Mental health medication: is it always A Bad Thing?

Mental health medication: is it always A Bad Thing?

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image‘So when can you come off your medication, now you’re feeling so much better?’, someone asked me recently.
‘Well…um, never,’ I replied.
‘It’d be good if you could come off it at some point,’ they said.
‘But I’ll always have bipolar – why would I want to do that?’ I said, trying hard to keep my cool.

I know such questions are asked out of concern and kindness – with a bit of misunderstanding thrown in – but they still get me thinking, ‘Will I always have to explain this?’

Such conversations remind me of how people with conditions like mine (I have mixed affective state, a type of bipolar) still have so much further to go to proper understanding. And one of the big areas that needs to be talked about is medication.

Jennifer Lawrence, who won Best Actress at the Oscars for her role in Silver Linings Playbook (a film about bipolar and mental health), recently said: “It’s just so bizarre how in this world if you have asthma, you take asthma medication. If you have diabetes, you take diabetes medication. But as soon as you have to take medicine for your mind, it’s such a stigma behind it.”

I think I might write this on a postcard, laminate it and dole it out when I’m spent for explanations and ready to tear my hair out.

I think I’ll be handing it out a lot, and it’ll have to be laminated because I’m sure some people will want to tear it up in front of me as I warble on about why I agree with this view. That’s if responses to Rachel Whitehead’s recent article are anything to go by.

Rachel, who works in the Rethink Mental Illness press office, wrote a thought-provoking article in The Independent recently about the demonisation of mental health medication.

“What I find worrying,” she says, “is the automatic assumption that a rise in prescriptions, or someone taking medication for a number of years, is necessarily A Bad Thing.

“Medication for mental illness can save lives and give people the stability they need to survive. That may be for a few months, it may be years. While no one wants to be on any kind of medication unnecessarily, for some people, it’s the best option.”

It seems her article has opened floodgates, with one person accusing her of proffering a ‘pro disease model and pro the pharmaceutical industry’, saying that psychiatry, which prescribes these drugs, is based on ‘fear, fraud and force’ rather than ‘health or ‘cures”.

However, others agree with her. One says, ‘I’m so fed up [with] the anti-medication brigade out there’ and another concurs, saying, ‘This medication works for me…I have struggled with this diagnosis for the best part of my life and there were many people telling me not to take [it]…It’s easy to talk for those who have no idea of the suffering of the condition.’

I agree with this. I went on meds after years of ‘talking therapies’ failed to do the trick. Talking therapies definitely have their place – few people seem to dispute that. But drugs have their place, too.

For me, these drugs have been truly health-restoring and life-changing. Of course, these are my views and my experiences. I completely accept that others probably have different ones.

However, it seems to me that if mental health drugs work for you it’s verboden to say so. I want to challenge that (and no, I am not being funded by the pharmaceutical industry) – the enduring view that psychiatric drugs are all ‘bad’ is the stuff that stigma is made of.

It seems it’s permissible to stand up and say, ‘These drugs gave me hideous side-effects and didn’t work for me’, but somehow contemptible and collusive (and suggestive of being ‘in the hands’ of the pharmaceutical companies) to say the opposite, to say, ‘They really helped’.

Why not be allowed to say medication has worked for you without it being implied you’re some kind of misguided prescription junkie?

Listen, I’m not saying mental health drugs are always appropriate – for example, they may be more helpful where there’s a clearcut biological basis like bipolar or psychosis than for other mental health issues.

And I’m not saying my drugs are perfect. How can they be? I would imagine there are very few drugs that have no side-effects. Mine have plenty.

For starters, I now live a ‘Cinderella life’. Every day at 7pm, without fail, an alarm goes off on my mobile and the word ‘Meds’ flashes up, and I know that within two hours of taking said medication, I have to drop what I’m doing and run before I hit the decks (the drugs make me so drowsy you could poke me in the eye with a stick and I think I’d just roll over and snore).

If friends say, ‘Let’s meet up’, I’ll generally vote for an early rendezvous (note: mornings and afternoons are great…). If I take my drugs any later, I get a supreme ‘hangover’ the next day and feel like I’m wading through treacle until sunset allows me to sleep again.

I recently read that Carrie Fisher, actress and fellow bipolar gal, said of her daily drugs regime: “This constantly puts me in touch with the illness I have. I’m never quite allowed to be free of that for a day.”

