March 23, 2022
“I’m fine now - I don’t have to take my medicine,” the fool claimed, right before relapsing into old, maladaptive behaviors. Oftentimes, in therapeutic settings, SSRIs and other psychiatric medicines, originally intended to be prescribed in the short term, become long-term medicines. Though one can find an article to support anything, at least one researcher is concerned about long-term SSRI use, and another study found common adverse effects among SSRI users, as well as a significant amount (~30%) of still-untreated depression. And while SSRIs and other psychiatric medicines work for some, they do not work for everyone, described in a nuanced way by P.E. Moskowitz. Among other medications, many with ADHD/ADD do not enjoy being on stimulants due to appetite, cardiovascular, and mental side effects. Oliver Sacks, one of my favorite writers, describes a case of Tourette’s in which the patient, despite being a surgeon, requiring incredible hand dexterity and sensitivity, refuses medication for the issue, believing that they are not fully themselves when on it. The point of medication is recovery - for some, this recovery is ongoing with their medicine assisting them - but for others, who dislike the side effects, discontinuing medicine is part of their path to recovery. However, medicine is often viewed as an ongoing cure for a psychiatric illness. How then can recovery happen without; the patient’s lessons kept from their time on medicine?
There is no one way, but there are a few paths that I know of. Between the transition from high school to college, I experienced severe intrusive thoughts, every hour of every day about my own death. To say the least, it was incredibly distressing, and it was a vicious cycle; I would think about the thought, then think about not thinking it, which in turn made me think of it again. Cyclical thoughts are annoying when they are not in your favor! For this cycle, SSRIs served to interrupt it; once I escaped it, I was able to look at the cycle from the outside. I found the side effects too much personally and ceased right before coming to college; by then, the cycle was less trigger-able, and I did not have to think about not thinking about it to lessen its severity.
Another way is the traditional way; antidepressants as a way to make things more bearable while going to therapy. The lessons learned in therapy are the real treatment, and SSRIs enable executive functioning, willingness, etc. to learn. In this, they allow for processing during an especially bad episode.
Finally, time heals a lot! Remission rates for serious (bipolar, depression, schizophrenia) mental illness (general) are fairly high, with a ~25% recovery rate in one’s mid-twenties, increasing from there. For borderline personality disorder (BPD), the recovery rate is incredibly high over the timespan of 2-8 years. For ADHD, full remission was seen in ~1/8 of patients, partial in a third. We underestimate time’s ability to heal, though medication helps in the meantime.
Occasionally, people can be gatekeepers to recovery, claiming that one is not truly recovered if they are still on medicine - this is an incredibly outdated belief, and not the purpose of this post. Rather, this is intended to be hopeful; for many, medicine does not work as well as they wish, and side effects, refills, doctors’ appointments, and costs pile up, making treatment insurmountable. Luckily, we are more resilient than we think; recovery and prescription, though correlated, are not the same thing.
On February 27, 2022, I thought it would be a great idea to create some sort of content - writing, art, coding, etc. - every day of the next month. Luckily, the alliteration worked out. This should be the twenty-third post in the series.