Mental health and medication

Mental illness is like any other issue with the body. There are effects from it, there are treatments for it, and like someone who’s diabetic, you (probably) lack the correct balance of chemicals in the brain and there are medications for that. Of course we live in a society where a small, but vocal, group of people are pushing for “purity.” You don’t need medication, you can just eat healthy, think your way through, change your attitude. That is a lie and one that is deadly. You cannot fix mental illness through diet and exercise anymore than you could ask a diabetic to start producing insulin on their own.

That isn’t to say diet, exercise, etc. can’t help or supplement proper treatment. It just should not and cannot be the first line of treatment for someone with mental illness, especially when it’s serious. Now serious is person dependant, so your mileage may vary, but I believe any mental illness is serious when it affects your quality of life. In other words, if you have a mental illness, then it’s almost certainly serious. So today I’m going to share a story, my story, about how I found a magical medication that helped me in ways I could never imagine.

This post is about a decade in the making if I’m being honest. I’ve been through so many different medications for my depression/anxiety/PTSD/etc. and it turns out the thing that helped me the most wasn’t even a medication to treat depression, it was a medication to treat excessive sleepiness (more). The effects of modafinil were drastic and almost instantaneous. With a half life of about ten hours and about two hours to peak serum concentration, there’s no weeks of buildup to see what happens and coming off is just as quick and painless. It’s not addictive, has minimal risk of side effects (at least from what I’ve read), and it completely changed my life. Until it was taken away.

Now quick background. I’ve decided somewhat recently that I may not even actually be depressed or that isn’t the whole story. I think it’s something else there either in addition to depression or something very similar to depression, but then again what do I know? I’m literally crazy. So some of symptoms are, serious depression, all the stuff that comes with it (exhaustion, literal pain, loss of interest in life, etc.), inability to focus, anxiety, serious insomnia, parasomnia, and hypersomnia (all the somnia!). Oh and the complete and overwhelming urge to kill myself.

That last part, that’s why I don’t think it’s technically depression, no matter how I’m feeling, there’s a part of me that wishes I would just kill myself. It’s not even me exactly, it’s just a feeling that constantly nudges me that direction. They call it suicidal ideation, but with how consistent it is and how diametrically opposed it is to how I feel sometimes, I don’t know that I would call it that.

That said when I found modafinil I felt like my search was over. I was finally content with how I felt and I describe the two years I was on it as the most normal I had ever felt in my entire adult life. I describe my “normal” or normal without modafinil anyway, as walking through an invisible vat of razor blades and molasses. It takes a considerable amount of effort to think or move and when I do physically move it causes very real pain in my joints and just everywhere in general. So I conserve as much energy as I can and most days I have to be careful about overextending myself because I will pay for it.

When they took my modafinil away the first time I spent a full three months on the couch. I got up to use the bathroom and eat only. Literally, I went from the best I’d felt and looked physically to gaining almost 100 pounds. Part of it was whatever is going on with me and part of it was the stress of having the one thing that helped taken away. It was a dark time and I’m surprised I survived it.

People think medications like modafinil or Adderall are performance enhancers. In one sense this is correct, but they only work if you have the problem they treat. Studies have already been done that show no improvement when people who don’t have problems take them, feel free to google. The difference between Adderall and modafinil is that Adderall is a stimulant. While they both treat the same problems, Adderall did absolutely nothing for me, but cause side effects.

Interestingly, the mechanism of action for modafinil isn’t understood so we really don’t know how it works, just that it works. If I were a betting person, I would bet that whatever is wrong with my brain is literally the mechanism of action for modafinil because it fixes the problems so specifically. I don’t have side effects from modafinil, well minimal, it does make my “time skips” worse if I don’t be careful, but if I’m not careful I can lose whole days, so it’s a trade I’m willing to make. I wouldn’t be surprised if one day modafinil was used on label as a adjunct therapy to treat depression, there are already a good dozen or so studies showing it’s effective.

With the recent news that I will now FINALLY be given this magical medication once again, I’ve decided to share some very real examples of how my life was completely changed. Because everything felt like a serious amount of effort, in class taking notes was a challenge. I felt like no matter how quickly I wrote I was always missing things and I couldn’t keep up. Most of my notes from before and after are almost literal scribbles that I cannot read or make sense of. The differences are night and day. Now you would have to just take my word on this, but me being me, I save all my notes. So we don’t have to rely on my admittedly horrible memory.

So a random selection of before and after. This would be the best (nicest) notes I could find from before.

Compare the examples of the best written notes I could find above to some of examples of the worst notes I took while I was on modafinil.

Even my handwriting is more legible, but more importantly the notes themselves are more organized and easier to follow (at least for me). The thing that helped me accomplish this was that I no longer felt like everything was coming at me in super speed. I had a chance to write and draw and make things look nice. I could organize everything in a way that made sense.

Those are the “worst” examples, some of the best examples are even more stark. I apparently can draw very nicely (in my mind anyway). I forgot about the examples below until I saw them. I always enjoyed drawing, it helped me make sense of what I was learning.

All this to send a very simple message. If you need medication, you did nothing wrong. You can’t fix it with a change in diet or exercise. You can’t change the way you think to get out of it and you can’t take any weird supplement to fix the issue. Don’t let people shame you for needing medication. Mental illness is just as real as any type of illness, I link to this post a lot, but depression literally eats away at your brain (here). There’s no thinking your way out of that, there’s no magical diet for that, there’s no supplement that will fix that.

Our best understanding of what the problem is, is that your brain is not producing the correct concentration of chemicals. Much like a diabetic cannot produce enough insulin, there’s no way for you to correct this “naturally” so we take medication to fix the problem just like a diabetic takes insulin. The difference is that by comparison the brain is far more complex so finding the proper treatment isn’t a matter of changing the dosage, it’s about finding the correct medication for you.

Now my issues were best treated with a combination of depression and anxiety medications with the addition of the modafinil. I’m not here to sell anyone on the magic of modafinil. That’s just the example I’m giving because it’s what worked for me and it was surprising that a non-depression medication did so much for me. Instead I’m trying to point out that in all my experience, over the course of being incredibly fit to living solely on my couch, the only thing that ever truly made a difference was the proper medication. Because what is wrong with me is my brain, it’s physically broken, so we need to treat it as such.

Medication isn’t magic. Even when modafinil was doing its magic, I still dealt with the depression, the anxiety, the whatever the hell is wrong with me. The difference is it make it more tolerable so I COULD focus on other things that improved the quality of my life, like diet, exercise, friends, therapy, etc. There’s no amount of exercise or diet that will save a person from drowning. It may not feel like it, but if you’re dealing with mental illness, then you are almost certainly drowning. Get out of the ocean before you try making lifestyle changes.

Lastly, if you find a medication that makes you feel normal, stay on it. I know it’s tempting with all the noise about how medication is evil to want to come off it because you feel better, but you feel better because you’re taking the medication. It’s working, feeling normal while you’re taking it is the point. Your brain will not magically start producing the chemicals you’re supplementing it with, like a diabetic mental illness, at least with current technology, is a lifelong thing.

That’s not a bad thing, especially if you can hold on long enough to find the correct treatment. It’s a hard life for sure, but that doesn’t mean it isn’t a life worth living. At least that’s what I tell myself.