Medication and Mental Health

The world of using medication to treat mental health problems is a bit of a new one for me because despite suffering from multiple mental health problems for a number of years, I have only taken medication for the past 10 months.  However, the issue of medication to treat mental health problems is one that has long played on my mind and I would like to share some of my views on it based upon my own experiences.

In my experience, medication is prescribed very readily to treat mental health problems.  Most people I know who have presented at their GP with depression or anxiety for the first time came to find that the first option they were given was to start taking antidepressants.  More often than not, this was the only option they were given.  For some people, this option is well suited to them.  In a way it makes sense and is very familiar.  If we have a physical illness of any kind, we are incredibly used to following the process of going to the doctors and getting some medication to make it better.  What I think is often overlooked though is the fact that no medication can cure a mental illness, it can only treat or lessen the symptoms.  Depression, for example, causes a chemical imbalance in the brain and antidepressants are designed to correct the imbalance.  They will not however treat what may have triggered or caused the person's depression.  Some people find that when they come off the medication, their mental health problem comes back as the underlying issues have not been resolved.

What I find worrying is that so many people, including young people, are packed off home with some pills that they are told will make them feel better without being informed of other options that may help them.  Sometimes making some simple lifestyle changes can make a surprising difference to a person's mental health.  If you are suffering from stress, it may be a case that you are simply doing too much and no pill is going to change that.  It is worth considering what may have caused a deterioration in your mental health.  Perhaps it has been a particularly stressful time for you - for example, suffering a bereavement, a relationship breakdown or being under considerable financial strain.  In these cases, a lot of people often feel what they need more than anything is to talk and so counselling could be a good option.  So often people can get so caught up in thinking about what's wrong with them rather than thinking about what happened to them.  As a CPTSD patient, I was reminded once that no medication would ever change the traumatic things that happened to me and I think that is a very important thing to remember.

I am not saying that medication is never the right option.  I know that medication can transform people's lives, especially those who suffer from severe mental health problems.  Truly, taking medication transformed my life but more I'd say, it helped me to transform my life more so than anything had done in the past.  The point I'm making is that medication should be a last resort, not the first one.  A person should try to make lifestyle changes and engage in talking therapy before being offered medication and if they decide to take medication, they should continue these other efforts alongside.  I know from experience that sometimes a person's symptoms can become so severe and overwhelming that they almost prevent them from being able to engage effectively in psychotherapy and in this case medication can become an appropriate option.

My Medication Story

A year ago, if you were to tell me that I would be taking medication three times a day, I would have said not in a million years! In fact, I developed a bit of reputation within the mental health services for being a notorious medication refuser! This refusal did not just revolve around mental health related medication, it extended to all forms of medication.  Even as a child, I would refuse to take medicine if I was ill.  I wouldn't even take a painkiller despite suffering a number of sports injuries over the years.  You could have gone as far as saying that I was phobic of medication.

I bet the question you're asking yourself right now is why?  So I'll try to explain...

Part of it, particularly refusing pain relief, was a form of self punishment or self harm.  Due to the trauma I suffered in the past, I saw my body as disgusting and defective, I felt as though I deserved to experience pain.  Having grown up with an alcoholic parent and coming from an extended family of addicts, I became very afraid and avoidant of anything I could potentially become addicted to.  To date, I have never even had a cup of tea or coffee purely for this reason!  This fear extended to medication, I was afraid of any medication that was potentially addictive.  The main reason why I wouldn't take medication though was linked to my eating disorder.  It was definitely a control thing.  I would not want to take a type of medication if there was any chance at all that it could cause me to put on weight - even if there was only a one percent chance.  I wanted to be in complete control of everything that went into my body and taking medication felt like handing control over to something else and that felt very scary.

This fear of medication did not bode well for me in the mental health services.  For a long time, I was absolutely determined to beat my mental health problems without turning to medication.  As far as I was concerned, it was not through taking substances that my mind ended up in the state it was in so I was not going to rely on substances to get me out of it.  To be honest, I think I did have a point.  The problem was that my symptoms were so severe and overwhelming that it became almost impossible for me to engage and benefit from the therapy I was receiving.  My mind was so chaotic that my head was rarely in a place to think clearly enough to make changes.  I was so overwhelmed by my symptoms that I was continually in a state of crisis and preoccupied with taking my life.

