At What Point Do We Stop Medicating

JamesThere is an awful lot of talk about medication in mental health. After all, when you have a mental illness, one wants to get back to a mentally healthy state. I’ll skip over the philosophical questions about what really is healthy and what is ill. Rather, I’m interested in the question of at what point do we stop medicating our illness?

The question was raised to me by my girlfriend. She pointed out that I tend to rely on my medication to control my moods. Feeling anxious, take a klonopin. Nearing panic, take xanax. Depressed? Cigarettes and coffee. Manic? Extra antipsychotics. Psychiatrists provide us with differing arsenals of medication to control our moods in various ways. This is of course a necessary thing to keep us within our bounds. Having bipolar means I need to clip the tops and bottoms off of my moods. But that wasn’t the question she was criticizing. It’s that I have too much control over my moods. I don’t ride through them, I fight them as though they are an alien presence.

Both of us have different behaviors toward our mental health. I tend to fall on the side of pharmaceuticals to control my moods toward my ideal mental health. But she rides the wave. She lets her moods rise and fall and accepts them. She’s even all but rejected medication. She takes a minimal amount of antidepressants to cut off the suicidal thoughts and that’s it. Instead of going further than that, she allows herself to fall into depressions as just a part of her natural rhythm. For her, being mentally healthy is sort of like living a healthy life style. One eats well, exercises, but gets sick and doesn’t fuss unless antibiotics are needed. She takes her antibiotics, but if she gets sick she doesn’t reach for the nearest cold medicine, she just stays in bed and lets it pass. To stretch the metaphor, some of us do need our antibiotics, but to what degree do we just accept getting sick as our natural state of being healthy? So I take her question to mean more about that. Is it mentally healthy to constantly attempt to control moods using medication? Or is there some point that riding the wave is what is supposed to be mentally healthy.

I don’t have the answer to that question of which is healthier. Nor am I proposing that these are mutually exclusive ways of approaching our mental health. In fact, I think we need a bit of both. But the question is still out there, what is healthier? Control oriented, or acceptance oriented approaches? And this ties into defining what we mean by mental health. What do we consider to be mentally healthy. After we figure that out, I think that we can start to determine just how much medication we need and when to stop. So this will end more as a question than an answer, are you an acceptance person who lets the sick days come and go and try to prevent them from getting too bad, or are you a control person like me, where I try to stop getting sick ass much as possible? At what point do we stop using medication for our illness? And which do you think defines a healthier mental state?

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6 thoughts on “At What Point Do We Stop Medicating

  1. Nice to see you on Canvas!

    When it comes to medicating, it is really an individualized experience. Here’s a perfect example. My sister and I were diagnosed at around the same time. She had a bad experience with Abilify and I had great results with Lamictal. I stayed on the meds and even added some in the last 2 years. She quit them cold turkey and didn’t look back.

    We are very different from one another. I don’t mean this in a bad way, but she’s always been very preoccupied with herself. That’s good, in a way, because she is very accepting of herself and doesn’t feel the constant need to change. She goes with the current, no matter where it’s taking her.

    I’m a control freak. I was always self-conscious and constantly reinventing myself to strive for something better. I didn’t have the confidence and I couldn’t stand the levels of dyfunction that threatened to destroy me.

    I hate when I go into an episode. I get to the emotional breaking point where I lose control of my actions. But, I have to be accepting that the possibility is there, even though my medicine does provide me with way more stability and control than before.

    It’s balance. It’s finding a way to function at the level that you’re comfortable with. My sister is comfortable with riding out a depressive episode and kind of indulging in it. I can’t stand it. I don’t want to lie in bed, call off of work, and I’m not comfortable with the idea that I might have a crying fit in front of someone. I want everything to stay the same.

    Two sisters, same family, same illness, different ways of handling it. I expect to be on medication for the rest of my life because I believe in the biological model. Others don’t agree. That’s why there are so many different medications, therapies, and other treatment options.

  2. I agree with Lulu, and with you James, that the approach is a highly individual one. I also believe that it may be quite dynamic and change in each individual with time.

    A bit of (hopefully) short background on me: I react abnormally to pretty near every medication synthesized for manic-depression, and many prescribed for other things. Meds don’t work, the few that do land me in the ER, the combo I take now should bring a man three times my weight to the floor – I’ve been told – and yet I have one-third of that reaction.

    I learned all of this by going the traditional route of someone with a severe mood disorder, and taking medication for everything. Had they worked, I might still be.

    So I reached a state where I had to learn to ride out many of the highs and lows in my own way, and be vigilant to when it was time to call my doctor. I very rarely take anything for depression, no matter how hard it hits, but that is due to med reactions, not desire. And mania – well that I do my best to quell before it becomes something you can remove the “hypo” prefix from. There are a few drugs I can call upon if I must, but I don’t like them and I refuse to take them long term.

    I’m not trying to press an agenda, from what I can tell, you certainly function considerably better in the world at large than I do. But my methods, while born from necessity and lack of alternatives, actually seem to fit me quite well – most of the time. 😉

  3. Welcome James!

    I had a similar discussion with my husband the other night. We had been watching something on television and we launched into a discussion (as we often do) and I started talking fast and acting a little hypomanic. (This mood was prevalent for the entire evening and I hardly slept that night.) Now that I’m on Geodon, there should be no way that I can become manic. Does one sleepless night turn me manic? Probably not. Does a brief episode of flying thoughts mean I’ve becoming hypomanic? Or am I just excited about something? Where is the line?

    I have a similar situation with depression. When does it stop being a “bad mood” and start becoming something serious? This is where journaling (or in my case, blogging, because I’m a horrible at keeping a journal) helps. And like Lulu said, what are you willing to put up with? Now that I know that I am bipolar, I’m not going to let myself suffer like I did before the diagnosis. But at the same time, I hate all this medication. So where’s the line?

    As for what is healthiest? I think that’s up to you.

  4. Hi, James – great to see you here!

    First, I think we’re all in agreement – we hate medication. Who really wants to take something every day for the rest of their life? Evey time we have to pop a pill it’s a reminder that something isn’t quite right. I’ve always been resentful of having to take any kind of med – even if it was just for a cold or to control an infection. I won’t even address the joy side effects bring. That’s another post.

    As for psychiatric med, I believe it’s quite simple. Once your functioning is impaired, then you need to consider just popping the damn pill. We all have to function in the big, bad world. And if getting up and going to work isn’t happening because of your mental state, then it’s time. If you’re feeling suicidal, if your family dynamic is being altered because of your moods, then it’s definitely time. We are all on Bipolar med because our functioning was impaired by our illness. Sometimes we are not the best judges of how severe that impairment is. Having moods is fine. It’s human. But not being able to participate in life because of your moods is not.

    It’s great if anyone wants to try and cut down on the medication they are taking. It’s great when people want to try and rely on coping skills rather than the pharmacy. My therapist is always talking about ‘narrowing the band.’ But, you know what? There is still a band. Moods are normal. Being crippled by them is not. So, it’s up to the individual but if impairment comes back to bite, it’s time to med up again.

  5. I honestly wish you hadn’t skipped the philosophical questions, I think the question of “. . . what really is healthy and what is ill. . .” is incredibly interesting, and the crux of what all the comments before mine seem to agree on. A healthy mental state is entirely subjective, which is where the individual comes in – as well as those around the individual. Sometimes they give sound advice, sometimes not so much, but one would hope that they always have our best interests in their hearts.

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