Living with mental illness: The question of therapy or tablets (or both)

Mental health blogger Fiona Kennedy talks about the balance of therapy and medication for mental illness

We get sick (of the non-viral variety), we’re prescribed an antibiotic, and with a bit of luck and a few days rest we’ll generally start feeling a lot more like ourselves again. For more chronic conditions, like diabetes, asthma, thyroid disorders, etc, some form of medication in conjunction with lifestyle changes tends to bring about quantifiable improvement. But what about medication for disorders that don’t show up in a blood test or an x-ray? Specifically, what about medication for mental health difficulties?

This is a really tricky one. I’ve lost count of the various medications or combinations thereof I’ve tried over the years, each with varying levels of success. Here’s what makes it really difficult though – how do you measure the success of an anti-depressant or anti-psychotic medication? Does improved mood mean that the medication is working and actively alleviating the problem? Or does our mood improve because the medication puts a buffer between us and our more difficult emotions? Is it solving the difficulty or masking it?

Some would argue that psychiatric medications are a central part of managing a chronic mental health difficulty, others would say they cause more problems than they solve. I’ve swung from one side of the argument to the other over the years, and at the moment am stranded somewhere in the middle. I’m no expert, what I know about these drugs comes mainly from personal experience of having taken them, stopped them (both cold turkey and under guidance) started them again, switched to alternatives, introduced a second one... It’s been complicated.

One thing I can say for sure is that none of them come without side effects. Each and every one has led to some delightful complications for me - drenching night sweats that require me getting up to change during the night, sometimes more than once, weight gain, constipation, and skin breakouts, to name but a few.

When I’ve brought these things up at medication reviews they’re regarded as the lesser of two evils that can be countered by other medications. This is all well and good but medication to treat the side effects of medication? Necessary at times perhaps, but I’d sooner it wasn’t.

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Having said all that, it has served a purpose in my life. Yes, there was a lot of work I needed to do with a therapist initially, and more recently, with a clinical psychologist, but I’m not sure I could have managed that work had I not been taking the medication. It stabilised me enough to allow me to see where the problems are, and start proactively taking steps to manage those problems.

However, I now find myself in an interesting position. I’ve reached a point where I can reasonably consider reducing the level of medication I’m taking. I don’t like the sedating effect it has on me, and I’m curious as to whether I’ve learned enough to be able to take care of myself by myself, without the crutch. But there’s a pretty big catch – stopping psychiatric medication too quickly is almost guaranteed to trigger a relapse, and even when reducing slowly, and under medical guidance, there can be fallout.

I recently started reducing one of my medications by a very small amount that shouldn’t really have been noticeable, but it was. I didn’t connect the two at first but after a week of struggling with bone crushing tiredness I asked Google, and it turns out that extreme fatigue is quite common when reducing this particular drug.

The problem with my being so tired meant that all the self-compassionate work I’ve been doing went right out the window because I simply didn’t have the energy to do it, and so my mood dropped quite significantly. Was it because I’m not well enough to reduce yet, or was it caused by the reduction?

When this has happened with other drugs in the past, I’ve tended to panic and revert to the original dose, believing I wasn’t yet well enough to start tapering. What if that wasn’t the case though? What if it wasn’t the start of a relapse, but simply my brain and body adjusting to having less of a chemical that I’ve become reliant on?

Image: Shutterstock

I’m not advocating for or against medication, I don’t know enough to stand on either side of the fence with conviction. I have a healthy, if grudging and sometimes slightly resentful, respect for it. However, it should be treated with caution, and I really do believe that people need to be given more information as to how it actually works before committing to taking it, as well as what the withdrawal process may involve.

Everyone needs to make their own choice, taking into account personal circumstances, available sources of support and advice given. I have recently come to feel it’s a bit of a chicken and egg situation though. Yes, I needed the medication to stabilise me until I could access appropriate support, but I wonder – had that support been available at the get go, would I have needed medication at all?

It’s such a complicated subject, and goes so much further than the question of whether or not to medicate. It’s linked in with our whole attitude to and understanding of mental health and mental illness, and operates within an out-dated and under resourced mental health service. In an ideal world, everyone would be offered therapy as a first port of call, not medication. In an ideal world, we’d also be able to acknowledge our difficulties before we reach crisis point, but we’re a long way from that conversation being commonplace yet.

Right now I’m taking medication, and will continue to do so until I feel I have developed the skills to both tolerate the withdrawal, and manage my mental well-being without it. I no longer believe that I will need it for the rest of my life, and there’s huge freedom in that. I also know however, that should the time come in the future when I simply cannot cope despite every effort I make, then I would be willing to consider medication again, with the caveat being that therapy has to happen first.

I wouldn't take an antibiotic unless I really needed it, because long term it could do me more harm than good. Why should psychiatric medication be treated any differently?

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Fiona Kennedy writes regularly about mental health issues on her blog sunnyspellsandscatteredshowers.org. You can also find her on Facebook and Twitter

If you are affected by any of the issues raised in this article you can contact Samaritans free any time from any phone on 116 123 or visit www.samaritans.ie to find details of your nearest branch. You can also find online information at www.yourmentalhealth.ie