By phasing out lamotrigine, known more widely by the trade name Lamictal, I have recently ended 18 years of uninterrupted medication use to treat depression. It’s been a rough ride with 20 different psychotropic drugs. I had a few good periods with their help, but for the most part the results have been disappointing.
My recovery started after years of taking antidepressants, years during which the condition steadily worsened. My personal and work lives suffered as I became more prone to dissociation, emotional indifference, irritability and memory loss. Improvement began after I changed my attitude about treatment and stopped expecting medication to be a primary source of help.
Do I Need Medication or Not?
Since getting better, I’ve continued to believe that the medications had little or no role in the change, but it’s impossible to know for sure. I have wanted for some time to take myself off meds to see if the methods I use to stay well are enough in themselves, or if, in fact, the drugs are also a necessary part of treatment.
It was hard to take this step. The combination of Emsam and Lamictal had been the most effective of the medications, although even these two had stopped helping after a year or two. Nevertheless, ending medication use completely is a big decision because there is always the fear that I could be wrong.
Is Long-Term Antidepressant Use Good or Bad?
It’s the same fear that kept me on antidepressants for so long despite one recurrence of the illness after another. I was always worried that if I stopped, I would be much worse off. But there was no evidence to support that idea, and I have not been able to find much evidence that long-term antidepressant use is either effective or safe. It certainly wasn’t effective in my case, and more and more stories and research have been coming out raising questions about whether taking antidepressants for decades could actually be harmful.
There are several studies indicating that stopping long-term use of antidepressants leads to a recurrence of the illness, but that finding doesn’t necessarily mean that antidepressants have been preventing such episodes.
S. Nassir Ghaemi points out in his Mood Disorders: A Practical Guide that this could result instead from a withdrawal effect after the brain has built up tolerance for these drugs.
Whatever the explanation, I braced myself for a possible depressive episode and started phasing out the medications. As I reported earlier, I had no withdrawal problems with Emsam. Lamictal has been harder to deal with, but my withdrawal problems have not been severe.
As many others have reported online, difficulties with Lamictal seem to emerge as you reach the end of the phase-out period. I had no trouble reducing the dose in stages from 300 to 50 mg, but the last reductions have brought on the irritability, fatigue and mental dullness that I had been hoping to avoid.
These symptoms have slowed me down in the last couple of weeks, but I’m prepared to put up with them for a while. I want to see if the recovery I’ve experienced is as self-sustaining as I believe it to be or if it needs the aid of some form of drug treatment.
The Meanings of Medication
I’m still open-minded about the potential usefulness of antidepressants and other drugs, even though there are far more questions than answers about their effectiveness. It’s also hard to think clearly about medication because of the intense conflict around every aspect of their use.
The use of medication for treating depression seems as colored by stigma as mental illness itself. Many people believe they haven’t really recovered if they still need to take medication to feel good. This attitude reminds me of the idea that depression reflects a weakness of character, an inadequacy in your make-up as a person. You ought to be able to tough it out on your own. A depressive mindset makes it hard to reach out for help.
If you do get help, the inner stigma wants it to be short-term, without the need for the “crutch” of medication for the rest of your life. My rational mind doesn’t believe that, but there is a tug of belief the other way too. I do want to feel that I’m well as a result of my inner resources rather than an external aid – that I can pass the “toughness” test.
Taking medication has also become something of a statement about your stance toward the whole field of psychiatry and the definition of mental illness. When I first went to psychiatrists, they did therapy and used drugs only for treating acute illness. Now psychotherapy is becoming more of an elective rather than a requirement in psychiatric training, and many believe that the field of psychiatry is concerned only with biology rather than the larger problems of the human mind and behavior.
The tone of partisanship surround medication use has become intense. I often hear from people who have either been harmed or saved by medication. The drugs are either toxic or life-saving, and psychiatrists get into the battle along with patients.
As Ronald Pies says in a recent article (How American Psychiatry Can Save Itself), the field suffers from a public perception that psychiatrists don’t pay attention to the emotional needs of patients but only offer drugs to reduce symptoms. Many psychiatrists are challenging prevailing practices about how mental illnesses are defined and the influence of the pharmaceutical industry on the treatment of conditions like depression.
Of course, those of us living with depression don’t really care about the psychiatric profession. We care about getting well and leading fulfilling lives. It seems bizarre that the medical profession we rely on for aid is itself so conflicted about how to help us. And it seems strange as well that there is so much partisanship surrounding questions of whether or not medication is an appropriate treatment.
I’ll keep plugging away at my recovery. If I should take a turn for the worse, hopefully I will be able to make up my mind about future treatment without fear, stigma or partisanship getting in the way.