Part 9: Musings on Treatment and Medication

In this blog I hope to give some insight into the various types of medications I’ve taken over the years. I’ll also be discussing common myths and misconceptions around psychiatric treatment. There’s one thing I’d like to make clear from myself as a medical professional: this piece of writing is by no means medical advice. It comes from my own experiences as someone who lives with Bipolar, aided by my medical knowledge as a doctor. If you feel like you’re suffering ill mental health, or know someone who is and you’re looking for medical advice, please speak to your Doctor or local crisis team.

The myths surrounding Psychiatric treatment

I regularly find there’s a certain stigma to psychiatric treatment. Negative connotations often arise from misguided research, media hype and hearsay. When I’ve spoken to people, and this is true more outside the field of healthcare, it seems that negative opinions are more prevalent. There tends to be a lack of understanding and a distrust of modern treatments. It’s likely that with this scepticism of psychoactive drugs, combined with its media portrayal, the stigma around them arises. From therapy and antidepressants, to antipsychotics and electroconvulsive therapy (ECT), there’s always a level of controversy associated with them. I’m lucky enough to have a more informed appreciation of what’s involved in treating psychiatric illnesses.

Talking Therapies

Psychological therapy, or counselling, is often seen as a luxury for the rich who can afford to pay people to make them feel better. This is far from the truth. Therapy on the NHS is free, and despite the long waiting lists, they’re very effective in helping treat illnesses like depression and anxiety. Therapy incorporates many different aspects of Psychology, it’s a process guided by what the patient needs to feel better. Cognitive Behavioural Therapy (CBT) is a well known type of counselling used by various different professional disciplines. It helps people rationalise their own thoughts and behaviours to help better understand their feelings and mood. I’m currently on the waiting list for long-term counselling therapy. I made this decision very recently as my mood had been dipping regularly, and felt that a lot of these issues could be talked through with someone.

Medical Intervention

A large controversy behind antidepressants is the belief that they suppress our true emotions and feelings; they prevent us from being our true selves. Although there’s an element of philosophical truth to this, I’d argue this: you wouldn’t stop taking your insulin just because having high blood sugar reflected your ‘true’ or ‘natural’ bodily state. High blood sugars are an indication that your pancreas isn’t functioning well. In the same vein, you wouldn’t stop taking your antidepressant just because you thought having a low mood was your natural mental state. It’s an indication that there’s an imbalance in your brain. Neither of those situations are healthy. Both are pathological, and both can kill you.

It’s worth noting that medical intervention should never be first line when treating depressive illnesses. As mentioned above, Psychological therapy is very effective, and should be the first line intervention. Brains are much more complicated than Pancreases; psychological illnesses take much more than just medication to treat. However, when it’s a matter of life and death, and someone is psychotic or suicidal, medication is absolutely necessary. At the very least, medication affects chemical imbalances in the brain to such a point where the person is deemed stable and can work on other areas of treatment.

Of all the treatment for mental health it’s the stigma surrounding ECT that is the most pronounced. Much like its portrayal in ‘One Flew Over the Cuckoo’s Nest’, ECT has been characterised as a controversial and barbaric treatment method for mental illnesses. Having witnessed the treatment myself, and also looked into the risks, it is in fact a very effective form of treatment, and a relatively safe one. Patients are put to sleep prior to the procedure, and are well looked after by trained professionals before, during and after the shock is given. The single shock, which is delivered via two electric probes placed on each temple, is thought to help re-circuit the brain’s anatomy, and act as a sort of reset button. Because the patient is put under anaesthetic, the treatment is painless. In many cases, ECT is administered to patients over a course of time, whereby they receive multiple shocks at regular intervals. I still get bemused looks from family members and friends when I tell them this treatment still exists in the UK. 

What treatment am I on now? What didn’t work?

Over the years, I’ve been prescribed several different psychiatric medications. When I was first diagnosed with bipolar, I was started on an antipsychotic called Olanzapine. As well as its capacity for suppressing psychotic thoughts, it also had mood stabilising properties, so worked well with my symptoms primarily consisting of delusions and fluctuating mood. I was only on this medication for two or three months as I wasn’t coping well with the side effects, namely weight gain and daytime drowsiness. I was also switched to another medication because I relapsed very soon after starting Olanzapine.

Aripiprazole, otherwise known as Abilify, was the next choice in treatment for me. It’s a much more modern drug to Olanzapine, working similarly as an antipsychotic, as well as suppressessing high mood. This worked in my favour, since during previous relapses, my mood tended to go up first rather than down. I was taking a tablet a day for three and a half years until one of my good friends suggested switching to a monthly depot injection. I was quick to make the change, and haven’t looked back since. My compliance with taking tablets varied, and at times when I was younger and more naive, I’d intentionally miss a dose with the hope I’d have more energy and a better mood for the day. This was dangerous and a decision I would come to regret. So long as I attend the clinic for monthly injections, I don’t have to worry about tablets the rest of the time.

Aripiprazole works for me. Since I started having monthly injections in 2018, I found that my mental health has been much more stable. Although I’ve had a couple of relapses, they’ve been few and far between. I also suffer little to no side effects from it. Between injections I’m able to temporarily forget about my treatment and get on with my day-to-day living. I’m capable of working long shifts and treating patients to the best of my abilities. Most importantly, it allows me to lead a happy and fulfilling life. Although I still frequently check in on myself, I’m more confident than ever with my mental health.

Medication for anxiety and sleep

Anxiety and sleep disturbance is part and parcel when living with Bipolar. Medication for sleep and anxiety is very effective, but also very addictive. I’ve resorted to these before, but it’s rare and never for a prolonged period of time. I’m prescribed zopiclone, melatonin and lorazepam. All of these are effective in their own way, but I only use them when it’s absolutely necessary and all other techniques to help me relax have failed. As described in my previous blog post, I have several different methods to relax, wind down and fall asleep. These are often very effective, but when they aren’t, as a last resort, I will then turn to medication. More often than not, when I’m struggling, I tend to use self-help techniques coupled with one of my prescribed medications for optimal effect. 

Taking sleeping tablets and benzodiazepines come at a cost, especially when working as a doctor. They can make me feel groggy and lacking energy the following day. They can also make me more anxious at times. This is one of the paradoxical effects of benzos. When I work night shifts, I will tend to have a melatonin the morning after my first shift. This helps me set my sleeping pattern right, allowing me to function at my very best. In previous experience, when my mental health is at such a point where I’m resorting to zopiclone or benzos, I take time off. It’s the safest option not only for myself, but for the patients I treat.

Moving forward

The management of my mental health is by no means perfect, however I’m striving for an ideal balance in my treatment. With Bipolar, sleep can get very disturbed. Feelings of high mood and delusional thoughts can creep up on me insidiously. Depression can last indefinitely. I’ll likely be needing the depot injection for the foreseeable future. I’ll never be truly ‘cured’ of this illness, and there’s only so much that medication can do in managing my mental health. The real change comes from learning how to live, and deal with Bipolar, and I gain more insight as time goes by. I’m also grateful for the fact I’m still here, I’m still happy and still living my life.