Over the holidays, I was driving around New Jersey with my dad. We talked about lots of stuff, the way we do when we've got some time together and some miles to cover. He asked me a question that was quite evidently borne of genuine curiosity, without a trace of judgment.
"Do you think you'll always be on medication?" he asked.
I didn't even have to pause to consider it.
"Yes," I said immediately. Then, remembering that I always like to leave room for miracles, I added, "I mean, probably."
Until our exchange, I'd never considered when it was, exactly, that I came to accept the fact that I'll most likely always take drugs to deal with depression and anxiety. It certainly wasn't in my teens, when I felt shame every time I swallowed a pill. And it definitely wasn't in my early twenties, when I feverishly chased some lavender-scented, valerian-root fueled dream of yogic enlightenment, believing that if I only read enough Yoga Journal articles, I'd find the secret to mental well-being.
In my late twenties, I was too busy churning out ridiculous web videos and chasing the stand-up comedy dragon to pay much attention to mental health, and my illness responded surprisingly well to the lack of attention. I took the pills, I went to the shrink, I got on with my life and didn't waste time feeling broken or lame because of my treatment.
Then, when I was 30, I realized I'd been doing pretty well for about seven years, mentally speaking. By "pretty well" I mean that I hadn't been confined to my bedroom out of fear of the outside world, the way I was when I was 21. Nor had I experienced episodes of depression that had me contemplating suicide, the way I had when I was 23.
There hadn't even been the hopeless crying jags of my teenage years. I'd gone to graduate school, held down a series of respectable jobs, and started a writing career on the Web. I even had a book deal.
Plus, I was dating a nice guy, and my weight was pretty good by my own standards, and my hair was looking fine as hell. These and other thoughts comprised the mental calculus that led to my decision to taper off my medication -– without asking for a doctor's help.
That went about as well as it usually does for people with chronic mental illness. Things were fine for a few months, and then outside stressors (my book was due, the guy got deployed to Afghanistan) triggered a wallop of a mini-breakdown. It wasn't like the cataclysmic breakdown I'd experienced when I was 21, if only because this time I recognized the symptoms early on and asked for help immediately. It was more of a bite-sized baby breakdown, the mental illness equivalent of a mini-cupcake (though decidedly less delicious).
Needless to say, I went back on the meds (and back to the doctor). And my state of mind improved rapidly, so that I was able to return to work, finish my book, and stop scaring my friends and family.
I guess that's when I realized this depression and anxiety thing isn't temporary. It's not going to disappear when I hit a certain age, or achieve certain career milestones, or get a really great deep-conditioning treatment. I can keep it at a manageable level with the help of drugs and therapy, but I can't cure it or wish it away. Diabetics don't just happily toss away their insulin once they've followed a successful course of treatment for a few years. Why should it be any different for folks whose chronic conditions are of the mental rather than the physical variety?
And yet so many folks with mental illness do the exact same thing that I did. We take our drugs, we feel better, we go off our drugs, we feel like shit. And the cycle begins again.
The pharmaceutical industry refers to this practice as noncompliance, and does tons of research each year to try and figure out how to address it. My understanding is that patients with schizophrenia and bipolar disorder are particularly notorious for noncompliance, perhaps because the drugs that treat those conditions can have some difficult side effects (weight gain being just one of the issues that may come into play).
I've heard that some pharmaceutical companies have developed once-a-month injectables that take the place of daily pill regimens, making it a lot easier for doctors to keep track of patients' compliance and for patients to comply with their health plan. I know that needles freak some people out, but I can see the benefit of visiting your doctor once a month for an injection. That way, you get actual face time with your doctor as well as the medication you need.
Because make no mistake about it, human interaction with a caring professional is an essential part of any healing regimen. The pills help a great deal, but the human connection –- that's what really makes the difference between surviving and thriving.
So while I've never committed to a guy for more than 2.5 years, and never committed to a full-time job for more than 2 years, and never lived in the same apartment for more than 2 years, and never stuck with a gym regimen for more than two months, I can say that me and my meds and my therapy are in it for the long haul.
Because without them, I won't have much of a life at all.