Introspection on taking psychiatric medication

Prologue to High Roller or Bipolar

For years I’ve learnt to live with taking antipsychotic / neuroleptic / major tranquiliser medication for a supposed "final" diagnosis of Bipolar Disorder which has ended up with just one main pseudo-positive in my opinion (yes, a somewhat counterintuitive thing I deem as ‘good’) that I can simply put as it will continue to keep me in a state of ‘relapse prevention’ and therefore out of and away from any potential hospitalisation resulting from not taking medication continuously on a once-daily basis.

As for the negatives (a non-exhaustive list)...

It has long since become impossible to lose any substantial weight despite eating well, taking food supplements and previous attempts at serious exercise (i.e. gym based cardio and weight training); By contrast it was super easy to have gained weight which plateaued out years ago with my BMI stuck at officially ‘overweight’. No surprise then that a change of medication at some point from one pill a day Olanzapine (notorious for moderate-high weight gain) replaced by one pill a day Aripiprazole (listed for mild weight gain) made the most or only real difference to my overall weight management which indicates to me that the medication is indeed the problem when it comes to body-weight metabolism. Of course, when not taking medication my weight would eventually have dropped to within the ideal of the BMI with far less visceral (belly) fat, something that seems to never shake off on medication.

In terms of impulse control I feel like a Lamborghini sports car locked in a garage occasionally revving the engine waiting for someone to open the door i.e. entrepreneurially numbed, my driving spirit has been muffled with an apathy-induced outlook. Notably I get once-in-a-blue-moon ideas that I fail to follow-through with. If we exclusively think for a moment that I’m taking an ‘anti’ (i.e. something to keep me from having another bout of) psychosis pill then we’d be a bit mistaken as the synonyms the drug better goes by i.e. neuroleptic or major tranquilisers explain the way they work in the body more accurately. The sedative effects continue to affect me everyday. I tend to enjoy my sleep a little too much at times and often too early in general, like someone much older than myself. I would rather be off the antipsychotic meds and take sleeping pills on-demand to prevent another relapse for lack of sleep (insomnia).

Getting to the decision to reduce and taper down medication is like having a bad credit history, only worse. In other words, the now incumbent GP who takes on my primary care albeit infrequently and distantly doesn’t want to take the risk of it all - every appointment is a waste of both our time thus. This is both unfair and insulting at the same time, so I remain entrapped by the medical ‘authority’ waiting for the necessary guidelines to do things properly and inline with my own wishes (for once). Meanwhile the GP has just look-up book knowledge (BNF) of the drug taken for said condition and no real first hand insight. They have their hands tied from doing the right thing. There simply aren't any proper and complete guidelines on why and how to reduce and cessate from the medication. This is not like the stupid diabetic analogy doctors are inclined to give. Nobody should have to take antipsychotic medication for longer than absolutely necessary if given a choice which sadly one rarely has depending on the prescriber or rare doctor willing to attempt a de-subscribe course of treatment.

We then have the catch-22 of wanting to reduce and potentially stop the medication to return to a state of individual normality reinstating one’s suppressed cognitive functions, creative soul and inner feelings. On the one hand I could book an appointment with my GP (my primary care point of contact) anytime to ‘discuss’ the inkling or possibility of reduction usually to no avail because I’m asking in the first place instead of them coming to their own conclusion from reviewing me annually (at a standard medication review for someone on repeat prescription). By the time they see me at their discretion annually the previous notes and appointment or doctor seen is easily forgotten (despite having a digital record in front of them) and the clock on ‘when’ will be a good time to reduce the medication is reset for another year. This is both stupid and unfair at the same time. I’m damned if I ask and damned if I wait for ‘the authorities’ to tell me what they are unlikely to remember to ask given the time between appointments. Alas, the problem of zero aftercare and being ‘discharged’ from the last prescribing consultant psychiatrist who probably has enough people ‘on the books’ to keep them from considering a decision for a deprescribe for an old patient long forgotten. My only hope meanwhile is for my bodily tolerance of the somewhat toxic medication to increase and therefore I can declare how I’ve ‘overcome’ the annoyance and pain of taking them but that shouldn’t mean I don’t continue to ‘fight the system’ when I’m prepared to reduce and discontinue the medication in a proper way i.e. slow and gradual taking months and maybe years, certainly not just days and weeks.