Every visit to the psychiatrist brings a trip to the pharmacy, and every trip to the pharmacy brings a 20-30 minute wait. I don’t begrudge the time, because the staff are so thorough and always make sure that my drugs are labelled up in such a way that even on a very bad day I can’t get it wrong. If I’ve forgotten to bring a book, or my mind is too fast to concentrate on reading, I find myself l looking at the posters. Most remarkable is the prescription charge notice screwed to the wall next to the counter; every time I visit, I marvel at the fact that it is so ancient that it still refers to the “DHSS”. Someone has printed out that current charges and taped them on the wall, an action that has presumably been carried out every 1st of April since the 1980s.
Health promotion messages abound. One poster reminds me about the importance of cervical smear tests. Another one points out that “it could be YOU” who has developed mouth or throat cancer, the ideal message for the depressed or paranoid patient. The notice I always end up looking at is a list of all the types of drug for which the Mental Health Trust produces an in-house medicines leaflet. There’s nothing special about the poster itself; it’s just a list of psychiatric drugs, some common, some less well-known. What’s fascinating to me is just how many of those medications I’ve been prescribed over the past 20 years.
Generally speaking, I’m not an anti-medication person. I’m a pragmatist – if it might work, I’ll give it a go. But there’s no doubt that psychotropic drugs come with a whole host of “interesting” side-effects and emotional baggage. Here follows a personal A-Z of psychotropic drugs – the good, the bad and the downright scary.
A is for antidepressants. SSRIs, SRNIs, tricyclics, MOAIs; I’ve tried them all, some for as little as two weeks, one for 8 years continuously. It’s thought that one in three women has taken an antidepressant at some point; I’ve been popping enough pills for the other two.
B is for blood tests, a regular part of my life since I started taking lithium. I have a secret rating system for those taking my blood. What I’m looking for is this: minimal pain (should be easy enough, I have great veins – the blood’s nearly leaping spontaneously into the Vacutainer); some basic knowledge of what my blood test is for, based on my records which are RIGHT IN FRONT OF YOU; and the smallest possible amount of well-meaning advice about how your friend or your sister manages their bipolar with no drugs at all. Apparently it’s very difficult to find someone who hits all the bases.
C is for constipation. Sorry to be so coarse, but since I started my current antipsychotic medication, my entire digestive systems has slowed r-i-g-h-t down. Doesn’t matter how much water I drink or how many prunes I eat; my intestines are as sedated as the rest of me.
D is for “discontinuation syndrome”. Most doctors and drug companies don’t like to hear the unpleasant symptoms caused by stopping SSRI or SNRI antidepressants referred to as “withdrawal”. Withdrawal gets a bad press, being too closely associated with addiction to illegal drugs; discontinuation syndrome sounds nice and clinical, an unavoidable inconvenience. Well, I’ve worked with illegal drug users who are late picking up their methadone, and I know withdrawal when I see it. When I stopped Effexor suddenly (on medical advice), I spent a week in bed struggling to cope restless legs, shooting “electric shock” type pains in my limbs, sleeplessness, sweating, and an upset stomach. Without a doubt, one of the hardest times of my life.
E is for elation, the key symptom of my bipolar that makes me consider not taking medication. Usually I follow medical advice and prescriptions to the letter (see O), but when I’m experiencing a high, filled with feelings of joy, wonder and energy, it seems perverse to take something to bring me down. Intellectually I know that it’s part of my illness, and needs to be stopped before it turns into a more destructive mania or flips to a deep depression, but I don’t want to let the elation go.
F is for fluoxetine (aka Prozac), the first antidepressant I was ever prescribed age 20. I don’t remember much about the visit to the psychiatrist which led to the prescription, other than that I didn’t feel that he was listening to what I had to say at all, and that he told me, “if you are bipolar, these will send you as a high as a kite.” This approach led to a couple of weeks of highly agitated suicidal impulses and put me off taking antidepressants for many years.
