the weight (on the side effects of psychiatric medications)

A few highlights:

The day I went to the hospital I weighed 177 pounds. Three months of meds later I weighed 235. 177 was not a healthy weight for me either, at 6’1 - when I am manic I work out like a demon and I don’t eat - but still. In those first few months my body expanded so quickly I could hardly believe it. The conventional advice for managing this side effect, diet and exercise, always felt pitiful in comparison to the power of the pills. Through a long process of trial and error I have gotten down to a fairly consistent 220 pounds. But when I slip the progress seems to be erased in a matter of days. Without constant vigilance the weight gain is relentless, unyielding. Due to signs that I have developed pre-diabetes I now take the drug Metformin, which helps regulate my blood sugar.

But lithium has its price. It is a prime culprit in the weight gain and many struggle to remain on the drug for that reason alone. My hands shake, sometimes to the point where I can’t lift a coffee cup to my mouth, thanks to the lithium. I pee more often than a pregnant woman, maybe 10-12 times in a day. And it causes gastrointestinal distress, which is sometimes severe.

Antipsychotics make you drowsy; antipsychotics can make you dizzy. Some can cause debilitating gastrointestinal effects. Some who take them suffer from dangerous fluctuations in their blood pressure.
It is the cognitive side effects of antipsychotics that have come closest to breaking me and forcing me off of meds. Frequently, these cognitive effects are defined as lack of focus and impediments to short term memory. This definition is not wrong, exactly. Certainly I have suffered from those. On these drugs my attention drifts like a floater in my eye; paying consistent attention to one thing feels like trying to line up a crosshairs with a target that keeps skittering around in front of you.

Finally there are the most troubling side effects of all. You may be familiar with the uncontrollable repetitive facial tics that are sometimes the product of antipsychotics, known as tardive dyskinesia; the syndrome is common to portrayals of the severely mentally ill in popular culture. Tardive dyskinesia is thankfully far rarer with second generation antipsychotics than with first, but it still does happen, and it is frequently permanent even following cessation of taking the drugs. Scarier still is neuroleptic malignant syndrome, a potential reaction to the pills that causes dangerous increases in body temperature and is often fatal.
The side effects of antipsychotics are sometimes treated with ancillary medications. I have a prescription for benzodiazepines to deal with the chronic restlessness and one for amphetamines to address the extreme inability to focus.

And yet!:

The myriad controversies concerning these medications can have no relevance for my behavior, as I cannot survive another episode. If I go off the meds, I will relapse into mania or a mixed state, and when I do I will either ruin my life or end it. I am out of second chances. I have no opinions on the degree to which psychiatric illnesses are the product of psychology or physiology, other than to say that bipolar disorder is a profoundly physical condition, one I feel first in my body. Perhaps many of the critiques voiced by the anti-psychiatry movement have merit, I don’t know. I do know that I have to continue to take my medication. After 15 years of running I finally achieved the clarity of rock bottom, and I am not going back.

That is quite an extreme case here. I mean, such medications have side effects, yes, but in most cases, you either get your meds switched, or you live with it because the pros outweigh the cons — by a lot. We can only imagine how this person feels with no medication at all. There’s really nothing serious to fear, usually. Just like everywhere else in life.

I take meds, too, and anecdotally, sometimes when I experience these side effects, I take them as a physical reminder that they do, in fact, work, and that things are getting better eventually. IDK, maybe I’m lucky, but I’ve been on 10 different meds so far on my one-year medication journey, and I haven’t experienced life-threatening stuff yet, and I doubt that I will.

I experienced drowsiness, anxiety, mood swings, anhedonia, appetite changes, libido changes and a handful of milder side effects, but you just agree to take that risk when you choose to take meds. And I haven’t seen enough people saying this, but you almost always know what medication induces what side effect, and it is almost always in your control to get off, if you feel like you need to. It’s not like you are being held hostage by a drug, the untreated conditions that make you take them in the first place are way way way scarier.

It may be useful to think about all of it as of COVID-19 AstraZeneca vaccine, with 37 blood clots in 17 millions successful vaccinations. Oh, and there are also thousands of different medications you can try to find the one that works for you.

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