Have you taken the Depression Quiz yet?
First thing first, meds are like anything else when it comes to your mental health. It can be highly personalized and dependent on various factors. At VE, we always recommend personalized individual therapy, but if you don't have access to that, or just aren't there, we hope we can relate to you. Okay, now that that little disclaimer is out of the way; let’s talk about medications.
If you are viewing this post, you’re probably struggling and looking for some insights that tell you whether you SHOULD or SHOULDN’T get on meds. I can’t tell you what you should with your life. I don't know much about you.. All I can do, is give you the information and tell you to trust your own gut on it. Also, be willing to talk to your healthcare provider at length about it. They are (ideally) informed professionals that are genuinely trying to help you, part of that being finding medications that will make your life healthier and more whole.
If you have hesitations, I get it. I was adamantly against medications for myself for almost the first two decades of dealing with my depression. I didn’t mind if others got on medications. I would actively support clients that wanted to get on meds and actively support those that didn’t. I would inform people as much as I could about the potential benefits and costs of medications. When thinking about medications in relation to myself though… well, let’s say my stubbornness streak was strong with that one.
It was one of those things where I had a different view of others than I did for myself. It wasn’t weak for others to take meds. It WAS weak of me if I needed to take meds. I should just be able to muscle through it. I shouldn’t need to resort to medication for something that was environmentally induced...right? My beliefs were pretty set in stone. I had people who would frequently challenge me and the fact that I would be fully supportive of others that wanted medication to alleviate their mental health issues but not my own. I had people beg me to get onto meds for several years before I actually did.
A little background on this, my mom is pretty conservative about medical issues. Not in the anti-vaccine kind of way (she was pretty adamant about following vaccine recommendations). It was more in the “we aren’t going to the doctor unless something is definitely broken or you’re bleeding profusely enough that we know you’re going to need stitches.” She would scoff at my dad for going to the doctor for a common cold. He would go almost annually for it, insistent that it was something worse than the cold. I didn’t realize at that time how close-minded it would make me at times to seek treatment for myself. I know she didn’t mean any harm to me when she would joke about my dad “being a big baby,” for going to the doctor for every little thing. She was trying to teach me to be more resilient, to not cry wolf, and not waste money on things I could solve on my own.
I spent the longest time thinking that I should be able to solve my depression on my own. In my head, I would be a big baby if I needed to get on medications. So logical, right? Except I know I’m not alone in those sentiments. I can’t tell you how many people have been sitting in my office and have said the same exact thing that I used to think.
“I should be able to get over this without meds.”
“I’m weak if I need meds.”
“Others might need them, but not me.”
Insert any other shame based message that prevents people from meds
When I would hear them, I would see their perspective as valid, even noble in a sense. I'm such a strong person to try to go without help, right? That’s what society encourages. We should do things without help. Wrong. It is just as noble and brave to get on meds than to choose not to. I’m not just saying that because I eventually came around to getting on meds. It's just that I’m not about to tell someone they are not making a strong, brave decision in terms of how they attempt to manage their mental health.
You’re probably wondering what brought me over to the dark side, huh? A couple years ago, things just aligned in a way that made me consider them differently. I had recently turned 26 and had started to feel my first partial remission in several years. The last remission my mind can remember is when I was 19 or so. In those years from age 19 to 26, I may have had days or a week where I would feel “okay,” but they seemed short lived. I’d get those couple days where I could breathe and see a point to life, and then, wham, everything sucked and was pointless again. I actually got to the point where I would dread being hopeful because depression was always worse when it snatched the hope away. It was better to not hope at all than to have small little bursts of hope that would be robbed from me. It was so devastating to find myself plummeting into despair after brief moments of hope. I would much rather stay chronically low than hope.
When I hit that partial remission, I started to feel “normal.” It felt like emerging from years in a cave to see sunlight and the beauty of the world again. Slightly jarring, distrusting, but also not disillusioned. I knew life still sucked at times, but it was a manageable suck. Then, I broke my hand. Just like that, my relief from that abyss of apathetic existence was threatened. Roller derby was a huge contributing factor to my remission. Not only the exercise component, but how it had helped me develop more confidence and better self-esteem. I felt like I belonged and was valued. If I couldn’t skate, I was worried it was only a matter of time before I was consumed by the darkness again.
