polyamory and mental illness

Course of Treatment: Treatment Options – Medication

Gah! Late again! Sorry folks, what was supposed to be a 2-hour out-patient deal yesterday turned into a full day at the hospital thanks to a mild reaction to anesthesia. 

 

Disclaimer: I have some very strong feelings about the use of psychiatric medication. I’m going to be as even handed as I can here, but please do your own research and come to your own conclusions.

Disclaimer 2: I am not a doctor, psych, or any other kind of health professional. As always, this blog is for informational purposes only and information found here is not meant to be used to diagnose, prescribe or otherwise treat mental illness.

Understanding Psychiatric Medication

Okay. That is a misleading title. There is very little we understand about psychiatric medications. We understand that sometimes they work and sometimes they don’t. We have theories about how they work. But for those of us on the receiving end, it often seems that psychiatric medication is prescribed by guess and the gods. But let me break this down a bit.

Types of Psych Meds

Anti-Anxiety

Just what it sounds like, anti-anxiety meds are intended to reduce anxiety and/or stop anxiety attacks. If you get a really bad panic attack, to the point you need to go to the hospital, they will give you an anti-anxiety med as an injection. The one time I had this happen I went from full-on panic attack to relaxed and calm in seconds flat. It was wonderful. Depending on your level of anxiety, these meds will be prescribed daily or as-needed. As a pill, anti-anxiety meds don’t work as quickly or effectively as injection–the digestive system slows things down a bit. However if taken soon enough an as-needed anti-anxiety pill can be effective in preventing an anxiety or panic attack.

Anti-Depressants

Anti-depressants are both the best known and most controversial of psych meds. The controversy is largely due to the difficulty of evaluating their effectiveness combined with incomplete understanding of how and why they work. If an anti-anxiety injection can take a person from full panic attack to calm in ten seconds, obviously it works. If anti-psychotics can stop hallucinations, obviously they work. These are extreme and obvious symptoms that are either present or they aren’t. Anti-anxiety and anti-psychotics may not work for everyone, but it’s hard to deny that for the people they help, they are effective.

Depression doesn’t have symptoms like panic attacks and hallucinations.  Things that you can *bam* it stopped. Depression is one of the most subtle of the mental illnesses, and there is no obvious way to tell is an anti-depressant is working or not. Doctors put you on an anti-depressant and ask “how are you feeling, do you feel better?” If you feel better it’s working, if you don’t feel better it’s not.

The problem with this is it’s like saying “If you don’t have allergy symptoms today, your allergy medicine is working.” Well…maybe the medicine is working, or maybe the pollen count is just down today. Did you check the pollen count? With depression, there is no good way to check the “pollen count.”

Anti-depressants have helped a number of people to manage their depression. Many people report that finding the right anti-depressant that works for them was a turning point in their treatment and allowed them to regain their lives.

The most popular anti-depressants are SSRIs, selective serotonin reuptake inhibitors. Tricyclics are older anti-depressants, only used today when SSRIs don’t work, and I’ve known several shrinks who won’t prescribe them at all due to side effects. Wellbutrin, Effexor and a few other new anti-depressants don’t fit in either category.

SSRIs and Tricyclics both effect the neurotransmitter serotonin, at different points in the neurotransmitter’s cycle

Anti-Manic (aka Mood Stabilizers)

Anti-manic agents, also known as mood stabilizers, are mainly used to treat bipolar disorder, but can be used for other mood problems. Anti-manic agents suffer from many of the same problems in identifying their effectiveness as anti-depressants, however the swing between mania and depression, which tends to include a predictable duration, gives a better measure for judging the effect than is available for anti-depressants.

Anti-Psychotics

Anti-psychotics are best know for treating hallucinations and delusions. As such, they are a class of psych meds who are unusually easy to measure the effectiveness of. Antipsychotics are also used to treat thought disorders (when something interferes with your ability to think), bipolar for short periods, and  recently have been tried with some success for extreme depression.

Anti-psychotics regulate the neurotransmitter dopamine.

