The Rest Is Not Restlessness

I went out for dinner and drinks with an old friend the other night. I was broke and she was buying. We hadn't really sat down and talked in 18 months or so. In the midst of talking about whatever ails post-modern society, she said, "You seem a lot less edgy these days."

"You mean less agitated?"

"Yeah. What happened?"

"It's those meds that I was on."

When she and I first met in 2002, I was on Risperdal and Lexapro, among others, and then later was on Wellbutrin and Seroquel. Then, in late summer 2005, I ditched everything except Lamictal. It was both an experiment (my doctor approved) and playing a hunch. Polypharmacy hadn't been kind to me--I'd gotten light EPS symptoms from both Risperdal and Seroquel, and anti-depressants had always started strong for me and, then, a couple of months later either stopped working or agitated the hell out of me (not that I went off them even then, mind you). I'd hit a fork in the road.

I looked at the whole thing as--I know I don't have my term quite right--a challenge, re-challenge protocol. If the one-med plus a lot of work on my end approach didn't work, then other options existed. None of them especially pleasant.

"Well, you seem a lot calmer."

"Yeah, it's funny."

"Why?"

"Well, docs are always giving people like me loads of meds. When things don't work well, they give you more of the same or another pill that's pretty much like every other pill. They are supposed to make us calm and stable. Didn't work that way for me."

"I like you better this way."

"Me too, I think. But we'll see how it goes."

I did fairly well as soon as I got off the hardcore dope--Lamictal is like water compared to Seroquel--and that weird restlessness that had dogged me for years was gone. For a few months, I figured it was all halo effect. But it's continued. That's nice. So was losing the puffiness in my face and the weight on my ass. I should've realized the obvious years before--that some meds and classes of meds make me a mess--and tried the same experiment when I was 38. Live and learn.

I'd say after almost two years of going this route that I am both--knocking on wood--recovered from meds and the dread disorder (well, 90 percent of the time) and in a position where my doc and I are reevaluating how I should go about things in the future. One med? No meds? Who knows?

The process I just laid out goes on far too infrequently in mental health care. Too often the blame for symptoms and lack of progress--the less than half remission that most patients experience--gets placed on the patient or the illness. I buy those arguments but only up to a certain point. Patients are doing themselves a disservice--and docs aren't doing right by their patients--if they don't approach a lack of clinical improvement over time with skepticism and a willingness to experiment. Both parties to the unspoken health care contract--you're going to get better and the patient controls the terms--are reluctant to strip away the layers of meds people are on. And the patients who are willing to do it often go about it all wrong and get put right back into the bad old cycle when they fall apart. But that's for another day.

Posted by Philip Dawdy at April 27, 2007 12:03 AM
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