Reflections on psych meds

Navigating uncertainties around diagnosis, side effects, and the underlying meanings of extreme states.

Since I started this Substack, last week was the first week in which I did not publish a post. Prior to that, I’d achieved a 7-week posting streak (including my initial announcement that I had started the Substack), which I feel proud of. I knew that I was going to break the streak at some point; I struggle with consistency in general, but especially with creative productivity, as the internal pressure I feel to make the next piece of work at least as good as the last can make me unable to produce anything at all. But Substack posts aren’t supposed to always be elegant works of art. They’re a place for me to be human. To be imperfect, inconsistent. To practice a creative habit, and when I temporarily depart from it, to return to habit like a home.

But this delayed post has an additional, specific cause, something that has been frequently on my mind in the past two months. I take daily medications prescribed for bipolar disorder, and last week, I skipped taking those meds for two days. Soon, I started having experiences consistent with (hypo)mania: not wanting to sleep, feeling highly energetic and social, and generally being buoyant and revved-up. I then got back on my meds for two days, as I did not want to spin out of control; the immediate result was a depressive state in which I struggled to focus and wanted to sleep more than usual. Then, I stayed at my parents’ home for the weekend, but I forgot to bring my meds, so I ended up skipping my meds for two days again. The emotional instability caused by my inconsistent medication intake made it really hard for me to get myself to write.

This is actually the third time this summer that I’ve suddenly stopped taking my meds for at least a couple of days. The first time, it was in mid-July, when I was still living in my parents’ home. I skipped my meds, partially intentionally and partially not, for two or three days, and experienced an intense, though somewhat off-brand, euphoric mania: instead of having “racing thoughts,” I had extremely vivid thoughts and sensations that captivated me into a slowed-down yet scintillating flow-state. I had to experience everything super slowly, for every experience was super intense. It was because of this manic state that I started this Substack: I had somewhat considered this idea prior to that, but mania gave me such an intense feeling of spiritual awakening that I had to something to respond to it. I do believe it was a spiritual awakening; I was very ripe for one. Just because something is labelled as a symptom of mental illness, doesn’t mean that it is all bad.

In fact, I feel that every one of the “extreme states” that I have had, whether manic, anxious, depressed, or otherwise, has meaning to it. Whether a spiritual crisis — a momentous question — or a spiritual awakening — a momentous answer, these intensely embodied states are deep communications from one part of myself to another that something must be done. To call it merely mania, or depression, or dissociation, or whatever diagnostic label some clinician — or I myself — might consider, feels utterly lacking, like it misses the point, the meaning. Yet to neglect the impact these states have on my well-being — and that of others — is denial. But so is to ignore the oppressive, pathologizing nature of Western psychiatry and the trauma that I now carry from it.

Currently I’m midway through a mental heath IOP, or intensive outpatient program. A few days before starting it, I got upset at my meds, not wanting to take them anymore. I wanted to know if the euphoric mania that happened in July would happen again. It didn’t quite happen in the same way: I became restless and sleepless, but also very moody. I was intensely struggling with the questions of my meds and my diagnosis: did I really need my meds? Am I actually bipolar, or am I just experiencing withdrawal symptoms? (After all, I didn’t think I had any mood episodes since my second psychiatric hospitalization in late 2021, and whether any of the “episodes” I had were true hypomanic or manic states had been a question that even my psychiatrist was unwilling to definitively answer.) I wanted to know what I would be like if I stayed off meds for a longer period of time: after any withdrawal symptoms passed, would I be “stable”? Or would I become more intense? If I did experience extreme states, would I now have the tools to manage them? (After all, I was managing these recent manic states fairly well, settling myself down with my weighted blanket and tactile soothing — though it was still challenging, and sometimes I did not want to settle down.)

Eventually, I gave up this days-long refusal and restarted my meds in order to begin the IOP in a relatively stable state. I mostly complied with my medication regimen until last week, when I got upset again at the meds. My father works in pharmaceuticals, and he has frequently warned me of the not-thoroughly-researched long-term effects of being on psychiatric medication. What harms could these pure-white pills be silently, gradually inflicting on my bodymind, while supposedly they work merely to balance my moods? The “chemical imbalance theory” of mental illness, popularized by pharmaceutical companies in the 1980s to market psychiatric drugs to larger populations of consumers, has long been considered by researchers as a spurious, overly simplistic hypothesis. Medications definitely can benefit some people, but many more have been prescribed meds not strictly out of necessity, but rather because that is what prescribers know best to do. Do the benefits outweigh the potential harms? A question everyone must ask themselves — and which, hopefully, their clinicians also consider thoroughly.

I had a psychiatry appointment today for the first time since graduating from college (I had both therapy and psychiatry through my college’s Counseling and Psychological Services, as they were offered for free to students). I felt really nervous about being placed into a box — of being labelled “seriously mentally ill” because of my two psychiatric hospitalizations without consideration of the contributions of neurodivergence and trauma, of being seen simply as a “noncompliant” bipolar patient without attentiveness to the complexity in my thoughts and feelings about medications. It is quite common for people diagnosed with bipolar disorder to not want to stay on their meds because mania, though unstable and potentially dangerous, feels too “good” to be something “unwell.” I have definitely felt tantalized by the intense thrill and/or bliss of mania and was influenced by this feeling when deciding not to take my meds, and yet my resistance is not from mere denial. There are actual questions that I need answered, and I’m not going to feel fully okay with taking meds until I find satisfying answers.

I do think though that it is a good idea for me to comply with my medication regimen and make changes to it only as prescribed. Though not yet really trusting, I feel optimistic about my new PNP (psychiatric nurse practitioner) and hope that I can continue to openly share with them my questions and concerns and that they will thoughtfully address and explore them with me. If it seems like a good idea to try getting off my meds for some time, I can do so gradually under the supervision of my PNP. Stopping meds cold-turkey like I have been doing just causes too much instability (and could potentially lead to worse consequences).

Now, I need to take my meds and go to sleep :) Expect another post in a few days (since this one was supposed to be last week’s).