M is for Medications

When I started writing this piece about two years ago, I took the approach of describing my life and how it related to the meds I was on. Instead of focusing on my story, though, I’d rather share what I’ve learned in a more straightforward way, to allow you to benefit (hopefully!) from my experience. So this will be a list of tips and advice that I sincerely hope will be helpful when medication for mental illness comes into play for you or your loved one for the first time.

THINGS YOU NEED TO KNOW WHEN DEALING WITH PSYCHIATRIC MEDICATIONS

  1. Seek a psychopharmacologist or psychiatrist, preferably a referral from your doctor or someone else you trust; of all the mental health providers, only they can prescribe medication. A GP (General Practitioner) can do it, because all of them have MDs, but your regular doctor likely has minimal knowledge about psychiatric medications. They can certainly help you if you’re in crisis, but ultimately, you should seek an expert if at all possible.
  2. Ask Questions: About the medication, its side effects, its interactions, how soon you might expect results, or anything else that concerns you. Do not be afraid to ask. Take notes, too, because you will most likely forget some of it due to the nature of your particular crisis. (We aren’t as good at note-taking when staving off a panic attack or a crying jag.)
  3. Educate yourself: Do your research, but be careful where you look. There is so much on the web that can help or harm you, with no way to know what’s legitimate information based on scientific studies. Stick to reliable organizations’ sites like the National Institute for Mental Health (NIMH), or reputable universities and colleges with large medical clinics, like Johns Hopkins, Mayo Clinic, or Lahey Clinic. You want a .gov or a .edu (but even then, be careful that you haven’t just accessed a student project from their undergraduate course in psych, for instance). Do NOT rely on any .com sites (the latter are most likely trying to sell you something.)
  4. Get to know your pharmacist(s): As a CVS frequent flyer, I feel really comfortable asking my pharmacists for advice, and they tend to have a vast arsenal of knowledge about any given medication, including, and this is important, dangerous interactions between the meds you’re on. One pharmacist warned me about an interaction with a drug I’d been on for years that would render my birth control less effective. (My doctor hadn’’t mentioned it.) Good thing I found that out, or I’d have definitely made national news as one of the oldest mothers in the universe!
  5. Be patient. Some medications take weeks or more to kick in. It is never easy to find the best possible med or combination of meds. And you’re always going to be working with your meds doctor to help you minimize side effects. Which brings us to…
  6. Side Effects: Unfortunately, what can help you in one way can hinder you in another. Psych meds have lots of unglamorous side effects, some of which I’ve mentioned before, but I’ll repeat: weight gain, blood sugar issues, high cholesterol, sexual dysfunction, dizziness, nausea, tremors, brain fog, memory loss, balance/mobility issues. And that’s just for starters. But let’s be honest, most meds of any kind have side effects; not just the ones for mood disorders.

THIS is really important: What you absolutely must know, and you’ve heard it on the drug company commercials, is that some psych meds can make you have suicidal ideation (thoughts) and can be dangerous. If this happens, get in touch with your meds doc, your GP, urgent care, or the emergency room at your nearest hospital IMMEDIATELY if you feel you might act on these thoughts. It’s not your fault you feel this way, and you can avoid tragedy by asking for help.

Phew. Back to the list.

7. Get and use a pillbox religiously; some meds have a side effect of foggy brain or memory loss, so it helps to have a system to manage them on a daily basis. I would not be able to manage my meds properly without a plastic box with slots for the three times of the day I take my medication

8. Keep track of your refills: You don’t want to run out, especially if you are traveling. There’s a thing called a “vacation override”, which you should mention to your pharmacist and/or meds doctor, because it allows you to extend the meds allotment so you won’t run out while on the road. You can often get some extra meds if you’re travelling, especially out of the country.

9. Insurance companies: You can spend a lot of time and energy trying to get a medication approved by your insurance, and you may need prior authorization from the doctor who’s prescribing it. Again, talk to your pharmacist, check in and see how the process is going. You can also call your insurance company, of course, but be prepared to be shuffled all over their phone systems where you end up talking to five different people, and getting five different answers. Having insurance is better than having none. Medications are expensive, especially first-generation ones whose patents haven’t expired yet. Once that happens, other pharma companies can make what they call generics, which means they have a different name, but they’re the same drug as your pricey one, with a much lower price tag.

10. Watch out: If you’re prescribed things like Xanax, Ativan, Valium, or Clonipin, be very careful. They are not meant to be taken on a daily basis over an extended period of time. They’re supposed to be drugs that you take in moderation and only relatively briefly, usually after a trauma or breakdown (or both). I learned that the hard way. After a breakdown I had when we lived in Pittsburgh, my psychopharmacologist put me on, among other things, Clonipin. It’s very sedating, makes you forgetful, and you fall down a lot. When my family and I moved to New York, the first psychiatrist I saw said that my meds regimen was, and I quote, “a hot mess,” and then he proceeded to teach me how to wean myself off this highly addictive drug.

11. Never just stop taking a medication your doctor has prescribed you without talking to them first. (unless, of course, you have a life-threatening reaction to it, in which case, go immediately to your nearest emergency room.) Your doctor can tell you how to take yourself off the medication safely. It involves titrating down, which is going off the med slowly, not abruptly. Also, every drug has a different half-life, which is honestly too much math for me to adequately and coherently explain. But all drugs break down at different paces in your system. (Prozac takes a loooong time to leave the building.) Ask your doctor. In that same vein, a good meds doc will only adjust one medication at a time in your arsenal of meds. If you change two different medications at once, how can you possibly know which ones are related to the results you’re looking to achieve, or avoid?

12. Keep track of your mood consistently: There are mood apps galore available, but I’ve never found one I like. Having both Bipolar and OCD, there are just too many variables to track, and I don’t want one app for Bipolar and one for OCD. I use my own system (inspired by Ellen Forney’s excellent system that can be found in her awesome book, “Rock Steady.”) (If you have bipolar, you could benefit greatly from this book) I use a blank daily calendar planner where I fill in things like whether I ate, slept, and exercised enough. I also include some basic emotional information like how irritable, calm, frustrated, or content I am. I always put in my mood range because that’s important for bipolar tracking, and I also put in what I call my day’s Life Force, which is, in a nutshell, the strength of my will to live. A bad day is 2/10, a good one,6/10, and a great one, 8/10. This system is useful for me to catch a depressive dip before it takes over. But, ultimately, it’s up to you how to track your moods and behaviors.

It’s always a trial-and-error process getting your meds right, and it can take years. Over the past 30 years or so, I’ve been on different combinations of fourteen different medications, some for days or weeks, others for decades. And I know that there will, no doubt, be more, as new ones emerge, hopefully with more efficacy and fewer side effects.

Okay. Having read all of that, of course, the prospect of taking meds probably seems rather overwhelming, I realize.

Why would you subject yourself to such things?

Because they work.

They work on your brain.

They help balance your brain chemistry so that you are less sick.

They can make you feel better.

A lot better.

They’ve saved my life on more than one occasion.

And now’s as good a time as any to remind you:

Meds aren’t a weakness, they’re for treating illnesses.

And as we’ve said many times already, mental health disorders are illnesses.

Ultimately, the critical question is, are the side effects worth the good this medication is doing for your condition or not? Keep in close touch with your doctor, monitor your symptoms, make friends with your pharmacist, be patient, and hold onto hope. You are stronger than you think. It may take awhile, and not all meds work, but many do, and you can also seek therapy in many forms that can greatly help you with your mood disorder. I will talk more about therapy in, you guessed it, the letter T.

Godspeed, my friends.

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Emi Jean

Emi Jean

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