When is the Cure Worse Than the Illness?

Last week I saw my psychiatrist and we talked about my illness and what things we could do to improve my treatment outcomes. We talked about one medication I’m on that causes up to 80lbs of weight gain, and plugs up my dopamine receptors so I don’t feel joy and excitement like other people do. It also increases the risk of diabetes. We talked about the other medication I’m on, that causes cognitive impairment—especially with finding words and using them well. We ended the visit agreeing that, since I haven’t had a bipolar high since last fall, these were the best treatment options.

But something he said in passing made me think about whether or not I should stay on this regime. He mentioned that I’d tried lithium but developed a hand tremor that was so bad at higher doses that I couldn’t tolerate it.

The question is: what’s worse? Weight gain, diabetes, lack of feelings, and cognitive impairment? Or incredibly shaky hands?

The first set of side effects doesn’t make for a great quality of life. I hate going out sometimes because of my weight. I dread blood tests because I worry I’ll be over the A1C threshold and become a diabetic. And I hate not being able to really feel feelings other than be depressed. Plus there’re the cognitive issues, which bother me because they’re centred on words—which is pretty much all I have left that brings me some amount of joy.

But what about a hand tremor? I already have one—essential tremor—and it means I can’t carry anything with food on it in my right hand because I’m liable to spill or drop it. But if I took lithium, that tremor would worsen. I know this because I was on lithium 12 years ago when the bipolar first started, and my family doctor increased my dosage in the hopes that it would help what was then being called major depression. The tremors were bad. I couldn’t even write, my hands were so shaky. And as a writer, I need to be able to write.

But is it worth giving up everything else so that I can still write by hand? Since I can’t access my emotions, my writing is necessarily more ‘flat.’ Since I’m having problems finding words, I struggle to communicate—especially in conversation. My weight gain has damaged my self-esteem, so I’m not keen on going to writing events in person.

On the other hand (see what I did there?), tremors will likely make it impossible for me to write by hand. I’m not sure how it will affect my ability to type; I might have to speak my thoughts and transcribe them onto the page. Which will be hard because I’m so used to seeing my thoughts flood out on the page from my pen or my keyboard. I don’t know if I can wrap my brain around thinking orally. But maybe without the cognitive impairment I can do it better than I can now?

I don’t know, and I’m torn about this decision. I still have a lot to find out, like whether lithium would allow me to stop two of my medications. What the side effects of lithium are. How to wean off the drugs I’m on safely and carefully. Whether I’ll lose weight once I’m not on that medication anymore.

I’ve had to make this decision before. When my bipolar depression gets really bad, and there are no medications to help me, my doctor has suggested electro-convulsive therapy (ECT). Granted, it’s become a bit more civilized than it used to be (as much as sending an electric shock through somebody’s brain three times a week can be civilized). And it works for about 50% of patients. But there are side effects, including loss of short term memory and sometimes even long term memory; and confusion, which is said to only last for a few hours. So even on my worst days I’m afraid of ECT, that it will wipe away my memories and turn me into a confused zombie. In this case, I’ve decided that weathering deep depression, as difficult as it is, is a better option than getting ECT.

It kind of reminds me of the anti-vaxxers during the worst of COVID, who claimed that the vaccine was worse than getting COVID itself. There are so many ways that this wasn’t true, but it was presented to the public like a choice: get COVID or get sick from the vaccine. Which is worse? They thought getting the vaccine was worse.

Life is full of these kinds of decisions. But I feel like in this case the stakes are pretty high: it’s an existential question, not just a thought problem. It’s my health we’re talking about, and any shifts in these drugs will have major consequences on my body and mind. I have to do what works for me, what I can tolerate, and how I want exist. Hopefully my doctor will have some insights into whether or not this is a good fit for me.