Stimulants

Stimulants are exactly what they sound like, and many are closely controlled due to their close chemical relationship with methamphetamine. Stimulants are most often used to treat ADHD, as people with ADHD usually share an atypical reaction to stimulants. Instead of being stimulated, they are calmed down. This is, in fact, one of the rare cases where diagnosis by medication actually has some validity, because giving someone tentatively diagnosised with ADHD a stimulant is the best way to find out if they have this common symptom of ADHD. (That’s rather circular, isn’t it?)

Stimulants are also sometimes prescribed to treat depression, especially when lethargy is a primary symptom.

How Psych Meds Work

Anti-depressants and anti-psychotics work, as noted above, by affecting neurotransmitters levels in the brain. Serotonin and dopamine are both neurotransmitters that are believed to be involved in mood regulation. Lowered levels of serotonin are believed correlate with depression, and heightened levels of dopamine are believed to correlate with psychosis. The theory is that by bringing these neurotransmitters back to their normal levels, it prevents extreme moods caused by the neurotransmitters being out of sync.

It is important to note that this is a correlation. No one knows if depression causes low levels of serotonin or if low levels of serotonin cause depression. Proponents of the medical theory of psychiatry will say te cause is the neurotransmitters. Skeptics of the medical theory are more likely to say the neurotransmitters are symptoms of depression which is caused by something else.

My own (inexpert) knowledge of biochemistry leads me to believe that like many biochemical reactions, there can be many causes, and it may be that both are true–in some cases a disruption of biochemistry or genetic predisposition may cause high serotonin levels, which in turn leads to depression and in some cases outside influences affect our thoughts and moods, leading to changes in serotonin levels which are then a symptom of depression rather than a cause.

Stimulants psych meds work like any stimulant, and their metabolic pathway is well known. Most anti-anxiety medications are tranquilizers. Both stimulants and anti-anxiety meds are used to treat symptoms only, no one believes that they actually address the causes of mental illness. Anti-anxiety meds, in particular, should not be taken for long periods of time, due to long-term side effects.

The Argument Against Psych Meds

Even the most optimistic supporters of psych meds can only point to a 30% success rate. Some studies have found little to no difference between the effect of psych meds, anti-depressants in particular, and placebos. For a detailed review of the argument against psychiatric medication, review the work of Dr. Peter Breggin.

In addition, psych medications often have side effects that can be as detrimental as the illnesses they are supposed to treat. In the case of anti-depressants, a common side effect is an increased risk of suicide. (Yes, you read that right.) Some speculate that this increase is the result of the anti-depressant increasing an ill person’s energy without addressing underlying problems causing the depression. However, some studies have found an increase in suicide risk among people who aren’t depressed. These studies are inconclusive but concerning.

Other side effects common to psych meds range from chemical dependency, to liver damage, to reduced libido.

The first shrink who was actually able to help me was a follower of Dr. Breggin. His rejection of the medical model of psychiatry caused him to look passed the obvious chronic depression and recognize the symptoms of ongoing mental and emotional abuse that prior shrinks had ignored.

To this day, I remain extremely skeptical of anti-depressants and the arguments made for them. I have seen through personal experience and the experience of those around me how beneficial anti-anxiety, mood stabilizers, and anti-psychotics can be when used correctly.

How Psych Meds are Prescribed

Psych meds can be prescribed by a medical doctor or psychiatrist. From personal experience I highly recommend that if you are seeking treatment for the first time you seek out a psychiatrist who also offers counseling, or only see a psychiatrist alongside a licensed psychologist or counselor.

A medical doctor will not be as famliar with psych meds, and will be less able to recognize the best med for you or dangerous side effects. Psychiatrists that only prescribe medication will see you for 15 minutes once a month. Seeing a counsellor or psychologist while going on medication for the first time will allow you spend time with a trained professional every week who can help you evaluate the impact of the medication and recognize any side effects.

If you find a medication or combination of medications that are an effective treatment for you, and you know of any adverse affects it has on you, you can safely switch to just getting your prescription from a medical doctor or psychiatrist who does not provide counselling.

Impact on Polyamory

There are three ways seeking medication as treatment can cause problems in a poly relationship.

