Tom Petty was right

My patience has grown over the years, but it is still not one of my hallmark traits. My elder daughter has inherited whatever genetic defect I have in this area and, if it is possible, is even more impatient than I am. Funnily enough, it is her impatience that has taught me more patience in the last seven plus years.

Psychiatric medicine is an enigma. Similar to anesthesia, we aren’t necessarily 100% sure that we know how it all works scientifically. Drugs have been developed, tested, and approved, but that still doesn’t mean that they affect everyone in the same way.*

For most of my time living with depression, I have not been on medication. The last two years represent my longest stint yet. Earlier episodes of my depression have been managed with a single drug, Prozac. It’s one of the best-known selective serotonin reuptake inhibitor (SSRI) drugs approved by the US FDA to treat depression. Long off-patent and frequently referred to by its generic name, fluoxetine, Prozac has been a lifesaver for me, literally. When I was first put on medication, in college, I was prescribed Paxil, also known as paroxetine, another SSRI. I don’t recall any comparative discussion of medications, but this was also 20-some years ago, when most of these drugs were still only available in their name-brand forms, health insurance policies hadn’t yet fully caught up to the advances in psychiatry, and free-samples from drug company representatives were seemingly ubiquitous. I’ve often wondered if I was prescribed Paxil because it would essentially be “free” for me. I only remember getting it from the pharmacy once. The rest of the time, I was given the sample boxes.

What strikes me most about this part of my story is the benefit of access that I had. Because my family could support sending me to a university with a sophisticated counseling center, I was able to get treatment and intervention early. As an adult, it’s been more difficult than it was in college to access quality mental health care. I’ve found that I have to look a lot harder to find doctors and therapists who are taking new patients and that it’s important to keep looking until I find providers whose treatment philosophies are compatible with my needs. However, my experience pales in comparison to those who, for socioeconomic and other reasons, do not have their symptoms believed and cannot get access to even the most basic mental health care. [This is a subject I want to research and write more about and I’d welcome hearing from those with lived experience or who work in the area of mental health care accessibility.].

Depending on numerous factors, psychiatric drugs can take a while to show results in an individual. For me, this meant that I kept taking Paxil for several months despite not noticing a marked change in how I was feeling. The lethargy, apathy, and disconnectedness from the world remained. After four months, my doctor and I decided to call it off. It wasn’t working. Not yet understanding the complexity of psychiatry, I became more despondent, believing that I was irretrievably broken and that the medication’s lack of efficacy was a personal failure on my part. #JerkBrain was in full effect.

Since that time, I have been lucky to find a combination of drugs that has seemingly worked for me. When I restarted medication in December 2016, it was just a low dose of Prozac. When I rapidly started entering my latest depressive episode in September 2018, Wellbutrin (also known by its generic name, bupropion) was added to the mix. Whereas Prozac targets serotonin, Wellbutrin is aimed at dopamine, another mysterious brain chemical. Every couple of months, I would backslide and my medication would be increased. As my dosages went up, I still found myself unable to rise out of the depth of my depression. My laundry–the leading indicator of my mental health–started to pile up again and again. In early 2019, we added Topomax, which goes by the generic name topiramate. Originally approved for epilepsy, it’s now also used as a mood stabilizer. Topomax seemed to help for a period of time, but the side effects became more than I could bear. Side effects can vary widely and, for me, they were debilitating. I’ll write more about my experience with those side effects down the line, but I’m not ready to dig into it yet.

The first step in my renewed and focused recovery has been to come off of the Topomax. However, it will take time for me to assess whether this is the right move. That means that it will also take time before I can determine potential alternatives to my Prozac and Wellbutrin regimen. Making too many changes at once can be counterproductive at best, and dangerous at worst. As previously noted, I am not an exceptionally patient person. Yet, that is what recovery from depression is forcing me to learn: patience.

You take it on faith

You take it to the heart

The waiting is the hardest part

– Tom Petty

*For those interested in reading more, there is a ton of literature on this topic. I’ve included links to a few peer-reviewed articles below that I find accessible in terms of their readability by non-medical professionals for those who are interested. However, this is just the tip of the tip of the iceberg. I encourage you to do your own research so you can develop your own evidence-informed perspectives.

Harmer, C. J., & Cowen, P. J. (2018). How do drugs for psychiatric disorders work? Epidemiology and Psychiatric Sciences, 27(2), 141-142. doi:http://dx.doi.org/10.1017/S204579601700066X

Jacobs, D., & Cohen, D. (1999). What is really known about psychological alterations produced by psychiatric drugs? International Journal of Risk & Safety in Medicine, 12(1), 37-48.

Moncrieff, J., & Cohen, D. (2009). How do psychiatric drugs work? British Medical Journal (Online), 338(b1963), 1-4. doi:http://dx.doi.org/10.1136/bmj.b1963