I’ve spent much of my mental health posts discussing symptoms, treatments, breaking stigma, and ways to ask for or offer help. What I’ve been reluctant to address because there is so much stigma-and yes, many pitfalls- are psychiatric medications to treat conditions like bipolar disorder and depression. I am a firm believer in medication, when it is warranted. I don’t believe that everyone who experiences a depressive bout for a couple of weeks needs to rush out and ask for a prescription. These medications can come with a slew of unsavory side effects and they can also be very expensive, so unless your depression is more long term clinical as opposed to short term situational, I’ll promote talk therapy and other therapies over medication every time.
However, if you’ve tried therapy and time has passed and you are still not feeling better, it *may* be time to discuss medications with your doctor. Doctors can give you a thumbnail sketch of what side effects are common, to their knowledge, and pharmacies can give you a three page handout on every possible side effect, but if you really want to know what a medication is like…ask someone who has taken it. Just remember we’re all different and respond differently so don’t write off a medication just because your friend’s cousin’s German Shephard had a bad experience with it.
Bipolar disorder is something that almost always requires a medication to stabilize the mood swings, whether you are axis one, two, or three. The extreme swings of mood can be disruptive and sometimes dangerous. There are many options for mood stabilization these days, but for brevity’s sake, I will cover the three I’ve had personal experience with.
1.) Lithium- 100% effective once you find your proper therapeutic dose. Downside, numb affect, weight gain, nausea, inability to cry even when sad, sometimes I threw up after taking it, and I never knew if it was going to make me groggy enough to need a nap. I took it on and off for over ten years but after my daughter was born and she asked me why I was throwing up every other day, I knew I needed a different medication.
2.) Lamictal- An anti seizure med, very effective for me, with no side effects. There is a rare but very serious rash that can occur during the first few weeks of treatment but if you don’t develop that, it’s pretty much smooth sailing in my experience.
3.) Seroquel- I did not have a good experience with this even in small doses but I have a friend who credits it with basically saving her sanity. I include it for this reason. I found it overly sedating, it made my thoughts foggy, and the weight gain was terrible even with diet changes. It also has the awful side effect after long term use of tardive dyskinisia, which are uncontrollable twitches and muscle movements that often do not go away, you’re just maimed for life. They have treatments for it now, but they are new and efficacy in the long term is questionable. I still have minor TD from using Seroquel as a sleep med for 6 years. I would not take it again if you paid me. But again, my friend and thousands of others have had a different experience, so never close your mind.
Antidepressants for depression are plentiful and I’d need a hundred bullet points just to cover the variants that have been released in the last 30 years. Again, to keep it shorter, I will mention a few that are likely common to your knowledge simply because they’ve been out for so long.
1.) Prozac- very effective, very few side effects, the one ‘go to’ medication I’ve been on off and on for twenty five years.
2.) Zoloft- very effective for many but it failed me at higher doses and left me feeling drugged, groggy, and just sluggish. Others have found it a wonder drug.
3.) Effexor- Excellent medication for depression. WORST drug ever to come off of cold turkey. I went through that back in the 90’s before the med establishment recognized that antidepressants cause withdrawal side effects and I was hallucinating and sleeping with a knife under my pillow. My doctor told me it wasn’t the med removal. The doctor on call said my doctor was a moron and it absolutely was cold turkey quitting of Effexor.
Moral of number three- be aware that no matter what your doctor or the literature says, your body may respond to going off antidepressants with symptoms of withdrawal from a drug. It is very common, it can be very disconcerting and scary, but tapering off can help make it less awful, If your doctor won’t taper you off, insist they do so or get a new doctor. I was put through Prozac withdrawal awhile back by an inexperienced psych nurse and it was A NIGHTMARE.
Newer meds that may not be as well known yet are even more effective:
1.) Cymbalta- few side effects, but wicked withdrawal even tapering off
2.) Abilify- decent med, but akathisia (inability to quit moving) can occur
3.) Lexapro- very effective for many, but again, akathisia may occur.
I could go on and on about the options, but honestly, it’s entirely up to the doctor and the client. Never be afraid to ask a doctor about a medication. Ask what the starting dose is, what the maximum dose is, what side effects are common, what might not be as common. Ask questions. If you read about a medication you’d like to try, do your research then ask the doctor if it might be right for you to try. Don’t be afraid to advocate for yourself and ask questions and express interest in trying something older or newer, depending on your own individual needs and reactions. If a medication works but causes too many side effects, asking to try something different is not being too demanding. Speak up.
Too few people realize that they have the option of speaking up and saying, hey, this medication makes me too groggy to function, can we try X instead?
Medicating mental health issues, especially if they’re not chronic and maybe you just need short term treatment, is a very personal private decision. It should never be swayed by stigma or what others think of you. You should never read something online and think, oh, cool, it worked for them, it will work for me. My experience has been that my reactions are usually in the 0.1% of rare side effects so I offer only examples of medications that have helped me. I offer no promotion for any specific medication. I even understand people who loathe the idea of medication. I just know from experience that if help is out there, you owe it to yourself to at least give yourself that opportunity to feel better.
Outside of chronic mental health diagnoses like bipolar disorder, schizophrenia, etc, many people only need to take an anti depressant 4-12 months, then can wean off of it. So don’t think needing a little help for a few months means being on medication the rest of your life. It’s just a lifeline to help you get across a bridge and to the other side.