Beginner’s guide to happy pills

[I wrote this post last year for a World Mental Health Month collaboration, and have had numerous occasions to share it since. Here it is for posterity…]

I popped my first anti-depressants ten years ago, and I count myself lucky that in all the years since, no-one has ever given me a hard time about being on medication for my mental state. Frankly, if anyone did I wouldn’t care. The fact that a couple of pills can make me feel like a human being and not a condemned vehicle about to be compacted in a scrapyard, is too marvelous for words (to correct a common misconception, they are not “happy” pills. They are “be-able-to-get-out-of-bed-and-act-like-a-person” pills. Which is good enough for me.)

I LOVE my drugs.

Not everybody feels that way. Lots of people hate the idea of pills, whether because it seems weak to take them, or because taking them labels one as “crazy”, or because they’re ashamed of acknowledging they have a problem. Other people have tried medication for depression, anxiety or other things, but have had bad experiences – side effects, feeling numb, or even not feeling much change at all. These are all very real problems.

I’ve been really lucky to have found drugs that seem to like me. I haven’t gained weight, got more anxious than I already was, or developed dire digestive issues. Lots of people have side-effects bad enough that they prefer their original illness. Sexual dysfunction is probably the biggest reason people – men especially – discontinue treatment. Mine mainly seem to raise my body temperature (handy for winter surfing), and by reducing my social anxiety, to remove some of my inhibitions. This can be entertaining. A few months back I was at a wedding, where another guest told me he worked for a pharmaceutical company. “I LOVE [Generic Producer Pty Ltd].” I enthused. “You make my very favourite psychotropics!” I’m guessing that’s not what he usually hears during those polite what-do-you-do conversations, but he turned out to have his own favourites in the product line, and a happy discussion of life and chemicals ensued.

Being inclined to share inappropriate personal details like this in assorted social settings has some surprising spin-offs. More often than I can say, these moments are followed by nervous approaches from people either new to the whole mental illness thing themselves, or concerned about a friend or family member. People (not me obviously) find it hard to talk about, and even harder to find help for. My oversharing, it seems, might be a public service.

I’d like to put a few things down here that I find myself saying over and over again, to people thinking about, new to, or struggling with medication, specifically for depression and anxiety. I’m not a doctor, obviously, and this does not replace proper medical advice (see item #2 below to qualify “proper”). But these are things that are useful to know, and I hope they help you too.

#1: Give medication a chance. Lots of people really, really don’t want to take drugs for their mental state, for a wide range of reasons. Other people try drugs, find the first thing they try doesn’t help, and stop trying. The fact is, we live in an era of ever-growing varieties of medication, and there are plenty of options to try if at first you don’t come right. In the antidepressant line, only 33% of people actually do well on the first-line treatment (serotonin reuptake inhibitors, or SSRI’s – such as fluoxetine/Prozac). You need a doctor who knows not only the medications available, but the subtleties and potential of the different options. A small percentage of people with mental illness won’t do well on any of the drugs currently available, but the majority of us will.

#2: Find the right doctor. This is essential. Any GP can scribble off a script for the conventional first-line treatment, but every one of us is different, and you might have to try several different dosages, varieties, combinations before you find your best medication fit. For me, this took eight years, but would have been a lot less had I had the right help. Your doctor need not be a psychiatrist (mine is a family physician), but he/she needs to know and care about mental illness, be familiar with the drug options (and they are many and complicated), and have really good interpersonal skills. None of these things is a given in any healthcare worker – keep looking until you find the person you can work with to find the solution that will work for you. Your doctor also needs to know the limits of his/her knowledge, and be ready to refer you if needed. If a psychiatrist seems necessary, it’s a good idea to ask your family doctor for recommendations: she should know you and your situation, and be able to suggest someone who is a good fit. (I could write a whole separate post on family physicians and why our SA private sector habit of going straight to specialists for everything is such a mad and potentially disastrous idea).

#3: Get good at noticing what the drugs (and your illness) do to you. No matter how clever a doctor you have, there is no blood test for how you feel – you are the one who will know if/how something is working. Medication can help not only with the obvious symptoms of mental illness, such as low mood or intrusive thoughts, but also with the more physical aspects (such as sleep and appetite), and the cognitive symptoms (e.g. poor concentration, inability to make decisions) that interfere with our functioning. Because mental illness in itself makes it hard to judge things with perspective, I tend to making notes in a journal most days on how I’m doing. It feels a little odd (a bit like being a biomedical scientist who is also a lab rat), but it works.

