Medication Holidays: Vacations Not Worth Taking
By Steve Lappen

I was first diagnosed back in 1969 with manic-depressive illness (long before bipolar disorder entered the psychiatric vernacular). Six years of extreme and unstoppable mood swings later, I finally submitted to medication. Denial is a most formidable foe to treatment. But I am often reminded that "ripeness is all." And six years of suffering ripened me for treatment. I was medicated with both a mood stabilizer and tricyclic antidepressant. I stayed the course for one year, but abandoned it because I did not derive either expected or tangible benefits. The expression "twice bit forever shy" comes to mind, with a twist. For me, it was once bit forever shy. Having an unfavorable first experience with psychotropic medication was all the ammunition I needed to convince me to go it alone. Coincidentally, I managed to find therapists who were ideologically opposed to treating psychiatric conditions with medication. In retrospect, I think their positions were both untenable and irresponsible. Little did I know that I was on a course that imperiled my very existence. Believing as I did then that medication would provide me no relief and that psychotherapy (traditional and unorthodox) was beyond my reach, thoughts of terminating an intolerably painful life became part of my psychic landscape.

Nearly thirty years later my commitment to life, its conflicts and resolutions, won out. But it has been a struggle that has left me scarred. I have tried several medications with varying degrees of success and outright failures. Repeated failures have "inspired" me to take medication holidays. And I took these knowing that my life was unmanageable without some treatment regimen. I would often justify my holidays by convincing myself that my creative urges were best served medication-free. In fact, some of the medications I took did dampen my highs, which in turn clipped my creative wings. Like Icarus, sporting wings of wax, I would soar higher and higher ever closer to the sun until my wings would melt and I would begin my hellish descent into the inescapable depths of yet another depressive episode. But to experience mania is to embrace ill-advised risk-taking behaviors. Still and all, I wanted to believe I could manage solo - that is to say, medication-free. The fact that I had a treatment-resistant condition seemingly untouched by medication served to justify my belief that no medication would provide me the relief I desperately needed. After so many years struggling with a raging mood disorder which left in its wake a broken career and a broken marriage (I have since happily remarried and maintain close and loving ties with my two children), I could no longer go it alone.

I began to reframe my thinking in such a way as to accept the necessity of treating my illness medically. I knew there were many medications on the market, and new ones always in the pipeline. I began to convince myself that every medication failure would bring me that much closer to one that would achieve the desired effect. This position is borrowed from a sales maxim that states that every rejection brings you one step closer to a successful encounter. Sure enough, after years of trial with far more tribulation than jubilation I have found a combination of medications that has given me a measure of stability. Though I am still prone to dipping into depression, these episodes are short-lived. I no longer wake up feeling that my depression is forever, and my wellness fleeting. I am less susceptible to the cognitive distortions that accompany depressions. A fruitful psychotherapy helps me to identify these distortions and see them as such. One such distortion is that I had to sacrifice my creativity once I "surrendered" to medication. To be candid, had I steadfastly refused to treat my medical condition I would become yet another tragic statistic. Though I may not believe in a cure, I certainly embrace the notion of recovery. Recovery is a journey. And I've come to realize that I'm far more interested in the journey than I am in the destination.

Steven Lappen is on the Board of Directors of MDDA-Boston, serves on the State Advisory Committee for the Massachusetts Department of Mental Health, and in his free time enjoys waxing poetically and philosophically in print.