The view from the precipice
How it feels to come off psychiatric medication
It’s hard to find a metaphor that accurately describes how it feels to have the opportunity to come off psychiatric medication, almost nine years after taking my first desperate anti-depressant. What followed was a roller-coaster, to put it mildly (and I don’t enjoy them at the best of times). Depression gave way to hypomania, then depression again, full blown mania, hospitalisation, depression. I was prescribed drug after drug — I must have been on 20 or so different drugs during that four year period — and of course the diagnosis: bipolar disorder.
Almost five years ago now, I broke the cycle.
I came out of hospital after a two month stay, had the obligatory low, and then set my mind to rebuilding. I’d become very good at rebuilding — patching up my CV, smoothing over the gaps, getting a job I could manage (criteria: each job should be slightly less shit than the previous job). Fortunately for me, I’ve never been one to bury myself in the house — even when depressed. I was out volunteering in charity shops even when I felt like the walking dead.
That drive to keep busy, to get on and build a way out of this, stood me in great stead.
This time I found a permanent job, with actual prospects! I built myself up, got stable, got promoted. I met a boyfriend, now my husband.
I feel like one of those horses who has been written off with disastrous odds, then comes up from behind, out of nowhere, suddenly back in the race, to everyone’s shock and delight.
All this time I’ve been taking Lithium — the so-called ‘gold standard’ mood stabiliser, unrivalled and unchanged practically since the end of the second World War. But contrary to the ‘received wisdom’ of psychiatry, I don’t believe it’s the Lithium that has been keeping me well. Not least because I was taking both Lithium and Lamotrigine at the time that one of my manic episodes took place — and I was good at complying with the dosages (until I was manic, at least). Two mood stabilisers couldn’t keep me away from mania, so it stands to reason that Lithium can’t have been doing it alone.
So with my healthy scepticism towards psychiatry ‘out there’, I now find myself in an interesting position.
After mandating me to take medication for so long, society is offering me the chance to come off it — because I want to try for a baby.
I say society — what I mean is psychiatrists and the health service, my family, my friends. Everyone is comfortable with me coming off Lithium in the context of trying for a baby in a way they wouldn’t be if I was to just announce I wanted to try life unmedicated (in fact I’m sure that for some, such an announcement would ring ‘alarm bells’). Which is interesting in itself.
So here I am, about to start the withdrawal process.
It’s exciting, because I’ve dreamed of this opportunity for so long. But it’s also scary.
It feels like I’m standing at the edge of a precipice, at the top of a tall mountain. It’s been a long, hard climb to get here, and I’m so happy and proud to have got to this point. But I can’t stay here forever — to progress, I need to descend. I’ve set up all the ropes to abseil down and am confident I’ve done everything right. But there have been a lot of casualties on this mountainside by others in the same position as me — or so I’ve been told. It’s a dangerous descent, and one which could wipe out all the good work I put in getting to the top.
If I want to progress with my life, then coming off medication is the essential next step. Because I refuse to take the risk of exposing my potential future child to toxic medication during pregnancy, if I can avoid it. And because I have done my time, I have complied, I don’t believe I’m forever ill and I deserve the chance to test out that theory.
But what happens if it doesn’t go to plan, and I get ill?
On a practical level, it would obviously impact our plans to try and start a family. Getting pregnant can be hard enough as it is, without having to contend with mental health challenges. But what worries me even more is the deeper, existential trauma I would go through if I was to ‘relapse’. I built my recovery narrative on the core belief that I am not fundamentally chronically ill. I do not believe in my diagnosis. I do not believe in the therapeutic supremacy of medication over, for example, therapy, hard work to address the imbalances and unhappinesses in one’s life, helpful lifestyle choices, and so on. I’ve read too much about the lack of evidence for the efficacy of these drugs, and pharmaceutical companies’ tenuous research trials. I’ve heard too many psychiatrists admit that they really don’t know much about how any of this works.
Clearly, I’ve got pretty strongly held beliefs about all of this — and it all works for me, as long as I’m well.
But getting ill would throw those beliefs into question in a major way — and I don’t know how I’d deal with that.
That’s why one process I’m initiating before I start the withdrawal process is therapy. I haven’t seen a therapist for several years now, but I think that on the watershed of a new chapter in life is a good time to re-start. I want to soften the pressure that I’m putting on myself, and build some new, more flexible foundations. A more forgiving narrative that won’t tip me back into an existential crisis if things don’t go the way I hope they will. Like making sure there’s a safety rope (or a few!) before I start that abseil off the precipice.
Alongside that, I’m planning on building in the other things I know help with general mental health — exercise, sleep, meditation, tracking myself on my ‘mood management’ app. I know I’m doing all I can.
It still feels hard though, because ultimately I’m doing it alone.
Don’t get me wrong — in terms of support, I’m incredibly lucky. My family, husband, friends, even my employer — I’m privileged to have a loving and understanding network. But I’m the only one who knows what it feels like to be me. I do have some friends who’ve been given the same diagnosis. But mental health is so personal. Everyone’s experience is unique and everyone’s attitude towards their own situation — not to mention psychiatry as a whole — is different.
Information about psychiatric success stories — can we call it recovery? — is hard to come by.
I’ve heard whispers about people managing life off medication (can we call that recovery?). When I’m quoted stats about relapse it always strikes me that they’re designed (even with benign intentions) to encourage me to reinitiate medication after my hypothetical childbirth, and ultimately stay on it forever. There are always some people in those statistics who don’t relapse. But somehow their existence is brushed over, implying anomaly or fluke.
The system feels weighted against my belief that I can do this. But I want to resist the drive to ‘prove it wrong’ — because that’s exactly the kind of pressure that I’m trying to avoid. And ultimately, I can never prove it wrong, with finality. I just need to live the rest of my life out, well. But first I need to get down off this particular mountain…
