Teresa Theophano
I want to scream it from the rooftops: IT’S OKAY IF YOU CHOOSE TO TAKE MEDS. You always have the right to follow your own path to becoming your best version of yourself, whatever that means and however that looks to you. You do not deserve to be shamed for your decisions, no matter what you read courtesy of mass, alternative, or social media.
Mind you, I write these words as a reminder to myself as much as to any of you who might be reading. Because despite taking antidepressants for decades and also working within the field of mental health care, I still find myself struggling not to internalize the ableist rhetoric I encounter regularly on- and offline.
I first started writing about med-shaming, and sharing about my own lived experience, about seven years ago. Reading an opinion piece in the New York Times entitled "Breaking Up With My Meds" led me to realize what strong feelings I harbored about the topic of quitting psychotropics. I admired the Times author’s openness in sharing what turned out to be a series of essays on weaning herself off psych meds, and I realized that some of her criticisms of pharmaceutical companies, and of the antidepressants and benzodiazepines they produce, resonated with me. She verbalized concerns about the meds’ long-term effects and side effects, of concealed studies, and of the companies hard selling to pediatric and adult psychiatrists alike.
Fortunately, I haven’t experienced any noticeable side effects from my own meds, though the long-term impact of them remains a crapshoot. And if my deeply compassionate psychiatrist has received swag from or been nefariously influenced by the major pharmaceutical companies, she hasn’t let on.
Still, I can’t deny that I have never been entirely at ease with the idea of ongoing medication therapy. As a radical queer social worker and community organizer who came of age in the punk scene, I’ve been questioning institutional and cultural assumptions and norms for a long time. So the notion of taking pills to feel emotionally better wasn’t something I embraced from the start. I value peer support, and cherish the creation and sustenance of grassroots organizations and peer-based mental health networks such as the Fireweed Collective (fka the Icarus Project), whose publications such as "Harm Reduction Guide to Coming Off Psychiatric Drugs and Withdrawal" are an invaluable resource. In 2014 I helped launch a short-lived but vibrant queer mental health peer support network myself here in NYC. I am grateful for how the psychiatric survivors movement crucially supports the self-determination and wellbeing of anyone who has been harmed by mental health care systems.
Meantime, over my decades of experiencing major depression and the effects of trauma, I have explored multiple paths to wellness that included studying integrative and holistic nutrition, receiving acupuncture and homeopathic treatments, practicing yoga and meditation, taking herbs and supplements, and making lifestyle changes to better my external circumstances so that perhaps my internal world could improve as well.
But guess what?
I am never breaking up with my meds. I'm going to stay on my antidepressants and am, in fact, likely to take those tablets every single day for the rest of my life.
Twice as an adult, I felt that I had finally become well enough to titrate down from my meds. After attempting to do so under my therapist’s supervision, I hit rock bottom and stayed there. Several times I have begun different courses of treatment; it took many years for me to find the right “cocktail.” And then in 2017, after years of stability and while still adhering to my regimen, I was hospitalized for the worst depressive episode of my life.
But with time, care, and more adjustments to my meds, I once again recovered; I have been in remission since mid-2018. It has taken a great deal of effort for me to heal from significant trauma, break dysfunctional relationship patterns, and learn to make healthier career moves. But with this combination of developments, and even as chronic physical illness has emerged as a new obstacle in the past couple of years, generally I have been able to feel more fully engaged in my life. My ebbs and flows feel more and more manageable, and my clarity of mind has increased my ability to experience joy and try new things.
It may not be surprising, then, that I don’t want to spare the time or energy once again battling a resurgence of racing, dysphoric thoughts about my own worthlessness or wading through despondency that could impair my daily functioning. So it’s not worth it for me to take chances in weaning myself off meds--my quality of life became too high once I found the right treatment. My will to stay well in the present outweighs my worry about the future health of my internal organs or developing other maladies later in life.
My friend Stephanie and I had an anthology on the topic of LGBTQ+ mental health published in 2019; for years now we’ve written and talked extensively together about accessibility to treatment and paths to wellness.
Like Stephanie, whose essay in our book Headcase details her struggle to afford her meds, I have fought tooth and nail to be able to acquire my medication. I was unable to afford health insurance for several years as I searched high and low for full-time employment that would be the right fit, taking as many freelance gigs and part-time jobs with no benefits as I could. Prior to that, my health insurance as an MSW student in the early aughts was woefully, shamefully inadequate: there was simply no coverage provided for mental health care and my medications were not covered under the plan’s formulary. Mind you, I’d purchased the policy through the university at which I was studying social work--and despite my multiple angry appeals, I got nowhere in arguing for parity.
During those times I was resourceful about procuring my meds: I applied to pharmaceutical companies' patient assistance programs and sometimes succeeded in getting several months' worth of pills at no cost. I ordered prescriptions online and had them shipped from Canada or halfway across the country--despite my meds having gone generic, NYC-based pharmacies could still charge hundreds of dollars for a 30-day supply. While I’m happy to have employer-sponsored health insurance these days, my coverage is limited. I encounter numerous out-of-pocket expenses, and I find that few queer-affirmative trauma therapists—including my own—are in network. Being a therapist myself, I understand some of the reasons for this; still, it’s frustrating, which is why I advocate for anyone in need of care to learn about applying for a single case agreement through their insurance company.
Further, I understand that meds are not the answer for or accessible to everyone, and I will continue to support self-advocacy efforts and alternatives or complements to conventional psychiatric treatment. For a time I worked at Rainbow Heights Club, a psychosocial support program that stressed peer-based collaboration, and witnessed firsthand how effective it was. That influenced me to open up more in essays, blog pieces, and articles about my own lived experience. The stigma and shame of living with mental health issues prevent a great number of people from telling their stories--and that seems to be particularly true for members of LGBTQ+ communities, who have long been pathologized on the sole bases of our sexual orientations and gender identities.
My vision of a genuinely holistic approach to care includes the consideration of multiple treatment options both mainstream and integrative. I still engage in some mindfulness practices and attend regular psychotherapy sessions, which I think are particularly important given my own work and stressors. What I have never found helpful is being lectured by proponents of natural and complementary therapies--many of which are not financially feasible for members of low-income and marginalized communities--about how it is possible for everyone to be totally well without meds, as if people living with mental illness are simply not trying hard enough.
The comments I have heard from some holistic practitioners and general opponents of psychopharmacology reek of ableism and reinforce the damaging theory that extreme states of distress can be somehow conquered by sheer force of will. To my knowledge, there is no empirical evidence that “mind over matter” has ever constituted an effective intervention for these. When you are struggling with anhedonia, hopelessness, irrational or intrusive thoughts, panic, or any related symptoms, the last thing you need to believe is that it’s your fault. It is not some personal shortcoming that prevents you from getting better without treatment. Trust me on this one.
Are meds the answer for anyone and everyone experiencing extreme states? Of course not. But I’m not going to discount the role my meds play in my current high level of wellness just to prove a point to myself or anyone else. And if you are suffering and you have tried everything else to no avail, I urge you to consider doing the same.