In which I attempt to analyse why we resist taking psychiatric drugs, but suggest that for all their evils, they’re the least worst treatment option for serious endogenous mood disorders.
My reluctant recommendation, if you’re diagnosed bipolar is that you accept the need for a pharmacological treatment, that you very systematically track each drug you take, and carefully assess its effects, and communicate those effects as clearly and decisively as you can to your psychiatrist. Before insisting on a different regimen, you should be clear in your own mind that you have properly assessed that drug after taking it as prescribed. But once you have properly assessed it and found it wanting, don’t hesitate to insist on a change, unless your psychiatrist can offer clear and persuasive reasons for persisting.
The horrible truth is that it can take years to find the right combination of pills to stabilise, and this is the only way – slow and painstaking and terribly hard – to find that combination.
Let me address some of the reasons why you (and I) may resist this conclusion, and let me suggest why I think we should set aside that resistance. I’m writing this because I have suffered enormously for close on 30 years, and have been enormously resistant myself to pharmacological treatment at times. If I can possibly ease the way for anyone else avoiding such trials, I’d like to do that.
Of course there are non-medical remedies for some forms of depression that can and do work – exercise, yoga, good sleeping habits, eating well… and psycho-therapy when there are real psychosocial problems, such as bad relationships or stressful environments or a history of abuse, that must be sorted out. But bipolar depression goes far beyond the reach of those remedies.
Thoughts about adherence and ‘taking drugs’
Adherence means, ‘are you taking your pills as prescribed?’ Most doctors talk about ‘compliance’ which sounds rather more authoritarian. I prefer the term ‘adherence’, which I learned during my time as an HIV journalist. Since psychiatrists are often ‘power-hungry maniacs’ (I’m quoting a friend who is a highly qualified pharmacologist) you may hear the word ‘compliance’ from them more often, though in my experience, it’s rare to encounter a psychiatrist who even begins to understand that a patient of theirs might not follow their prescription to the letter – none has ever asked me whether I find it easy to adhere to the meds they prescribe.
Many of us are resistant to the notion that our state of mind can be eased or repaired by taking the right combination of pills. There are a number of reasons for this, I think, and I’d like to explore them a little here. I want to do this in case you’re someone who is reading this thinking, ‘I’m depressed, but I want to fix this without taking the pills.’
If you’re only mildly depressed, if what I’ve described above sounds far more extreme than your own experience, then yes, it may well be the case that getting your sleep right, exercising and eating well, and sorting out any unaddressed sources of psychosocial distress (such as relationship problems) may do the trick. But if your depression is more severe, if it cannot be traced to simple external causes, if your diagnosis is somewhere on the bipolar spectrum, then it may well be that the only thing that will work for you is the right combination of pills.
A friend of mine who is prone to depression relates that her doctor is fond of pointing out that in our culture, we’re happy to treat major disorders of most organs with pills, and that there’s no logical reason why the brain should be an exception. (Here’s a reminder that severe depression is a physical illness.)
So why do we resist?
Taking pills to affect our minds and moods is different to taking pills to treat other parts of our body because our minds are far more intimately related to our sense of self than, say, our heart or stomach. It’s one thing to take a pill to deal with indigestion, quite another to take a pill that’s designed to affect our thoughts and feelings. There’s no way around this really, other than to understand it as a possible source of resistance, and remember that of course, any medicine we take, no matter where it’s targeted, finds its way into every part of our bodies.
We don’t always trust Western medicine or psychiatrists. I’m very sympathetic to this one, as I describe here… There are many reasons to be cautious about Western medicine, and psychiatric medicine, as there’s evidence pharmaceutical companies have manipulated many drugs trials. These problems notwithstanding, Western medicine is still extremely good at some things. The trick is trying to create the conditions in which it is good, such as making sure that you read up and find out as much as possible about your own illness. The terrible truth is that many psychiatric problems are very poorly understand and their treatment remains a hit or miss affair, despite our culture of scientific triumphalism. We maximise the treatment hits by being persistent and systematic, as I’ve suggested above. This may take years to get right, and yet it is still worth persisting. There are documented case studies of people who have taken 25 years to find the right treatment… but have found it in the end, and rebuilt their lives. As I write this, I hope I will be one of them, but that remains to be seen.
We’ve started taking the pills, but stop or are erratic, either for the reasons described above, or because you simply forget to take them, or are experiencing side effects that you hate. The thing is, if you have taken the plunge and are taking the meds, it’s probably best to do so properly, and avoid erratic consumption. This is because in some cases, the efficacy of some of these medicines may be reduced by erratic use, and you may need them again. Also, if you take them properly, you can be sure you’re doing the right thing if you need to switch.