I’ve already written about psychiatric drugs, but this is a new post, and perhaps more personal than the last. For me, and I suspect others, taking psychiatric medication is a problem every day of my life. It’s like I have two people in me, one saying – ‘Yes, you know you need to take them, people will be angry with you if you don’t, and they may, just may, be keeping you well.’ Except they don’t always manage to do that. The other person is saying – ‘Don’t be a fool, there’s no hard evidence that you even have an illness, let alone that you need to take these dodgy chemicals. Your kidneys will fail, your metabolism will stop metabolising, and for what? Just to keep other people happy?’
I’ve been taking ibuprofen recently for a painful back and leg (yes, I know it’s not ideal with lithium) and the difference is that it works! Obviously this may be a placebo effect, but there’s no denying the fact that half an hour after taking it I’m no longer in pain. Blood pressure tablets take your blood pressure down, antibiotics cure your chest infection. I know that there are many tablets that have similarly unobvious effects to psychiatric drugs, but then I also know that lots of people are uncompliant with a whole range of medications.
The last couple of years haven’t been great for me. As well as one or two severe episodes, my mood just doesn’t seem to be as stable, which would be fine except that I’ve probably been more compliant than ever before. I’m a naturally compliant person, the kind who always did what she was told at school. I like being told what to do. And I think it all comes back to the difficulty of seeing oneself as others do. When I’m depressed or – less often – high, I still feel like me. I am me. Why ask for help then? I don’t actually know. But I think now, after having this illness for many years, a small bit of me can step out and say – something’s wrong. I think I’m better at this than in the past, previously my husband was more likely to notice.
And then the only thing I have to do is take the drugs and wait. Sometimes I have to wait for a long time. If I don’t take them, or stop them – and I use these next words deliberately – I get into trouble, which, as a mature woman, is hard to take.
As a psychiatrist, obviously I prescribe drugs. I like to think that I only prescribe when a clear diagnosis has been made, and the drugs are likely to work, but we all know that’s difficult to prove. And being a prescriber makes my own conflicted views even harder to manage. Even more important – Will the patient take these drugs? Do they think they will help? Of course I try to explore this, but time is limited, and it’s often hard to follow up on it.
And I suppose this is what it all comes down to. We are prescribing, or taking, drugs that have effects that can be difficult to quantify or qualify, often with side effects that border on the intolerable. I’m not saying they don’t work, and they may provide enormous relief for some, but for many others it’s a bit grey. For some, the disadvantages outweigh the advantages. And many will stop them, or take them incorrectly.
We need to provide more support to people taking psychiatric drugs, we can’t just provide them and scarper. But many psychiatric services are organised such that people get minimal follow-up after being seen, or their GP is supposed to follow up. The stress of trying to get a GP appointment would eliminate many of these people after the first phone call. Don’t blame the GPs, they’ve been left managing all the problems that secondary care can no longer cope with – they just don’t have the time.
I’m sure there are phone lines that can be called, information that can be googled, but at the end of the day we’re not doing enough. Don’t blame the psychiatrists either; if we tried to see people more often, then the waiting lists would explode, and other people would suffer.
I am a fortunate, middle class psychiatrist, but I still have to believe that I have a serious psychiatric illness that requires unpleasant psychiatric drugs with potential future risks, and I find this really difficult. Possibly it’s worse for me, as I know too much about it, but I think that there are also advantages and disadvantages of knowing less. People should be informed of both their diagnosis and why they are being prescribed pills. They should know the side effects most relevant to them. And – somehow – this should be followed up. People should not remain on cocktails of medication, recommended by various different doctors.
The other day, some medical students came to speak to me about deprescribing. It’s a curious concept, that has probably arisen from the lack of follow-up. I still don’t understand the rationale for the name. But many people don’t necessarily need to be deprescribed. They might need to be underprescribed, they might need represcribed, but many will just need supported prescribing.
So, back to me, where the story started. I am painfully taking my pills, every day. I worry about the consequences, every day. And, even more painfully, I worry that, for me, they won’t work, that they will not, in fact, prevent further episodes of illness. I find this collection of ideas difficult, and it’s compounded by the problems of admitting you’re on medication. People can make jokes about taking psychiatric medication, but, believe me, being on lithium is no joke.