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Stop Trying 'Really, Really Hard' to Get Off of Your Medicine

Posted Sep 29 2009 10:15pm

My friend told me that she wants to stop taking her anti-anxiety medication.

"It's important for me to get off of it. I want to try really, really hard to eliminate it from my life."

Bear in mind that this is a woman who has suffered from crippling anxiety for many years, to the point that she wasn't even leaving the house. Countless therapy sessions did nothing. Yoga, meditation, acupuncture, exercise, vitamins, you name it. Nothing, nada. She was a complete mess until she met her good friend, Mr. Paxil. And then she was much better. At least to the point that we could have this conversation in a bar and not simply through text messaging while she sat alone in her bedroom.

Knowing this about her led me to get on my soapbox about her desire to stop her medicine, to the point that I was told by the bartender to either lower my voice or leave. Apparently I can scream all I want when the Yankees lose - and believe me, I do - but I have to use my Indoor Voice when discussing matters of health.

Before being scolded, I listed for her several valid reasons that physicians and patients will stop a reasonably successful medication regimen:

1) Side effects: sometimes the benefits of the drug are simply offset by the cons that come with it. Most of my patients tell me that many side effects go away after a few weeks, but whether it be significant weight gain, loss of libido, dry mouth, dizziness, etc., some people decide that the gains are simply not enough to warrant continuing the medicine. An extension of this would be when a patient's mental health medicines are contraindicated due to a physical issue such as pregnancy.

2) The issues or circumstances that led to medical intervention have been resolved: some patients need medication as a temporary band-aid to simply take the edge off or alleviate symptoms on a short-term basis. I have plenty of clients who have panic attacks that are so agonizing that medicine gives them an almost-required relief. They then go to therapy, learn the skills to control the panic and then make a conscious choice that they feel better equipped to deal with the issue. At that point the drug is often removed. Another example would occur when a patient loses a loved one and, for whatever reason, is unable to get out of bed in the morning or function throughout the day. Anti-depressants are often prescribed to help the patient get to work and manage their daily tasks until they gain some control over their grief.

3) Cost: while most of my clients have some type of health insurance and can get at least generic versions of medication at a reasonable cost, this is not true for everyone. Some patients simply do not have the funds needed to get the drugs that will help them. And unless they have a doctor who will provide them will samples on an indefinite basis, some people simply can't access what will help them.

4) Dependency: certain medicines such as Ambien or Klonopin have habit-forming properties and are often used only on a short-term basis. Some patients need to stop taking these drugs after a period of time due to the risks involved.

"I've known you forever and none of those apply to you," I said. "So tell me the reason."

"I don't like the idea of needing it," she said. "It's like, I'm weak if I have to take the pill."

I've heard this innumerable times from clients, friends and even Dr. Pete. I almost always say the same thing in response.

"So if you were diabetic would you bat an eyelash at taking Glucophage?"

My friend sighed, knowing where this was going, fully prepared to humor me. "No, doctor of sorts."

"And would you even consider your own intestinal fortitude if you needed Zocor for high cholesterol?"

This time she rolled her eyes. "No, I would not, you pedantic dick."

"So it's fine for you to have problems with your kidneys or heart. In fact, I'll bet any organ gets a free pass as long as it's not the brain. Where did you even get this idea?" I asked.

"Come on," she said. "You know the stigma. You talk about it all the time on that stupid blog of yours. It's just the way society looks at this type of thing."

Of course she's right and, while the stigma has weakened over the years, it still exists. Many people (most of whom probably don't read this site) feel the same way as my friend: the brain is the sole organ that you are supposed to have full control over. Unfortunately it doesn't work that way in real life. The reality is that she doesn't have control over it and needs the medicine.

"You're actually being very judgmental to both yourself and everyone else who needs these drugs," I said. "So what's going to happen? You'll stop the Paxil, become a screaming ball of anxiety again, and be 'strong' because of it?"

She threw back a bit of some pineapple-scented drink. "I don't know, maybe. I suppose I could get lucky and the anxiety could go into spontaneous remission."

"After all these years, I doubt it. How about, as an alternative, you remain a happier person with the medicine instead of being a martyr?" I suggested.

"Or," she countered, "how about you go fuck yourself?" To solidify her request she stabbed me in the arm with a paper umbrella from her drink.

Although I think she agreed with me on an intellectual level, her gut was still telling her that 'mental health medicine = weakness.' And this is the case for so many people who rely on the drugs. The point that needs to be drilled home is that, ironically, a weak person is the one who will not admit that she needs help. Strength is the ability to say "I can't do this alone, it's not working." You can't allow your mind to wrap around the notion that it's a good idea to remove an agent that has improved your life immeasurably, only to return to a previously miserable state. And all for the sake of falsely claiming strength.

Are some people in the world over-medicated? Yes. Do some people use it as a 'quick fix,' a way to not have to address their problems? Of course. Could our society strive toward a less biochemically-altered state? Absolutely. But none of this is applicable to my stabby friend who never did apologize for her assault on me. This is a psychological battle for her. She has to resolve the fact that there is likely something going on in her skull that needs to be addressed through modern medicine.

I don't know as of yet what my friend is going to do. We saw the violence she is capable of when her medicine is keeping her reasonably calm, so I'm pretty sure she could kill me if she goes back to her former self. That in and of itself should make the decision an easy one, but we'll see.

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