In light of the severity of the mental health problems I suffered from, it got to the point on a number of occasions that I was facing sectioning purely because of my refusal to take medication when I was such a high risk to myself.  It pains me to say this but unfortunately, even with the threat of sectioning hanging over me - the risk of losing everything, I still wouldn't take medication.  My feelings towards medication started to change though.  I started to come to the conclusion that taking medication would actually be the best thing for me.  It felt as though everything I was trying to help me recover wasn't working and medication was something I hadn't tried.  When in the midst of a dissociative episode in which I was hearing voices and completely consumed by suicidal thoughts, what I would have done to grab anything to make it stop but I still refused.  I knew taking medication was in my best interest and I actually wanted to take it but felt prevented by the fears I spoke about earlier.  I was so frustrated with myself.  In hindsight, what I realise now is that what all my fears surrounding medication really boiled down to was that I was afraid of getting better.  I often think that my anorexia represents the part of me that is afraid of getting better.  I have suffered from mental illness for such a large proportion of my life and I hated it but it was all I knew, it was familiar.

What changed my mind?  I don't know completely but it was one of the best decisions I ever made.

Having confronted crisis after crisis and eventually landing myself in inpatient care, having watched my life fall apart around me, somewhere in the chaos I came to an important realisation.  I came out of hospital and despite continuing to refuse medication, I had decided on something important - I wanted to live.  When I came out of hospital, I was still in a complete and utter mess and so easily could have ended up in the same place I was again or worse!  I can't explain why but one evening, I had a moment of clarity and it changed so much.  I had a moment of quiet and relief from the chaos of my symptoms and in that moment I realised that my life was worth fighting for and that I would do anything to go out and get it, even if that meant doing things that I was afraid of or seemed impossible.  

That was it.  I went home that evening and for the first time in my life, I took a sleeping tablet.  The next day I rang my community mental health team and completely shocked them when I told them that I wanted to have medication prescribed.  If there's one thing I've found out about myself through all this, it's that I am very determined, once I set my mind on something, I make it happen.  

I never looked back.

I'm not saying that medication solved all my problems because it didn't but it did lessened some of my symptoms which helped me to engage better in therapy and focus on my recovery.

Things you should know about medication:

They have side effects

Your doctor should explain these although mine certainly didn't!  The side effects will be outlined in the leaflet that comes with the medication so it is worth reading.  When you first start taking medication, it is likely that you will experience some side effects,  These will differ from person to person but it is basically just a case of your body adjusting to the medication.  Unlucky for me, I had just about every side effect possible and felt extremely ill.  The first day I took it, I became extremely paranoid, anxious and was seeing things climbing up the walls.  I had quite an extreme reaction but I know it is not the same for everyone so don't be put off.  I'm actually very surprised I stuck it out and carried on taking the tablets because the side effects were so bad for the first two weeks.  I'm really glad I did though and the side effects will wear off eventually.  It is worth noting though that medication can have bad side effects at first.  There is no way I would have been able to work while experiencing those side effects and it was important to have family around me to make sure I was safe.  It's just a case of bearing these things in mind and working around them.  For example, I decided to increase my medication during a holiday so that if I was to experience side effects, it wouldn't interfere with my work. Some side effects will stay.  The side effects of my medication are that I usually get an attack of nausea and dizziness once a day and I am a bit more sensitive to sunlight.  For me, this is manageable and the benefits of taking the medication outweigh the side effects.  If the side effects feel unbearable or unmanageable then it is worth speaking to your doctor and changing to another medication.  Sometimes it can take a while to find the medication that is right for you.  I was quite lucky on that front!

Some take time to work

There are some medications that are designed to take effect immediately.  I know of some medications that are prescribed to people who are suffering from anxiety that will offer some relief from their symptoms almost instantly.  In the case of antidepressants though, most will take a number of weeks until you notice any improvement.  Mine took nine weeks before I saw any significant improvement. You have to be a bit patient which is hard if you are feeling very overwhelmed by your mental health problems and are desperate for some relief.  You almost just have to keep telling yourself that it will be worth it in the end.

