The Perfect Picture that is – Mental Health Meds.

So, I want to talk about my meds today. It is part of my journey after all, and it is and was not a perfect picture at all. The point of this is not to list off facts and stats, but just to give insight into my experience with mental health drugs. As you will see through the next 8 billion paragraphs, the journey will vary from person to person. 

Like with every other ‘issue’ in life, individuals with mental health sicknesses deal, confront and maybe reconcile with their issues in different ways. And so, while I feel the concept of story and experience sharing is important and pivotal for the development and progress of mental health systems and the ‘right’ support structures overall (and what I am trying to achieve with this), I too understand that my personal experiences may not necessarily apply to another person who is diagnosed with the ‘same’ disorder. It is never the same– and this is because of the very simple reason that we experience and react to our emotions and feelings in completely different ways. X is hard-wired to his ways, and Y is hard-wired to her ways. Can a person really change? Could X be Y? – I am not sure – for myself. I cannot answer that for myself today.

For me though, it is all about perspective:

  • Why are the experiences so different?
  • What could I possibly learn from that?
  • Why might have it worked for you and not me?
  • Is there a way we can help each other still? (Yes, it is good to talk to other human beings who are not doctors – drill that in your head R).
  • Am I just a stubborn fuck? (Probably.)

And that’s where story-telling and sharing does become so important.  A lot of people last year (notably during my ‘coming out party’ on social media) told me about how for example, CBT (cognitive) or DBT (dialectical) therapies saved their life (among other philosophies, etc), and they look now at how they operate and think in completely different ways. Those said people resonated with those ideologies in practice (and that is probably just only one of a million ways to look at it; but I personally take away and learn best from things I resonate with the most), and so it worked for them, and they were able to adapt even if they did not think that they could do so.

I do not necessarily want to talk about my experiences with CBT or DBT therapies today, but long story short, my experiences with either form of therapy has not reached the same level of success. That being said, listening to stories where those therapies have worked has still helped me to shape my own experiences into perspective.  And of course there is still the possibility that I can apply what I took away, in time, so those stories provided me with perhaps, some semblance of hope. Because everyone lives and breathes a different journey, maybe I need to experience P, Q and R first before CBT or DBT will work – who knows. At least I can acknowledge the tools are there, and they will not go away; and may be they will progress too with continued research and development. Maybe one day my story will come into alignment with those success stories I have heard. Like with most other things in my life, I just do not know at this point.

So, it happens. There are 5,692,83X combinations of treatments that ‘might’ theoretically work for a mental health patient, and that is why doctors are so transparent (and have to be) that the field and area still remains grey. When I started seeing my very first – goodness-to-true – psychiatrist at St. Mike’s and she finally decided on a diagnosis, she was actually very transparent 1) that the research on Bipolar II disorder is still grey (streams and streams of literature to get lost in, but nothing all too conclusive), and 2) that dealing with medications would very much be a trial and error process. In the softest of tones, I cautiously asked her about timing. She kind of laughed and said, “the process is grey (once again, that word), and we will keep on trying”.

Taking a step back, I know that I am very lucky to have a psychiatrist, especially, one through OHIP; and I had a really good relationship with that doctor until she transitioned me to someone more long-term once my suicidal ideations subsided (long words for another day). But, coming back to the present thought her words would always stick with me, because it was through that conversation and that particular day that I knew this would be a life-long journey (you know, at least until the day I wrack up the guts to finally drown myself – oh c’mon R). Even though my medications have ‘stabilized’ over the last eight months, I wait in silent anticipation for the day where it will all blow up again. I know that the combination of medications and therapy (stay positive, stay positive – and remember you are in control too, R) are supposed to prevent that from happening, but for whatever reason, I still continue to shift back and forth between a state of ‘stable’ numbness (what I consider to be an upswing now), and depression.

As per usual, it took me a really long time to get to these thoughts, but I wanted to talk about medications today. I am not sure if it will help anyone in any sort of way (since I literally took ten minutes above to describe the point that everyone’s journey is different), but except to drill on the idea that where mental health is concerned, trial and error will play an evitable role. A few years ago, when I initially started to have volatile mood swings, I went to my family doctor. –>

[Actually before this, I met with a counsellor through an anonymous support program through my-then company, but this proved to be a bit useless].