Over Optimistic Partners

Find the right medication, assuming any medication is right, is a fraught and exhausting journey. It will be very tempting for poly partners to expect immediate improvements, a quick solution, here’s your meds, what’s your problem?

Seriously, some people spend decades trying different medicaitons and combinations of medications before either finally finding one that works, or giving up on medication entirely. (And yes, I kjnow people who have finally found the right medication after decades of searching, sometimes it does take that long. Sometimes your are unknowningly waiting for them to discover a medication and sometimes it’s just dumb luck.)

You and your poly partners need to go into this treatment plan like a prospector hunting for gold. Not like someone with strep picking up an antibiotic.

The Rollercoaster Effect

Continuing my gold hunting analogy, the search is full or ups and downs. You think you find something that works, like a glimmer of gold at the bottom of a stream. But it turns out to be just a temporary up swing in how you are doing (fools gold) or a minimal improvement that isn’t enough to allow you to function (a bit of gold dust with no clear source).

It’s not just that the search is long, but the constant swing between hope and failure. The way for a few months you seem to be getting better, you are getting better, and then for some reason the medication stops working and you are back at square one. Was it ever working in the first place? Do something change your body chemistry so you know longer respond to it? What the hell happened? You don’t know. You just know that one day you had a successful treatment, and the next day you are picking up the broken pieces of your life and relationships.

This can seriously wear out a poly partner. You want to be supportive, you want your loved one to find help and heal and be able to be fully themselves. But watching them go through the up and down cycle, and living with them through their mood swings on the rollercoaster can be extremely difficult.

For both poly folk with mental illness, and their partners, this can put a huge strain on relationships.

Adverse Effects

As mentioned above, adverse effects from psych meds can be pretty scary at times–increased risk of depression, liver damage, etc. They can also be irritating–disrupted sleep schedules, stomach troubles, lightheadedness or dizziness. And they can be relationship time bombs, like loss of libido. And that doesn’t even consider the really odd adverse effects that they don’t warn you about because they’re just idiosyncratic–like the time I was put on Adderall for a couple weeks, and spent the entire time ready to rip someone’s face off. I’ve never heard of anyone else reacting to Adderall that way, but you can bet the next time a new doctor suggested it my answer was “Fuck no.”

Some adverse effects won’t impact your relationships at all, or will only do so in minor ways. If your medication makes you lightheaded, you probably won’t be going on rollercoasters with your poly partners, and really acrobatic sexcapades will need to take a back seat, but for most people that won’t cause a relationship meltdown. Loss of libido, on the other hand, is a common adverse effect of psych meds that can seriously mess with relationships.

For this problem, I can actually give some useful advice.

1) If your poly partner starts a new psych med, take any personality/behavior/attitude changes with a grain of salt for the first month or so.

2)  Both the person on the psych meds and their poly partners can work together to keep track of changes that occur in the weeks after taking the medicine. Poly partners doing this can actually be a big help because it’s easy to lose track when you are inside of it. So if you hear your partner complain of dizziness a lot, when they never were dizzy before, if your sex life changes drastically, if they start having stomach troubles, or personality changes (good or bad), or being more active, or less active, or happier or quieter or calmer, or anything at all, good or bad, take note, keep it in mind. Let your partner know that you’ve noticed this change.

3) Poly partners can help poly-folk on psych meds assess the effects–good and bad–of a new psych med. Is the good outweighing the bad? As hard as it can be, try to keep this assessment focused on their overall life and wellbeing, not just the impact on your relationship.

4) When poly-folk on psych meds find a psych med or combination of psych meds that work, they and their poly partners can work together to find ways to deal with the adverse effects that impact the relationships.

 

Okay folks, I’ve topped out at nearly 2,500 words–even for me this is a bloody long post! So I’m gonna wrap up here. I hope you’ve found this helpful. Sunday I’ll cover what you can expect from talk therapy, some of the different kinds of talk therapy, and how talk therapy can impact poly relationships.

 

This post of part of the Polyamory and Mental Illness blog series.

 

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