G is for GP prescribing. Most people will naturally go to their GP as their first port of call when they are experiencing mental distress. GPs have a good level of familiarity with first line treatments (see S is for SSRIs) but are of course less familiar with more specialist medicines that would normally be prescribed by a psychiatrist. One of my biggest medication mistakes was continuing working through one GP-prescribed antidepressant after another for a period of 18 months of depression after my second child was born. Once I finally saw a psychiatrist, I was placed on a much more unusual reversible monoamine oxidase inhibitor which worked well for me for over 8 years. With hindsight, asking sooner for a Consultant review of the medication options might have reduced the impact of what was a very difficult episode.
H is for happy pills. How I hate the tendency for the media to use this phrase to describe antidepressants. It’s not just tabloids like the Daily Mail or the Sun; the should-know-better broadsheets (such as the Times, the Guardian and the Independent) and the BBC have been known to do it too. What’s particularly unpleasant about it is the snide implication that those of us who take antidepressants are after something more than the “stiff upper lip” coping of the article writers. Surviving is not good enough for us, oh no, we demand to be happy. If the headlines are going to be glib, they should at least be truthful: “Use of non-kill-yourself pills doubles”, “Doctors push day-without-weeping pills on unsuspecting public.”
I is for iatrogenic (“doctor induced”) health problems. Many psychiatric drugs have significant side-effects, some of them irreversible. Continued treatment is a balance between the therapeutic benefit of the medication, and the potential harm it can cause. In the case of lithium, which I am taking now, long term kidney and thyroid damage can result from the treatment. This has to be weighed up, however, against the damage done to my life by the condition itself.
J is for “jellies”, as everyone referred to the benzodiazepine temazapam when I was at university. Based on little more than Black Grape’s song Temazi Party, my friends and I had high hopes for the drug’s effects and were disappointed when I took one and promptly fell asleep.
K is for kilos. Noticeable weight gain is a joyous side-effect of many psychiatric meds, including both the drugs I take at the moment. What could be better than being depressed and fat?
L is for lithium, the newest addition to my list of medications. It’s been a big decision for me to try it, as I described in a recent blog post, but I’m trying to approach treatment with as open a mind as possible. There’s no doubt however that the possibility of toxicity and organ damage is something to take very seriously.
M is for marketing. I would love to know who comes up with both the generic and the brand names for psychiatric drugs. I imagine all these marketing guys sitting in a room somewhere, kicking ideas around. “How about – no, wait a minute, it doesn’t have a Q, a V, an Z or an X in it. Get the Scrabble tiles out.” I particularly like the brand names which allude to desirable outcomes: need to overcome your difficulties? Take Surmontil! Feeling wobbly? Choose Stablon! Lack joie de vivre? Ask your doctor about Vivactil today! On the other hand, I can’t believe that a pharma company actually paid someone to come up with Depressin, Ambivalon, and Dumyrox.
N is for nausea. Open any patient information leaflet for any mental health drug, and I guarantee you nausea will be listed as possible side-effect. The worst I ever had was starting venlafaxine (Effexor), when for the first couple of weeks I had to keep lying down as I was battered waves of what felt like sea-sickness. On the upside, I was too busy feeling physically awful to be anxious or depressed about anything else. Right now the lithium seems to be making a play for the number two slot in the Nauseating Medicines Hall of Fame.
O is for obedience. I’m what the health professionals call a compliant patient; I take what I’m told to take, when I’m told to take it, and I don’t stop unless there’s a treatment plan to get me off it again. I think there are several reasons for this. I’ve previously worked in a clinical NHS role, and I do have a lot of faith in the medical model (so long as it’s combined with self-help measures; I don’t expect to take a magic pill and be instantly well). Also, it seems the responsible thing to do, for my family and my employers, as well as myself. Finally, the side effects and “discontinuation effects” can be scary enough when taking/stopping medication as instructed. I’m just too chicken to ditch it and go it alone.
P is for propranolol, the first ever mental-health related medication I was ever prescribed, at about age 16. The GP didn’t tell me what type of drug it was, but I found out from a nurse acquaintance that it was a beta blocker. Usually prescribed for heart and blood pressure problems, beta blockers are sometimes also used to treat anxiety. Unfortunately, I was clinically depressed rather than anxious, something my GP at the time seemed determined not to acknowledge.
