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.
Excellent post Al! I really appreciated the last paragraph – it is important to not judge people for the choices they make! This is critical really in everything, but in speaking about mental health. Many people with a mental illness and those without sometimes thing that because it is a certain way for them it must be that way for everyone. This could not be farther from the truth. Nobody’s body works exactly the same way as another. No one experiences pain or joy, taste or smell in exactly the same manner. Surely we know that medications affect people differently and because of that we should respect someone’s choice and let them find what helps them the most.
Thanks for the continued posts!
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I was very moved by this honest post. I was impressed by your wife’s support during all this whether supporting your taking time off work to doing lists of things you could do to have a sense of accomplishment. I am saddened because my now ex wife did console me but did not encourage or insist upon me stopping the actions that made me suicidal and then I imploded.
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I really enjoyed your post and how you explored the complexity of medication, the need to ask questions of your health professionals and the need to withhold judgement of others. In my blog I discuss how I couldn’t breast feed because of the medication I had at the time. this was unexpected and traumatic for me. I have been compliant on medication but my symptoms remain chronic. Just another layer of complexity. I can understand why people would think why bother with meds, although for me the alternative is unbearable.
Thanks for your comments and for sharing part of your experience. I really appreciate it. I believe the more we all share our experiences, the more we can chip away at the stigma! Be healthy! Al
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I had had several suicide attempts starting at age 15. My mother was very ill with schizoaffective disorder & was not able to get helpful treatments as she probably could now with new medications & therapy. She did end up being successful at killing herself after many attempts when I was 15. Guess where I learned suicide was a coping technique…
I was finally dxed with bipolar 1 disorder. I had started thinking delusionally that my husband wanted me to commit suicide & if I didn’t he was plotting to murder me.
I was helped tremendously by an anti-psychotic medication & others. I was able to think rationally. So the medication was necessary.
However, my psychiatric n.p. recommended therapy. I tried numerous therapists, but repeatedly talking about my abusive childhood & focussing on it didn’t help. I understood intellectually why I had such deep depressions & daily suicidal thoughts, but understanding didn’t heal the pain & chaos in my heart.
Part of my mother’s symptoms included abuse & her saying she was going to kill us children. I’d call police & back into mental hospital for her, but when she got fairly stable on meds & ECTs they would release her & then she stopped meds & started her psychosis again. Useless alcoholic father wasn’t home much, but he did pay for her medical stuff. I know we would have been placed in foster homes if this happened today. I am 63.
Then I discovered DBT (Dialectical Behavioral Therapy) & the weekly group classes & weekly individual therapy changed my life. I learned I wasn’t at the mercy of my thoughts or emotions. I could learn new thinking pathways that didn’t include suicidal thoughts & I didn’t dwell on the past. It is kind of like CBT on steroids.
After 3 months of actively applying the DBT skills I was learning, I told my n.p. that I thought I was ready to get off the anti-psychotic medication as my thinking had become more rational & my life was improving daily. So after about 15 years on that medication, I went off it with the understanding that I would go back on it as needed.
As an aside I quit about 3 psychiatrists due
to their unwillingness to work with me as a collaborative team. They just dictated to me & not take into consideration my input. One, after I told him my agitation & anxiety were lower on the medication he prprescribed, but I was still severly depressed. He asked me if the radio was giving me special messages (never one of my symptoms; perhaps he was looking at someone else’s chart). I said, “No.” I told him my quality of life was not good on this medication & he told me, “This is as good as it gets.”
Well, I wasn’t going to take some heavy-duty psych meds for this “quality of life.”
Finally found my n.p. Even though I have moved out of state, I fly back to see her & also do occasional phone appointments.
I have developed some chronic pain (non-diabetic neuropathy in my hands so that even touching anything causes extensive pain) & someone in my NAMI (National Alliance on Mental Illness) support group who has chronic pain said she takes a certain anti-depressant, different than mine, & it helps with pain & depression.
My n.p. did extensive DNA tests through GeneSight (I think it is called) & it can tell whether an anti-depressant will be useful for you, whether you would need extraordinarily high doses to make it effective. The anti-depressant my friend was on was not a good one for me.
The test also looks at pain medications, ADHD meds, anti-psychotic meds, & the MTHFR test analyses an important gene to see if your body converts folic acid into its active form. Folic acid deficiency can result in abnormal homocysteine levels & may interfere with the creation of dopamine, norepinephrine, & serotonin. It can easily be fixed with a folic acid supplement.
Also, any drug interference between meds or dangerous interactions between meds is identified.
Well, sorry to go on so long. One of my “symptoms” is rambling.
Thank you for sharing. I’m sorry that it’s been such a struggle for you. Must have been hard to hear from a psychiatrist that, “This is as good as it gets”. Glad you searched for another doctor after that. I think it’s important for doctors to listen to the patients and work collaboratively as a team. Good luck to you! Al
Just a heads up about Gene site, however, it is not covered by US health insurance so if your doctor thinks that you need it you need to have him issue a prior authorization before you send the test it as I found out several hundred dollars later after he had done it backwards. He had me on it insane amount of ADHD medication I’m talking like almost double the legal dose of it daily but it’s also a medication that I literally cannot function without. And dealing with Gene site to get it covered by insurance after the fact is an exercise in futility.
Thank you for sharing your experience. Glad you’re doing so much better! Al
Thank you for sharing this story even though its a old post. I would really like to know what medications ended up being helpful. My insurance is horrible and I have to make suggestions because they are interns and have zero experience and constantly rotate. I’ve tried a few medications with poor results. I don’t want to continue to spend another 2-3 years experimenting while my child needs me.
I’m really sorry that you’re going through such a difficult time. As someone who is not a doctor, I can’t recommend a particular med for you. I do know that if you’ve tried at least two medications, there are other options that you might want to look into. Again, I’m not recommending them, but believe you should at least know about them and try to find out more information about them. Esketamine was just approved a year ago or so by the FDA, so it is now covered by insurance (probably not ALL insurance companies). It’s used for drug-resistant depression and/or suicidal ideation https://www.mayoclinic.org/drugs-supplements/esketamine-nasal-route/description/drg-20458442https://www.mayoclinic.org/drugs-supplements/esketamine-nasal-route/description/drg-20458442 (I think the Mayo Clinic is always a great resource). The medicine is called Spravato and is administered nasaly at a clinic. There is also Transcranial Magnetic Stimulation (TMS). It’s non-invasive and apparently has few side effects https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625. There is Electroconvulsive Therapy (ECT), which has some possible significant side effects, some that involve memory https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894. Some people swear by naturopathic approaches such as diet and various vitamins. I think it’s REALLy important to not rely on one medicine or strategy to recover from depression. I believe strongly in therapy and support groups. Please remember that I am NOT a doctor and am not recommending any of these approaches. Just trying to help give you information that you may not be aware of. Feel free to email me anytime at email@example.com if you have more questions. Remember…it takes time and effort. You WILL get better! Thank you for reading my blog! Good luck and be strong! Al
Your links to information from well-respected medical sources such as the Mayo Clinic as well as numerous support groups like the National Alliance on Mental Illness (NAMI) make thedepressionfiles.com stand out from most other blogs. Keep up the good and important work!
Thank you, Jerry. I really appreciate the comment! I’m hoping to get more time to write and add to the blog, now that I’ve changed the schedule of TheDepressionFiles.com/podcast from twice a month to once a month. Thanks again for the comment and for checking out the blog! Stay healthy! Al