My tumultuous love affair with psychotropic medication began in May of 2017, when I voluntarily admitted myself to a psychiatric hospital. For the past few months I had been flirting with the idea of suicide, haunted by a series of traumatic events that left me distraught and desperate for relief. I had been taking Lexapro for many years, but evidently it was no longer helping. Perhaps, I thought, my suffering would dissipate if I could attain new medication, and the quickest way to do this was through inpatient hospitalization. Little did I know that in the next month I would be given seven different psychotropic drugs, many of which were prescribed hastily and simultaneously as my doctors acquiesced to the precarious practice of polypharmacy.
I was admitted to a hospital called Pinecliff* late on a Wednesday night, and the following afternoon I met with my psychiatrist, Dr. Patel, a portly woman with a terse manner who wore skintight business clothes in shades of mustard yellow and rustic red. My request to try new medication appeared to please her.
“Let’s try you on Cymbalta,” Dr. Patel said after spending approximately ten minutes piecing together my story. “It’s in the same class as Lexapro but addresses two neurotransmitters instead of one.”
“Okay,” I nodded.
“I also want to put you on a low dose of Ripseridone. It’s an antipsychotic that is sometimes used to supplement antidepressants when a patient isn’t responding well to them. It might make you a little drowsy, so you’ll take it at night.”
I nodded again, a quiver of hope running through me. While I was anxious about adjusting to new medications, I had nothing to lose and no reason to doubt Dr. Patel’s expertise.
“That sounds good,” I replied. “Thank you.”
* * *
I remained on the ward for six days, and secretly, I was relieved to be stuck there avoiding my fears of real-world reintegration. Other than nodding off in armchairs after my 8 p.m. Risperidone, I felt the same, if not a little foggier. I mulled over the past, contemplated my future, and prayed for the medication to kick in. Psychologists say it takes SNRIs two to three weeks to have an effect, so I convinced myself it was normal that I didn’t feel better, not yet.
I was released on a Tuesday with a practical discharge plan. I would attend a ten-day outpatient program run by a hospital affiliated with Pinecliff. I would find a therapist in the area and get a job. I would attempt to resume a “normal” life.
Exiting the hospital’s double doors with my parents, inhaling the first breath of fresh air I had encountered in days, I held my head high, attempting to portray a newfound stability. Yet, beneath this façade, I felt utterly petrified and alone. My confidence resembled that of a low-hanging spider web: delicately wound, glistening in fragility, and prepared to be torn apart at any moment.
* * *
The next few days passed in an acute haze. I noticed myself slipping into what can only be described as a dissociative state. A thick, moist fog crept over my mind, creating a porous barrier between my brain and body through which messages were haphazardly transmitted. On a peripheral level, my thoughts remained synced to my bodily actions, but internally it felt as if I were morphing into two separate entities. My subconscious was displaced from its home, floating in some imperceptible sphere around me, witnessing helplessly the deterioration of its other half. I existed but was no longer there, feeling absent in my own life, devoid of character.
It was difficult to discern what was causing this out of body sensation. Was it the antipsychotic medication? Or had I become so ill that my overwhelmed mind was detaching itself from my body as a protective mechanism? Or, could this all be psychosomatic — a reaction to my fear of the medication’s side effects and the fact that I was gripping my sanity by a thread. Either way, I woke up each morning sweating in terror, having to shove this feeling aside to make room for basic functioning.
I attended my first week of the outpatient program, staring blankly at the group counselors, engaging listlessly in their presentations and handouts but absorbing nothing. I was too distracted by the estrangement of my body and mind and the frequent brain shocks I was now experiencing, a side effect of changing or withdrawing from medication that feels as if one’s brain is being electrocuted every five to ten minutes. I also landed a mediocre job, something tangible to grasp onto that made me feel like more than a psych patient; something, I hoped, would guide me back to stability.
Yet, by day seven in the real world I was at my wit’s end, curled up in an awkward corner between life and death. This is the part of the story whose rationale is impossible to relay; the part that is humiliating and harrowing and irreversibly imprudent.
One night after a dull day at work, I made the decision. Whatever pills lay around my bedroom were hastily consumed: the remainder of my Risperidone, some stray Benadryl, a handful of Cymbalta, some year-old Ativan. Whatever would knock me out instantaneously — not necessarily end my life, but transport me to another realm, somewhere I could bask in a blissful, insouciant stupor. Anywhere but in this torturous reality.
I have almost no recollection of the next forty-eight hours save for a few minutes here and there. When I regained consciousness, I was told that my parents had found me in the morning, mumbling incoherently with vomit strewn across my comforter. They rushed me to the emergency room and after some time I was transferred back to Pinecliff, the only place with an available bed. It was there that I awoke, disoriented, drooling, and outfitted in a fresh set of pajamas with a small bag of belongings leaning against my dresser.
Neglecting my appearance, I stumbled into the common area and confronted a mental health tech. “When can I see my doctor?” I inquired desperately.
“Dr. Patel should be making her rounds here in the next hour,” he replied. His face looked familiar from my last stay. Was it Jason? Josh maybe? “It’s good to see you up,” Jason/Josh continued. “You should get your meds from Erika and then you can have breakfast. We saved you a tray.”
I nodded meekly and approached the nurse’s station.
“Amy! It’s so great to see you awake!” exclaimed the nurse, apparently named Erika. “How are you feeling?”
