My fifth challenge - 7 Pill Puzzle: Navigating Complexities of Depression Treatment

My next challenge was taking seven medications twice daily. In the past 5 years, I had started taking them three times a day but then stopped. This was a bad decision, as my psychiatrist explained that when I stopped, my body developed a tolerance, requiring higher doses each time I restarted the medications. Previously, I had taken them for three months, stopped, then restarted for six months before stopping again.

My doctor said this was a poor decision. He explained that I would need to take the medications continuously for at least two years, even if I started feeling better. And even after that, he couldn't be sure if we could stop, as based on my history, it might need to continue for up to five years. I told him I was ready this time, but due to the severity of my condition, I had to start taking seven different pills daily. This was daunting, as I had never seen anyone my age taking that many medications. With my existing asthma and anemia issues, that brought the total to nine pills per day.

It was scary because I felt like, “Am I going to die, is it this bad?” This time, I decided that no matter what, I would go through with it. I promised myself that I will shut the medical person in me and like a child will follow every instruction of my psychiatrist. Other option was 20 rounds of ECT, and then we start with less number of medicine. Though I was a medical person, I wasn’t ready for ECTs, so I started with medicines.

While I'm not an expert in psychiatry, it is an emerging field that I've studied to some degree. We still don't know as much about the origins, pharmacology, and pathology of mental health conditions compared to other diseases like asthma and anemia. It's hard to know pathology of why someone like myself, who seemingly had everything, could still develop depression. Is it a neurological defect, a psychological maladaptive mechanism, or a chemical imbalance of hormones? I'm still not entirely sure what the root cause was in my case, but likely a combination of factors.

My doctor said we would start with medications first, then adjust and change them as needed.I read about all the medications and their actions. This uncertainty about what would ultimately work best for me was unsettling. The psychiatry field is more honest about this trial-and-error approach, unlike other medical specialties where detailed study has proven the pathology and pharmacology needed for treatment. For example, with diabetes, a doctor would prescribe medication with full confidence knowing in the details of the disease and treatment. In psychiatry, it's often a process of trying different options to see what works best for the individual.

In my case, I was diagnosed with major treatment-resistant depression and anxiety, so I was started on a regimen of seven different psychiatric medications.I was told to remember these 4 key points when it came to the medications:

1. It takes about two weeks to feel any effects. For the first few days, I had to take them on faith, even though I felt like, "Why so many tablets, with no effect visible ?" But my friends and family kept me going, with Harshali video-calling and my partner visitng me twice daily to remind me and to make sure I take medicine in first two weeks.

2. The medications come with side effects like drowsiness, headaches, dry mouth, indigestion, sleepiness, and weight gain. I gained 30 kg over two years, which was likely a combined effect of my inactivity, sweet tooth, and the medicines. Initially, I slept a lot, but my workplace was supportive and gave me six-hour shifts.

3. Another challenge is the high cost of these medications. My first bill was ₹3700, which I could afford, but not everyone can. I believe there are generic options available at government hospitals.

4. Once I started feeling better, I knew from past experience that I might be tempted to stop taking the pills. So I set alarms on my phone to remind myself. It's crucial to continue the medication even after feeling good, as my doctor advised, which can be tricky.

My main ongoing challenge is to consistently take the medications, even when I'm feeling better. Whether my doctor says I need them for six months or six years, I'm committed to following his guidance. I have been guilty of forgetting doses at times, but I try my best not to miss any.

After two and a half years of medication, with monitoring and tapering, I'm now down to just two medications and continuing to taper. I feel so much better - I feel alive again.

There is still a stigma around taking psychiatric medications, with some people saying they can "fight it on their own" and don't need medication. But I've learned that's so illogical, like refusing a cast for a broken bone and trying to heal on your own. Just as a cast supports the body while it heals, these medications are like a "cast" for my brain after its "major accident" with mental illness. They provide the support I need, and as I continue to heal, my doctor will gradually reduce and eventually remove them, just as they did for me from seven medications down to two.

Depression is similar to a chronic condition like diabetes - lifestyle changes can help manage it, but medication is often necessary as well. It's not a sign of weakness to take medications when you're ill - it's actually the wise and responsible choice. Medical science, including in psychiatry, aims to reduce suffering and improve quality of life.

I no longer feel any shame in taking the medications that have kept me alive and restored my sanity. I still experience sadness and anxiety at times, but it's because I can empathize with others who are suffering, or because of normal life events like being away from home or starting a new job. I feel truly blessed that I can now feel the full spectrum of emotions - sadness, laughter, and everything in between. This is the life I want, to no longer be trapped in a dark, numb state.

Seeing my loved ones so proud of me has made all the pain and struggle I went through truly worth it.

I'm deeply grateful to be living in an era with access to life-saving psychiatric medications, which have given me a second chance at life.