side effects

Can I Just Say #6 – A Note on Psychiatry

Operating SystemI am grateful for the work that medical science has done on depression. I am grateful (really!) for the medicine, which I’m taking and which is helping. But can I just say that I would appreciate some humility from the psychiatry crew?*

Your science is very young. You have no idea of the actual mechanism of most of your tools, and most of your interventions work only in the short and medium term. You don’t know my body better than me. You don’t know my mind better than me, and you don’t know which meds will work.

You ask me to track my symptoms and then ignore me when I say that it’s driving me crazy. (Are these thoughts worse than yesterday? These feelings? Oh. That was a bad one. Is this anger or anxiety…).

What’s the point of a bunch of painfully collected data if you can’t even begin to infer causality? Am I more anxious than a week ago because of the meds or is it because I just started a job at a call center where customers tell me to go fuck myself? Please stop acting like we have a counterfactual, an alternate Mfupi who didn’t start that job. Another Mfupi with my biology and history who’s not on the meds you recently switched me to. Just stop.

Also, there aren’t that many drugs for depression. You should be familiar with them.

I appreciate your help. I believe you have my best interests at heart, just have some humility. Please recognize that “everyone is different” means that you don’t actually know how to help me.

So don’t act like my doubts = noncompliance. This isn’t a relationship in which one person should comply. This is a partnership. You bring your imperfect understanding of my condition. I’ll bring my imperfect interpretations of my thoughts and feelings. And we’ll figure it out together.



*I’m a huge fan of psychology, where PhDs and other experts provide talk therapy. This post is about the medical field of psychiatry, which, for depression, mostly concerns itself with managing medication regimens.

Photo by Mark Anderson on Flickr

The Premise of the Question

The Confused Gaze I once heard what I thought was a very good question to a panel of mental health professionals. “Isn’t it true that mental illness causes myriad physical problems, and that we as a society, and insurance companies in particular, would do better to take that into account in how we treat mental illness?”

I thought to myself, Yes! It causes all sorts of physical problems. Take us seriously, Rest of the Medical Community!

But the panel politely took objection to the premise of the question. They said that mental illness does not need physical illness to make it important. By itself mental illness is an enemy to the productivity of the workforce. By itself mental illness is a cause of profound human suffering. It is not just the cause of other, more consequential public health problems, it is a public health problem, deserving of the same type of public concern as heart disease or diabetes. This is what we mean by mental health parity.

From a public health perspective, the problem with thinking that mental illness can cause other, real illnesses is that it perverts the structure of mental health research and treatment by confusing real recovery with the repression of symptoms and the mitigation of secondary outcomes. It’s bad science.

From a personal perspective, the problem with sticking to a physical interpretation of a mental illness is that it invalidates my suffering. It makes me feel as if I don’t matter.

Screw that.

Can I Just Say? #2

I want to talk for a second about chain reactions. When an antidepressant gives you a racing heart, that’s not just about a racing heart. The racing heart makes it hard to take a deep breath, it makes you lightheaded and afraid to bend down to pick something up. It makes it even more difficult to exercise. In quiet moments, it reminds you that you’re sick and you don’t have control of your body or (at least in part) your mind. Which, of course, can give you racing thoughts and, very likely… a racing heart. Ooof.

Night sweats are the same way. Your sleep suffers. Your laundry situation suffers (the humanity!), you wake up freezing and clenched up in a ball, leading to muscle tension, a wicked headache, and a head cold the next day. You’re even more lethargic than the depression alone has been making you and you know why? Because you did a fucking fashion show of pajama tops in your sleep!

If you feel like you’re dealing with a shitstorm, it’s probably ‘cause you are. Be nice to yourself. We’re behind you.

The Cozy Beast

Guys, I gotta tell you about the newest technology in night-sweats management.

I have discovered a Hot Water Bottle Solution.

Many antidepressants, including SSRIs (lexapro, prozac, zoloft, etc.) cause night sweats and MAN is this shit annoying. I’m not talking about waking up with a damp hairline because your bedroom is too warm. I’m talking about changing your shirt three times (that’s four shirts!) in a night because you’re drenched and freezing.

First I freaked out. Then I felt extremely downtrodden (nightmares aren’t enough?), then I stopped using a space heater or my hot water bottle. Then I did some googling and my unemployed ass bought 100% cotton tank tops, sheets and shorts. No success.

THEN I thought screw this. I’m going to run straight at it. Real night sweats are not due to overheating. I don’t know what the fuck they’re due to, but it’s not a temperature thing. I wake up freezing because I’m drenched, so why not just fight fire with fire? I now sleep WITH my hot water bottle (the best hot water bottle in America, courtesy of my Aunt Nell in England, a hot water bottle aficionado).

The Best Hot Water Bottle in America

I leave the cozy beast by my feet and when I wake up freezing I just hug it close.

BAM. The Hot Water Bottle Solution.

It heats you up, let’s you go back to sleep, makes you feel like you’ve conquered the SSRI demon.

(Hot water bottles can be hard to find in the US, but they are hidden in many a CVS, on the bottom or very top shelf, folded up into a cardboard box that looks nothing like a hot water bottle. They come without covers, so I recommend plopping them into a pillowcase.)

Remember, kids. We’re behind you.

ps. A note to a terrible psychiatrist: “Thanks, My-First-Psychiatrist-Ever, for telling me, a thirty year old single woman who wants to have kids one day, that my night sweats were probably early menopause. Surely they couldn’t be a common side effect of a drug YOU prescribed! What else could they be? Cancer? A brain-eating parasite???” Lord this disease requires even more patience than it robs from us.

The Incognito Cozy Beast