“Umm… okay. Kind of confused.”
Erika smiled, flashing a set of straight, pearly whites. “That’s understandable. Your body just went through a major shock, it will take a little while to feel totally normal again.”
Normal, right. It felt unfathomable that I would ever feel normal again.
“Ready for your meds?” Erika prompted. “I’ve got 75 milligrams of Effexor, 1.5 milligrams of Invega, 50 milligrams of Lamictal and .5 milligrams of Klonopin.”
Excuse me, come again? None of these drugs were part of my previous regimen. I had never even heard of Invega or Lamictal.
“Uh, did I meet with Dr. Patel yesterday?” I asked in bewilderment.
“You did,” Erika replied, glancing at my computerized chart. “I believe the two of you talked in your bedroom.”
“Right,” I stretched out my hand for the pills. “Um, would you mind printing out the drug information for each of these when you have a chance?”
Erika smiled again. “No problem.”
* * *
Through the wisdom of WebMD, I discovered that Invega is an antipsychotic primarily used to treat schizoaffective disorder, which can also decrease symptoms of depression. Dr. Patel had substituted Invega for the Risperidone, surmising that Risperidone simply wasn’t the “right” antipsychotic for me, and completely overlooking the possibility that its side effects could have precipitated my undoing. Lamictal is administered to prevent seizures and extreme mood swings, and can also be effective in amplifying the properties of SNRIs, such as Effexor, which had been swapped for my Cymbalta. Effexor is in the stimulant category of antidepressants, meant to bolster a patient’s energy level so they can return to daily functioning. Given that this was my second hospitalization in less than two weeks, Dr. Patel had made radical adjustments. And apparently I had consented to them.
This potpourri of new medications served to counteract one another. The Effexor made me implacably antsy and skittish, as if I’d just downed five shots of espresso, while the Klonopin thankfully ameliorated these symptoms, sending a marvelous, anesthetizing haze through my body and mind, smothering the disquietude of my thoughts and the intensity of my emotions. The Invega plunged me deeper into a trance of dreamlike proportions, causing me in certain moments to seriously contemplate the tangibility of my experience. In this spell of stupefaction, the effects of the Lamictal were rendered null. Hence, it was impossible to discern whether any of these new drugs were helping me or merely having a depersonalizing effect. If anything, they helped in the sense of shutting me off, replacing my mind with that of a docile robot. In retrospect, such numbing was probably preferable at the time, since the thought of facing my distress seemed insurmountably overwhelming. Yet in terms of my future healing and return to selfhood, this multiplication of medications had traumatic and time-consuming consequences.
* * *
I stayed at Pinecliff for another six days as Dr. Patel and my family contemplated what to do next. After many phone calls and a torturous waiting period, I was discharged from Pinecliff and flown directly to one of the best psychiatric hospitals in the country. There I was assigned an extensive team of practitioners: a psychiatrist, a psychologist who administered all my testing, an individual therapist with whom I met twice a week, a substance abuse counselor, a social worker who facilitated family therapy, a primary nurse and a mental health advisor. A significant portion of my treatment was dedicated to straightening out my medications. After undergoing gene testing, where a swab of DNA is taken from the cheek to identify specific genetic markers that help match a patient with the most fitting medication, my psychiatrist Dr. Kay put me on Pristiq, an uncommonly prescribed antidepressant. She kept me on the Lamictal and added Gabapentin, which is primarily used to reduce nerve pain, but because of its relaxing and non-addictive nature, can also be prescribed for anxiety. The plan was to wean me off the Klonopin in a few weeks once I stabilized, and allow the Gabapentin to take its place.
This proved easier said than done. At four weeks in, Dr. Kay pronounced it time, and as the rapturous effects of the Klonopin slipped away, a cascade of distress poured over me. I hit a startling low, refusing meals and company, thrashing around in bed and cursing out every doctor for denying me Klonopin — my salvation, my lifeline. I swore to die of starvation before acquiescing to the gentle coaxing of my team. “Just come sit in the common area for a little bit… why don’t you try eating a granola bar… You’ll feel better soon… just be brave…”
No. I was done being brave.
But then, suddenly, I wasn’t. Thirty-six hours into my hibernation, I emerged, peeking around the covers, putting one foot on the ground and then the other. I tiptoed into the common area, squinting into a foreign light, and was immediately surrounded by the solace of my peers. I ate a granola bar, then a full plate of dinner. I performed in the talent show. I talked and talked and cried until my head pounded from dehydration. My mental and physical state began to improve, slowly, and then rapidly. I never touched Klonopin again.
* * *
Today, I take low doses of Pristiq and Lamictal, with the intention of weaning off the latter medication soon. My mental health has been stable for over ten months, allowing me to finally graduate from college and work a full-time job while maintaining a strong support network. Ironically, my post-traumatic stress disorder no longer stems from the events that led to my hospitalizations, but from the maltreatment I received within the hospitals. Now, every time I take my medication late, or forget to refill my prescriptions and miss a day’s dose, I feel the unsettling presence of dissociation creeping in, the terrifying panic of losing my mental bearings and being rehospitalized. While this physical response is likely primarily psychosomatic, it is a testament to just how powerful and destructive the practice of polypharmacy can be, and why it must be curtailed to protect individuals, like myself, whose livelihood it has harmed rather than helped.
* All names of institutions and persons in this piece have been changed to preserve anonymity.