How I Managed Chronic Depression on my AT Thru-Hike
There were a few points during my Appalachian Trail thru-hike where I felt like I’d lost my mind.
I remember sitting on a rock outside Palmerton, Pennsylvania crying hysterically. And not cute crying. Like full-on heaving sobs where I can’t catch my breath and start hyperventilating. A ridge runner saw me and asked if there was an incident I wanted to report. I think he even asked me if I’d seen a bear and gotten spooked.
But the truth was that the trail was fine (well, as fine as the trail in PA ever can be). I was just having a flare-up of my depression.
Eventually, I stopped crying and kept hiking, but this wouldn’t be the last time that my depression pressed in and I had to take a break from hiking. At other points, I needed to cut my days short, and at times, even stay off-trail altogether to recuperate.
As annoying and painful as these episodes are, they’re just a reality of my life.
I expected them to happen while I was on trail, since I’ve never gone six months without a flare-up. So before heading out for my thru-hike, I made sure that I was prepared to handle them as best I could on trail.
The first step, and arguably the hardest one, was accepting that my depression would follow me on my hike.
It was so tempting to believe that all my problems would magically disappear when I entered the wilderness, but that’s just not how mental illness works. My depression is a chronic illness, and location and environment will never eradicate it. Accepting that even being outdoors and exercising all day, every day wouldn’t “cure” my depression helped me prepare for when I did have depressive moments.
By expecting them, they didn’t have the chance to catch me off guard and potentially end my trip. Once I took this first step, I was then compelled to design safeguards for when they happened so they wouldn’t derail my hike.
Caring for my mental health looked different on trail than it does in the rest of my life.
The biggest components of care for me are medication and a support team. Let’s start with medication because that one’s way easier.
My anti-depressants have stayed stable since 2018, and overall I’m pretty happy with them. For me, it was a given that I’d stay on my meds and keep the same dosage while on trail, and it was really easy to continue taking them throughout the hike.
Getting my medications was pretty much like any other resupply. I kept track of when I was running low and would either resupply at a CVS in town or have my parents mail them to me. The biggest determinant was whether there would be an easily accessible CVS in town. For the most part, there weren’t any, so my parents often would get my prescription from the pharmacy near their house and send them to me wherever I was on trail.
Yes, this all added up to another thing to plan for and factor into my town days, but going off meds wasn’t an option for me. In the end, it didn’t feel like any more of a hassle than any other part of my resupply chores.
The biggest things to check about medication before even stepping on trail is that you have a renewed prescription and whether your insurance allows for three-month prescriptions. A lot of insurances offer a three-month supply of anti-depressants, so if that’s an option, that reduces six separate medication pick-ups to only two.
As for the prescription itself, make an appointment with your prescribing doctor before heading on trail to make sure it will last for the next 6-7 months. You don’t want to get caught mid-hike with an expired prescription and need to make a last-minute appointment with your provider. That wouldn’t be the end of the world, but it’s an easily avoidable hassle.
Now for the matter of therapy.
I personally chose to put my therapy appointments on hold while I was hiking. I came to this conclusion with my therapist who agreed that I had enough coping mechanisms to handle my depression without therapy for the next six months. We decided I’d reach out to resume therapy once I was back.
But if someone wants to keep going to therapy while on trail, many therapists offer virtual or telehealth appointments. (I actually see my therapist normally over telemedicine and find it just as useful and as in-person appointments.) The only caveat would be that good service is required for these appointments, which isn’t always available on trail.
I’d recommend planning town days around therapy appointments if you are interested in continuing therapy during your thru-hike. It’s very doable. It would just be another level of planning on town days. But for someone who wants that support while on trail, it’s definitely worth the extra bit of logistics.
In addition to therapy, my support system includes friends, family, and support groups.
I think the hardest part of trail for me was that I was away from my friends and family. While pausing my therapy, I planned ahead of time who I’d be able to call on a whim if I was in a sticky situation or when my depression was too much for me to handle on my own.
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Most peaks have enough service to make a phone call, and it’s usually easy to get off trail and go into a town if I needed a night off trail where I had guaranteed service. My parents were super supportive of my hike and know how to help when I’m feeling really depressed. They were always my number one call when I needed someone to talk to. Before heading out, think about who in your life you can cry to at any hour of the day. Use that support when you need it.
Above all, and evident by this post, I was super transparent with other hikers about my mental health and when I needed support. I wasn’t talking about my feelings 24/7, but I let my friends know when I felt a storm coming in. I let them provide friendship and support when I needed it and didn’t try to hide my depression from them.
One annoying preparation I made was padding my hike with extra time in case my depression took me out for a few days.
And it did. I once sat out for four days in New Hampshire, and there were other unanticipated zero days when I just didn’t have any energy to hike. I get that there’s still a lot of stigma around mental health and taking time off for mental health, but it’s just the same as taking time for sick days.
Some people took time off because they couldn’t stop throwing up. I took days off because I couldn’t stop crying. Every year a ton of hikers take multiple days off for norovirus, giardia, and injuries. Taking days off for mental health is no different. Parts of our bodies were malfunctioning, so we paused until they were back in tip-top shape.
Obviously, there’s a difference between bad days and depressive episodes.
Going on trail, I was ready to deal with both. I had inspirational musicals (whatever, I am what I am) and comedy podcasts ready to get me through the bad days. But when my depression hit hard, I was ready to take the time and support I needed to get through a rough patch and then keep hiking.
I didn’t let my depression derail my hike, but I did acknowledge it for the obstacle that it is and overcame it when it tried to get in my way.
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