–>I think between that, and ignoring that something is going on, your family doctor should be your first avenue of approach. It is funny to me now, but back then, he did not really think anything was wrong with me. For context, my family doctor is super socially awkward, in the way he talks to and stares at you; and while I say every year I am going to find a female GP, I never do. Jon sees this guy too, so at the back of my head, I kind of want us to stick together. So, I have stayed with him, and truthfully, progressively over time, he has gotten a bit better as medical counsel. But, a few years back, in this particular story, he sat there with a clueless look on his face, Googled on his computer for a while, and directed me to see a life coach. Step backwards to my italicized point above, the one useful thing that came with said-counselor is that she made me take this standardized psychiatric test, which was evaluated through a psychiatrist in Montreal. I did not bring the “I am fucked up” test results to my first doctor appointment that day; but the next day, (and if you read my very first post on this site, I was unemployed at this time), I sat cross-legged outside his office, leaning on a wall, until it opened and he showed up, and I basically asked over and over for “five more minutes of his time” until he agreed.

He finally listened. He prescribed me my first anti-depressant – Sertraline (for ease of reference, I am just going to use the drugs’ street names). As you all know, I tried to kill myself repeatedly that week, and ended up at St. Mike’s. So, from there, the trial and error really began. From my own personal experience (and I make that a heavy caveat, because this is written based on just one person’s perspective), until you are diagnosed, doctors will probably try prescribing anti-depressants first (notably – SSRIs, selective serotonin reuptake inhibitors – most popular being Prozac), because their initial guess is that there is usually some element of depressive disorder involved. From my personal observations, only through time, talking and more trial and error, will more complicated diagnoses like Bipolar Disorder, Borderline Personality Disorder, Schizophrenia, etc. etc. come to surface. It makes sense. And then, there lies the huge complication of determining the right trial-and-error-path to embark on:

  • Should you be on meds only?
  • Should you be on meds with therapy?
  • Should you be on just therapy? If yes – what kind of therapy? Group, individual, both? Under what methods, ideologies?
  • With the meds – should you be on anti-depressants, antipsychotics, mood stabilizers? In what combination?
  • Are there other things we are not thinking of? (electromagnetic therapy, etc., etc)

No one wants to be defined by their diagnosis, but there is some feeling of clarity and relief when someone tells you what is actually wrong with you. At least that is what I felt. I could then focus on trying to understand my complications, and maybe even be proactive in determining “the what’s next”, because I could begin to see more clearly the faculties of what I would be dealing with every day going forward.  I became more aware of my inner monsters (and outer – I fucking cried a lot). And do not get me wrong, sometimes, diagnoses are wrong. And even worse, sometimes a person does not discover that his or her diagnosis is wrong until years into the process.

Luckily for me so far, the diagnosis has lined up. I resonate with it, I believe in it, but once again, I try my very best not to let it define me. Some days it does, some days it does not. It really just depends on the day. All that being said, defining a mental health ‘program’ for an individual is complex, complicated, convoluted, and every other flowery c-word I can think of.

Over the past few years, to share the full picture, I have tried the following medications (and in some ways, I am lucky, because I have talked to others who have probably tried the whole list you can Google out there), these were their effects on me, and subsequently why I had to let them go:

Med (street name) Experienced Side Effects Why I moved on
Sertraline – anti-depressant Amped up suicidal ideations – of drowning myself especially. Feeling and being actively suicidal is not really ideal.
Prozac – anti-depressant At first, I was very hyped up; perhaps this is what ‘speed’ feels like. Then suddenly, I felt removed of all my emotions, and I basically flat-lined as a feeling human being. I did not move on because of the side effect, but because I overdosed on these on an attempt, I could not continue with them due to its newfound trigger effects from just looking at them.
Lamotrigine– mood stabilizer I experienced a rash. Doctors take you off this drug immediately if a rash surfaces, as severe rashes can result in death.
Latuda  – mood stabilizer Same as Prozac. At the time, I explained to the doctor that I wanted to feel, and so I could not accept a “solution” that turned me into a robot.
Seroquel – anti-psychotic I could not, for the life of me, stay awake. This was fine when I was unemployed and could sleep 22 hours a day, but when I was employed again, I fought really hard to get off this med right away.  This, for me, was the worst drug I ever experienced to-date.
Mirtazapine– anti-depressant Same as Seroquel. Same as Seroquel.

