On Taking Pills

I sometimes joke that I ought to become a doctor and advertise my practice on billboards, much like some lawyers do. The billboard would feature a picture of me wearing a white lab coat, with a cheesy grin, giving a thumbs up next to the caption “I’ve got a pill for that.”

It’s not too far removed from how I oftentimes think. I have pills to do just about anything. Trouble falling asleep? I’ve got a pill for that. Feeling disconnected? I’ve got a pill for that. Tired during the day and don’t have time for a nap? I’ve got a pill for that.

Having taken an untold number of different prescriptions over the years — dozens and dozens of them, I feel as though I’m pretty well acquainted with the sorts of things medications can and cannot do. We very much live in a prescription-based culture where taking a pill is expected for just about every health problem.

This attitude, that “I’ve got a pill for that,” is a far cry from my attitude five or six years ago. I used to hate my pills, and with good reason: they make me fat, lazy, and stupid. The side effects of psych meds are among the heaviest in any group of medications.

I’ve already mentioned the weight gain, the immense fatigue, and the cognition problems (which are really the top three) but I’ve taken medication that has made me drool uncontrollably, I’ve taken medication that has made me see double while riding my bike, medication that makes my hands shake so uncontrollably I can hardly draw a picture or write a word. I’m currently taking medications that makes my joints (particularly my knees) ache and pulse with pain. I’m taking medication that gives me seizures from time to time or paralyzes me. I’m also taking a medication that sometimes (usually right after the weather starts getting hot) makes me somewhat cold blooded, poikilothermic it’s called — burning hot in sunlight and freezing cold in the shade.

Psychiatric medicine often doesn’t feel like medication. It’s not like an antibiotic where you go through your bottle of pills and you come out of it feeling much better — your ears no longer burning and throbbing — and ready to tackle work again. Psych meds are taken for the rest of your life. I’ll be taking some cocktail of medication twice a day, every day until the day I die. Antibiotics might make your stools loose, but they don’t help debilitate you. At the height of my medication intake, I was sleeping 12-16 hours a day. There wasn’t much I could do in a day. And my day often had to involve a nap. Pills are supposed to make you feel better so you can continue living your life and my psych med routine was putting me to sleep so much that I missed out on most of the day.

People with mental illness often have a difficult time taking their medication: sometimes because we don’t think there’s anything wrong with us; or, in my case, because the side effects seem worse than the illness. And it totally makes sense. Relief only starts to trickle in after about six weeks of consistently taking them, but the side effects (particularly the sedation) are almost immediate. I remember when I tried Zyprexa for the first time. I took it an hour early because Dr. Carlson had told me it’s pretty sedating, and I ended up sleeping until 4:00pm the next day. I’d missed school, I’d missed work, and I was in deep trouble.

I hated my pills and so I never really gave them a chance. My parents tried to encourage me to take them, but it wasn’t any use. When they offered to get me an anti-psychotic while I was going through a psychotic episode I got angry, the suggestion seemed to make the psychosis worse. I didn’t want a freaking pill, the pills didn’t help, the pills were worthless, I just wanted the psychosis to end. I didn’t even remotely associate an extra dose of Geodon as something that would help me.

Fast forward five years and I’m all about my medication. If I start feeling a psychotic episode coming, the first thing I always do is reach into my bag for some of that Geodon I used to hate so much. I’m completely committed to my morning and evening pills. When pill time comes I’m right there, taking my pills, taking them gladly. I’ve hardly missed a dose since I promised to start taking them and not once has a missed dose been intentional.

It’s my little cousin, Maren’s fault. One Christmas, while my dad and I were video chatting with my mom’s family, Maren told me that she prayed for me every night and hoped I would feel better. You can trust the sincere, almost naive truths of four year olds. She knew nothing of mental illness, she didn’t have the ability to try to talk me into taking my pills like so many people had. And it took that naivety, that simple hope of her’s and the knowledge that she was doing everything she could by praying for me, for me to realize I was being selfish. Dr. Carlson had told me repeatedly how much of an investment medication is, how it takes weeks for them to start working fully. I’d chip in a couple-three days worth of taking pills, but never a full six weeks.

