Medication for mental illness can be a touchy subject, and everyone is entitled to their own opinion. But I do honestly believe that some of us need psychotropic medication the way a diabetic needs insulin, the way short-sighted people need glasses, the way anyone else takes medication for a migraine or high blood pressure. Understanding that my brain is chemically imbalanced, and that I need medical help to balance it, has been a critical part of my illness and treatment. I refuse to be ashamed of that, and I’m happy to share my thoughts on it here.
You may recall from a previous post that I was started on Celexa by a college health center doctor who knew little about my personal depressive symptoms, and that I later learned that Celexa in particular can increase tiredness and fatigue (my primary, and most debilitating, symptoms). From there, I sought treatment from a psychopharmacologist who journeyed with me from Celexa to Wellbutrin, Prozac, and eventually Cymbalta, which I take now. At each visit she would ask how my mood that day was on a scale from one to ten. I’d answer as honestly as I could, tell her how the past couple of months had been, and we would discuss whether I felt good on the medication I was currently taking or if I was looking to make a change. As a person with depression, it’s always hard to know -- is this as good as it gets for me? Is there something that can help me feel even more like myself, with energy and passion and positivity?
But tinkering with medication is no joke. Each time we made a switch I would have to taper down slowly, sometimes adding in the new medication gradually, and take note of how I was feeling and what side effects I might be experiencing. I remember that Wellbutrin gave me a lot of energy, which was great, but when we bumped up my dosage I started to feel crabby and anxious, irritable and unable to tolerate even the slightest frustration. So we tapered back down. Some of the medications cause weight gain, or dry mouth, or hot flashes, so anything new that starts happening with your body sends up a red flag -- is this a side effect? My current medication (Cymbalta) causes hot flashes and excessive sweating, which is a lovely thing to deal with as a woman in her twenties. There’s nothing like being asked at a toddler’s birthday party if you’re crying, and having to wipe your cheeks and answer “no, I’m just sweating.” It’s a real self-esteem booster. But hey, at least I can smile while I answer. Cost-benefit analysis.
Other than that, I will sing Cymbalta’s praises (for me, and only me, as I’m not making ANY medical recommendations for anyone here). It has been a complete game changer for me. I was on a lower dose of it when I began to see my new therapist (who also now prescribes my medications), and she suggested going with the maximum dose to see how much it could help. And, you guys, IT HELPS! I went from feeling sort of okay some days to having REALLY GOOD days. My husband would come home from work in the evenings to find me having worked a full day, showered, dressed (these are bigger feats than I know how to explain) and cheerfully making dinner after doing several loads of laundry and cleaning some of the house. He said, on more than one occasion, “I haven’t seen this Lauren for at least five years.” I remember walking through my house one day, on my way to wash a dish or switch the laundry, and thinking to myself, “I’m just really freaking happy.” (Full disclosure: maybe my brain didn’t think the word freaking, exactly.)
Some people may argue that it’s unfair to simply take a pill and be happy, and to them I will say: this is not a permanent condition. There is no guarantee. I am not happy every day. I might not even be 50-50 on good vs. bad days. But my good days are so much better than the supposedly “good” days I have experienced in the past couple of years. More often, I am able to say that the highs of life feel as high as they should, instead of just moderately okay. More often, I am able to face the day without a mounting sense of dread or complete apathy. More often, I do what I need to do during any given day or week without missing work or canceling plans six different times.
Those who are against the use of medication to treat mental illness will say that the drugs are shortcut, a way of putting a bandaid on a wound that really needs stitches and professional attention to heal properly. They clamor that “putting in the work” (i.e., working through issues in therapy) is the only way to truly treat the disease. I will answer that while therapy may be the stitches and attention my wound needs to heal, the antidepressants are the ointment and dressing around the wound that keep it from getting infected, that make it livable, that make it tolerable and keep it safe while the healing occurs. I’m not choosing one or the other, but I will say that the meds help make this “wound” of depression tolerable while I’m working on healing myself in therapy -- and on some days, they’re the reason I can even get myself to therapy in the first place.
By July after my college graduation, I had a job and an apartment about an hour and a half away from my parents in one direction and my now-husband in the other. I met good people and enjoyed my work in a residential facility for teenage survivors of complex trauma. Most of all, I liked having the freedom of my own space. I found a psychopharmacologist who could continue to manage my medication, but I did not feel I needed a therapist. I was managing my fatigue and wasn’t, to the best of my memory, really experiencing other symptoms of depression at that time.
During my first meeting with the psychopharmacologist, she asked what my biggest depression symptom was and I answered promptly, “fatigue and exhaustion.” She looked at her notes and shook her head. I looked at her curiously, and she asked, “You were fatigued and they put you on Celexa?” I nodded. “Well, that’s interesting, because Celexa makes you tired.”
I remember raising my eyebrows and saying simply, “oh.” It hadn’t occurred to me to do any research on all the different medications available to me and their side effects, benefits or disadvantages. I took what I was given and went on my way. Looking back, I realized I had continued to feel tired, but my frame of mind had improved to the extent that I was able to manage the fatigue better. Lauren-on-Celexa was better than Lauren-on-nothing, but not as good as I could be on something else.
I don’t think I realized at the time how daunting it would be to spend months, and ultimately years, trying new medications on varying dosages (this continues to be part of my story, and I imagine it always will be -- more on that to come in a future post). However, I think this conversation did help me begin to realize that something better could be out there. If the wrong medication helped me feel a little better, how much could the right medication improve my condition? My condition -- there it was. After meeting with the psychopharm once every couple of months for awhile I began to see my situation for what it really was: an illness that required me to manage and attend to it in order to keep myself healthy.
I remained optimistic; this was a good time in my life. I really did love my job, and met one or two lifelong friends there, as well as several people who would shape my understanding of the social work field and of mental health in general. I was learning and growing, planning to become engaged soon, and aside from frequent bouts of fatigue, I felt well. But at the same time, I made frequent trips back to see my parents and visit the psychopharmacologist near their home; I took my new pills and contemplated the implications of living as a person with depression. I began to use my newfound understanding of the disease as a way to relate to the world around me. I no longer counted my depression as a passing phase of life; I planned to treat it with medication and self-care for the foreseeable future. This is not to say I had any clue what would come in later years (hint: it’s not pretty) but I at least was becoming aware of the need to adjust my expectations, however slightly, to include depression in my plans.