Some mental health problems are very resistant to medication

I just so happen to suffer from one of them.  Borderline personality disorder has been found to be very resistant to medication - even mood stabilisers which are seen to have a dramatic affect on patients with bipolar disorder are found to have little impact on the extreme fluctuations in mood that many people with BPD suffer from.  Personality disorders are generally said to be so ingrained in the make up of the person and the way in which they perceive themselves and the world that many of the symptoms are naturally very resistant to medication.  I have found this myself.  I take antidepressants and that seems to stop my mood hitting such an extreme low that I become suicidal however my mood does still fluctuate in a very extreme manner and so my world is still very chaotic.  It's clear that medication can help with some of the symptoms though, you just can't expect it to be the answer to all your problems.

Tips for Taking Medication:

Know what you're taking

This is an important one.  You should know what you are putting into your body, how the medication will work and what you should expect from it.  You should know what the side effects of taking the medication will be both in the short term and the long term.  For example, some medication can affect your fertility.  Others, such as a number of antipsychotics, are known to induce significant weight gain.  You should always feel comfortable with taking the medication you are prescribed.  Do not let your doctor prescribe you anything that you do not want to take or have serious doubts about.  At the end of the day, you are the one who is going to have to take the medication so you need to find something that you are both comfortable with.

Don't let the side effects put you off

I've spoken about this a fair bit already but it's important when you start taking medication to try to focus on the bigger picture.  Hold onto the fact that the side effects will wear off eventually and you will notice some improvement.

Make sure you are working on your recovery in other ways

It is important with mental health problems not to completely rely on medication to make you feel better.  Recovery is not just about taking medication, there are so many other things you can do that can help you.  I'm hoping to write another blog post soon about how lifestyle changes can improve your mental health.  There are also so many self-help books and online resources which can be helpful.

Don't suddenly stop taking your medication

You should always seek advice from a medical professional first if you want to stop taking your medication.  If you stop taking your medication completely all of a sudden, it can be a great risk to your health.  Some medications have withdrawal symptoms and so you have to be weened off them slowly.

Don't stop taking your medication if you think it isn't working

I know this is a reason why a lot of people will taking their medication.  It is a bit of a logical response - if something doesn't seem to be doing you any good why would you want to carry on taking it?  It may be though that you need to be on a higher dose or another type of medication would suit you better.  That's why it's always the safer option to talk to your doctor rather than stopping altogether.  You can build up tolerance to some medications so sometimes you do need to have your dosage increased or change to something else if you've been on it a long time.  What I would say from experience though is that sometimes it's not always that your medication has stopped working, it's more that you've got used to the feeling of being on it.

Don't stop taking your medication as soon as you start feeling better

This is almost like the other extreme but also another trap that I've heard of people falling into.  When you start feeling better, you can start thinking to yourself - why am I taking medication when I'm not ill anymore?  You might also question whether you were ever ill in the first place.  A lot of people who decide to stop taking their medication for this reason often find that they are indeed fine for a while but then the same problem comes back again.  Generally doctors will recommend that you stay on antidepressants for at least 6 months even if your symptoms improve significantly.  It can be more helpful to think along the lines of - well I feel fine but carrying on taking it for a few more months won't do me any harm.

Don't take medication on an empty stomach

This one is probably more aimed at people with eating disorders although is also relevant to anyone really.  I learnt the hard way with this one - taking medication without having eaten for a number of hours can make you feel very unwell.  I'm not exactly sure why but I think eating and drinking helps the medication to be absorbed better.  I always try to plan my meal times around taking my medication and I do feel better for it.

Be organised - don't forget to take it and don't run out!

Funnily enough, despite never taking medication for the majority of life, now that I do, I have no trouble remembering to do so.  I take comfort in routine and once I set my mind to do something I just seem to do it so I find it easy to remember to take my medication.  Having a 7 day pill box can help though, especially when you have to take multiple medications.  I know some people can really struggle to remember to take medication though.  I have to admit, I do find it more difficult on a really busy working day.  I've heard that setting alarms on your phone can be really helpful.  Making sure that you order in your prescriptions on time is another thing that you have to keep on top of.  Running out of medication can be a nightmare and dangerous for your health if you have to go some days without taking anything at all.  My surgery has an online system to order prescriptions which is really helpful because as soon as you remember, you can order it straight away wherever you are at the time.  Whenever I collect my prescription, the first thing I do is calculate when I'm going to run out and set a reminder on my phone calendar to order my next lot a week before I run out.

Once you have a bit of a system, these things can become hassle-free.

I hope you have found some of the things I've suggested helpful if you do take medication and interesting even if you don't.

Love and Strength,

The One Day Seeker.