Just Say No

I've been filling out more than my fair share of medical paperwork over the last few weeks, what with trying to get everything cleared for Yale and all.  It's all very standard stuff, but there is one question that continues to trip me up, every single time I see it: please list all medications you are currently taking.  Obediently, I put pen to paper and start to list the four or five prescriptions I have in my name.  Give or take a few seconds, and I'll pull up short and remember - I'm not taking any medications these days.  Not a one.  For someone who has been on one form of a psychopharmaceutical or another since I was nineteen, it's a little bit unsettling.  Also, given the manner in which I went off of my medications, I consider myself more than lucky to be doing as well as I am.  Suffice to say, it was not one of my more responsible moments.

Moving to another city presents many challenges, and finding psychiatric care - that I could afford - when I moved to Boston proved to be a challenge.  I halfheartedly started seeing a new therapist, but balked when she mentioned an every day intensive outpatient program for eating disorder treatment.  I had already had one job blow up in my face as a result of being honest with my employers about things I struggle with, there was no way I was about to come clean to my new bosses in order that I might leave work an hour early in order to make it to IOP in Harvard Square every single night.  Add to that, I was still speaking to my New York therapist on the phone every other week, and there was no way I could afford to keep paying two therapists.  So, I reasoned that doing phone therapy twice a month was sufficient, especially since I was seeing a new psychiatrist to manage my medications and my plummeting moods.  The first session I had with her was exhausting.  I left feeling like I had been poked with a sharp stick for an hour, never mind the fact that I had paid her $350 to do it.  With instructions to return in two weeks, I drove home in a driving snowstorm and promptly crawled into bed.  Two weeks later, I paced the floor of her waiting room with barely contained maniacal energy.  She ushered me in, took one look at me, and said, "This has got to stop."  I clamped my hands down on my thighs to stop their frantic twitching and asked her what she meant.

You're twenty pounds underweight, she told me.
You're headed for a manic break, she said.
Your medications can't work for you if you're not eating enough to metabolize them, she scolded.
We might have to put you on lithium.

I think my heart stopped.  I tightened my grip on my emaciated thighs as I started to shake uncontrollably.  Lithium.  It's not for the faint of heart.  Lithium is an excellent drug, one that entered the scene of psychiatric treatment in the 1950's and was found to be very effective at managing manic depressive illness, particularly in controlling manic episodes.  It comes at a cost though.  Lithium has a narrow therapeutic/toxic ratio, meaning I would need weekly blood draws to measure my plasma concentrations.  Side effects include a perpetual dazed feeling, hand tremors, dizziness, nausea, possible birth defects and permanent kidney damage.  A toxic dose is deadly.  The most common side effect, however, is weight gain.

I can't I won't I can't I won't, I chanted in my head, and the rest of our $300 session passed in a blur.

I never called her back.  I never returned her calls.  Two weeks later, my medications ran out and I didn't have any refills.  I went cold turkey off of five serious medications, each of which I should have been weaned off of over a period of weeks, and possibly months.  She left me angry (albeit, concerned) voicemails and I deleted them without even listening.  I won't pretend that any of this was a good idea.  My moods swung wildly.  Without sleeping pills, it was weeks before I slept through the night.  I had days of such paralyzing depression that they reminded me of how I had felt before I went into the hospital three and a half years ago.  I had nighttime anxiety attacks so bad that I would grip my headboard until my knuckles turned white, trying desperately to breathe, focusing in on Tucker's glowing eyes in the dark while he sat with me, never leaving my side.  Eventually though, the storms began to pass.  I could feel sad, and it wouldn't knock me to my knees.  I could feel happy, and it wouldn't lift me ten feet off the ground.  I could cry over Alix, and still get up for work the next day.  Even hearing about my dad's diagnosis only spurred me to try harder to pull myself out of the eating disorder's grip, until eventually, I resembled a healthy human being again.

Two weeks ago, I sat down once more in a psychiatrist's office (not the expensive lithium-suggesting doctor of this past January) and laid bare my history.  "I just want to see whether you think it's okay that I'm not taking anything," I told the nice, earnest-looking resident.  "I don't want to do anything irresponsible or stupid when I'm starting a new school year like this."  He listened closely to my colorful history, asked all the right questions, and finally told me that no, I didn't need to be on any medications right now.  He cautioned me, though, and made sure I understood that the very nature of bipolar disorder is that it is cyclical.  That there's a greater than ninety percent chance that I will need medications again at some point.  I already knew that, and I told him as much.  He told me to pay attention to my moods this fall, when the days begin to shorten and Seasonal Affective Disorder begins to set in.  He told me about exercise, and good sleep habits, and the benefits of surrounding myself with supportive people.  I stifled a yawn, and told myself he was trying to be helpful.  There was no way for him to know that I could have given that speech myself.

I don't know how I feel about the likelihood that I'll be popping handfuls of pills again at some point down the road.  Maybe he's right, and it will happen, or maybe he's wrong, and it never will.  Regardless, I am fully enjoying being unmedicated for the first time in five years.  And the last medical form I filled out, where it asked me to list all of the medications I am currently on?  I drew a smiley face on the lines instead.