watched that all happen to his eldest child and I think he has some sort of post-traumatic stress from it so can’t talk about it. Plus, he’s religious and suicide is considered a sin in his religion so I think he just can’t accept it on any level. Mum has changed a lot since then too, she became obsessed with you, with everything you were doing/ not doing, saying/ not saying.

Speaking of, our mum had serious bouts of depression when we were growing up, do you think we’ve inherited ours?

Older sister: I think it’s probably a mix of nature and nurture. I think a mix of our upbringing – we were taught to try and keep feelings inside and that feeling angry or upset was a weakness. I think this means we both find it hard to express emotions. And since going to therapy, I’ve learned how important it is to let the feelings out.

Younger sister: We both received cognitive analytical therapy from the same therapist. Harriet, the wonderful Harriet. I started mine once you’d finished yours. In some ways, I felt like I went through something with you. It affected me, obviously, but more as your sister I think. When I was staying with you in hospital, the nurses kept getting us confused – which is funny because you were critically ill and I wasn’t – but of course, you can’t see that in mental health patients. I felt like we were bonded in a way we never had been before.

Older sister: It's been so good getting to know you properly as an adult. Having someone there while I was getting better who I trusted was really important.

Younger sister: What else did you learn about depression in therapy?

Older sister: I don’t know how much I learned about depression, but I think I learned a lot about how to keep mentally healthy. A lot of what I had always thought was abnormal or “just me” was actually common.

Younger sister: You were depressed for such a long time that I really thought it was “just you” – your personality. Then when you were on the right medication and had come through therapy, I couldn’t believe you were the same person. You were happy and inquisitive and bright and funny and I thought “what! Is this the real you?!” I learned (with regards to you) that depression can be very angry and dark. Like – a person who has severe depression doesn’t necessarily want to talk about it – you wouldn’t talk about it and you were angry and upset and you scared me sometimes. Not even sometimes, a lot. I’d walk around on egg shells and I probably seemed fake to you because I didn’t know what to say, I was worried you’d snap at me. Did you feel like a different person when you were better?

Older sister: I think having the right medication is really important as well as being able to talk. Both are necessary to keep healthy. I don’t know about a different person. It doesn’t hurt anymore to be alive. Things seem a lot more possible. Maybe the same person on a good day? I definitely like other people a lot more these days. Before I was very suspicious.

Younger sister: Do you wish people asked you about it more?

Older sister: I don’t mind. I’m happy to talk about it if I think it will be helpful to others, but I don’t feel the need to go over it again. It’s nice (at least for now) to put it behind me.

Younger sister: Are you worried about the future?

Older sister: I’m worried my depression will come back. I think it will at some point. But at least I know what to do to treat it and what medications work for me so hopefully it won’t be so severe.

Younger sister: Can you feel it coming on though? As in, how do you know when to act on it? Doesn’t depression cloud your judgement?

Older sister: It does cloud your judgement but you are aware that you aren’t well.

Younger sister: There’s this quote from that film The Hours about Virginia Woolf and her depression where Virginia Woolf says to her husband Leonard Woolf: “If I were thinking clearly, Leonard, I would tell you that I wrestle alone in the dark, in the deep dark, and that only I can know. Only I can understand my condition. You live with the threat of my extinction. Leonard, I live with it too.” It always makes me think of you and I hate the thought of you being alone in it. I wish I could banish it for you, so it never returns.

Older sister: Oh I’d love for it to go away but I think it’s just something we have to manage.

Younger sister: Thank you for talking to me. I love you and will support you through anything again and again.

Older sister: Love you too. Thanks for chat.