Psychiatry has changed my life for the better in so many ways. Starting mental health medication was the single most important part of overcoming my anxiety disorder to the point that I could live a life that wasn’t primarily focused around my anxious thoughts. However, my journey to finding the right provider and the right medication was not an easy one.
When I first got a psychiatrist, I felt that stigma train coming into the station…hard. Like many people, I asked myself what it meant that I needed to see a psychiatrist. Looking back on it, it makes me really sad, because I wonder how many people don’t end up getting the help they need because of the effects of stigma. Like many people, I felt shame about needing a psychiatrist. Then, I asked myself an important question: Why?
I think our society has some ideas about who needs to see a psychiatrist, and who is okay getting medication from their general practitioner and/or managing their mental health through therapy. It’s almost like, if you go to a psychiatrist, it somehow means that you’ve reached a new threshold where your mental health is a really big problem. Then, there’s the shame that goes along with that interpretation, which is completely unwarranted.
If your back hurts, you will likely see a chiropractor or a physical therapist. If you’re thinking about getting pregnant, you’ll probably see an OBGYN. If you’ve got an ingrown toenail, you’re gonna be taking yourself to the podiatrist. Seeing a psychiatrist is not different. If you have a mental health diagnosis, psychiatry can help you. Period. This doesn’t mean you have to manage your mental health using medication, that’s a personal choice. However, if you choose to, I can almost guarantee that there is a medication out there that will make managing your mental health easier. Just like you would get a referral to a podiatrist for that pesky toenail, a referral to a psychiatrist who can get you on the right medication is never a bad idea.
Like most people, I was initially prescribed mental health medication by my regular doctor. My doctor at the time was a fantastic doctor. I cannot say enough good things about this woman. She was compassionate, she showed genuine care for me, she took her time to really talk to me, and, most importantly, she knew her stuff. I felt that I was in good hands when I would go see her for almost any issue. But, when it came to managing my anxiety, she did it all wrong.
For about a year, I was on the wrong medication. At first, the medication helped with my anxiety quite a bit. However, it made me hyperactive, unable to sleep in past 5 a.m. no matter when I fell asleep, and it made me wake up in the middle of the night nearly constantly. My anxiety was better, but I was sleep deprived and frustrated with my inability to sleep through the night. When I asked my general practitioner about this, I was told that waking in the middle of the night is not a side effect of the medication I was taking (even though it started happening exactly when I started the new medication), but was prescribed a sleep aid nonetheless to help me sleep through the night. It helped. However, I was now on a medication to treat the side effects of another medication…and we had only tried one option. With the number of mental health medications out there, we could have done better, but I didn’t know that and neither did my doctor. My psychiatrist did.
After about a year of being on the medication prescribed by my general doctor, the anxiety-reducing effects started to fade. It might have been that I was getting used to being less anxious, so I felt it wasn’t working as well as it had been because my bar was higher. It might have been that the effects of it changed over time, or that I was under more stress than I had been during other times of the year. Regardless, my doctor’s response was to increase the dose of my medication. That’s when shit got weird.
I mentioned that the medication made me hyperactive. Well, upping my dose sent me into a state that might have met the criteria of hypomania (read more about hypomania here). I was up at 5 a.m., organizing our filing cabinet, scrubbing the floors, and feeling full of energy. My wife pointed out several times that YOU DON’T NEED TO YELL, I AM SITTING RIGHT NEXT TO YOU during everyday conversation. Now I had a problem that I hadn’t had before, and the lack of sleep was starting to wear on me. Since I knew this medication had affected my sleep before (I knew what I was experiencing, even if it isn’t a side effect on the label), I had my suspicions that these symptoms occurring right around my medication increase was anything but a coincidence.
That’s when I called to set up an appointment with a psychiatrist. Full disclosure: I think my psychiatrist is the freaking best. There are good fits and bad fits for everyone out there, and not everyone will have an experience like the one that I had on their first try with a psychiatrist. However, I do think that finding a good psychiatrist who fits you is well worth the time and effort.
My psychiatrist validated everything I had experienced. He told me: “No, nighttime waking is not a side effect on the label of Sertraline, but it can happen, and clearly it happened for you.” He immediately took me off the sleep aid, echoing my sentiments that we can do way better than having me take a medication to treat the side effects of another medication. Finally, he put me on a medication that was intended to treat anxiety.
Oh, minor detail here, the medication prescribed by my doctor was not an anxiety medication, but a type of antidepressant called a Selective Serotonin Reuptake Inhibitor (SSRI). To be clear, my doctor wasn’t completely screwing up, SSRIs have been shown to have an effect on anxiety and treat anxiety disorders effectively for many people. They are often the first thing that doctors and some psychiatrists will try for patients with anxiety because they are considered non-addictive, generally have fewer side effects than other medications, and are relatively safe (as far as we know, they haven’t been around long enough to know much about the long-term side effects).
