I take drugs therapeutically for depression but am worried about this

 

Further Reading

Dear Dr. Peele,

I am so grateful for your web site! I wish I could see you personally–do you have a private practice? I would like to talk to you to clear up some things about my own addiction.

I have a hard to treat case of double depression along with headache,and self-medication led to addiction to prescription pills. I am now taking the weakest strength of the pills I used to abuse–but I am taking them moderately. They improve my functioning–if I take too many I get groggy and headachy and depressed, and I don’t look for that kind of experience any more! I have been on and off of them for years at a time, and I am pretty sure I could go off them again if I had to. I may have to because they are not tranquilizers and that is how I use them, which I guess is a case of misuse.

Without them I am usually pretty tense, socially phobic, and unable to write (I am published, just returning to writing.) When I take too many I experience highly unpleasant adverse effects. Right now I am not taking too many–I guess it is the equivalent of two or three glasses of wine a day. I am afraid of “having” to take them — but I do notice that when I do I am more relaxed and productive. I do not take them to get high, and if I am severely depressed they don’t take away my depression in the least.

I have been on stronger drugs and tranquilizers, both of which increased my depression (as did liquor). I am abstinent from alcohol (used to have a problem). I would like to moderate my use of these drugs until my doctor finds something non-addicting that would ease some of the nervousness and fear, but I am afraid that he won’t find anything that works. I’ve been trying lots of different meds for years, with little success.

I went wild with drugs for a few years, and the results were so horrifying that I am not in the least tempted to take any of those stronger drugs again. (None were illegal). My life has improved since I have taken responsibility for it, learned to live with my depression as best I can, quit therapy with a 12-step oriented therapist (she was good in some ways, but I’ve been too dependent on the opinion of therapists and AA sponsors for too long, and I want to control my life again.)

I quit because I had a headache and got the painkillers (from a doctor who was made aware of the precise nature of my addiction). My therapist told me I was heading for a relapse, and I dropped her soon after that. I find that guilt and fear are poor motivators in my case, and they have always made my addiction worse than better.

I would like to be able to use this medication appropriately, and think that I can. My use has decreased over the past 2 months, not increased, and I went from stronger drugs to weaker ones. But that nagging self-doubt and fear of being compelled to take a drug doctors aren’t willing to prescribe is immobilizing me. I hate refilling the prescription.

Ironically, when I took too many of the pills, I quit promptly. My instinctive feeling is that it is the lack of access to this medication and the stigma of being known as an addict which makes the whole situation intolerable. I do not longer desire to drink much, or get high, or “escape” from life. Life is actually pretty good in itself–when I am not guilty and apprehensive I do not doubt what I am doing–I am a grownup, with responsibilities and a pretty full life, and I use this stuff to function. But I know that is what drug addicts do, and I am afraid it will get worse. The problem is, I am doing all of this cogitating by myself– I really don’t have anyone to talk to about it who would understand that addiction does not man instant automatic death and insanity.

I would like to know what kind of questions I should be asking myself!

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I appreciate (a) your concept that you can benefit from some interaction with a sympathetic listener, rather than having long-term therapy; (b) that you have substantially reduced your drug use and its dangerousness, and that you can judge for yourself the likelihood and dangers of addiction; (c) that you continue to try to confront the meaning of drug use to you; and (d) that you want to control your life again, free not only of drugs, but also of therapeutic control. Bless you, and I identify with your goals.

You should realize that I’m not a doctor, and that I don’t prescribe medications. I do relate to your need for medication, for the effects they have on you, and for your fears of their downside.

My reaction to your request for a better level of medication, since your current level is pretty effective, but you fear escalation, and you hope your doctor can come up with an appropriate non-addictive replacement, includes the following ideas:

1. no medication used for critical psychoactive purposes is free from the danger of addiction in my view — you become dependent in good part on its psychoactive benefits;
2. you have not yet found a ready, totally reliable pharmaceutical cure for your depression, and it is likely that everything you try from here on in will have similar or alternative drawbacks;
3. I’m glad to hear that you’re getting back into writing — constructive, rewarding activity is in my approach the best antidote and preventive to addiction;
4. I hope you don’t have to feel depression is a permanent part of your existence, at least at its current level — you can improve your state of mind;
5. there are therapies in addition to pharmacotherapy for depression — the best is fairly close by (referral to a cognitive therapist).

With best wishes, Stanton

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Dr. Peele,

Thanks for your reply. I will be calling (the therapist you recommend).

I would like to say that one of the most helpful things about your writing is your ability to empathize without judgment and the encouragement you give to people who want to be self-reliant. A friend of mine came out of a crisis after reading your stuff! (He was caught between AA and a hard place: his family!) I also notice that you are far more open-minded than the AA zealots give you credit for.

Thanks again,