In the desperation to avoid regressing into depression, I finally decided to get on medication. It was the first time in my life, I actually genuinely considered them. It's crazy to think that I needed to be in a partial remission to see how they could be helpful. When I was in the thick of depressive episodes, I think one of the things that prevented me from considering them (on top of viewing it as weak) was that I didn’t have hope that they would actually help. I didn’t want to lose that remission though. So I was willing to try anything to maintain my remission.
I will admit that my efforts came with stipulations. I refused SSRIs and told my nurse practitioner at the time that I was only willing to try Wellbutrin, which is an NDRI. Why? Mostly to try to control other factors that contributed to my depression. Traditionally SSRIs are known for having common side effects of increased appetite, weight gain, and sedation. Being someone who has been thick the majority of my life, and hated it, I was not about to go on a medication that would potentially increase my weight. I already had enough difficulty with managing my weight, I didn’t need medication to make it worse. That would definitely increase my likelihood of being depressed even while being on an SSRI. Also, dealing with chronic fatigue (I wasn’t diagnosed with narcolepsy yet) I didn’t want to deal with the likelihood of experiencing more sedation and fatigue.
My nurse practitioner was on board and I started Wellbutrin within a couple weeks of breaking my hand. You can look out for another upcoming blog about my experiences with Wellbutrin. The medication didn’t entirely combat my depression. I still had issues and life events that would exacerbate it. I still had weeks sometimes when I’d deal with profound emptiness and lack of drive to do things. I’d still have moments of time where everything felt bland. I knew pills weren’t going to be a magical fix. I knew that I would still need to deal with depressive spurts.
What the medication did do for me was give me the breathing room to try to combat it myself. I could finally start to implement some of the skills I knew to be effective for others. I spend years trying to do behavioral activation with myself and trying to improve my consistency in engaging in healthy behaviors. I spent years trying to work in reward systems to get myself to exercise and do household chores. With medication, I could now convince myself to do the things because they would eventually be naturally reinforcing. Don’t get me wrong, I’ll sometimes still give reinforcements like new workout clothes for consistency in the gym, but I don’t NEED to do that in order to go to the gym after getting on Wellbutrin. I could finally see the point behind doing the behavior even if I wasn’t feeling it.
The other major change was my ability to challenge my own thoughts. I knew *in theory* how to challenge my thoughts and why it was beneficial. I didn’t see it as practical or feasible until meds. My depression tells me I’m worthless and a waste of space. When I would attempt to do thought challenging in the past, it felt like I was lying to myself. It also felt extremely condescending and invalidating to me when I would read about CBT and the power of “just change the ways you’re thinking.”
Back then, I would frequently think “oh yeah, if it were that easy, no one would be depressed.” I thought it was all complete bullshit to be quite frank. Many of my clients would probably be in disbelief reading this now because I do utilize a lot of thought challenging techniques now. In the thick of depression though, you think anyone that tells you to change your thoughts is just one of those positive vibes - never lived through true hardship or strife, rainbows and butterflies - type of person.
By the way, for those of you that might have similar thoughts, thought challenging should not teach you to think of rainbows and butterflies only. True thought challenging should help you think of reality as it is, which has some beautiful aspects, and some really ugly ones too.
Medication took enough of the edge off of my depression, that I could actually practice skills. Now, I will admit that my age might be part of this too. I was at an age where developmentally, my executive functioning had finally reached maturity. So that could influence my ability to now utilize logic to combat depression. However, I do attribute it to medications because even now when depressive episodes hit, I struggle with logic brain. Who knows though, maybe it was just coincidental timing. Whatever it was, I think a lot of the factors of my success were helped along by medication. I still had to do the hard work. It was just easier with meds. In counseling, I talk about it like weightlifting. Meds are a weight belt. They can support you and protect you, but they can’t lift the weights for you. You still need to do the hard part for yourself.
So it's up to you if you want that kind of assistance in doing the hard parts. The actual work. I’ve seen people overcome mental health concerns without and I’ve seen people that recognize that they need them. Everyone is different, which is why I can't tell you what you should or shouldn't do with your life. Whatever your path is, cool. Just don’t get in your own way because of preconceived notions of how you should heal. Also, probably best not to cling to medication like it is a cure all solution. If you’re still struggling to try to figure out what to do, here are some questions that may help.
Am I allowing shame to make my decision for me?
Am I refusing a certain choice because of pride?
Am I allowing the fear of others' judgments to influence my decision?
Am I allowing fear of negative outcomes (e.g., med side effects) to influence my decision?
Am I hoping for a quick fix?
Do I need a little help in being able to do the hard things (i.e., actually change)?
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