This is how I feel, too. No matter what I’m doing, no matter how ‘normal’ the task or action I’m in the middle of, the alarm is like a bump back down to earth, reminding me that there’s something different about how I now live my life.

If I don’t take the drugs at all, I feel fine (presumably they have a half-life) but immediately have a shocking night’s sleep where my mind races and my fingers fidget with imaginary touch-typing or piano-playing. In other words, how it always was before meds.

I then worry this will set me on track for what I call a bipolar depressive ‘wobble’ (my drugs have also made me realise how I spent years sleeping fitfully, despite regular attempts at ‘sleep hygiene’).

The drugs also mean I’ve put on a bit of weight, and I can’t drink, smoke or have caffeine. I have to have quarterly ECGs because the drugs could cause prolonged QT intervals in my heart which could lead to my heart just stopping. I also have to have regular blood tests because the drugs are known to raise blood cholesterol which could put me at risk of heart disease. Oh, and I may get cataracts. Great.

I guess this is where the pharma critics find their fodder – ‘How can it be good that this woman is subject to all these side-effects?!’ I understand the anxiety. I also understand that prescribing can be about trial and error, and I can see why people – doctors as well as patients – find this unacceptable.

It’s true to say, too, that psychiatric meds have acquired something of a bad reputation over the years, partly due, it’s true, to inappropriate or indiscriminate use; for example, mass use of benzodiazepines in the 1970s, leading to addiction. Many people also feel that ADHD medications have been over-used in children, especially in the US.

As Dr Ian Drever, consultant psychiatrist at The Priory Woking, tells me: “In time-pressured NHS environments, prescribing a medication may be an easier and more readily-available solution than providing long-term and resource-heavy psychological work. So against that background, it’s possible to see how many people are wary of medication, and see any proponents of medication as being ‘in the pocket’ of big pharma.”

Last year Dr Ben Goldacre, author of The Guardian’s ‘Bad Science’ column, published Bad Pharma, a book in which he describes how there are serious ongoing problems in the pharmaceutical industry, in particular with clinical trials. He says important information from them is still being withheld from doctors and patients and that patients experience avoidable suffering and death as a consequence.

It goes without saying that this needs to change. Thank goodness Ben Goldacre, with his influential voice and dogged determination, is campaigning to do something about it.

But whilst it appears that challenging pharma companies in this way is vital for patient health and safety, it shouldn’t detract from the fact that some people, like me, appear to need medication and seem to benefit from it greatly.

I acknowledge that I was lucky that I found a medication and dose that appears to work for me pretty much straight away (I know many others aren’t so fortunate and take forever to get there, if at all). I’m also aware that the side-effects may come back to bite me in years to come.

In an ideal world it would be marvellous to find a drug that was side-effect free. And maybe, over the next few years, with more R&D by pharma companies who are well-placed to fund this, I may end up with one.

In the meantime, I feel it’s important to acknowledge, where appropriate, that for some people like me the drugs have affected me positively, too.

Before the drugs, I was up and down within the same day, or more precisely, within the same minute within the same hour within the same day. Mostly I was hideously depressed. I was sick and sad whilst also trying to mother, to work, to be a friend and to deal with difficult times. I feel I barely managed it. I don’t think it’s any exaggeration to say I felt like I was hurtling towards my own demise because I felt so unable to function effectively. I felt fractured and with no way of getting fixed, no matter how hard I tried.

And so, I may now be at risk of living a shorter life because of heart problems or other iatrogenic issues, but I’m hoping I’ll live longer than I would have done before meds because I am no longer feeling ill and broken.

It also means that I am better able to utilise therapy appointments because they are now constructive, working towards better ways of managing my condition – before, they were more about crisis intervention, with little space for true change.

Dr Drever, who specialises in depression, anxiety and addictions, says medication can “help to improve mood, or diminish anxiety, thus creating a foundation on which the psychological work can take place to maximum effect.” I agree – my meds and talking therapies are something of a ‘team’, facilitating wellness where talking alone was unsuccessful.

Even my daily 7pm alarum cry has started to become a welcomed interruption. It may be a reminder of my illness but it’s also a reminder of my wellness. It is constant proof that I have a diagnosis and am able to do something about it.

I’m actually one of the lucky ones, not a ‘poor sod’ who has been ‘dumped on medication’. I now have more constancy and stability in my life as a result of medication. In Rachel Whitehead’s words, meds for me haven’t been A Bad Thing.