You also need to be prepared for side effects from medication, which can unfortunately be significant. The four main types (for antidepressants at least) are weight gain/appetite changes, sexual dysfunction, sleep disturbances and cognitive problems, and everyone responds differently, both physiologically and emotionally. Most of us will need to find a trade-off between effective treatment and a side-effect profile we can live with (see both #1 and #2).

#4: Be aware that starting to feel better can be dangerous. Not to freak anyone out, but a lot of suicide attempts happen on the way out of the worst. At the bottom of the abyss, you are immobilised. When you begin to get yourself back, you still remember how horrible it was, and you cannot face ever going there again. You also have the energy and presence of mind to do something about it. No-one starting out on treatment should be left to their own devices while the pills kick in, particularly if they have had thoughts about self-harm or suicide in the past.  If you are beginning to feel better but this somehow still fills you with despair, talk to someone. Hold on – it really can get better.

#5: Don’t come off your drugs too soon. Having begun to feel better, it’s natural to want to stop the medication as soon as you feel “fine”. Don’t do this. Some medications need careful weaning, and can make you feel really awful if you stop abruptly. Also, a lot of people stop taking their meds too soon, and quickly end up right back where they started. Rule of thumb, when you feel ready to drop the pills, maybe give yourself another six months. It’s unlikely to hurt you, and you might find you can feel even better than “fine”. Definitely don’t try to come off at the same time as other major life changes – moving house, new job, getting married, whatever. My doctor says she never advises anyone to come off their meds in winter, because of the powerful role of daylight in regulating our moods.

If and when it’s time to stop, do it with your doctor’s support and monitoring, do it slowly and carefully, and don’t let it worry you if it takes some time or needs to be delayed a while.  Some of us possess systems that will, for whatever reason, need medication to remain well and functional in the long term. I’m one of these, and to be honest, I’m so grateful it’s an option that I don’t care whether it makes me “crazy” or “dependent”. With chemical support (among other kinds), I can live independently, work and do other stuff I love, have good relationships, be there for other people and generally be a reasonable human being. These things in their turn make me better all the time. It seems a small price to pay.

#6: Finally, having said all of this, meds are almost never a stand-alone solution. Nobody should be slapped on pills and expected to get better just like that. This is at best unhelpful, at worst dangerous (see #4). There are reasons you get to the point of needing help, and unless you address these things, pills will not hold you. They can get you through and out of the worst, and put you back in a state to deal with the real issues, but you should also be looking at other strategies. Exercise is an extremely powerful mental health builder and maintainer, and has multiple positive spin-offs (although you do first need to feel safe getting out of bed in order to do it, which is why I used to want to punch people who told me I should just go running instead of taking pills). Therapy/supportive counselling is another proven strategy, and can help you figure out the root problems and learn tools to cope better. Cognitive-behavioural therapy (CBT) and mindfulness-based practice both have solid science behind them and can actually change the brain structures behind mood and anxiety disorders. Stress is the enemy, as far as mental health is concerned, so these and other techniques which equip you to reduce and manage stress in your life are essential for recovery. Madness, as Einstein said, is doing the same things over and over, and expecting a different result. Even the best drugs might not help with that.

A “six easy steps” post can never do justice to the multi-shaded, unpredictable and generally unique-to-person terrain of mental illness and recovery. I have not touched on the big questions about what really causes depression and anxiety, or whether adding drugs to your own particular neurochemical soup is the best idea. The commonness of these conditions today causes some to dismiss them as insignificant (obviously no-one who has actually experienced them), and certainly to expect that finding effective treatment should be straightforward. In my experience, it really hasn’t been. But hopefully the things I’ve learnt and put down here will make it a little easier for others. If nothing else, know that you’re not alone, and that things really can get better.

Warm thanks to my wonderful doctor, who vetted this post and added important points. She prefers not to be named.

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One thought on “Beginner’s guide to happy pills

  1. […] Therapy doesn’t have to be lying on a couch ruminating to a stranger about your childhood for years on end. Ideally (in my view at least), it’s a skillful and compassionate conversation, giving you space to reflect, gain more insight into yourself and your situation, and figure out what to do about it. It’s not self-indulgent or feeble, and it’s no less practical than seeing a tax consultant or a dentist (nor is it necessarily less difficult and uncomfortable, although you don’t generally have to stare up your therapist’s nostrils). Supportive counselling has been proven to be as effective as medication for many people with mental health diagnoses, and has very few side effects (Note: I’m all in favour of meds when appropriate – see Beginner’s guide to happy pills) […]

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