The chart is not 100 percent reflective of how it all lined up and played out because I actually took either mood stabilizers, anti-psychotics and anti-depressants in different combinations (two out of three, or three out of three). Mood stabilizers were explained to me as “the preferred method” for treating bipolar disorder notably the swings, but sometimes anti-psychotics would be introduced to see “what would happen”, especially where suicidal ideations and numbness would occur. It was kind of like a scientific experiment, with controls, those being the medicines that work in some way, and variables, to test out those aspects that are still not working. Okay, it’s not “like“, it actually is an experiment.

So, where am I now?

I am on:

  • Lithium– mood stabilizer. This was marketed to me as the “gold standard” for treating bipolar disorder. Truthfully, this drug works with me, because – tried, tested and true – I know that when I am stupid, and I forget to take it (to the point, where I am then unintentionally not taking it because my mind has already turned), I am immediately suicidal and a fucking mess.
    • Lithium, for me, has not resulted in any severe side effects. However, at high dosages, the drug can introduce toxicity into your blood streams, and so my blood levels have to be monitored every now and then to ensure that while enough is taken, it is not introducing any significant harmful effects.
    • Also, if one day I want to become a mother, I want to get off this right away (for breast-feeding). Not really a concern right now since I cannot shake the image away that I will end up killing myself with my child in the next room.
  • Wellbutrin – anti-depressant. I was told (in layman’s terms) that doctors try not to introduce anti-depressants into the Bipolar regime with a mood stabilizer or anti-psychotic, as they technically all work in contrasting ways, and may offset each other negatively if not prescribed in the exact right dosages. However, with Bipolar II disorder, there is a greater tendency towards major depression (true – I know this because I experience it), and so the anti-depressant is prescribed to offset the volume of depressive episodes that occur versus the only one or two manic episodes a year that come as a gift. So, while Wellbutrin does not make my upswings necessarily go up, it does help me with retaining energy so I can be a productive, thinking human being.
  • Abilify – antipsychotic. I was prescribed Abilify specifically to help with reducing my suicidal ideations. Similar to Wellbutrin, it has also helped me with improving my energy levels. The med is supposed to help with improving concentration and focus; I have yet to see those results. I am still 154-thought unfocussed.
    • Once again, it is probably a safe enough drug to stick with.
  • Clonazepam – anti-anxiety drug. This is self-explanatory – I have differing levels of anxiety with people, situations, everything.  It also acts as a sleeping pill, because I take all these drugs that increase my energy, but do not help with sleep. I will probably need to ween off this one one day as it has addictive properties.
  • Zoplicone – sleeping pill. Occasionally, even with Clonazepam, I cannot sleep (and in the past, I have stayed up a good part of the night; not a bad thing entirely because sometimes I write, but sometimes I just stare at the ceiling lost in harsh thoughts). So, this particular bad boy knocks me out. I cannot take it often though as it results in severe dehydration. Once it was so bad my mouth was burning for a few days. So, this is a contingency drug rather than a regular drug.

So, that’s a little bit of insight into one’s medication diet. Once again, I know everyone’s ‘medication diet’ is different, but I am always curious to learn what someone else is taking and how it works for them; why they stay with something; and why they ween off of it. It helps me to learn. For the last while, my prescriptions have been watched very carefully in terms what volume I can keep at home, since I have tried to commit suicide through overdose, multiple times now. As part of this little suicide prevention plan I keep on my fridge, Jon has sometimes hidden part of my prescription when I am spiraling, so I can only access what I need. Once again, makes sense.

I read this New Yorker article recently, and it made me think wistfully of days where I wondered what it would be like if I completely went off meds. I am pretty sure I would experience symptoms of withdrawal, and maybe I would lose it, break a window and jump. Trying to think more positively, curiously, I wonder if I would be pleasantly surprised, and find I was actually a regular human being underneath it all still. And by that, I mean, that I would be okay, and maybe more than okay. And that, all of this just happened for no reason, but to teach me a hard lesson to find a better version of myself always, to survive, to never settle, and connect more with the world outside my bubble. But, right now, I can’t give up on drugs that easily because I have been reliant on them for so long. So, the path to finding answers continues.

It’s weird because a year ago (and even way long before that), I felt like I was always saying and thinking that “I don’t know what to do”. I still feel that so very much today. But, apparently, to the professionals I am seeing, I have at least made some progress by wearing down my walls, talking, asking questions, and wanting to seek help….craving to seek help (even if it means flying halfway across the world to find connections and meaningful answers). So…fucking 32 pages again later…all I have left to say is that the journey continues still.

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