The Struggle That Is New Meds

Or: the many challenges in trying to be well.

I am in the process of starting a new medication for my bipolar disorder. It’s been a hell of a ride so far. While I’m not a medical professional, I wanted to share my experiences thus far in the process.

Anyone who takes medications for a mental illness can testify that those medications tend to do funny things to your body. Because they typically work to alter your brain chemicals so you can feel less depressed, anxious, manic, etc., they often have interesting side effects on your mood and other mental and emotional patterns, in addition to physical side effects.

The most famous issue is the fact that some drugs cause suicidal thoughts in teens and young adults, running counter to their intended effects. The medication I used to take has a range of interesting potential side effects, including everything from feeling dizzy or drowsy to weight gain to high cholesterol to low white blood cell counts. One of the interesting ones that I’ve developed is an involuntary twitching in my legs.

My new medication, which I’m not going to name for privacy reasons, has a lot of similar side effects, as well as insomnia and/or sleepiness, nausea/vomiting, diarrhea and/or constipation, anxiety, restlessness, and a bunch of other stuff that sounds like a blast. Weight gain is also on there, so I’m looking forward to being unable to shed my belly for another decade while I’m on it.

Then, in addition to the side effects that you might experience, you also get the joy of going through withdrawals from your old medication. This can be relatively mild, leading to almost unnoticeable symptoms over a week or two. Or, the process can be excruciating, as when I stopped taking an antidepressant last year and was, generally speaking, a giant mess where I was anxious, angry, sad, or some combination of those pretty much every waking hour for two straight weeks.

Right now, I’ve been on my new meds for just over a week, and the withdrawal symptoms have been much lighter compared to the antidepressant. The most notable symptom is that, for most of the past week, I’ve been unable to sleep more than about four hours at a time. This resulted in an interesting bit of work-related fun where I had to email my bosses on Monday and let them know that they might get emails from me at odd hours, and I also might disappear for a few hours to sleep. They were, thankfully, understanding and supportive.

I’ve also been dealing with a general fogginess of the brain. Generally speaking, after waking up, I have a few hours of productivity and functioning, after which my brain would turn to mush and I’d be pretty much unable to do anything that required concentration or complex thought. After a few hours of that (and generally some food), I’d get another productive spike for an hour or two, and then my brain would mush again and I’d be useless again.

On top of all of that was some very rapid mood swings, where I would have low energy for a few hours before rapidly gaining energy and motivation for a few hours. Sometimes, I would cycle like this several times a day. It was exhausting.

Thankfully, on day nine of just the new medication, I appear to be leveling out. I’ve managed to sleep through the night for three nights in a row, and my brain fog is becoming less burdensome. I’m fairly confident I’ve got another week or two of withdrawal symptoms, but I’m hoping that I’m through the worst of it.

So why go through this process at all? Why put my body through all of this misery for a fancy new drug? Simple: tolerance.

Drug tolerance, which is not the same as dependence or addiction, is when your body becomes used to a drug and it loses its effectiveness. This generally happens due to prolonged exposure, which causes your body to become accustomed to the drug’s presence.

In my case, I’ve been taking my old drug combination for about twelve years, which is long enough that they were starting to become less effective at preventing my symptoms. After about two years of worsening symptoms, I finally talked to my prescriber about changing, which led to this point.

Honestly, I should’ve talked to her sooner, but I was afraid. Having gone through the horrible withdrawals from my antidepressant last year, I was afraid of starting a whole new set of drugs and going through the withdrawal process again. Even mild withdrawal symptoms suck, and the thought of doing that again was scary.

Even more scary was the thought of doing it multiple times over the next few years. Different drugs work differently on different people, which means that I could spend several months to a year on this new medication only to decide that it doesn’t work. I was on the antidepressant for almost a full year before deciding that it wasn’t working for me.

So, I’m a bit afraid of the idea that I might spend the better part of a year on my new medication only to decide that it doesn’t work and I’d have to go through the process again. Add onto that stress the fact that my new meds are so new that they cost me $200 a month after insurance (normal retail price without insurance: $1,600 or so), and I’m looking at potentially $2,400 in costs to figure out that it doesn’t work.

This proposition is scary for even people with iron wills. It often leads to people downplaying their symptoms and experiences on meds that work less effectively just to avoid having to go through the process again. That is literally what happened in my case, and I kept it going for two years.

But, and this is the important part, I needed to do this. Could I have eked out a few more years on my old drugs? Sure. Would it have been miserable? Absolutely. I suspect that continuing on the old course would have led to more mood swings, more long periods of depression, and an increase in self-destructive behavior like compulsive spending.

For me, a couple of weeks of withdrawals and paying through the nose for a top-of-the-line medication is worth it for my mental health. Even though it took me a bit of time to get there (along with some gentle and not-so-gentle prods from my wife), I understand that this is a process that I have to go through to be well.

Medication is a key element of my self-care. I take my meds every day, and I understand that it is dangerous to miss a dose or go off them without talking to my prescriber. Having done that in the past with disastrous results, I don’t plan on repeating it.

I’ve got an appointment with my prescriber in a few days, so I’ll be telling her about what I’ve been going through. We will probably schedule another appointment in a month so I can update her on how the transition is going, and we will probably keep up regular appointments until we understand how the medication is affecting me. It’s a necessary part of the process.

And, if it turns out in a year that it’s not working for me? We will try it again. It’ll be hard, and maybe a bit painful, but I’ve got a support network to help me get through it.

So, for anyone out there who might be going through what I’ve been going through, I encourage you to be honest about it. If you feel like your meds aren’t working, tell your doctor. Get new ones that do work. The withdrawal process sucks, but it’s a necessary component of being well. Lean on your network if you’re having trouble and need support or encouragement.

And above all, don’t lose hope. Getting new meds can be a long process, but the outcome is worth the wait. I know that as someone with bipolar, I absolutely crave the highs that come with my mania, but I also understand that those highs come with major falls. And, having experienced a state of emotional stability, I find much more value in that. Achieving some form of stability feels much better in the long run than any manic high.

So, if you feel like you need to change medication, be honest with both your doctor and yourself, hang in there, and don’t lose hope. I know you can do it.