Today marks the tenth week of working as a clinician at a private psychiatric hospital where five years ago I was a patient. In a different place in my life, I voluntarily admitted myself when thoughts of self-harm became too overwhelming to manage.
Four years before that hospitalization, I had consumed my last drink after spending most of my twenties on an alcohol-fueled spree sustained by long periods of manic energy (a symptom in today’s world but a gift in others). This ostensibly successful propulsion allowed me to secure my first graduate degree and employment in conventionally respectable jobs until alcohol’s incitement ran its course. In that final year of use, I walked out of a corporate position, left my partner, and drove 1,500 miles to my childhood home all in about a week in an act of unconscious self-preservation. Two weeks after arriving home to my unsuspecting family, though, I attempted to end my life and woke up in a psychiatric hospital. A year-and-a-half of recovery work later, I experienced my first sober manic episode; I managed to avoid hospitalization with the help of a keenly perceptive therapist I had started seeing a few months before, alongside a good dose of lithium. And then the real fun began.
Of all the stories I could tell of the psychological pain, the grieving for my past and dashed future, and the endless pursuit of healing, there is one story that upsets me most. That is the story of the psychiatric violence I’ve experienced since my diagnosis, observed in peers, and witnessed carried out by prescriber colleagues. While medication may at times play a role in healing, I struggle to see past the psychiatric discipline’s deficits: its lack of humility, its questionable scientific rigor, its embrace of specious claims, its cozy relationship with Big Pharma, and most of all its frequent denial of the suffering it’s capable of inflicting upon those desperate for relief.
My mental health and substance-use recovery work unearthed a history of trauma. Yet it is the benign (I hope) ignorance of psychiatrists that has caused me the most pain since finding sobriety. Instead of relying on memory to recount these prescribing mishaps, allow me to share primary sources.
A few months after scribbling down a Bipolar Disorder diagnosis on my chart, my then-psychiatrist abruptly stopped an SSRI I had been taking for eight years. About three months later, I experienced nearly daily panic attacks for 33 days, each attack lasting about an hour, sometimes more than once a day.
Random scrawl from my notebook during that time:
Damnit, happening again
Walking around house, got flushed
Panic all day
Walking on the street
Middle of the night
Cat lying on my legs
Hiding in the bathroom
Ran out of meeting
Almost hit pedestrian
Meeting with sponsee
Walking around the parking lot
A few days after the panic attacks — which I had never experienced before — took over my life, my psychiatrist prescribed Xanax with the knowledge that benzodiazepines had played a role in my first hospitalization. I reluctantly took a round blue pill or two during the worst of the attacks and stopped leaving the house for fear of killing someone or myself while driving to a recovery meeting. The attacks ended soon after my psychiatrist re-started the antidepressant. Still new to this world, I brushed it off and returned week after week to my prescriber’s office. That springtime month of crippling panic attacks ranks as the most scarring experience in my recovery journey.
Coming in at number two is my adventure in Seroquel withdrawal, again precipitated by a botched taper plan that was too short and too drastic. Like the SSRI withdrawal, I documented the antipsychotic experience in my journal to share with my prescriber, hoping this would be helpful information for my “treatment.”
* * *
For last 10 days or so, sleeping only 3 to 4 hours a night. Difficult to nap during the day, if at all. Feeling more and more sleep deprived.
Last Seroquel taken Thursday evening – 50 mg
Friday – started hitting a wall, akathisia, mind shutting down. Starting seeing lights (repetition of real lights) that were not there and my cat running around/in front of me while the actual cat is on a different floor. Decide to take 1 mg Xanax ER at bedtime along with regular meds (lithium, Lamictal). Slept 3 or 4 hours.