Q is for quetiapine, an atypical antipsychotic I was prescribed in the spring to try and stabilise my bipolar mood swings. It hasn’t controlled my moods as well as my Consultant and I had hoped; its main effect is to knock me out into a heavy sleep from about 10pm to 9am. I am a scintillating party guest.
R is for reminder. Despite taking one medication or another every day for the past 11 years, apparently I am apparently incapable of remembering to take my tablets without a reminder in my phone (unconscious denial?).
S is for SSRIs, the most often prescribed form of antidepressant. Fluoxetine, paroxetine, sertraline, citalopram or another selective seratonin reuptake inhibitor (SSRI) are often the first line drug treatment offered by GPs. My own experience is that each one I tried worked for a while, and then became less effective. My doctors have always told me that can’t happen, but hey, I was the one who took three different SSRIs in a year.
T is for tricyclics, these days a less commonly prescribed class of antidepressant. My only experience of them occurred when I was acutely depressed and struggling to manage at home with two very young children. Unfortunately, the trazodone I was prescribed made me feel incredibly spaced out and unable to focus (a well-documented side effect), which seemed actively dangerous when trying to care for a baby and a toddler. I fairly quickly switched to another drug.
U is for uncertainty. Every time I am prescribed a new medication, there is a period of uncertainty. Will it work for me? Will I experience side effects, and if I do, will they be transient or long-lasting, trivial or serious? It can be very dispiriting to find after a few weeks or months of living thorough the uncertainty that the drug isn’t doing what was hoped, and to have to begin the whole process again with something new.
V is for velociraptor. Just checking if you’re still paying attention this far into the alphabet. Actually V is for Valium. Benzodiazepines have a bad rep, and there’s no doubt that they have been overprescribed and left some people struggling with pernicious addiction problems. But a short course of benzos has helped me out more than once, particularly when transitioning from one long-term medication or another.
W is for wine, something that’s becoming a distant memory for me. I had no difficulties drinking alcohol with my long-term antidepressant, but starting very sedating antipsychotics has made drinking alcohol nearly impossible. Combine that with the need to avoid dehydration to prevent lithium toxicity, and alcohol has become a real no-go. Like I said, fantastic at parties.
X is for X-ray. A chest X-ray was one the battery of tests I was told I had to undergo before starting lithium therapy in 1995. The whole package of tests was scary, and put me off taking it for a very long time.
Y is for a year. Two of these = the minimum amount of time recommended to continue with drug treatment for bipolar after an acute episode, according to NICE. That’s a lot of lithium to swallow.
Z is for zopiclone. Anyone who’s ever complained about insomnia to their doctor will have been offered “something to help you sleep” at some time, and zopiclone is one of the most frequently prescribed – almost four and a half million prescriptions were written out for it in 2007. I’m not terribly keen on sleeping pills; even after a short period of use, I get to worrying that I can’t do without them.
Now, let me go back to that list in pharmacy, and see what’s still to tick off…
I love your sense of humour – the tablets are working!! I can share a joke because I’ve been one of those 1 in 3 women. The more people I get to know, the more people I find out have or are taking SSRIs. Wishing you continued ‘ups’! xx
Thanks, Ange… humour is probably the only way I’m going to get through this! Thanks for reading my post (((hugs)))
Q – yes – if you need to catch an early flight it seems almost perverse to be going to bed at 6pm.
Que sera, sera
Or Sera que, ra-que.
Never mind an early flight – getting up to get the the office for 9 would be enough of a challenge!
The whole GP SSRI thing is so true. From my experience I know only too well when SSRI’s become ineffective, now documented in some texts as SSRI “poop-out”.
Still, I enjoyed your A-Z, with a wry smile & a snigger or two.
Then my work here is done 😉
Loved this – really laughed at the ‘J’ for jellies entry. But ‘B’ for blood tests hits a spot too, and ‘K’ for kilos. I thought there must be humour somewhere in all this stuff… thank goodness you found it!
Thanks, Julie… it’s my only defence!
