My first fifty milligrams…

50 mgs of a drug,

A drug that i have been prescribing without a second thought or hesitation to so many of my patients since almost 6 years now…

50 mgs of a ssri ,a drug which i remember my father taking when i was a baby and getting back to his normal chirpy self,20 mgs of its brother drug which my mother has been taking since long.

50 mgs of an ssri aand here i am questioning my ability as a mental health professional,or is it a part of my illness?

i ponder i procrastinate,i suffer even after knowing that this might help

i delay,i think ,i judge myself,

50 mgs of an ssri for the first time and i feel low about it,it is a sinking feeling,most probably a symptom of my illness

june 2020 i take my first 50 mgs of ssri,and i feel ,empathise and understand all those peoples plight,who hesitate taking psychotropics ,who refrain from opening up about it ,and suffer for longer they could,this pill shaming runs deep,it is embedded deeply,difficult to overcome and uproot …

pill shaming can be defined as the negative reaction and responses that one receives when they are taking medications

it is usually seen with mental health issues or menstrual issues,i would restrict this blog to psychotropics…

so why is it there and why do we justify it?

1. IGNORANCE: many of us including myself minimize our distress,invalidate our feelings of despair and say to ourselves ‘ah this happens to everybody”it will get better on its own’ ‘it is not severe enough ,that i need to take meds’ ‘my distress is not that bad that i warrant taking medicines’ well i know how it feels,especially when your judgement is clouded ,i fortunately had my mother and reliable seniors who helped me get over my procrastination and reservations related to being on medicines.
2. within the mental health community,mental health professionals at times themselves engage into pill shaming, majorly psychologists and alternative therapists(not at all generalizing,i have my share of very good and aware psychologists) and they believe ,that since the medicines did not work very well for them,or some other modality worked better,it is not the right path for anyone else,on the other hand due to the stigma associated with mental illnesses ,people who have genuinely benefited with pharmacotherapy do not open up about it.
3. Within the medical fraternity as well,people consider psychiatry to a non scientific or vague subject,even though recent advances and studies prove that apart from environmental and psychological factors,biological causes of mental illnesses are equally or even more important,

• for example like there is insulin resistance in diabetes,similarly in depression the neurotransmitter serotonin has deficient levels in the brain,and just like giving insulin injections,diabetes can be put under control ,giving antidepressants can help in treating the biological etiology of depression, like stress can aggravate diabetes ,it can affect the mental health as well,like exercising and dietary changes  help with mild insulin resistance,similarly they might help with mild depression and anxiety symptoms as well,when we are diagnosed with diabetes,we get conscious about everything and take our medicines regularly,because we are well informed about the ill effects of not taking the meds and the effects are clearly visible and evident,but for mental illnesses we take a different approach,just because it is not visible and we are not well informed about the adverse effects it can have on our quality of life
• on our work and functional efficiency
• Our physical health and immunity 
• our relationships and social standing
• it can led to life threatening events like suicide

effects of pill shaming:

• the lag between the onset of distress and treatment is increased massively ,we delay seeking help,the solution to it is reaching out to people you trust,seeking professional help and letting the experts decide along with your agreement on what will be the correct line of treatment,ask questions whenever in doubt.we as mental health professional are already trying and will keep trying to reduce the stigma and burden of mental illnesses from our side.
• once starting,we hurry to taper or adherence to medicines is poor,which can lead to frequent relapses,solution to this is again asking your doctor,till what time you will have to take the medicines and reminding them to taper it when they and you feel it is right.
• people often have to struggle with negative beliefs about themselves,thinking they are ‘less than’ if they have a mental illness or if they need medications,these feelings feed shame,it makes people feel alone and isolated.
• talking about side effects ,they can be a powerful deterrent if someone is already ambivalent about taking medicines,often side effects subside once our bodies acclimatize to the medication,some might even persist.Like any other treatment the pros need to outweigh the cons,that i why we advocate holistic approach towards treatment,where both the patient and the doctor have a role in deciding the treatment plan,no doctor will ever force you to take medicines(unless there is a lack of insight and your life is at stake”
• 

These believes are pervasive  and deep rooted in our culture as a whole, but is even found in some self-help books or mutual-help support groups .It is never helpful to shame individuals struggling with mental health issues and to discourage them from getting help in the same way that they would for any other medical condition.

take home message

Ps:SSRI: Selective serotonin reuptake inhibitor