However, as my psychiatrist explained, for someone like me, with a tendency to become hyperactive and a pure anxiety disorder without co-occurring with depression, an anxiety medication would make a lot more sense than an SSRI. My psychiatrist prescribed me a benzodiazepine, and told me to take it twice every day, once in the morning, and once in the evening.
I’m not going to lie, I was shocked, and for a second I thought I had found the world’s most irresponsible prescriber. Being a therapist and knowing some things about mental health medication, I knew it was not common for these meds to be prescribed on a daily basis. I also knew that my general doctor had prescribed them to me on an as-needed basis in addition to my regular medication, and never gave me more than ten pills at a time, telling me to “Only use them as a last resort.” Whenever I would ask for a refill, the nurse would ask me several questions that generally made me feel like a drug addict, for example: “Last time the bottle lasted you two months, this time it’s only been five weeks, what’s going on?” “How often are you taking it?” “Why are you taking it?” “You need to cut back on how much you’re taking this, or else we won’t prescribe it anymore.” I had been taught that this medication is SCARY, that I am holding a loaded gun in my hand when I pop that pill in my mouth, and I had better be REALLY REALLY CAREFUL. I was also getting this message: “Here’s a medication that you can take, but if you do, we’re going to make you feel really bad about taking it.” Oh, and I have anxiety, so naturally I worried about this a whole hell of a lot.
I argued with my psychiatrist. “Those aren’t indicated for long-term use, and they’re really addictive, aren’t they?” My psychiatrist did something that I am now so accustomed to that I can predict his reaction before the words come out of his mouth. He asked me: “Do you think that you are having anxiety about taking this medication?” Things got very clear very quickly when he asked that question. Yes. I was absolutely having anxiety about taking that medication, because I am a person with an anxiety disorder that is not being properly or adequately treated. He asked me what my specific concerns were. He told me what to look for to make sure that I wasn’t becoming addicted to the medication. He gave me the statistics about adverse long-term effects of taking the medication, which were extremely minimal. He sent me home with a prescription for sixty pills, told me to take them twice a day, and to let him know if anything came up right away.
Things got better for me really quickly. I stopped having difficulty sleeping through the night. I returned to my old, normal energy levels, and my anxiety was very well-managed. Nonetheless, when I went back for my next appointment, I was scared. “I know that you can develop a tolerance to these meds, and I’m worried that they are going to stop working for me and then my anxiety will come back and what will we do then?” My psychiatrist gave me that knowing look. “So, you’re having anxiety about developing a tolerance to your medication?” Hell yes I was. “Have you ever felt the need to take more than the amount I prescribed?” No, never. “Do you feel like this is working to manage your anxiety?” Yes, for the first time in my adult life, I feel like a normal human who doesn’t freak out several times per day for no apparent reason. “Leora, I have lots of patients who have been taking this medication at the same dose for years. If it’s working for you, you should keep taking it. You have anxiety, and the last thing we need is for your anxiety medication to be a source of increased anxiety for you.” Damn, he was so right.
After that appointment, I began to realize something about my experiences with mental health medication. Whenever you take a medication for any condition, whether it’s a mental health condition or a physical health condition, there are risks. Your doctor has the expertise to weigh the potential risks against the potential benefits, and help you make an informed choice about what is best for your health. When it comes to mental health medications, we worry about the potential risks a whole lot more than we do for other types of medication. The message behind that is something like this: Since this is about a mental health problem, it doesn’t matter as much. You shouldn’t need to take medications that come with risks, because you can fix this by thinking it away. In other words: It’s all in your head. Try harder.
That was the moment that I decided that I would tell everyone and their mother about my psychiatrist. I don’t give long lectures like this post on a regular basis, of course. But, if I have a psych appointment, I’ll mention it if someone asks me what I did that day. If something comes up that reminds me of a conversation I had with my psychiatrist, I’ll mention that my psychiatrist and I spoke about that topic. I treat it like any other doctor, because I refuse to be shamed out of doing the things that I need to do to stay well simply because they might make other people uncomfortable.
Ultimately, I hope that openness allows others to feel less afraid to seek help through a psychiatrist if that is something that could benefit them. Finally, the message that I’m trying to portray in those moments is this: my mental health is just as important and just as valid as my physical health, and my anxiety deserves the same level of attention and care as any other ailment. It is not all in my head.
Written by Leora Mirkin LSCW
TOOLS
1. Use psychiatry as a resource to find the right meds for you
2. Be open to all the things that can help you feel better: therapy, meds, coping skills, lifestyle changes, social interactions, etc.
3. Know that it can take time to find the right medication
4. If you use medication to manage your mental health, know you are not alone! Check out the #myfavoritemeds movement, for example!
CITATIONS
Harvard Health Publishing. (2019, June 19). Ask the doctor: What is hypomania? Retrieved from https://www.health.harvard.edu/staying-healthy/what-is-hypomania.