Just wanted to let you know I love your blog! First got access to it through the Mind page. I am 53, been depressed on and off now for 15 years, all on sorts of meds, been throuhg Lithium, SSri’s, Maoi’s etc etc So great to hear form someone else………..take good care
Amazing post, well done. It’s my first time on wordpress and your posts are an inspiration to me. I too suffer, not got a firm diagnosis but tearful, paranoid, putting on a smiley face all sum up me. Keep the posts going, it really helps and I feel less lonely, finally finding someone who ‘gets me’ .
I am so happy to hear that my blogs helps in some small way. I find a lot of support on Twitter, some great people on there who are suffering with similar issues, we all support each other and keep each other going. Take care 🙂
Thanks so much for all your posts. I just stumbled onto your blog at a much-needed time in my life. I was wondering if you had any advice or reading suggestions for helping people who are depressed/bipolar interact with family. I just resigned my position and moved in with my parents and I feel like everything I do hurts them…
Hi Elise, that’s a hard one, I suppose what I would say is if your parents are willing to read information on depression/bipolar it may help them understand a bit better… Somehow your parents are going to have to learn not to take behaviour cause by your condition personally. What I realised when I went off and read some blogs after getting my new diagnosis of bipolar this spring was that a lot of what I experience might not be *normal*, but it is normal *for bipolar people*. In other words, some of my experiences were not just my weirdness, but the weirdness of my condition. I find the leaflets produced by Mind http://www.mind.org.uk/help and the Royal College of Psychiatrists http://www.rcpsych.ac.uk/mentalhealthinfo.aspx informative, person centred and non-judgemental. Not sure if that helps…. There are also self-help groups out there …. not sure if you are in the UK, if so there are local Mind associations or the Manic Depression Fellowship http://www.mdf.org.uk/, they might be able to help with people willing to work with family members/carers. Good luck!
Another great post and one I can really relate to. My psychiatric team had me go through – seroxat, mirtazapine, duolexetine, an antipsychotic I can’t remember the name of followed by ever increasing doses of venaflaxine in 9 months. The ven. made my insomnia much worse but psychiatrist stopped my zopiclone anyway. As I had been using it for over 10 years and the ven. was making me really ill I ended up quite suicidal so he discharged me! I am now under the sole care of my GP and doing quite well on mirtazapine and amitriptyline. Sorry to go on so long! Looking forward to your next post.
Great, if not slightly scary, alphabet! I get hideous amounts of nauseas with whatever antidepressant I get prescribed which normally ends up with me not taking them. And nothing chemical has yet cured my insomnia, ah well. It sounds worse than a doctor’s waiting room, all that offputting threatening medical advice. 🙂
Good post! I especially like the one for H. I too dislike how they’re called happy pills which is not an accurate description of them. Your description fits much much better.
Another post I will point folks in the direction of. And, if you don’t mind (I’ll give you credit), I might just do an ABC of meds from my chronic pain/chronic depression/chronic illness perspective. I’ll try and keep a sense of humo(u)r through the process!
Ooh yes Phylor do that, my area of expertise unfortunately ! I too suffer from chronic pain caused by arthritis, and have mental illness to boot, oh joy
Sure, Phylor, sounds like a great idea!
If you do, please let us know! I’d like to read that too
Sometimes having velociraptors as side-effects would be better. Especially if you have to change doctors and your new one doesn’t listen to you. Thanks for another great post – each one helps remind us that we are ‘normal’.
What a great post! As has been mentioned above, I really agree with the “Happy Pills” definition.
Reading your blog inspired me to start writing my own again. And to actually share it with people this time. So, I want to say thank you!
V is for velociraptor! That made me smile, on a morning I really needed a smile.
I’ve been following your blog for a while now, and want to tell you that I greatly appreciate the time you take to post about your experiences. You are an inspiration 🙂
Thanks, Brenda! Couldn’t resist the velociraptor, glad it made you smile! Really appreciate your kind words about my blog 🙂
Prozac, tick. Mirtazapine, tick. Venlafaxine, tick. Quetiapine, tick. Diazepam, tick. Lorazepam, tick. Zopiclone, tick. Hospital, tick. Thanks for your blog. So many people just dont ‘get’ mental illness. As you say, people see how I present myself – confident, articulate, sociable, etc. But no one noticed when I shut myself away for 8 months. I still have difficulty going out now. And yes, I miss the wine too. Being sociable is hard when I’m still trying to work out who I really am after hiding for so long and only now beginning to accept that I am actually very ill.
