"I was a kid, and I had really bad self-esteem issues. I was making dumb choices," she says.
Now Susan is 43, married, and a mother of four. Over the years, her depression has changed. Sometimes, it's felt as if hard times have brought it on. At other points in her life, the depression has been severe and seemed to come out of nowhere.
Her first bout with severe depression came when she was living in California and had taken a year off from classes.
"I was driving down the road after work one day, and I just started bawling," she says. "I had no idea why I was crying. It wasn't like there was some kind of trigger."
Susan knew she needed help the first time she considered suicide. She got into therapy, and later started on depression medicines. A psychiatrist prescribed several different medicines to find one that worked. Some of them made Susan too sleepy to function.
"If the kids didn't need me, I was in bed sleeping," she says.
Other medicines gave her energy.
"One time around Thanksgiving, I put Martha Stewart to shame," she says. "I made tablecloths and place settings. I quilted a table runner. But then I couldn't sleep because I was having these very vivid, crazy dreams."
Counseling has helped her cope and raise her self-esteem.
"Counseling was good for me to understand that I have value as a person, that I'm a kind person, and I do have a caring heart."
It's also helped her learn what can trigger her depression, such as a lack of sunlight in winter.
Exercise is her medicine now. "I know when I'm really stressed and really frazzled, that if I put on my iPod and just walk and really get in the zone, it does wonders for me."
But during her darkest depression, medicines were vital.
"I don't think I'd be alive if I hadn't made that choice," she says. "When you're fully enmeshed in [severe] depression, all the things that can help you—going outside, getting exercise, being around people, eating breakfast—those are the things that are physically impossible."
She and her husband now have a plan for when her depression hits. "When I get depressed," she says, "Dave tells me to go outside, take the dog for a walk, go take a shower."
"Having a friend or loved one to help you can really help."
Susan's story reflects her experiences as told in an interview. The photograph is not of Susan, to protect her privacy.
Medical Review:Kathleen Romito MD - Family Medicine & Lisa S. Weinstock MD - Psychiatry