Tales of a Boundary Ninja

jwd50 asked over on the Ask AG page why I had never spoken about medications. And I realized its mainly because I have been stable on my medication for a long time such that I don’t really give it a lot of thought.  But I know it can be an issue that a lot of people struggle with, so I thought I would share my experiences.

DISCLAIMER: I want to be very clear here that I am neither a professional therapist nor am I a medical doctor. What I am writing is based on my own experiences and reading, is anecdotal in nature and should not be taken as medical advice. Medications, their benefits and risks, should be discussed with a medical professional. People can also have widely varying reactions to this class of drugs, so I will not be mentioning the name of either medication I have used.

I was on my second bout of therapy with my first therapist when the issue of medication first came up, around the time that I started to recover memories of the sexual abuse. It was a difficult time during which I was struggling both with dissociation and trying to accept the memories, let alone process them. My therapist brought up the possibility of trying medications and I basically freaked. My family had a long and not so illustrious record of self-medicating. My father was an alcoholic, my mother at one point was using too much Valium and one sister and one brother had disappeared into a drug and drinking fog which my brother did not leave for 20 years (and then ended up hospitalized when all the pain he had been holding off crashed in on him). As for my sister, the last time I saw her, she told me with a perfectly straight face how well she was doing because she had stopped drinking and was off of antidepressants. This would have been much more impressive had she not been lighting up a joint every half an hour. Kid you not. I had lost the end of high school and the beginning of college in a haze of marijuana and alcohol which stopped when I experienced a religious conversion. So I was extremely wary of the thought of medications, convinced I would end up hooked on something. It was difficult for me to understand or accept the difference between a prescribed, controlled administered drug and grabbing whatever was handy, legal or illegal, to drown out the pain.

I was also concerned about how it would make me feel: would I still be able to feel, what was wrong with me that I was too weak to make it without drugs, etc. My therapist went back and forth for almost a year. Medication would come up, we would discuss it, I would say no, we’d go back to talk therapy. Until eventually, my case worker from the insurance company started to really push on my therapist about medication. BTW, my therapist had a lot of respect for my case worker and felt she knew what she was doing and was not expecting me to be better in a few months.

The approach that my therapist took that finally tipped me over the edge, was that medication was simply another tool in my toolbox. That I was on a two-legged stool of my support network outside of therapy and therapy, but that medication could be a third leg that would make the stool more stable. That it was taking me so much energy simply to manage my depression and trauma and face the challenges of life (I was a full-time stay at home mom at the time with two small children and later when back to work full-time) that there was nothing left over to actually do any work in therapy. That medication might provide the space in which I could heal by saving me some of the energy and attention I had to put into just coping.

So I agreed to at least try it, partially because she was making so much sense, and honestly, my insurance company was sinking a lot of money into my therapy that I felt I should at least give it a shot (I’m a lot more clear these days on not owing the insurance company anything. But considering how much my therapy has cost over the years I have wondered if my therapists have just written things like “this woman is bats$%% crazy, keep sending cash!” :)) So I went to my GP who put me on a very low dosage of  an older antidepressant (it’s not much in use these days.) There wasn’t much of an effect, but once again my insurance company stepped in and requested that I see a psychiatrist who specialized in psychopharmocology.

This entailed another round of discussions with my therapist as I was terrified of how “crazy” they would think I was. I also had no idea how I could talk to anyone else about what happened to me. My therapist was incredibly supportive and I managed to go to an appointment and although highly activated, I made it through. My therapist, bless her, then actually read me the letter that the psychiatrist wrote to her after seeing me, since part of what I hated was the thought that they would be discussing me and saying horrible things. The letter was actually a very compassionate summation of what I was facing and complimentary about how I had conducted myself.

This is where I learned what I would consider to be my first lesson about antidepressants which is to see a doctor with experience in psychopharmocology. They are much more familiar with this class of drugs than a general practitioner. The efficacy of these drugs also varies widely from person to person, it can take some time to find the medication or cocktail of medications, if any, that work for you and it takes time to build up to a full dosage. They also usually involve some side effects in the beginning that are not too fun but may not last. Someone who specializes has a much better handle on all of that. The first thing my psychiatrist did was to order blood work and it turned out I was on too low a dosage (the concentration was too low in my bloodstream) so he increased my prescription. That is when I really noticed a difference. I later switched to another medication, which I have been on ever since, with the only side effect for me being dry mouth. When I got on my present medication, the first week I felt like a total zombie, incapable of functioning. The second week I was pinned to the ceiling, agitated and feeling like I was drinking three pots of coffee a day. But my doctor was aware that this was normal for that stage and encouraged me to wait it out, with the result that I found an excellent medication for me. I still go to the same practice to oversee my meds,  although I see a nurse practitioner there now.

I am very comfortable on the medication I am on now because it does not make me feel high or euphoric and actually allows me a full range of feelings, something I feel is crucial to actually being able to heal in therapy. But it provides a “bottom” underneath me. I only sink so far, but do not descend into the depths of despair and suicidal ideation.

For a very long time, I viewed medication how my first therapist presented it: a tool I would use during recovery, but when I was “done” (hah!) therapy, I would get off of the medication. I no longer feel that way for several reasons. The first is that I am not sure I will ever be done with therapy. 😀 Ok, seriously though, one is that my (other) sister and I bear a strong physical resemblance and often react the same way to medications. She is on the same medication as I am and has attempted to wean off the drug a couple of times and ends up very depressed and struggling with suicidal thoughts. Considering the paucity of side effects for me on the drug, it just seemed more sensible to stay on it. The NP I see feels the same way; we have agreed to take a “if it ain’t broke, don’t fix it” approach.

The more important reason though was what I later learned about brain development. Trauma research in neurobiology has found a causal link between secure attachment and brain development. When a child experiences long-term trauma in childhood, it has a detrimental effect on brain development that causes the brain to not produce sufficient amounts of some chemicals. So an anti-depressant is necessary in the same sense that insulin is necessary to a diabetic. You are supplying something the body should produce but isn’t. I wear glasses to correct my eyesight and take antibiotics if I have an infection, as well as medication for my blood pressure. I honestly believe that it is the misplaced stigma attached to mental health issues that cause people to view antidepressants in such a negative way. For me, its just another of my medications that I take to treat a chronic condition.

All that said, I do not believe that everyone in therapy needs to take antidepressants. I believe everyone should make their own decision about whether or not to use medications. They do not work for everyone, for some the side effects outweight the benefits and for other people some other combination of exercise, diet and natural supplements works just as well. But here’s the thing, I think a knee jerk reaction in either direction: everyone should take medications OR it’s always wrong to take medications is a bad approach. Some people are helped by them. So taking medications should be approached like any other part of your health care. What are the possible benefits? What are the costs? What are the risks? If you feel like the possible benefits are worth the possible risks, then at least be open to trying them out to see if they are effective for you.

Therapy can be a long, hard, confusing road to walk and its good to be open to anything that helps. I have used books, music, poetry, friendship, dreams, medication, journaling, exercise (ok, not so much, but I’m a work in progress) medications, group therapy, therapy support forums and blogging along the way. Medication has been a very powerful tool for me, but I am also one of the lucky ones in that I have found one that is very effective for me with very little side effects. But the more tools you have in your tool box, the faster the work goes and the less often you come up empty-handed.