Recently I read an opinion piece in the New York Times entitled "Breaking Up With My Meds." Writer Diana Spechler has posted subsequent essays for the Times in a series called "Going Off," about her struggles with anxiety and her recent decision to discontinue her regimen of psychotropic medications.
I admire Spechler's openness and her efforts to become well without the aid of anything produced by pharmaceutical companies. The criticisms she posted of these companies, and of the antidepressants and benzodiazepines they produce, resonated with me in her initial February 12th post:
"I worry about the long-term effects of these drugs, which are still relatively new to consumers. I worry about Big Pharma. My stomach clenches when I read about covered-up studies and the ugliest side effects of the very medications pharmaceutical companies hard-sell to psychiatrists, including to pediatric psychiatrists. I feel great discomfort with my doctor’s Celexa clock."
Fortunately, I haven’t experienced any noticeable side effects from the pills I’ve been taking for the past decade, though the long-term impact of them remains a crapshoot. And if my doctor has received pharma swag, she hasn’t displayed it prominently in her office. Still, I can’t deny that I have never been entirely comfortable with the idea of ongoing medication therapy.
As a radical-leaning, queer-identified social worker and community organizer who loves punk rock, I’ve been questioning cultural assumptions and norms for a long time. I strongly support the creation and sustenance of grassroots organizations and peer-based mental health networks such as the Icarus Project, whose publications such as "Harm Reduction Guide to Coming Off Psychiatric Drugs and Withdrawal" are invaluable to many. Last year I helped launch an NYC-based peer support group and publicly accessible mental health resource guide, and I think that the psychiatric survivor movement crucially supports the self-determination and wellbeing of anyone who has been harmed by the mental health care system.
Over my twenty-plus years of experiencing what some might describe as a mood disorder, I have explored multiple paths to wellness that included studying integrative and holistic nutrition, receiving acupuncture and homeopathic treatments, taking herbs and supplements, and making major lifestyle changes to better my external circumstances so that perhaps my internal world could improve as well. At the urging of one naturopath who performed an obscure form of food intolerance testing, I went so far as to eliminate all fruit and related products--including olive oil and cashews, no easy feat for someone who was already vegan--from my diet in hopes of alleviating mood-related symptoms.
But guess what?
I am never breaking up with my meds. I'm going to stay on my antidepressant and my mood stabilizer. I am, in fact, likely to take those two tablets every single day for the rest of my life.
Twice as an adult, I felt that I had finally gained control of my life and my thoughts enough to titrate down from antidepressants. After attempting to do so under my therapist’s supervision, I hit rock bottom and stayed there--even after withdrawal symptoms ended. Since then I began a new course of treatment, and it took many years for me to find the right “cocktail.” It has also taken a great deal of time and effort to recover from significant trauma, learn to make smarter career moves, and break unhealthy relationship patterns (i.e. stop dating creeps).
But with this combination of developments, I feel fully engaged in my life as a busy, happy woman approaching 40. My ebbs and flows feel manageable, and my clarity of mind has increased my ability to experience joy and try new things.
It may not be surprising, then, that I don’t want to spare the time or energy once again battling a resurgence of racing, dysphoric thoughts or wading through despondency that could impair my daily functioning. So it’s not worth it for me to take chances in weaning myself off meds--my current quality of life is too high. My will to stay well in the present outweighs my worry about the future health of my internal organs or developing other maladies later in life (those pills can be tough on your liver, for one thing).
My friend Stephanie and I are co-editing an anthology on the topic of queer mental health, so I’ve been thinking about treatment and wellness an awful lot lately. Like Steph, whose essay details her struggle to afford her meds in years past, I have fought tooth and nail to be able to acquire my medication. I was unable to afford health insurance for several years as I searched high and low for full-time employment, taking as many part-time jobs with no benefits and freelance opportunities as I could.
I was reminded of my graduate school days, during which the health insurance I did have was woefully, shamefully inadequate: there was simply no coverage provided for mental health care and my medications were not covered under the plan’s formulary. Mind you, I’d purchased the policy through the university at which I was studying social work, for god’s sake--and despite my multiple angry appeals, I got nowhere in arguing for parity.
During those times I was resourceful about procuring my meds: I applied to pharmaceutical companies' patient assistance programs and sometimes succeeded in getting several months' worth of pills at no cost. I ordered prescriptions online and had them shipped from Canada or halfway across the country--even though both of my current meds went generic some time ago, NYC-based pharmacies could still charge hundreds of dollars for a 30-day supply. I am grateful to have employer-sponsored health insurance these days!
I am grateful too to be a relative success story among the medication-taking masses--pills are not a lifesaver for everyone--and am cognizant of the privilege that has facilitated my receiving overall competent care. I understand that meds are not the answer for or accessible to everyone, and I will continue to support self-advocacy efforts and alternatives (or complements) to conventional psychiatric treatment. For a time I worked at the Rainbow Heights Club, a psychosocial support program that stressed peer-based collaboration, and witnessed firsthand how effective it was. I have begun contributing to a queer mental health-related website and opening up more about my own experiences with my emotional and behavioral difficulties of years past.
The stigma and shame of living with mental illness prevent a great number of people from telling their stories--and that seems to be particularly true for members of the LGBTQ population, who have long been pathologized just for being LGBTQ.
My vision of a genuinely holistic approach to care includes the consideration of multiple treatment options both allopathic and drug-free, as well as a willingness to combine modalities. I still engage in acupuncture sessions, yoga practice, and attending regular psychotherapy sessions to help me continue making good life decisions.
What I have never found helpful is being lectured by proponents of natural and complementary therapies--many of which are financially unfeasible for members of low-income and marginalized communities--about how it is possible for everyone to be totally well without meds, as if people living with mental illness are simply not trying hard enough. The comments I have heard from several practitioners and opponents of medication therapy reek of ableism and reinforce the damaging theory that illness or extreme states can be somehow conquered by sheer force of will.
To my knowledge, there is no empirical evidence that “mind over matter” has ever constituted an effective intervention for people living with conditions like major depression, bipolar disorder, obsessive-compulsive disorder, or schizophrenia. When you are struggling with self-hatred, misery, irrational thoughts, anhedonia, or panic, the last thing you need to believe is that it’s your fault. It is not some personal shortcoming that prevents you from getting better without pills. Trust me on this one.
Are antidepressants overprescribed in general? Absolutely. Are drugs the answer for anyone and everyone experiencing extreme states? No way. But I’m not going to discount the role my meds play in my current high level of wellness just to prove a point to myself or anyone else. And if you are suffering and you have tried everything else to no avail, I urge you to consider doing the same.