Medication by Default, Not by Choice
Photography by Halacious
For those living with a serious mental illness (a brain disorder) – long-acting injectable antipsychotics (LAI) may be the only option.
Before you shut me down over patient rights violations, let me counter that I respect those who oppose this form of treatment; however, I also know firsthand the benefits of it. Without this option, I am quite certain the fate of my son would have been catastrophic. He would either be homeless and psychotic, in jail and psychotic, or maybe dead.
My son had no other option to stop the extreme level of psychosis and paranoia that invaded his mind. He no longer could think in a rational manner. He no longer could remember his parents or the life he once had. He did not understand the squalor of homelessness. He lost days to complete blackouts not caused by drugs or alcohol but instead caused by severe psychosis.
He dislikes all the side effects of the antipsychotic and frankly so do I – weight gain, vision problems, lethargy, metabolic worries that can lead to diabetes. Yes, a full menu of nasty secondary impacts, although a recent change in this LAI has made a difference and mitigated several side effects. Still, he must be diligent about his lifestyle.
Fortunately, the vision problem has been eliminated by reducing the dose. He controls his weight — a constant challenge — with proper nutrition and exercise. I forever worry about the long-term effects of these second-generation antipsychotics, also known as atypical antipsychotics which are serotonin-dopamine antagonists. All are part of a group labeled: psychotropic drugs.
Even just explaining all of this in the barest of terms sounds off-putting. Yet, whatever label you want to place on them, without taking this medicine routinely, my son’s brain would not have been able to heal. He would not have been able to retrieve his essence. His mind would not have found clarity. The disease that engulfed my son would have swallowed him whole.
Not an easy choice
I am no fan of any medication. Our home had been medication-free until this new normal changed our lives. My children grew up with home-cooking and organic eating. Hiking and backpacking. Vegetables seeded from the garden. Oranges and apples were picked from our trees. We respected everything Mother Nature offered. No one came around to exterminate bugs. Our lives were focused on living and eating healthy and clean.
Then severe mental illness struck my son and medications I never heard of entered our lives.
Multiple reasons moved my son from oral tabs to injectables. Initially, he took the tabs. Then he took them inconsistently. Then he didn’t take them at all. He objected to the way it made him feel and no cajoling could change his decision.
Going off medication due to the side effects remains the most common reason people stop their regimens. For my son it led to a revolving door of hospitalizations, homelessness, being in a constant psychotic state, and a complete lack of insight into his illness.
Once he received proper treatment and his mind began to clear, he agreed to move from oral tabs to injections. He did buck it at first. I understood his reluctance. But let’s be honest, it requires ironclad diligence to take medicine every day. Injections cut that problem out of the equation and up the chances of not relapsing.
Today with the right dose, he has found his path toward a future. His risk of relapsing is less likely. He was able to finish college, an important goal for him. He wants to enter the workforce because every human being needs to have purpose.
What the future holds
If scientists studying brain disorders and severe mental illness had better options (I am not talking about mitigating symptoms), I am talking about getting to the root cause, we would leap on that train. That means targeting specific areas of the brain, which would eliminate those nasty side effects on other parts of the brain and body.
There has been headway. Scientific discoveries aimed at cracking the root cause of schizophrenia have been reported. The National Institute of Mental Health and well-regarded scientific journals such as Nature and Journal of Neurodevelopmental Disorders published research on a deletion in the region of chromosome 22, labelled 22q11.2, which is found in those with schizophrenia. This damaging variant has been associated with psychosis.
Furthermore, a recent study indicates this genetic mutation starts in utero, influencing brain development prior to birth. The study was done at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo in New York. The researchers took stem cells from the skin of those affiliated with schizophrenia and those who were not. These pluripotent cells were then used to grow “mini brains” in a laboratory, which is how the researchers detected a “dysregulated gene pathway.”
The answers remain far from clear-cut. Is severe mental illness due to the environment, trauma, biology, or all of it? We still have a long way to go, but I am more optimistic than ever that we might be making headway. Advancements in neuroscience continue to improve. But we need millions more in funding support to advance neurological research in brain diseases.
In the future, we may be able to stop these brain disorders in their tracks even before birth. And, help those battling these diseases today with biomarkers that offer targeted treatment. I hope this happens during the lifetime of my son and for the sake of others who have to live with these disabilities.
Until then, an antipsychotic injection may be one of the best solutions we have for a sector of the population who struggles with serious mental illness.
