No, I would not like to go off my meds
A decade ago, I didn't want to go on pills for depression and anxiety, which were severe. I had this idea that medical intervention would leave me numb, emotionless, would make me a different person. After all, Remeron had really not worked for me as a teenager. I was taking it to stimulate my appetite and treat depression when I was recovering from/struggling with a serious eating disorder. I didn't like the way I felt on it, disconnected from myself. It didn't occur to me at thirteen, fourteen that finding the right medications and doses is a process, and usually a frustrating one. I just thought, didn't work, not trying that again. After stopping them cold turkey without telling my doctor (a big mistake, I now know), I randomly decided to take one again when I was particularly deep in it. Also, a big mistake. No one had told me you shouldn't just stop taking medications or start retaking them suddenly.
The psychotherapist I'd been assigned after a stint in a teen pysch ward also really didn't work for me. We didn't connect. I found her condescending. She talked to me like a child (which, of course, I was, but the last thing I wanted at fourteen). So, just like with the antidepressant, I thought, this doesn't work for me. I didn't realize that finding the right therapist can also be a long and frustrating process and that you're not going to connect with everyone. That doesn't make you or the therapy a failure.
I sought no help for years. Tried that, not for me, I thought. I was convinced I needed to handle things on my own. I couldn't. After struggling for years, I found a therapist with whom I developed a good relationship. She suggested medication but I was wary of that. I resisted for months. Finally, a manic episode led me to calling her in crisis one day and, after talking me through it and encouraging me to go home to my parents' house for a few days to recuperate, she said, "I think it's time for medication."
She connected me to a psychiatrist, who prescribed me antidepressants, anti-anxiety meds, and Lorazepam for emergencies. Slowly, we got me up to a dosage that seemed to work. I rarely needed the Lorazepam, though did take it a few times when I felt a panic attack coming on. After a while, things seemed to get better, the pain was more dull, the thoughts quieted, the panic slowed. We stayed the course for a while.
Two years later, my therapist was moving. Things seemed stable. I decided I didn't want a referral, to go through the process of finding someone new. For three years, the only mental health care I received was occasional 30 minute med check-ins with my psychiatrist. A lot happened in that time. My mom sustained a traumatic brain injury, I had an ectopic pregnancy that nearly killed me, I got married. Finally, things seemed to be looking up. My new husband and I were looking at houses. We were good. I told my psychiatrist I wanted to go off my meds. We weaned me off them slowly, but, once I was totally medication-free, I fell into a deep depression pretty much immediately. My psychiatrist had also warned me I'd feel like I had the flu for a few weeks. It was more like six months. I felt sluggish, detached, fragile. But I didn't want to admit I very clearly needed medication. I wanted to prove I could go it alone, to prove I didn't need to rely on drugs for the rest of my life. I tried St. John's Wort; it helped a little, but felt like a Band-aid on a bullet wound.
It took me another six months or so to come to the realization that, not only did I need to go back on antidepressants and anti-anxiety meds, and that I also needed to get back in regular psychotherapy. My psychiatrist referred me to someone who would turn out to be the perfect match. Slowly, we got me back on medications. She also prescribed a new emergency med, Alprazolam. Then, a bunch of other stuff happened: we bought a house, I tried to talk to my mom about her drinking, which didn't go well and meant I rarely saw my parents anymore, I started grad school, my husband and I separated for a few weeks then reunited. Panic attacks and sobbing for hours for no clear reason became a problem. We went to couples' therapy. My therapist recommended I start psychoanalysis three or four times a week. A series of manic episodes, one that lasted two weeks finally resulting in a bipolar diagnosis. I took the Alpazolam a few times to quell panic attacks during that two-week manic episode. I hated the way I felt on them, the way I was so dependent on them after just a few pills. After my most severe manic episode, during which my husband told our therapist and me, "I can't take this," my psychiatrist decided to make some medication adjustments. Add a mood stabilizer, up the anti-anxiety meds, try a new antidepressant.
Anyone who's ever dealt with the months-long trial-and-error process of medication adjustments knows it's a real bitch. Regular check-ins; this isn't working, that needs to be changed. How are you feeling? Any side effects? Wondering whether my emotions are the bipolar disorder or the drugs, blaming myself for feeling despondent, exhausted, unfocused. Is it too much or not enough? My psychiatrist, though generally helpful, would often ask me what I thought I needed, which would frustrate me, because wasn't she the doctor? Wasn't she supposed to know? After all, I was the one who'd thought I could go off my meds completely. What the hell did I know??
I told both my therapist and my psychiatrist that all these meds, several of which warned about drowsiness and operating heavy machinery, were exhausting me. I felt totally drained. I could barely keep my eyes open on the hour-long drive to therapy three days a week. One morning, after an early morning session, I fell asleep at the wheel, and hit a bridge, totaling my Nissan Rogue. Thankfully, no one was hurt. We adjusted my meds again.
Recently, after five years of intense therapy and two years of psychoanalysis, my therapist and I decided to call it quits. Things are going quite well, I haven't had an episode in over a year, and besides, I don't really have the time for it anymore, with three jobs and a book in the works (OK, four, but who's counting?). It seemed a natural sunset to this time.
A few weeks after ending therapy, I met with my psychiatrist for an overdue check-in. As I filled her in on what had been happening in my life, she was impressed. Have you experienced any manic or depressive episodes in the last six months? No. Are you active, physically and mentally? Yes. How are things going with your marriage? Great (6 years married tomorrow, 12 together, and the pandemic brought us closer together)! She said it was an excellent report, then brought up something I hadn't thought about but realized was a small worry at the back of my mind. Did I want to reduce any medications?
My first instinct was that this was a good idea. Things seemed good, and I didn't want to rely on meds forever. But, then I thought of the last time we tried this, how immediately shittier everything got, how hard it was, how I felt like I couldn't admit defeat and say that I really needed more support. "Not right now," I told her. I explained I was apprehensive of falling back into old patterns, and things seemed to be working, so let's stay the course for a while. We'll revisit the issue that next time we meet, later in the fall. She called the decision sensible.
While I hope to not be dependent on medications for the rest of my life, the reality is that I may be. That it's not weak to admit you need support. That part of the reason I'm doing so well may actually be some of that support. That I'm also going into potential danger with publishing my book and shaking up people's perceptions of me, certain relationships, and that maybe ending therapy and going off meds all at once might make that harder. That maybe it's not a great time to make those changes. Despite the (slowly) shifting perception related to mental health and social-emotional needs, taking antidepressants, anti-anxiety meds, or mood stabilizers is still highly stigmatized. When people asked me what happened when I crashed my car, I was embarrassed to say, "Well, I'm bipolar and on all kinds of shit that makes me super sleepy..." But what if that was OK to say? What if taking an antidepressant was seen as no different than an Advil, something you need to help you get through pain? Maybe my saying I plan on being on these medications for a while will help someone who needs to know that that's OK.