Today’s #thoughtfultuesday emerges with a rather perplexing cluster of feelings; a statement of which, I am certain, is how many of my posts commence. As evidenced previously, through the writing process, clarity typically transpires. Accordingly, I would like to thank-you in advance for bearing with me as I untangle the matters of my mind. The most persistent matter I would like to address is the vastly under-developed and under-discussed world of psychiatric medications, which will later encompass the experience of withdrawal from prescription psychiatric medication cessation. Obviously, the experience of withdrawal is pertinent to most prescription medications, but I do not possess the education or prestige to have a worthy opinion on medication I have not directly or indirectly consumed. Before delving into this content, I would like to highlight that I assume a rather neutral stance to the use of psychiatric medication. I am of the opinion that a generic approach or solution is non-existent, meaning each case should be evaluated independently. As someone who practices and preaches client-centred care as a philosophy, I feel rather strongly that the individual with the presenting concerns and symptoms should be the executor (unless there are extenuating circumstances) of their care. One bias I do entertain, which happens to be based in scientific inquiry, is that medications as an intervention alone are rather ineffective. Greater outcomes are observed when medication is used in conjunction with psychotherapy. This is evidence that primary care physicians and specialists should be dolling out prescriptions for therapy, but my activism may be a tad overzealous. On another note, find a comfortable chair as I take you through the gripping excursion that has been my life with prescription medications.
My first encounter with a psychiatrist occurred at the age of sixteen. At this time, I was frequenting an Eating Disorder Clinic as an outpatient at the Alberta Children’s Hospital. Fortunately, this psychiatrist was not prescription fixated; many psychotherapy sessions occurred prior to the entertainment of medication use. Now in my thirties, I am aware that this psychiatrist is virtually an anomaly, as the majority rely heavily on chemistry to address neurobiological imbalances. Significant discussion took place prior to the authorizing of a prescription for a low dosage of antidepressant. Certain antidepressants are used in the treatment of Eating Disorders as they have some efficacy in reducing the prevalence of obsessive thought patterns and binge-purge compulsions. Given my emaciated and skeletal-like existence, I did observe a slight increase in mood after a few weeks of consistent intake. What this shift is attributed to it is difficult to determine, but is neither here nor there; any sign of life was welcome. Regardless of an increase in optimism, my rather critical physical condition continued to decline as I had zero intentions of eating or gaining weight. This led to a serious of hospitalizations and releases. Following my final hospitalization at the age of seventeen, I was admitted to an adult psychiatric ward, where I resided for a month while I was awaiting transfer to an inpatient treatment centre at the University of Alberta Hospital.
Entering the Eating Disorders Unit at the University of Alberta Hospital was like stepping into a foreign universe. There were so many patients for such a small unit; the hallways were lined with exercise mats, all occupied by heaps of blankets covering sleeping patients. I quickly realized that the lead psychiatrist was the master of this universe; all decisions relating to the workings of the unit, inclusive of my personal freedom were under his governance. Although I liked this psychiatrist, his theories differed from the one I had been working with previously. This psychiatrist assured me, “One day, there will exist a medication that will remove all of your problems.” I laughed at this sentiment, only to discover that it was uttered with full conviction. It was at this moment that I thought to myself in Alice and Wonderland fashion, We're all mad here. Here began my experimentation with psychiatric medication. The presence of the antidepressant did not waver, but I was introduced to the world of benzodiazepines and antipsychotics as additives. During this time of experimenting with varied cocktails, I felt much like a lab rat. Over the course of the three months, I was rather groggy and slept heavily when I wasn’t consuming copious amounts of food. I acknowledge that it wasn’t much of an existence, but I was rather grateful to be sedated and not consumed by panic and anxiety. Only on one occasion was I concerned with the level of sedation, as I was so heavily medicated that I urinated myself because I was unable to wake to use the restroom.
Upon turning eighteen, I decided to leave treatment as I exercised my authority as an adult. High school graduation was nearing, and I was determined to be “done” with institutions. At this time, I was regularly taking a benzodiazepine in addition to the original antidepressant. I entered the free world without any cautioning regarding the use of these medications and operating motor vehicles or in the consumption of alcoholic beverages. You can likely predict that the following year didn’t unfold smoothly. Over the course of one-year, I was in five (thankfully minor) car accidents. I wasn’t able to connect that the sedative effects of the Xanax were greatly impairing my reaction time. Fortunately, I was still deathly afraid of calories, meaning my consumption of alcohol wasn’t excessive, but it was here that I began to experience blacking out after consuming a few drinks. It was many years later that I approached a pharmacist and inquired about alcohol consumption with antidepressants, of which I was informed that one drink is equivalent to about three. By this time, I was no longer taking Xanax. I would assume with its presence, the potency would be doubled, which would be the equivalent of six (again, following the consumption of one alcoholic beverage).
