Medications and mental illness. This is a topic that seems to quite controversial at times; so much so that I considered not writing on the topic. However, I believe that multiple perspectives are crucial and that is what I provide here…another perspective. I also want to be clear that this post includes my opinions and thoughts. I am not a doctor and do not claim to be one.  There seem to be two very distinct camps when it comes to medications for mental illnesses: 1) Those who are very opposed to medications and even consider them to be detrimental to one’s health, and 2) Those who believe the medications are beneficial and a necessary component to regaining one’s mental health through the challenges of a mental illness. I would imagine there may be a third camp consisting of those who neither strongly support nor strongly oppose the meds, yet these are the voices seldom heard. I would classify myself in this camp for several reasons. I do not believe medications are for everybody, I believe strongly that they work for some people, I believe there should be more research conducted, and I believe that the business of pharmaceuticals and the amount of money in the industry can certainly allow for questioning the ethics and morals of those in the business.

I have heard some horror stories from people on medications and I have heard some stories that attribute the medications to successful recoveries. In my own case, one medication that had worked in the past did not seem to be working any longer. The psychiatric PA switched me to another medication in the same family (both were SSRIs). I began to have general thoughts of suicide on my new medication. I asked the psychiatric PA if my thoughts of suicide could be due to the medication, as antidepressants have a known possible side effect of causing suicidal ideations. In fact, in 2004, the FDA required manufacturers of all antidepressant medications to add a black-box warning to their drugs stating that they may increase suicidality in children and adolescents (drug watch.com). How ironic…antidepressants that cause suicidal thoughts? I guess this speaks to part of the complexities of mental illness medications.  After I had asked the question, the doctor responded exactly as I was expecting, “It could be the medication or it could be the depression.” He increased the dosage of my new medication, something I should have questioned at the time. A psychiatrist I was to meet with later told me that he never would have increased the medication that I had been taking, as there was no evidence of any further efficacy with a higher dose than what I was taking. My once general thoughts of suicide now became very detailed. I developed a plan and thought of it often throughout the day. It felt as though the thought was invading my brain. It would come out of nowhere and, at times, I could not stop thinking about it. It really began to frighten me after having a dream about the plan one evening. I found myself looking in a mirror, thankfully only with my finger and thumb acting as a gun, determining the angle I would need to hold the real gun at against my temple. Suddenly, I broke down into tears (uncontrollable crying bouts had become an evening ritual by this point), shocked at what I was doing. I became very fearful that suicide was going to become a reality.

Due to this overwhelming feeling of fear, I shared with my wife that I needed more support.  She and my sister joined me for an appointment with the psychiatric PA and we all shared that I needed more support. I made the decision, with the help of my sister and wife, to take time off from work in order to enter a partial hospitalization program.

At my intake meeting, I met with another psychiatrist (the one who had suggested that he never would have increased my previous medication). This psychiatrist spoke with my wife and me at length and, together, we came up with a new medication to try. This was based partly on what had worked for family members and partly based on the medications that I had previously tried. These medications seemed to work like magic. I had the significant side effects that the doctor had mentioned for the first few days; dry mouth, increased anxiety, slight dizziness. However, the side effects subsided within the first few days, never to return again. We had to discuss other medications, as well. My previous psychiatrist had me on sleep medication. I had mentioned that I seemed to sleep well once I fell asleep, but I was still struggling initially falling asleep.  I took this doctor’s suggestion and began to take a prescription antihistamine to get me to fall asleep, while continuing the other medication to keep me asleep (reminder that I believe all meds are different for all patients and this is not necessarily best for all-consult your doctor if you think this may be helpful for you).  Sleep medications, I discovered the hard way, are also something to be concerned about. Have a conversation. While it’s important to get proper sleep while recovering from depression, it’s also important not to overmedicate. While I was in the partial hospitalization program, I would return home in the evenings and my wife was kind enough to allow me to sleep through the nights. Once I had made it through the three-week partial hospitalization program and was on my way towards recovery, my wife (rightfully so) decided that I could wake at night to help with our crying three-year old twins. Due to the large amount of sleep medication, combined with the prescription antihistamine, I fainted soon after getting out of bed in the middle of the night. The first night, I fainted three times when I got out of bed. Two nights later I fainted again after getting out of bed in the middle of the night. This time, we decided to call 911 and I was taken to the Emergency Room for evaluation. After checking my blood and heart, the doctor was quite certain that my fainting spells were due to the medications. He casually informed me, “You can leave things the same…no need to change your medications…the only risk you would have to worry about is that of accidental death from banging your head from another fall after fainting.”  Still being depressed, the sarcasm of his comment didn’t sink in until I was in the parking lot. Working with my psychiatrist, I quickly weaned off my sleep medications.

I believe it is absolutely critical to discuss one’s medications with their doctor. Ask questions. If on multiple medications, what is the purpose for each of the medications and how might they interact with one another? What are the side effects? How long might I need to be on these medications? If your doctor does not seem to value you or your questions, if his/her answers do not satisfy you, seek another opinion. It’s very common to get second opinions for other serious diseases and I believe that if you do not have trust in your current psychiatrist or family doctor, one should seek another opinion.  I would also highly recommend, if at all possible, to bring a loved one to any appointment in which you think a change in medications may be discussed. As I had mentioned, I was too depressed to question the doctor, too depressed to answer questions accurately and probably would have left the appointment eating dog food if that was what the doctor had suggested.

Another issue to be sure to consult with one’s doctor is the weaning of medication.  I have heard of many people who, because they were feeling so much better, stopped their medication too soon. I believe it is absolutely essential to work with your doctor if you plan to stop your medication. Together, you would come up with a plan to wean. I believe it is common practice to wean most medications that are given for mental illnesses, rather than to stop abruptly.

As a final note, while some people may believe in the medications and others may not, I believe it is very important not to judge people for the choices they make. Mental illnesses and their medications are very complex and complicated. People faced with a mental illness have enough on their plate. They do not need to be judged, they need to be supported.

As always, I welcome, and encourage, comments and thoughts to this post.  Thank you.