Don't Stop Your Meds; Keep Seeing Your Therapist

Here's the second ground rule from the book I'm working on:

Ground rule number two: Keep taking your meds and keep seeing your doctor and/or therapist.

I maintain, and insist, that meditation, movement and meaningful work are adjunct therapies.  I believe they are absolutely necessary to manage mental illness, so in this sense one may think of them as primary therapies.  I just don’t want to imply that they will replace medication and psychotherapy.

Medication and psychotherapy have the proof of years of research and practice to illustrate their efficacy. Using these therapies, 85% of people with bipolar disorder’s conditions will improve.  But 64% of people with mental illness will stop taking their meds as directed at some point in their treatment, and months or years of talk therapy become very expensive and the number of sessions is often limited by health insurance plans. If these treatments work so well, why do so many people, knowing they’ll likely get sick again, stop them?

Possibly because these people overidentify with their mental illness, and possibly because, even when medically treated well, life still sucks.  

Sure, side effects and cost factor into many people’s decision to stop taking meds or stop seeing their therapist, but these can be addressed by conscientious doctors and therapists.  Many drugs are available for various mental illnesses, so if a person is treatment resistant to one, or the drug has too many unpleasant side effects, another is surely available to try. (some people are truly treatment resistant to many, if not all, medications.  My heart goes out to you.  But read on. There are still therapies that can help).

As for cost, only 9% of the people taking medication for mental illness are on brand name medication. The rest of us take generics which are much less expensive.  Even if the generics cost too much, programs exist that will help those with the lowest incomes afford their meds.  And Medicaid and most private health insurance plans cover all generics.

Although medication and talk therapy can make all the worst symptoms of a mental illness go away, life may still be disappointing.  This is a terrible let down that’s hard for many people to overcome.  Many will deal with the side effects and the cost and the sacrifice and still find life unsatisfying.  It happened to me.  I felt better but I still suffered.

There was a summer when it seemed everything was going well for everyone I knew.  But I was still sick.  The worst of my bipolar disorder was controlled, but I couldn’t stick to a sensible routine and stay healthy.  Physically I was OK.  Yet things still seemed wrong.

At the time I was taking an anti-convulsant that made me gain weight and an anti-psychotic that wiped me out.  I also had a PRN for an anti-anxiety med.

My doctor was a Canadian working in the US.  His visa status was changing, so he couldn’t practice for a few months.  I didn’t want to start over with someone new, so I just quit. I underwent no talk therapy at all, and within a few weeks I stopped taking my meds, except for the anti-anxiety pill, a controlled substance, which I began to abuse.

It didn’t end well.

I spun out of control, cycling between psychotic mania and suicidal depression.  I was cutting myself and drinking tequila like it was water. I crushed the anti-anxiety pills and snorted them.  Then I attempted suicide.

After a long hospitalization I emerged on meds that didn’t feel quite as bad when I took them as the meds I took before the suicide attempt, and my doctor returned and we began therapy again.  My moods leveled and I became more patient with the slow progress I was making.  I just got by, but I was getting by.

When I added meditation, a practice in focused attention, to the mix of meds and talk life brightened. Moods stopped slamming me and I stopped identifying with the disease.  While I don’t want to wean you off your meds, I don’t want to imply that you have to wait until everything is well to begin the therapies detailed in this book, either.  Practices in disciplined focused attention complement medicine and talk therapy, and they are meant to be undertaken together.

While I believe these therapies of meditation, movement and meaningful work are crucial to living well, I must again insist that when overcoming mental illness medication and psychotherapy remain primary, especially soon after a diagnosis of mental illness strikes someone down.  It would be irresponsible for me to even hint that if you meditate or exercise enough you can get off your meds.  Sure, there may be anecdotal evidence that people have done this, but much science weighs on the benefits of medication and talk.  I’m not about to stand up to science and say I know better.

But I do know what, for me, made life better after the meds kicked in and the talk was underway and I began to move toward stability.  Practices in focused attention.  

After many years of talk with my doctor we don’t undertake psychotherapy much anymore.  My doctor and I uncovered and dealt with some pretty big stuff, and he’s still available if I need to work on specific issues.  

It is important that I have this “on-call” arrangement with my doctor.  Many people who undertake a meditation practice uncover some uncomfortable, even painful revelations about their own suffering. In many cultures meditation was developed specifically to address suffering, and it is very good at that. Still, no one should suffer alone. In fact, you shouldn’t think of meditation as something you do alone.  It’s best practiced in a community.  As you begin to meditate, or return to meditation, or continue with meditation, it is important to have a means to address the painful issues that may come up while meditating.  For many of us, living on our own with an individual practice, this is a relationship with a good therapist.  In deep therapy community can be formed.

I still take my meds and probably always will.  I have too much at risk to stop them, and my doctor thinks coming off of them could be catastrophic.

Even so, it’s the adjunct therapies that make life worth living, and along with the medication and psychotherapy these practices help level things.  If I wasn’t practicing the therapies noted in this book I’d have no love, hell, I’d have no life, at all.  I’d feel no love for myself, and certainly no love for or maybe even from anyone else.

It takes a lot of work and discipline.  Anything worth it does.  But if you want to begin first listen to your doctor.  Take your meds and seek professional talk therapy when you need to. Then begin to practice meditation, move around, and find something to put some effort into that helps you focus, learn and feel a sense of accomplishment.

Meditation, movement and meaningful work, when combined with medication and psychotherapy, are likely to minimize the most intransigent defeats of an affective disorder.  All you have to do is bring some practiced focus into your life.  Not a focus on something you want to be, but a focus on what is happening right now.  The good and the bad.  Then you can see things as they are and act to change things for the better.