Medication.
Well, head meds as I like to call them, get prescribed so much that we should all be bouncing around like happy bunnies on hallucinogenic drugs, but we’re not and I’ve often wondered why.
They are the first line of defence for the embattled medic. But why, meds and not other help. I have no proper answer, but my theory based on personal experience.
I’ll start with a word picture, time to get your imagination caps on!
Mr X is sitting in front of his General Practitioner (GP), complaining of low mood and feeling sad. You know- you’re just don’t feel right. The GP, with dozens of other patients to see, notes to write up, prescriptions to review, referrals to make and who knows how many other tasks, sighs.
But why the sigh?
I do not think it’s what you would expect it to be.
I think it’s because there is little the Doctor can do to help Mr X. – in the U.K. at least. Sure, he can be referred to local mental health support, but they are overloaded, the wait is months long and Mr X needs help now! The Doc knows he has to make a positive action for the patient, and there are only minutes left in a ten-minute appointment – so he reaches for the prescription pad.
“Medication should never be considered the only tool for helping a person”
Temple Grandin
Is this why so many people are on Head Meds?
I believe it is why so many people are put on meds. Doctors are busy and have a limited arsenal to deal with something as complex as mental health. Mr X needs some sort of help now, even if it is just a sticking plaster for the issue.
So, he is given his first ‘anti-depressant’ and some advice about lifestyle. Maybe, even a leaflet on exercise and relaxation, and a promise that the local mental health team will be in touch. Or as is usually the case in the U.K. now, how to refer himself. Which does make me laugh that someone in a depressive state is expected to take another positive action on top of the doctor’s visit. There have been many times I’ve just not had the energy!
let me tell you a little about my history with head meds.
I was put on my first S.S.R.I (Selective Serotonin Reuptake Inhibitor) over thirty years ago (Dear God I’m getting old!). It was Fluoxetine which was a fancy new drug at the time. I was sent off with a hand-written prescription and the promise of ‘Don’t worry, we’ll get you better’.
What a load of rubbish that was!
Thirty times around the Sun later and I’m still not ‘better’. – whatever that means; a subject for another blog, I think.
Since that fateful visit, I have tried (in no particular order):
- Amitriptyline. (made me faint whenever I stood up)
- Citalopram and the less nasty cousin, Escitalopram. (Do not cold turkey that one, it will put you in the funny farm!)
- Fluoxetine
- Sertraline (Kept me awake for four days straight!)
- Mirtazapine (Made me fat!)
- Seroxat
- Pregabalin (That was one hell of a trip!!!!)
And others that I cannot remember the names of, nor care to.
“Always laugh when you can. It is cheap medicine”
Lord Byron
Why do I stop taking meds?
Let me quickly discuss why I usually stop taking the medication I’ve been given.
One reason are the side effects, those you want and those you don’t. What I mean is, the drug makes you happy, which is a good side-effect. On the other side, they can also make you poo yourself while shopping in Tesco, which is bad! Well, unless you hate shopping and think Tesco is a symbol of everything that is damaged in the Western World!
In my experience, the negative side effects can go away, but not always. Amitriptyline, for example, had one side-effect to do with going dizzy as you stand up which never went away. Prozac made it a pig to go to sleep at night. Sertraline stopped me going to sleep.
So, it is a balancing act. If you really want to get better, then you will live with negative side effects and hope they go away.
When they don’t, or the negatives out-weigh the positives effects, I tend to stop, much to the annoyance of my long-suffering GP.
One word of advice though, do not Dr Google the meds you’re on, just don’t do it!
Why?
It’s a quirk of human nature that makes people run to the Web to moan – so you will only see horror stories about the terrible things the drug may do to you. That will make you hyper vigilant about your own body, and you will have every problem that is listed. If you do not believe me read about the placebo effect. Now, I just chat with the pharmacist. They are, usually, the experts.
So, has medication helped me?
Yes, it has, no it hasn’t.
Let me explain that contradictory answer.
When I was at my lowest points in life. Times when the effort of simply breathing felt like I was trying to climb Mount Everest while carrying K2 on my back, or the anxiety was so bad I was planning my death, drugs saved my life – prescription drugs not the other kind.
They lifted the darkness, damped down the anxiety. Allowed me to breathe again. For a while at least.
“The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.”
Thomas Edison
What I consider to be wrong with mental health medication.
The problem I have found with medication is that it deadens you, gives a false sense that things are all right. Because your drug-soaked neurones think all is okay, you stop engaging with whatever counselling you are getting – if you are getting any. You stop working at solving the causes of your depression, whether that be lifestyle, food, alcohol, or some past trauma. Because, with the drugs, you feel ‘normal’.
That is until either the drugs stop working, or you decide you do not need them any-more.
Now, the second reason is okay if you managed to deal with a simple, short-lived depressive episode with an obvious cause, such as work stress or a relationship breakdown. Wean off them nicely and you can go skipping off into the normal sunset like some character from a Disney film.
But, if you have not weaned and you just ‘cold turkey’ or have not, or cannot deal with the cause of your malaise, then you are in trouble – possibly. I have had lots of experience of going cold-turkey, and it’s not always bad – never fun, just not life threatening. Brain zaps, dizziness etc are all wholesome fun, honest! Escitalopram, though, that was a git! Stopped that suddenly as I was all better (whatever) and within a few days I was clawing my kidneys out with anxiety and trying to end myself! Thankfully, a man in a white coat arrived with a load of Diazepam and quite literally saved my life!
Now the first one, the drugs stop working. That is trickier. There is a theory that the brain seeks homeostasis – it has a natural level of chemicals that it strives to achieve. So, if SSRI’s increase serotonin, the brain will, over time, reach homeostasis by lowering serotonin production or increases its use even more. So, you must increase your dose, or move to another drug. I cannot find the study to post the link. But, if the therapeutic effect of a drug is a positive side effect, why should it last forever unlike the negative ones?
“They say drugs are not the answer, but really, what is the question?”
Janet Finch
How can you tell when to come of off the meds, or change, I hear you ask?
Well, you just notice that you are not feeling quite right so you go to the Doc’s, and they play with the meds until you do – until the next time.
That is certainly the case for me. A medication helps me for between 6-8 months before I start feeling unwell again and I must restart the GP persuasion game.
Oh, forgot to add that lots of bodily functions require serotonin and when you stop the meds, they complain! For me, it is the guts. I get diarrhoea with a vengeance for weeks! It is all fun.
Finally, one last thing. The drugs take time to work. SSRI’s can take up to 6 weeks, so do not expect instant results. However, I believe the placebo affect does kick in earlier and helps. I need to discuss the placebo effect in a later blog as it is a whole minefield of differing opinions!
So, do I think drugs have a place in psychiatry. Yes. A resounding yes with spangly bells on it. Drugs have saved my life on many occasions over the years. However, I see drugs as a sticking plaster over a wound. The wound is your damaged mental health. To heal it you have work on what caused the wound – and that is the hard bit. It is a fact I did not realise for over twenty-five years, please do not make the same mistake.
Finally, the above is my view and my experiences of using medication for depression and anxiety. Yours may be different. Please don’t turn down pills if you are in a bad place because of horrid Google reviews. Give it a go and make your own decisions with the help of your healthcare worker.
Oh, yeah. The best medication?
Talking. But that’s the topic of another blog.