The Bipolar Lens

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Too, Too Marvelous for Words

When Are Psychiatric Medications Overkill?

A friend of mine recently told me that he had decided to go off his anti-depressant because he felt "too mellow."  I stared at him in disbelief.  My life with bipolar disorder has been many things – tumultuous, raucous, ecstatic, chaotic – but I would never in a million years describe it as mellow.  Mellow was something to aspire to, a far-away goal like nirvana and bliss.  How could anyone ever have too much bliss?

"I don't seem to worry as much when I get up in the morning," my friend continued.  "It makes it hard to get stuff done."  Again, my open-mouthed stare.  A troublesome lack of worry sounded frankly absurd to me, and I found it hard not to laugh.

I knew that my friend was not chronically depressed.  He didn't have bipolar disorder or social phobia or panic attacks, or really any psychiatric diagnosis that I could put my finger on.  What he had was a spate of nasty luck – a series of stressful experiences that had made his life harder than usual, and dampened his usual joie de vivre.  He told his doctor about this, and she had whipped out her prescription pad and prescribed the anti-depressant.

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No recommendation or referral to talk therapy, or cognitive behavioral therapy, or even a local support group.  Just sleight of hand psychiatry – a little bit of magic to balance on the tip of the tongue.  A subtle dose of mellow.

I can hear the anger bubbling up behind my words, but I can't help it.  It upsets me when psychotropic medications are casually prescribed for situational depression (as opposed to major depression or bipolar disorder).  Anti-depressants are supposed to address a chemical imbalance in the brain, not just pacify a patient who's having a bad day.  In my opinion, my friend could have benefited immensely from a short round of therapy.  And who knows?  He might have learned coping skills that would not only help him through his current situation, but serve him in good stead for the rest of his life.

Overprescribing psychiatric meds doesn't just hurt the patient who lacks a viable diagnosis.  It makes it worse for the rest of us who really, truly need these drugs to function.  Skyrocketing demand naturally drives up the cost, which is already shockingly prohibitive.  (Just one – one! – pill in my hefty cocktail is over $900 per month.)  The drug companies can blithely charge what they like, knowing that every day patients are going to walk into the doctor's office seeking that latest miracle pill they saw on TV, the one that made the sad girl smile. 

It's a doctor's duty first to do no harm; sometimes that means putting the prescription pad away and saying no.

This may be my personal bias, but what bothers me most about overprescribing that it cheapens the experience.  Taking psychiatric medication is a solemn thing.  Those side effects spelled out in the PDR and splattered all over Google aren't there simply for shock value.  You shouldn't be ready to pop a pill just because your wife's cousin did, or you heard an enticing thirty-second sound byte.  The decision to take psychiatric meds should be entered into wisely, soberly, and with reverence:  because believe me, it's a serious commitment.

My friend, like so many people these days, doesn't have an ongoing relationship with his doctor.  He sees her intermittently – there’s no real oversight or follow-up.  So when I asked him what his doctor had said about how to go off his anti-depressant, he looked at me blankly.  "I'm just going to stop taking them," he said, at which point I had to get up and walk around the room to release the steam building up between my ears.  It's essential to titrate down carefully with anti-depressants, or you risk severe withdrawal.  I've been through it, and it's hell.  My friend didn't know this, because the doctor hadn't told him. 

I explained about the need to go off the drug slowly.  My friend wasn't convinced, or maybe he was just too mellow to appreciate the seriousness of the situation.  "You're making way too big a deal out of this," he said.  That's exactly the problem, and that's why I'm so bothered.  Drugs are a big deal, they're a very big deal, and it's time that we all recognize this – doctors and patients alike.  Anti-depressants aren't mind candy.

 

Terri Cheney is the author of Manic: A Memoir and The Dark Side of Innocence: Growing Up Bipolar.

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