After a year of independence, I found my physical condition to be declining rapidly. Rather than returning to inpatient treatment, I entered a day program through the Alberta Children’s Hospital. Despite taking place thirteen years ago, the experience I am about to recall is vividly etched in my mind. I was on meal preparation for supper, which I was extremely anxious about; chicken burgers were on the menu. Carbohydrates and protein were both “fear foods”, so in combination this meal was a panic attack waiting to happen. To escalate matters, the burger was on a white bun and the chicken burger was battered. I was unable to comprehend that following the burger, I would have to eat dessert as well. To the ordinary viewer (and myself today), this probably seems like some sort of comical parody. To my then self, this meal was a phobia. I was standing at the counter, sorting ingredients when my world went black. I woke up on stretcher with no concept of where I was or how I had gotten there, and blood tangled in my hair at the back of my melon. Prior to this day, my prescription of Xanax had run out. I was unable to see a physician or psychiatrist for nearly a week, which meant I ceased taking this medication using the “cold turkey” method. The combination of stress and withdrawal had led to a seizure. On a positive note, the seizure occurred in hospital, so I was in capable hands. Given that I now had a fragility to seizures, I would no longer be prescribed benzodiazepines.
After this experience, I decided that day program was slightly too progressive in comparison to my level of readiness (I would be damned to have to consider eating another chicken burger). I ended up returning to inpatient treatment in Edmonton. While here, I had another seizure, beginning the trial and error period with anti-epileptic/seizure medication. Of anything I have taken to date, these medications take the trophy for the most prevalent and horrendous side effects. The looming fear of another seizure ensured compliance, despite my dissatisfaction. Upon physically regaining health and moving to outpatient status from the Eating Disorder Unit, the time had come to fully embrace the lifestyle of a young adult. Thus began my unhinged consumption of alcohol; again amidst taking potent prescription medications. Most of these nights, I have little to none recognition of. With my knowledge and awareness of substances and their influence on the brain and body, I am fortunate to have escaped the experience of an accidental overdose.
Following a seizure-free year, I was given the green light to wean off anti-epileptic medication, which was music to my ears. For the next six years, I was relatively stable and maintained a level of satisfactory wellness overall. In my mid-twenties, I spiralled into a non-functioning depressive slump, despite being on anti-depressants. Unanticipated changes in a relationship were at the forefront and repressed trauma was seeping from my being. I was in University at this time, and began connecting with a psychiatrist on campus. This was the most pleasant encounter with a psychiatrist in my adult life. We engaged in discussion as equals, my interpretations and perceptions were considered valid contributions. With this psychiatrist, I started a new antidepressant, supplemented with a low dosage of antipsychotic. Leading up to this point, I had been in talk therapy with various counsellors, employing a myriad of techniques. This episode warranted a deeper delve into psychotherapy. With the support of a community, consisting of medical personnel, counsellors, professors, family, and friends, I landed on my feet. This led to the completion of an Undergraduate Degree and a handful of years of instrumental field experience with government and non-profit agencies.
Only a few months ago, the thought arose that I have not been medication free since my adolescence. This was accompanied by fear of another major depressive episode or some unforeseen psychotic break. In leaning into this fear, I realize that the fear is the unknown; there is no means of predicting what lies on the other side. Over the past two months, I have been in the weaning process, which has not been pleasant. Withdrawal is experienced on a psychological, physiological, and soul level. In my training and experience as a counsellor, specifically in the field of addictions, I have not encountered a single discussion on the withdrawal symptoms relating to the ceasing of prescription psychiatric medications. This elicits an element of sadness. With the well-documented, elevated levels of diagnosed mental health conditions (which in some spheres is being referred to as an epidemic), there is an ever-increasing demand to have transparent conversations around medication use. The point of this lengthy story is to stimulate discussion around seemingly taboo topics as such. Much of the anecdotal evidence throughout was discovered through trial and error, largely of my own responsibility. There is exaggerated warning and caution surrounding illicit substance use, and licit substances such as alcohol, tobacco, and cannabis. Yet, throughout the many years of being prescribed psychiatric medications, I was given them at liberty without any practical information or guidelines. Sixteen years later, I still find myself at a deficit in understanding the mystery that is pharmaceutics. More specifically, I am not demonizing medications themselves, but rather the lack of cautionary use and the absence of transparent information.
In hindsight, some of my suffering may have been alleviated had I have been adequately informed. With sincerity, I hope that this is helpful to others who are familiar with the dance of psychiatric medications, or are in the contemplation process. My only caveat is to encourage a delving into the literature, if possible, so that your decision is not made in haste and is well-informed.
If there are any take-aways from my antics, refrain from: operating a motor vehicle when sedatives are present (benzodiazepines/anti-anxiety medications, anti-epileptic medications), consuming alcohol beyond the guidelines of zero, one, or two while taking any form of prescription medication, abruptly stopping any prescription medication, or taking multiple psychiatric medications without close monitoring and questioning. Oh, and I would like to add: trust me, that damn chicken burger just isn’t worth it.
Wishing you many days of walking on sunshine,