An Apple a Day

So many people with mental illness find themselves at a crossroads: stay on their meds and continue to feel numb, asexual, and half-alive, or go off their meds and risk a relapse – or even death. Until you have felt numbed out on psychotropic medication, you cannot comprehend the dilemma between staying on those life-saving meds and the risk of another depressive, manic, or psychotic episode.

I count myself lucky – unlike many with serious mental illness, I have only gone off one medication, without medical supervision, once. Once was enough: I was taking a very large amount of a medication and was having LOTS of side effects. In utter frustration, I went off that medicine cold turkey. The result? A grand mal seizure. Suffice it to say, I learned my lesson.

That's not the only reason I stay on my meds, however. The biggest reason is that one summer, before my episodes were well-managed, I had a spectacularly bad manic episode. More than a few things imploded in my life that summer, and I have been terrified of having another such experience ever since. In fact, whenever I feel like I am experiencing any symptoms that could herald in another manic episode, I do not pass go; I do not collect $200. I go straight to my psychiatrist. He has told me, every time, that I am chasing ghosts, that my fears are unfounded, and that everything is okay. Sometimes, I just need the reassurance.

Personally, an ounce (maybe a gallon in this case!) of prevention is well worth it, even when it means I take meds that sometimes numb my emotions. In that regard, I am fortunate to have a doctor who genuinely listens to me and collaborates with me to minimize side effects, keeping them to a minimum. Thus, I can live a fulfilling life – despite living it in the shadow of serious psychotropic medication.

One population that is chronically undermedicated is the homeless. Why do so many unhoused people go without meds? First and foremost, they are overwhelmingly uninsured. Instead of creating a system in which people on the streets have access to health care, we have created an environment where they generally cannot afford even reasonably affordable treatment.

We throw up barriers: beyond a lack of insurance, there is no incentive for psychiatrists to treat such patients, and there is a lack of affordable drugs that are effective without being numbing. And then there's the fact that a significant portion of people experiencing homelessness are suffering from a psychotic disorder, and the psychosis can cause paranoia, which can prevent them from receiving potentially life-changing treatment. And, even if a homeless person agrees to take medication, continued compliance with treatment (e.g., follow-up doctor's visits and medication refills) is the exception, not the rule. (Note: there are some good programs out there, but they're the exception to the rule – and it's hard to treat a population that essentially doesn't want to be treated.)

The moral of the story? Don't go off your meds!!! At the very least, don't go off your meds without medical supervision. Meds can, without a doubt, make you feel "off." My best advice is to take note of exactly what it feels like (e.g., numbness) so you can best explain to your doctor why you don't want to take a specific drug. My one caveat? If you start taking a drug and simultaneously become suicidal, STOP taking the drug and IMMEDIATELY notify your psychiatrist, ESPECIALLY if you are a teen or in your early twenties. INSIST on an appointment, as in yesterday. (This is per the black box warning on a number of antidepressants. Teens and young adults can actually become suicidal while taking these drugs.)