If more people realised that they might just be a good thing, then maybe people would feel less freaked out by them and the stigma would start to fall away.

Now, where’s my laminating machine? I think I’m going to be busy…

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Freelance journalist and mental health blogger, based in London UK

15 Responses to “Mental health medication: is it always A Bad Thing?” Subscribe

  1. Julia March 5, 2013 at 6:03 pm #

    Thank you, so similar to my experience. Medication has made my life worth living. Took a long time and lots of side effects to find ones I am happier to live with. My alarms go at 8pm and 7:30am.
    I may produce my own laminated cards, my diabetes meds never get the same attention.
    I read Ben Goldacres book the day it was published on kindle, fantastic.

    • martharoberts69 March 7, 2013 at 9:00 pm #

      Julia, thanks so much for your response. I’m glad to hear from a fellow ‘alarmee’ (!) and I’m glad to hear that you’ve found some meds you’re happier to live with. Lol (and interesting) re your thoughts on laminated cards. Best, Martha

  2. Ruth Kirk March 5, 2013 at 6:33 pm #

    I have chronic agoraphobia, chronic depression, chronic eye disease, chronic migraine and chronic fatigue. Years of trial and error have shown that I can just about get by on 5mg of Citalopram daily. Less, and within a few days I have unbidden suicidal thoughts and frankly, life isn’t worth living. Thank goodness for Citalopram, is all I can say. XXXXXX

    • martharoberts69 March 7, 2013 at 9:03 pm #

      Hello Ruth, thanks so much for your message. It sounds like you’ve got so much to deal with – what a relief that you’ve found meds that seem to suit you. Trial and error seems to be a common theme, but I’m glad you got there. Take care, Martha

  3. Tom March 5, 2013 at 7:04 pm #

    I too have benefitted from meds. For 10 years I have suffered with a social anxiety disorder for which I have been taking propranolol for most of those 10 years in conjunction with having CBT. When I felt that this was not quite enough and I couldn’t shake it, 6 months on citalopram gave me the breathing space to get the right mental attitude to manage my anxiety. When I felt ready I came off the citalopram and am reviewing whether I am ready to come off the propranolol. I have been lucky to find meds that work for me and CBT alone would have been a long and tough struggle. I believe there is a place for them in conjunction with other therapies in helping to manage mental health issues. Many can’t be ‘cured’ though and medication is a tool of long term management.

    Very interesting and thought provoking piece.

    • martharoberts69 March 7, 2013 at 9:15 pm #

      Hi Tom, thanks for your response to the blog. I think the ‘breathing space to get the right mental attitude’ that you talk about is spot on. It’s like being able to step back and see the lay of the land (something that, for me, felt impossible pre-meds). Sounds like you have used meds and other therapies together really effectively and have benefited from both, which is fantastic. I think that for any of us, being open to a range of therapeutic options (whether they involve drugs, talking or something else) and being allowed to pursue these without being coerced or made to feel that they are ‘wrong’ is probably key to accepting that you’re not well and then, hopefully, ‘finding a way’ and eventually getting better. Best wishes, Martha

  4. Graeme March 5, 2013 at 7:58 pm #

    I know several people who have benefited from mental health medications.

    On the other hand I have worked as an investment analyst covering pharma companies, and I am very cynical about how them: in particular the effect of their very expensive marketing on the appropriateness of some use. The high level of ADHD prescriptions is a good example.

    Their R & D spending (not as much as it should be, and misdirected from the point of view of society as a whole) is another major issue.

    • martharoberts69 March 7, 2013 at 9:24 pm #

      Hi Graeme, thanks for your message. How interesting to hear about it from a different perspective. These are definitely aspects of mental health that need looking into further (a la Ben Goldacre and other influential voices) – inappropriate or excessive use of meds, where the way has been paved by expensive marketing, cannot be right. Disappointing, too (though not surprising) to hear about R&D spending. Will this ever change?
      I really appreciate your response. Best wishes, Martha

  5. lowridan March 5, 2013 at 8:05 pm #

    ” It may be a reminder of my illness but it’s also a reminder of my wellness”. You’ve nailed it. Really thought-provoking post, thank you

    • martharoberts69 March 7, 2013 at 9:25 pm #

      Hello Lowridan, thank you for your message. I really appreciate your response. Best wishes, Martha

