I am always somewhat combative when I go to a meet with my psychiatrist. He’s a nice enough chap. He seems pretty genuine and he listens to what I’ve got to say.
My first objection to the meetings is the formula they follow. There’s never a great deal of time, so I sit down on that itchy fabric chair in his boiling office and he goes straight into interrogation mode.
Doc: “How are you?”
That’s a tough question to answer succinctly, under time pressure and without getting myself sectioned. So my reply is evasive.
Me: “Up and down.”
Doc: “More up and down than usual?”
Me: “I guess so.”
He looks at me. He’s waiting for me to elaborate. I don’t oblige. There’s an uncomfortable silence and he starts scrolling through notes on his screen.
Doc: “You had a bit of a blip in August.”
His intonation tells me that’s a question, not a statement. I am immediately irked by the understatement. Because what he’s referring to is a suicide attempt. A not 100% committed attempt, but an attempt nonetheless.
I am irritated enough that I don’t volunteer more information. So he asks what happened, and I tell him.
Doc: “Why Lorazepam?”
Me: “Because I liked the idea of falling asleep and never waking up again.”
He isn’t comfortable with that answer. He wants it to have been a strange, thoughtless impulse, not something I’d put any consideration into. Then we have an argument about my Lorazepam prescription. He’s miffed that my GP is still giving me 28 every month. He suggests we take it off the script and I become petulant.
After pushing his argument for a while he realises I am not in the mood to compromise. We reach a stalemate because I make the frank confession that if I had no Lorazepam I would just use something else. He gives up. I win.
Then we move onto the next argument. I want to phase out my medication. In fact I have already started doing so. I’ve stopped taking any Quetiapine at all, and my sleep hasn’t been too badly impacted. I’ve also reduced my Pregabalin dose by 50 mg. I have noticed an increase in anxiety, but I am working at managing it in different ways. Although tentative, I have started running again, and eating more healthily.
The massive problem with psychiatrists is the way they medicate. I have almost no faith in it. They don’t consistently measure outcomes and they don’t plan for the long term. What they do is fire shots in the dark. And when you don’t have an adverse reaction to drugs, they simply leave you on them. If I didn’t push for an alternative, I think I would be medicated for the rest of my life. I don’t want that.
Plus, their actions and assumptions are all based on what they ascertain to be ‘risk’. So my psychiatrist almost always argues that it is ‘too dangerous’ to change my meds at all. I pushed him this week to agree to me reducing my dose of Mirtazipine, an antidepressant. I knew his response before his lips moved.
Doc: “I don’t think now is the right time. It was only recently that you took an overdose. I really think it may be dangerous and I have a duty to try and make sure you are safe.”
Me: “You always say that. But if the medication worked, if it really kept me safe, I wouldn’t have ended up in hospital a few weeks ago, would I?”
Doc: “I have a feeling that if I refuse to change your prescription you’re going to reduce your dose anyway. Am I right?”
That meant he caved and I won that argument in the end too. Now talking of it as winning and losing sounds like I’m not taking it seriously. But I really am. And I am the only person who knows me well enough to make these choices. No doctor can present me with any evidence that the drugs are working. And no medication can alleviate the distress that certain events and circumstances provoke in me.
While there is a time and a place for psychotropic medications, I believe that the current approach to prescribing them is hugely flawed. I know for sure that if I wasn’t assertive about this, I would be on these drugs for the rest of my life.
Depression does not have to be a lifelong condition. It doesn’t always need to be ‘managed’ forever. If I believed I would always have this sickness, I would give up hope. I have to know that there is a human being beneath this numbed out shell of myself I move about in. I want to find out who is really there, beneath all the chemical alterations.
Essentially, I want to know that I am still me.
Photo: Janeis Katlaps, Creative Commons.