Lately, I’ve been excited to begin going in the other direction with medications as part of my depression recovery- reducing rather than adding. Through years of treatment, it seemed like I was always either increasing a medication or trying a new one. I never got much relief from antidepressants (except the one it turns out I’m allergic to), and lithium, the mood stabilizer that has probably saved my life, comes with the risk of kidney damage if the levels of it in your blood creep too high. I still take an antidepressant, two mood stabilizers, and Deplin (because I’m a mutant). These drugs help me function, and although they don’t kick my depression completely out the door, they are important.
I have a love/hate relationship with lithium. It dramatically reduces my suicidal thoughts, and that’s amazing. If I were to describe how it felt when I was at my highest dose of lithium: it’s like you’ve been gritting your teeth for years, and then all of a sudden you realize you’ve stopped. All of that pressure, the wear on your teeth every single day as you work your jaw muscles without cease, suddenly vanished. Like the peace you feel when static background noise shuts off, and you’re left in silence. When I got to a high dose of lithium, I was floored when I realized that I hadn’t thought about suicide all day. In fact, lithium makes it a little bit difficult for me to think about suicide in the same way I do without it. Focusing my thoughts on the idea feels a bit like trying to push the same poles of two magnets together. But when I had to reduce my dose because of the risk of lithium toxicity, the suicidal thoughts started to come back. Not to the degree that they once were, but it was clear that the change in my lithium dose was to blame. Still, I’ve enjoyed a lesser degree of suicidality than I experienced without lithium.
Lithium restrains my thoughts from straying into suicidal ideation, but it comes with some unpleasant costs. Because it’s processed through your kidneys, it has a tendency to make people thirsty. If I go too long without water, I feel like I’m shriveling up like a dry sponge. It also makes me feel absolutely exhausted, napping excessively (even more than I normally do when I’m depressed). So although it does some wonderful things for me, I’ve always hoped that I wouldn’t need it forever.
Overall, I’ve been enjoying a recent improvement in my mental health. This is because of IV ketamine infusions, which treat, among other conditions, treatment-resistant depression. When I started to feel better and my depression recovery seemed to be on track, the spark of hope that I might someday be able to come off some of my medications began to grow. I was excited- why stay on meds that are only half-working if you have something better?
I talked to my psychiatric nurse practitioner about reducing my lithium dose by about a third. Within a week, the consequences of reducing my dose were becoming clear. I started to feel less interested in things again, tearful, and guilty about my depression. The slip was minor; I wasn’t feeling much worse, but it was compounded by my thoughts about the situation. I was looking forward to reducing my medications so much that when it went badly, I let disappointment carry me into catastrophizing. I thought that I’d never be able to leave lithium behind me, and would always rely on it to keep me safe from myself.
I quickly went back to my previous dose and waited for my symptoms to subside. Honestly, if it turns out that I do need it forever, that would be okay. There’s nothing wrong with needing medication. For now, though, I’ll tell myself that I was just too hasty, and try again someday soon.
It’s tempting to beat myself up for “losing progress,” but that’s all just part of life. When I feel trampled by my mental illness, I try to reframe the “progress” I think about as being more about the time you spend living and the things you learn along the way than about the state of your mood. Progress is existing each day and surrounding yourself with ideas and actions that keep you going. You’re living along the course of your own life- whatever that might be- and that’s progress.