WHY I PLAN TO BE MEDICATED FOR THE REST OF MY LIFE

The first time I was prescribed a psychotropic, I was four years old. Every morning, I would drink liquid Prozac with my apple juice because, while I wasn’t too young to want to die, I wasn’t quite old enough to swallow a pill. Since then, I have been on pretty much every SSRI you can think of interspersed with years of raw-dogging it* (*attempting to exist without pharmaceutical help). My opinions about those medications have changed almost as often as my prescriptions. Over the years I have fluctuated between thinking everyone with anxiety should be medicated to weaning myself off despite my psychiatrist’s objections. In a surprise twist, getting my master’s in psychology only muddled my thoughts about it all further instead of giving me the clarity I wanted.

But now that I’ve learned to embrace nuance, I feel more confident in my own relationship to medication as well as how I view it in general.

My current opinions boil down to this:

Medication works for some people, but not for everyone.

Sometimes side effects are manageable.  Sometimes they aren’t. 

I don’t care if it’s the placebo effect if it makes you feel better.

Some people don’t need to be on medication long term but can still benefit from being on it short term.

Medication is more crucial for certain diagnoses than others (for example, medication is often the first line of defense for bipolar disorder, but not for generalized anxiety).

It is okay for general practitioners to prescribe SSRIs for generalized anxiety and/or depression, but if you are dealing with something more complicated or are not responsive to the original prescription, it is much better to see a psychiatrist when possible.

Medication is not a miracle cure and often needs to be combined with therapy and other lifestyle changes to be effective.

I should definitely stay medicated until I am dead.

This last hot take was cemented for me in the spring of 2021 when I took myself off my Trintellix/Wellbutrin combo in an effort to “prove I didn’t need medication anymore.” (In reality, the decision was almost entirely fueled by a desire to lose weight.) My hard-earned stability quickly flew out the window and within a few weeks I was returning to my psychiatrist with my tail between my legs, lucky that she is too kind to sing  I told you so in a supercilious tone. (Although I don’t know her well enough to determine if she secretly sang it in her head or not.)

This disaster of an experiment supported her original argument that since my development of OCD was biologically based due to a strep infection, it makes sense that my brain responds well to medication. I had originally fought against this reasoning after learning that the popular idea that treating mental illness is all about fixing a specific chemical imbalance isn’t really true. That’s why it’s not so simple as take this Zoloft and feel cured. Some psychotropic medication even seems to work for reasons doctors don’t fully understand, which is why more research is needed as well as new avenues for treatment. Whichever way you slice it, treating mental disorders with medication isn’t as clear cut as our brains would like it to be.

But all the uncertainty doesn’t mean they don’t work. While I used to strive for an unmedicated life, I now feel a great sense of gratitude that my particular biological makeup responds so positively to treatment. Sure, it is still technically the same makeup that made me so susceptible to OCD in the first place, but at least there is something I can do about it. Unlike other people who have tried different medications without ever having a net positive experience.

Part of what makes psychotropic usage so complicated is the side effects. These can range from weight gain to drowsiness to blurred vision, with antipsychotics in particular being especially harsh on users. This never-ending cost-benefit analysis is why many people choose to go without, even though their mental health suffers. For some, weight gain or sexual dysfunction are not acceptable outcomes, and they would rather white knuckle their internal experience. For others, the litany of side effects is so damaging they can’t find a way to live a stable life on or off medication. Neither of these situations is good, and it once again speaks to a need for better and more targeted treatment options.

This leads me to the one area of psychotropics I continue to fluctuate on: psychedelics.  While I was initially thrilled to learn that psilocybin is on its way to FDA approval, I’ve since become warier of its use as a mental health intervention. It’s not that I have an issue with the drug itself. I have an issue with how much power it gives clinicians and whether it will be used ethically. (For much more information on this conundrum, check out the nonprofit organization Psymposia and their podcast Power Trip.) That’s why whenever someone suggests trying mushrooms to help my OCD and avoid life-long medication, I don’t feel ready to take that step. This doesn’t mean I WILL NEVER DO IT. But at this point it doesn’t feel worth taking myself off drugs I know are working to try something that is still experimental when it comes to its incorporation with regulated, Western medicine.

I suppose that in an optimistic sense it is slightly misleading for me to say that I will definitely be on medication for the rest of my life. There might be some new, well-tested, safe treatment that will totally transform my life 20 years from now (or even 10, if I’m being super optimistic). But for now, it is helpful for me to lean into acceptance about my enduring relationship with medication. This acceptance means I no longer have to engage in an ongoing conversation in my brain about whether I will try to get off it while pregnant or if I really need it as much as I think I do. It’s an exhausting and unnecessary loop that I don’t want to engage in anymore. Plus, at this point in my life, I have enough evidence to prove I simply function way better medicated. That isn’t a sign of weakness or defeat. It is simply my reality. So instead of beating myself up for needing that support, I’m going to be thankful I have access to it. Even when my face gets really sweaty and I can’t make it stop dripping. (Thanks, Wellbutrin!)

Xoxo,

Allison

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