I was so touched by Maren’s words, touched by her sincerity and her innocent desire that I feel better. If even my little four year-old cousin was rooting for me, was trying to help me, why wasn’t I helping myself? I was letting mental illness walk all over me, I was just passively sitting there and allowing myself to suffer. It was the first time anyone in my extended family openly talked about my mental illness. And just talking about it, even with a four year-old, was incredibly powerful. I used to be paranoid about my mom’s side of the family, I had delusions of persecution about them. And to know that her parents were having their whole family pray for me was eye-opening. I had direct evidence that they loved me, that they wanted me to get better. She wasn’t talking to me with any kind of judgement, she wasn’t awkward. And, while it was probably because she wasn’t old enough to understand, her sincerity and love really moved me. I wanted to feel better for her, for the rest of my family, and for myself.

And it had to start with pills.

I figured out a schedule for my medication, I set reminders on my phone and on my computer. I told myself I would take all of my medication at the prescribed times every day for six weeks to see how it went. Swallowing pills is an easy way to start, though there are terrible stumbling blocks to get to the start. The main problem is psychological.

I think the trick is knowing yourself, in particular, knowing what motivates you. I’m very much motivated by helping people — if something I can do will help someone, I’m probably going to do it. Maren was trying to help me through her prayers and I wanted her to help me, because it’s so empowering when people finally start opening up about mental illness and talking about it openly and lovingly.

After the six weeks were up, people were telling me I looked better: I was more present, I was getting psychotic less often, maybe once or twice a week instead of multiple times a day. Dr. Carlson assured me it would only get better once we found the ideal combination of medicine. It can take years for you and your doctor to find the right combination of medicines and everyone has a different combination. It’s a frustrating journey; but completely worthwhile. Once I found the combination that works best for me, the difference in quality of life has been like night and day.

I’ve been on roughly the same set of medications for about a year and a half. The addition of famotidine (Pepcid AC) — a ton of it — has meant I can take a lower dose of one of my especially sedating antipsychotics and thus I sleep much like a normal person. I still wake up more tired than when I went to bed, but I have a system which means I get Dexedrine in my system as soon as I stir from sleep, so that it kicks in 30-45 minutes later and I’m good to go. It’s been so wonderful to not sleep an entire day away, and it makes taking the pills all the easier. I’ve gained a hundred pounds, but I’m working on losing it and have lost twenty pounds since the beginning of the year. My cognition isn’t the best, not like it was before I was diagnosed, but my brain works well enough for me to read, write, and fix the occasional computer and I’ve learned to be satisfied with that.

So much of life is compromise, and that’s especially true of mental illness. It’s like there’s an excess of compromise — a complex system of tradeoffs and sacrifices that must be made to attain the best level of mental health that you can.

Psych meds aren’t an end like blood pressure medication is, you don’t just take the pill and everything’s better, there’s no such thing has a “happy” pill. Psych meds are a means, a way to clear away most of the dysfunction so you can do things to actively make yourself feel better. My pills simply enable me to take care of myself, they’re the basis of my treatment, though they aren’t my sole treatment.

In living with a mental illness, you can’t be passive — you have to attack the problems head on, you have to be on your feet, weapons ready to defend yourself against the onslaught of your brain. And it all starts with medication, it did for me at least. Taking pills every day gets better, gets easier, soon it’s just another thing that has to happen in the course of the day — just another habit.

Facing a mental illness is daunting, it’s intimidating and it cannot be done by yourself. As I’ve said many times, it’s a team effort. I have my family and a solid group of friends who support me and care for me, and they make all the difference. Maren’s words struck me as particularly powerful because she was the first to mention my illness. Everyone else danced around it, avoided talking about it because it can be such a difficult, awkward thing to talk about. But Maren’s brave words (perhaps born from simple four-year-old-naivety) opened the doors to allow more conversation, her words made me realize that I wasn’t alone in my struggles, that people love me and want me to do better. And not feeling alone has made all the difference.

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