My recent experiment, in which I got off all of my medications and became horribly depressed, taught me that I do not do well without lithium and that lithium alone is not enough. This information wasn’t surprising, but I was hoping for a different outcome. I was really hoping. I was hoping that I could exercise, socialize, and exert enough effort to work my way to a healthy mind. By the time I realized I was losing weight and struggling to brush my teeth every day, those options felt out of reach.

The more depressed I became, the less I wanted to give up on my experiment. Some of it was a sunk cost fallacy, but some of it was my clouded thinking. I saw medication as an outside force that would influence my thoughts and distort reality. I felt suspicious of it. Looking back, I can see that I was not thinking clearly. I’m much more in control of myself now that I’ve been back on medication for a couple months.

Not only am I keeping up with hygiene and sleep, but I’m capable of appreciating the sensations of life outside my bedroom – a flock of house finches chirping in a bush, the sun on my eyelids, Stella’s wet nose against my hand. I no longer go to bed immediately after work, and I also don’t sit on my bed at night, staring into space in an apathetic stupor. I’m getting out and meeting people, running errands, and picking up my hobbies again.

I don’t feel good every day right now, but I feel capable enough to put the usual lifestyle tactics to use. My situation feels more manageable. These developments are partly thanks to therapy and my efforts outside of it, but I think they’re mostly due to medication.

So, I know very well that medication helps me, and I’m working on accepting that. I don’t have any desire to stop taking them, which is a step forward for me. But an internal conflict still exists within myself. I certainly still have some shame about it. I was uncomfortable when I was asked to list my medications at my recent dental appointment, knowing another patient was right behind the curtain. I feel reminded of my mental illness every time I pick my meds up at the pharmacy. I struggle when I pour them into my palm at night, and I see a number of pills that exceeds my mind’s arbitrary “acceptable” number.

Most of my difficulty with medication is eased when my mood improves, but the remnants come from my perfectionism. I want to be able to get better on my own, and I have a tendency to tell myself that it’s not that bad.

Despite the background beliefs that are tough to get rid of, I feel like my perspective on medication has shifted compared to a few months ago. I’m happy that my medications are working. I’m no longer uncomfortable with the idea of them affecting my mind.

It’s strange to look back on what I was thinking when my depression was worse. I had this idea that if I relied on medication to function, I wouldn’t really have earned that improvement. It would mean I wasn’t in control of myself enough to pull myself out of depression on my own. It’s a horrible thought that nobody else should ever believe about themselves. I shouldn’t believe it, either.

I was also very preoccupied with the idea that lithium prevented me from thinking about suicide in the same way as I did without it. Even though I knew that was the point, it made me very uneasy. I thought that I was seeing the situation more clearly than I did when I was less depressed and on medication. Part of me knew that was absurd, but part of me was sure it wasn’t.

Once it was long past obvious that getting off lithium was not going well, I really struggled to come around to the idea of restarting it. When you can’t trust your own logic, having people around you to tell you how they see things is very helpful. Still, for weeks after I restarted lithium, my evenings were spent arguing with myself about which side was right and whether I should take it or not. I think the combination of ketamine and Mirapex has improved my mood enough that I’m not concerned with it anymore.

There have been a few times in my history with depression when I found a treatment that worked but only briefly. Either I’d start to feel better and then something would go wrong, it just would stop working, or it would affect me too much, and I’d fly into an uncomfortable, sleepless state of heightened perception. After which, I’d descend back into depression, sometimes worse than before the improvement. This time feels different.

I think the last time I felt this positive about my improvement was in 2020, when I was getting ketamine infusions and they had started to work. I remember feeling amazed by how much easier life was and how motivated I felt to accomplish my goals. I feel a similar sense of improvement now. It is, as usual, accompanied by increased anxiety, but overall, my mood seems fairly stable in its new, elevated position.