Saturday – up around 3 or 4 am. Hit a wall. Feeling super fucking crazy. Could not go back to sleep. Pacing picks up. Restless legs when trying to lie down. Intense tension in shoulders/upper arms, the type I will get during panic attack. Around 10:30 am, take AM meds (but just 25 mg Zoloft – usually 50mg – and 1.5mg Vraylar). Decide to take 1 mg regular- release Xanax. Doesn’t do shit. Feeling like I’m going to die. Took 10 mg of Vistaril. Nothing. Getting crazier. Take another 10 mg of Vistaril. Nothing. At some point take two ibuprofen.
Did not want to take Seroquel – just wanted to get through this as part of the withdrawal. Didn’t want to have to deal with this process again.
Continue pacing and dying slowly. Roommate starts freaking the fuck out. Realized I missed a voicemail from on-call provider suggesting I re-start Seroquel. Finally gave in around 4:30 pm and took 400 mg Seroquel. Went to bed at 5 pm and woke up Sunday morning at 4 am. Feeling slightly better. Went back to bed at 6 am. Slept until 8 am. Back to bed around 10 am and slept another 30 minutes or so. Took AM meds, 25 mg Zoloft – usually 50 mg – and 1.5mg Vraylar. Mind starting to feel clearer and feeling less insane. Akathisia continues, however.
Pacing most of the day Sunday with brief moments of akathisia cessation. Stops around 8:30 pm.
Spoke to on-call provider around this time. Explained situation, and she said it sounds like akathisia. Advises I take 200 mg Seroquel and regular meds (lithium, Lamictal). And also 50 mg of Vistaril. Took all meds at 10 pm. Went to bed at 10:30 pm. Fell asleep ~15 minutes later. (Note: I only have 80 mgs left. Eight 10-mg tablets.)
Woke up this morning at 5:30. So about 7 hours of sleep. Less akathisia. Went back to bed around 7:30 am and slept about 30 minutes. Feeling better with slight akathisia and some discomfort/pain in the biceps area.
Have not yet taken AM pills – Vraylar and Zoloft
Saturday was in the top 3 worst days of my life. No exaggeration.
* * *
Thankfully, I no longer shudder when I think about that horrific week, and I am no longer angry at my prescriber (who will never be held responsible for medical negligence) for suggesting a taper schedule based on who knows what instead of empirical evidence or common sense.
My second and hopefully final hospitalization had occurred just a few months before the Seroquel disaster. During a period of low mood, my psychiatrist started a game of Russian Roulette with medication changes. Weekly appointments ended with new prescriptions, and increasing suicidal ideation and planning landed me in the hospital I work at today— only to have my medication regimen reverted back to the original pre-hospitalization plan. The abnormally overwhelming suicidality ultimately abated with continuing therapy and hard work.
A month after termination from this prescriber, I moved to my second and current psychiatrist, who supposedly has expertise in working with those with bipolar illness. What follows is a message I sent to him regarding what I termed at the time “the Vraylar withdrawal and propranolol experiment.”
To: Dr. “X”
An update on the last few days of the Vraylar withdrawal and propranolol experiment.
Last dose of Vraylar to stop emerging (internal) akathisia
Took 10 mg propranolol at 8 am. Moderate akathisia – physical and mental. Paraesthesia at random intervals in random places.
Took 10 mg propranolol at 2 pm. Call with Dr. “X” at 3 pm. Evening felt mostly okay – just aftermath emotionally.
Morning okay – just aftermath stuff. No propranolol. Started getting worse (akathisia, crazy thoughts, suicidal ideation, paraesthesia located mostly in shoulders – lots of heat, weak legs) around 1:30 pm. Becoming and more and more intense. Comes and goes in waves.
At 6:30 pm, took 20 mg propranolol. Next hour became as nearly as intense as when I was withdrawing from Seroquel. At 7:17 pm, called the on-call doctor and left a VM. Suicidal ideation, self-harm, drinking all became options in my head.
Around 7:30 pm, the symptoms cooled off a bit. Moderate symptoms through the rest of the evening. Waves on and off. On-call doctor called back around 7:40 pm and told me to take 20mg propanolol on Sunday if needed.
