Medical Mystery: She seemed trapped in a downward mental-health spiral. The real cause was a shock.

Blaine Butler’s first bout of depression occurred in 2002 when she was in her first year of a doctoral program in materials science at the University of California-Santa Barbara.

Unable to go to class, she returned home to Richmond, Va., for a few months. She was prescribed Prozac, recovered, and returned to California. Six months later, she left school for good and found full-time work in a coffee shop.

In 2007, she decamped to a better job in Charlottesville, where her sister Brittney Butler was working as a graphic designer.

“At that point I was always on medication [for depression] but we would change it up,” said Blaine, now 39.

Her illness seemed to follow a pattern: After a few years the antidepressant inexplicably stopped working; her psychiatrist would prescribe a new drug, and she would get better.

In 2008, she landed a job as a research scientist. She enjoyed the work and seemed to thrive.

But in 2013, her mental health deteriorated. “At work I just wanted to crawl under my desk. I had trouble focusing,” she said. She took a short-term leave, worked on coping strategies, and returned to her job.

Four years later, her breakdown was more severe and her recovery slower. This time, she took a three-month disability leave.

Blaine went back to work in February 2018, hoping to transfer to a job with less pressure. But just before what would have been her 10th anniversary, her supervisors gave her a choice: Resign or be fired.

She chose the former and began working as a server at a variety of restaurants in Charlottesville. She was fired from each for forgetting to put in customers’ orders — or to deliver them. “I remember thinking, ‘If I can’t even waitress, I just want to die,’” she recalled.

By late summer, Blaine had developed what she assumed were frequent migraine headaches — her sister had them — and was regularly popping Excedrin. Sometimes her balance was off and she complained that her vision had deteriorated.

In early December, Blaine stopped taking her psychiatric medicine; it didn’t seem to be effective.

Her family knew that something was clearly wrong during their Christmas Eve celebration.

“She looked awful,” Brittney recalled. “One of her eyes was pointing inward, she kept wiping her hands on her pants after she ate, and what she said didn’t really make sense. ... I thought her depression was just really bad.”

A few days later, her boyfriend, Kyle Gumlock, whom she met in 2014, feared that Blaine might be suicidal. Her mother drove up from Richmond and on the advice of Blaine’s psychologist, they took her to a hospital emergency room. Hours later, doctors decided to admit her.

“They got me back on my meds,” Blaine said, “but it felt like kindergarten. ... I wanted to get out of there as soon as possible.”

Less than three days after her return home, Blaine and Gumlock were in their kitchen when she suddenly collapsed and began vomiting. He called 911. Blaine was taken to the ER, where she was diagnosed with a “vasovagal episode” — fainting that results from certain triggers including stress.

Two days later, the same thing happened again. Brittney said that doctors suspected Blaine might have a urinary tract infection. But during the hours the sisters spent in the ER, Brittney noticed her sister making odd, jerky hand movements. Doctors wanted to send her home but Brittney objected.

“I told them her eye is crooked and it’s been like this ... and she’s doing weird things with her face and hands,” Brittney remembered saying.

After she and their mother insisted that doctors take a closer look, Brittney said, they agreed to admit Blaine to see whether she was having seizures.

An EEG failed to capture a seizure, but two days after she was admitted Blaine underwent an MRI scan of her brain, ordered after she reported double vision and was unable to move her right eye.

The resulting image was stark: A tumor the size of an orange had invaded the right frontal lobe of Blaine’s brain. She said that a doctor likened it to “an iceberg floating on top of my brain.” There was evidence of herniation, a potentially fatal condition that occurs when the brain is squeezed out of position.

The tumor was causing papilledema, swelling of the optic nerve that caused her double vision; it was also the reason for her odd-looking eye. The tumor was also responsible for a panoply of other symptoms: confusion, fainting, vomiting, headaches and, most likely, her recent severe depression.

Doctors told her she needed brain surgery and soon; it was the only way to definitively identify the type of brain tumor.

“I felt a huge amount of relief,” Blaine said on learning that her deterioration had an organic cause and “wasn’t just depression. I didn’t even think it might be cancer.”

During a 10-hour operation, University of Virginia neurosurgeon Ashok Asthagiri removed a grade 2 astrocytoma, a slow-growing malignancy that he said “could have been there for years.”

Astrocytomas, of which there are four grades, are diagnosed in about 15,000 Americans annually. A grade 2 tumor is not considered aggressive, although it can recur as a higher-grade tumor, while a grade 4 astrocytoma, known as a glioblastoma, is among the most lethal brain tumors. (Beau Biden and Sens. John McCain and Edward M. Kennedy are among its victims.)

Grade 2 tumors are typically treated with surgery, sometimes followed by radiation and chemotherapy. Because the tumor tends to infiltrate surrounding areas, doctors may not be able to remove it in its entirety for fear of causing damage to the brain or bodily functions.

The papilledema that distorted Blaine’s vision “had probably been there from weeks to months,” Asthagiri said. It is unclear why the doctors who examined her did not notice it.

But, he noted, it is impossible to know whether the tumor caused Blaine’s depression.

“Especially in the setting of mental illness,” the neurosurgeon cautioned, “it is easy to disregard symptoms that maybe should be evaluated.” Doctors “need to be vigilant. Once [a patient] gets labeled, everything is viewed as a mental-health problem.”

After recovering from surgery, Blaine underwent radiation and chemotherapy; she finished treatment in December 2019. Currently, her tumor is under control and she is scheduled to undergo an MRI every four months.

This month, after a year spent working as a scientific grant-writer, Blaine was hired as a scientist at a biotech firm. She has resumed the activities she previously enjoyed: rowing, cooking, and walking her dogs. In September, she and Gumlock married.

Her psychological health has improved significantly and her new psychiatrist is weaning her from her antidepressant. Blaine is resigned, she said, to not knowing how big a role brain cancer might have played in triggering or exacerbating her depression.

“It’s like someone flipped a switch,” Gumlock said of the difference. “I think the consensus may be that she doesn’t have depression now.”