Hi David, thanks for visiting the blog and so glad to know it “speaks” to you. Just in the past couple of weeks I have started to be able to do more “normal” things – still not back at work, but have done some social stuff. It took getting off 2/3 of the dose of Quetiapine to do it, thought! I turned to online support when I found “real” social interaction too difficult – thank God for Twitter! Take care, Charlotte
A great read – some of the letters I was really nodding my head at! I’m on Venlavaxine and Quetiapine and forgot to take them on a day & night away, by the following morning I was getting tired, then the sickness started. I’ve never fekt so ill, really feel for you to have to suffer a whole week feeling that bad. To me that is a withdrawal symptom and therefore is a sign my body is addicted to the medication.
I have been on Quetiapine for a year now, I’ve had it gradually reduced and now only have some at bedtime, but although it still helps me sleep I no longer fall asleep within minutes of taking it – so there is hope for you that your body will get used to it and it won’t be quite so sleep inducing forever!
I’ve never thought about the media calling them ‘Happy Pills’ but maybe its because I’ve only been on them for a year, but I do tend to call them my happy pills, also my nut bar pills, and anything else I can think of to make light of the situation I have found myself in.
Off to try and read some more of your blog.
Hi, thanks for leaving a comment – glad you enjoyed! I’m all but off the Quetiapine, just a little dose at night to help me sleep – I just don’t have the time to wait around and see if it will get better, I need to get back to work for financial reasons, and the Quetiapine was making it impossible (unless I went to bed at 7pm!). Also it wasn’t really controlling my symptoms. So far I think the lithium is working for me much better, the blood tests aren’t all that much of a hassle and I’m happy not t be sleepy all the time! Take care, and let me know what you think of some of my other posts 🙂
I wish the Quetiapine would help me sleep. I’m normally awake between 2 & 3 am and stopped taking Zopiclone as it stopped working. At the moment having lorazepam with the quetiapine is the only thing that gets me a full nights sleep – but then I have problems getting up, so it is either too little or too much. hey ho, at least at the moment I am still in hospital so neither issue is too much of a problem.
Oh goodness woman – you’ve done it again! If I sat here and listed out all the medication trials I’ve experienced, you would ban me from leaving comments ever again! At one point, I tried to keep a journal of pills we’ve tried and side effects involved. I can’t remember what I did with that journal but it was extensive. Effexor is one that I had to go back to but it wasn’t because of the horrible (and I mean, horrible) withdrawal. We tried a few other antidepressants because Effexor wasn’t working anymore (I had been on it for years). Every other antidepressant gave me such an upset belly I couldn’t stand it. When I told my dr. we decided to go back on it. It worked super well for about 4-5 months. And then not so much. It is completely frustrating to find the right meds.
Thanks again…your info and humor make your blog extra special to me! 🙂
It really, really is so very frustrating! Back when my kids were little and I didn’t have a BP diagnosis I tried antidepressant after antidepressant. My perception was that they would work for a time, then not so much. My GP told me that is “not how it works” but I know what I experienced! During my remission I was well on just one antidepressant but my suspicion is I would’ve been well anyway! Antipsychotics have definitely stepped the side effects up a gear, whilst the lithium – which I avoided for years because I thought it would be a big deal in terms of side effects – is absolutely fine!
Right?! I was on Lithium about 5 years ago and I think it was a good 2 years on it – my bloodwork was okay but the episodes continued. We switched over to Geodone and for a year it worked pretty well. Then it didn’t and when we increased my dose, my weight increased right along with it 😦 So we moved back to Lamictal…I’m “okay” but I think my husband thinks I could be better. What do ya do? I’m just SO completely tired of going back and forth…I’ve almost given up.