Mild symptoms in the morning. Ongoing paraesthesia with heat in my shoulders. Took 200 mg ibuprofen at 11:30 am. Heat in shoulders became better but with waves of akathisia and tunnel vision.
Took 200 mg ibuprofen again at 3:30 pm. Heat begins to dissipate more. Akathisia begins to wane more around 5:00 pm. Occasional minor wave through the evening. Emotional hangover.
Woke up and felt okay for about 30 minutes. Mild paraesthesia set in. Took 200 mg ibuprofen at 9:00am. Starting to feel better again. Mild waves of paraesthesia and tunnel vision/akathisia continue. Took another 200mg of ibuprofen at 1:45 pm. Hoping this is the last of it.
* * *
The DNA test for psychiatric medication response I took weeks after this “experiment” predicted that I would have a severe reaction to propranolol, and unfortunately, it was not “the last of it” as I had hoped. Paraesthesia-like sensations such as tingling, heat, and numbness have become a chronic response to stress and intrapsychic unease, discomfort I had not experienced before. Fortunately, a laundry list of “self-care activities,” including exercise, meditation, ongoing psychodynamically-oriented therapy, better nutrition, nootropics such as NAC and L-theanine, a solid sleep routine, and body-focused somatic experiencing have helped calm this and other life traumas. Not a doctor’s prescription pad.
Returning to school to enter the mental health profession (both to learn more about my own challenges and to help others heal), I dove into the literature on psychotropic medications, prescribing and deprescribing, the etiology of “mental illness,” and psychosocial interventions that do not require the intervention of a psychiatrist. I weaned myself off two drugs with reasonable guidance from my new psychiatrist. Considering stopping the SSRI I had re-started after the panic attacks episode, I reviewed countless websites and dissected dozens of tapering anecdotes shared online. I spent months scouring the empirical literature on SSRI discontinuation and found little that mirrored the experiences I had read and discussed among my peers. I located exactly one published paper with a comprehensive and transparent review of the side effects of withdrawal from various SSRIs, including the one I was taking.
Over the course of a few appointments with my well-meaning psychiatrist, I listened politely as he talked about halving my antidepressant pills every couple of days and hoping for the best in my next psychotropic-cessation experiment. I ignored his recommendation, and with the support of my cat and my therapist, I laid out a seven-month taper plan and marked up a wall calendar in my bathroom noting which days to take which dosages. I took my last pill the morning of June 4, 2020, and started another day of teletherapy as an outpatient therapist with a taste of joy and a touch of dread. I know, however, that I’m not completely out of the woods. I suspect that seemingly random days of acute anxiety, a run of sleepless nights, and occasional brain zaps are my bodymind telling me I continue to heal.
My therapist said to me a few months ago, “You are your own psychiatrist” (for better or worse). I am more conversant with the latest literature on the medications I still take than my prescriber is (and I suspect he knows this, too). While I consider his opinion and clinical judgment, I no longer accept every word that comes out of his mouth as the Gospel truth. I also know that I am quite privileged to be a white male with a support system, financial means, and an educational background that helps me staunchly advocate for myself in the language of medicine.
Today, I take two mood stabilizers (down from six or seven medications at one point or another). I struggle with cognitive side effects: increasingly worrisome challenges with memory, verbal fluency, and cognitive dulling. My goal in the next year is to taper off one of these medications and possibly the second some months (or years) later. I’ll continue to make these changes under the medical supervision of my prescriber and the holistic supervision of my therapist and friends, but I will not allow myself to succumb to the psychotropic violence the discipline of psychiatry has inflicted upon me.
I wish that my story were unique. Sadly, it is not. I am comforted to know, however, that some psychiatrists – perhaps even colleagues on my unit – do grapple with the state of the discipline and earnestly attempt to understand survivors’ stories so they can do the work of healing and stamp out violence in the field. After all, the word psychiatry is rooted in Latin, loosely meaning “healing of the soul,” and I sincerely hope that the discipline undertakes the honest and humble work of healing its own soul before trying to heal mine.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.