  6. anon March 5, 2013 at 10:12 pm #

    It’s great to hear that you feel your quality of life has improved. However, some of the medical myths perpetuated in this blog need comment. No “clear cut biological basis” for mental health problems – psychosis, bipolar, or otherwise – has ever been found. Medication does not reverse a disease process. It’s a coping strategy for managing difficult mental and emotional experiences. Some may find it their preferred strategy. However this decision shouldn’t be based upon a myth. You can’t compare mental health issues to diabetes and insulin. If you want to know more perhaps look at Joanna Moncrieff (psychiatrist who explains psychiatric medication) and Richard Bentall (psychologist who explains psychiatric diagnostic labels such as bipolar and schizoprenia). The criticism often raised with ever increasing psychiatric prescribing is because it isn’t correlated with a decrease in disability due to mental health problems, and longitudinal outcomes have got worse. Therefore can we conclude increased drug use over the last 30yrs has been helpful? If you want to know more look at Robert Whitaker (health care journalist who has extensively reviewed the literature on psychiatric medication).

  7. martharoberts69 March 7, 2013 at 9:38 pm #

    Hi there, thanks for your response. Thanks, too, for the information re Joanna Moncrieff, Richard Bentall and Robert Whitaker. I shall take a look at these.
    Obviously my piece is written from a personal perspective, as I hope I make clear. My positive experience of meds isn’t shared by everyone, as we know, but it’s very much my ‘reality’ and not based upon a ‘myth’ that these ought to work (despite what the literature may show). Perhaps I am an aberration, or an exception that proves the rule.
    (Just to clarify, the ‘clear cut biological basis’ information re bipolar and psychosis was quoted to me by a psychiatrist, not my own layperson’s words). Best wishes and thanks once again for your response, Martha

  8. Kat March 7, 2013 at 11:44 pm #

    This is pretty reminiscent of my experience, although I took SSRI medication for a fairly limited period; around 12 months.

    I also believe I was fortunate in that I had a patient GP who was careful to explore the options and make me aware of my choices and to explain the side effects – she also made considerable efforts in making sure I stuck to my follow-up appointments – I’m fairly convinced that was more down to her personality than to process, but I’m grateful.

    Either way, I was in a pretty bad place and failing in my responsibilities to my friends and family. As a small business owner I presented a risk to the wellbeing of my staff and clients, and me perceiving that was making it worse. Medication for me created a way to quickly contain the problem. It had some unpleasant side effects for sure, but by containing the depression I was suffering, I then had the opportunity to think clearly for the first time in a long time. That gave me the chance make decisions about what to do next.

    Thanks for writing your article.

  9. singingbirdartist March 7, 2013 at 11:49 pm #

    Hi, thanks for writing this, I am a complete convert to citalopram after refusing meds for 20 years because ” I’m not depressed, I have PTSD”. Finally a doctor took the time to explain there is a med for anxiety disorders! After six years on it, I appreciate the difference every single day. I have tried to reduce and can tell the difference in less than a week, and so now I am happy to stay with what works for me, because I still have symptoms, but the amount of life I can participate in is so much greater. My husband had bi-polar and to be honest I do think the comparison with diabetes is fair, I used to feel it was as basic as that…he died of a heart attack at 53, but it ran in his family, I don’t think the meds had much to do with it. I do think excessive smoking of cannabis to blot out the memories of forced medication (anal rape with valium) and electro-convulsive therapy and other traumatic memories and consequences of disordered living had a huge impact on his health, so anything that can help keep life stable so less bad stuff happens is actually worth some side/effects. I accept I will live a shorter life than my peers, but I have already outlived so many people with less traumatic histories than me who couldn’t take another day or sleepless, terrified night…it is the quality of life, not the quantity that matters to me.

  10. Susan Inman March 27, 2013 at 4:45 pm #

    I very much appreciate the ideas expressed in this article. Big Pharma does have many deplorable practices but anti-psychotic medications have given my daughter back her life. She lives with a schizoaffective disorder, has had good psychoeducation about her illness and has a very healthy acceptance of her glitchy brain.

    I’m very concerned about the impact of the anti-medication movement on other parents whose sons and daughters have developed psychotic disorders. Often people only get the help they need because of the consistent support they receive from their families so it’s important for families to understand these illnesses; unfortunately, in the US and Canada there is no public education about psychotic disorders and the best ways to respond.

    I discuss these kinds of issues in my columns for Huffington Post Canada:

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