“People think I should be able to handle my illnesses without taking medicine. In reality, without medicine, my illness would handle me.” Sarah Ceasar
Medications can play a significant role in the treatment of mental health issues. These chemical substances alter brain function by targeting neurotransmitters, the chemical messengers of the brain. The medications do not address the underlying issues associated with mental illness but can be very effective at reducing or eliminating symptoms. This in turn can lead to positive changes in thinking, emotion and behaviours.
Making the choice to take medications for some, is difficult. Although the benefits can be significant, there are many challenges and risks associated with them. For example, individual response to the medications available can vary significantly. What works for one person, might not work for the next. There is no way to determine one’s response except through trial and error. A person may need to try several different medications before experiencing relief. In some cases a medication that initially works, might stop working over time and symptoms return. Additionally, these meds can take anywhere from 2- 8 weeks before any improvement is experienced.
The side-effects of psychiatric medications can range from none to minor to serious. Common side-effects of antidepressants for example can include nausea, vomiting, headache, dizziness, sleeplessness, diarrhea and sexual problems. More serious side-effects are increased thoughts of suicide, worsening symptoms of depression and anxiety, new onset of anxiety, agitation, restless, impulsivity, mania and other unusual changes to thinking, mood and behaviour. Neuroleptics used to treat symptoms associated with psychosis can cause increased drowsiness, light-headedness, restlessness, weight gain, dry mouth, constipation, nausea, vomiting, low blood pressure, tremors, uncontrollable movements, muscle spasms, seizures, reduced white blood cells, hormonal changes, and unusual changes to thinking, mood and behaviour. Neuroleptics also increase one’s risk of developing diabetes and heart diseases. And, there are rare, but potentially life-threatening side-effects to consider, such as neuroleptic malignant syndrome or serotonin syndrome.
So Why Would I Take Them?
I often think of diabetes management as an analogy for the management of mental health issues. Some individuals with diabetes can reduce or eliminate the associated symptoms by making lifestyle changes, for example changes to their diet and incorporating regular exercise. Some people can manage diabetes effectively with a combination of medication and lifestyle changes. Others are highly dependent on a very regimented insulin replacement therapy in order to survive.
Often mental illness depletes us of our capacity to be in the world. For many, taking psychiatric medications can mean the difference between life and death, the difference between living well and living minimally, the difference between being institutionalized, either in a hospital or jail, and living in the community.
I have witnessed both amazing and horrifying effects of psychiatric medications from miraculous recoveries to debilitating consequences and everything in between. Because of my professional experiences, making the choice to treat my son with these medications was one of the most challenging dilemmas I’ve experienced. Jordan has Fragile-X Syndrome. Fragile-X Syndrome is a genetic cause of autism and developmental delay. Jordan, as a result, has significant cognitive impairments. He has difficulty with abstract thinking, formulating and expressing his thoughts, managing his emotional experiences and coping with external stimuli. Jordan is hypersensitive to sights, sounds, smells, and touch. His ability to shut out extraneous noise is severely impaired. His ability to tolerate change is severely limited. As a result, he can become quickly and extremely unravelled when overwhelmed. When in this state he will hit, kick, bite, spit, pinch, pull hair, swear and throw things at others, predominantly me. He has also engaged in self-injurious behaviour such as biting his finger. Unfortunately, as a single mother, I had to expose him to challenging environments, such as grocery stores. Inevitably, shopping and other excursions into the world would result in a ‘melt-down’. Despite these issues, I was determined to support him in managing without using medications. After all, I’d remind myself (many times over, like a mantra), most of the time Jordan is a joyous, loving, happy boy.
When Jordan was 8, he witnessed the murder of his sister Jasmine, my beautiful daughter, in our home. Jasmine had just turned 14. Jordan adored Jasmine and she adored him. Jasmine was his biggest defender. Jordan was extremely traumatized by her death. He would repeatedly imitate what he witnessed. He’d take a knife, hold it like a gun and yell, “I’ll f...ing kill you”. He frequently made reference to Jasmine’s blood. For example, one day I was making spaghetti sauce and he asked me, “Is that Jasmine’s blood?”. He’d mimic the sounds of Jasmine’s gurgling breath. Jordan refused to return to our house and quite honestly, I didn’t want to go back either, so we didn’t for five years. His anxieties heightened. Jordan returned to school a week after Jasmine died. Each day when I would bring him there, he would kick and spit at me, pull my hair (if possible) and bite, in an effort to leave. Within three weeks, he was threatened with expulsion for telling a teacher to “f...off”. Jordan’s ability to cope worsened and subsequently so did mine. Eventually, my decision to try medication came down to a choice between the lesser of two evils: take the risks associated with using these meds with the hope that he will get better or let him languish and potentially get worse.
Prior to medication, Jordan received counselling, art therapy and EMDR without success. The first medication he tried, at age 9, was risperidone, an antipsychotic. Jordan very quickly showed significant improvement in his cognition and coping. He was better than his baseline. He was able to grasp the concept of reading for the first time and although his capacity was limited, he got it! He started identifying emotions. His ability to tolerate the world improved and his ‘melt downs’ lessened. Jordan experienced significant strides from that time until age 17. Then everything shifted again, for the worse. He started lashing out aggressively, both verbally and physically. These behaviours very quickly escalated and I had to remove him from school. He started staying awake all night, washing his hands repeatedly to the point where they were raw and bleeding, yet he continued. He hid in the basement, in the dark. When he came upstairs he would lurk behind walls and stare suspiciously. He would suddenly erupt and smash anything breakable. He would rage for hours at a time. He was inconsolable and frightening. I became concerned about his fate. What kind of life could he possibly have like this?
Jordan knew he wasn’t well and agreed to visit a doctor. He kept a blanket over his head during the drive so he could tolerate it. The journey toward finding a treatment regimen began. Jordan now takes a combination of medication, including Risperidone. Without these meds, he would not have the life he does. Jordan lives on his own (with support), he is socially active and generally content. Jordan has become an amazing young man. I don’t believe he would be where he is without medication.
I’ve known many people both professionally and personally who have benefited greatly from medication. Despite the benefits that some individuals experience, there is no “magic” pill. Recovery from mental illness usually includes a comprehensive approach that explores and addresses underlying issues while developing skills, and incorporating strategies for improving mental wellness.
While many individuals benefit from treatment with psychiatric medications, others do not, and others won’t even go there. Psychiatric Medications, Should I or Shouldn’t I, Part 2 will explore reasons a person might choose to manage their mental health issues without medication.
“Taking medication isn’t my weakness, it’s what I do to help me feel strong again.” Arielle Smith