The medications that change who we are
January 11, 2020 7:01 PM   Subscribe

They’ve been linked to road rage, pathological gambling, and complicated acts of fraud. Some make us less neurotic, and others may even shape our social relationships. We’re all familiar with the mind-bending properties of psychedelic drugs – but it turns out ordinary medications can be just as potent. From paracetamol (known as acetaminophen in the US) to antihistamines, statins, asthma medications and antidepressants, there’s emerging evidence that they can make us impulsive, angry, or restless, diminish our empathy for strangers, and even manipulate fundamental aspects of our personalities, such as how neurotic we are.
posted by Lexica (42 comments total) 53 users marked this as a favorite
Mod note: Deleted a couple; please engage with the article if you have criticisms, rather than dismissing it out of hand without reading it.
posted by Eyebrows McGee (staff) at 8:14 PM on January 11, 2020 [5 favorites]

This is sort of scary. Also the low cholesterol-high aggression link is a bummer. I mean, geez, nature, way to dick people around.
posted by pelvicsorcery at 8:23 PM on January 11, 2020

Interesting that low cholesterol results in low empathy by way of seretonin. I'm mildly skeptical about the paracetemol effect. SSRI impact on personality is well-known.

It certainly does seem like our personalities are emergent phenomena of our chemistry and biology (along with our memory) which raises existential questions about identity and self. I wouldn't worry about taking Tylenol for a headache, though. In that respect the article takes a borderline scaremongering tone.
posted by grumpybear69 at 8:27 PM on January 11, 2020 [19 favorites]

This article seems suspect to me. It lumps together a diverse set of things:

- Rare risks of statin drugs
- Rare risks/effects of Acetaminophen
- Various cases of criminals blaming drugs they were given for their criminal behavior
- "Drugs that treat asthma" and their effects, as if there were one class of drugs that treat asthma
- Uncommon side effects of L-Dopa
- Antidepressants, which are taken to effect the personality, having effects on personality

It would take me all day to read all of the referenced studies, but I feel like the author is cherrypicking worst cases to fit a thesis ("Drugs are bad, m-Kay?")

There's definitely an interesting topic here as grumpybear69 mentioned -- exactly what are our personalities? If a drug I take or a food I don't eat can have a dramatic effect on it, then is that part of who I am? And could I change who I am by changing those things? And how does this affect the question of free will? And how do people face the tragedy of a disease where the only treatment will also affect who they are? -- but this article just seems like iffy science journalism.
posted by mmoncur at 8:34 PM on January 11, 2020 [33 favorites]

I lost faith in the idea of any one “true” self when my grandmother passed away.

Growing up, I always knew her as quiet, calm, taking life slow—the kind of woman whose favorite activity was pulling a chair up to the fish tank and watching it for hours on end. She didn’t talk much, but she was always sweet and gentle when she did. That was the grandma I knew for over twenty years. I think I was 17 when my family finally told me she had bipolar disorder. She’d been on lithium for most of her life—nothing else worked for her.

Towards the end of her life they had to take her off of it because her kidneys were failing. I distinctly remember the brief period after they took her off the meds. The difference was stark. She seemed... brighter, more animated. She had opinions I had never heard her voice before, she seemed actually engaged in conversations in ways she never used to. It’s hard to put into words, but talking to her was nothing like talking to the grandmother I had grown up with, and that unsettled me. I need to make clear, I did not necessarily find this “better” or “worse” in any way. It was just clear that there was a difference.

For a little while I had it in my head that that was who my grandmother “truly” was, and that the medication was dampening her real personality. Of course, off her medication, she quickly slipped into a manic episode, which was further punctuated by dementia. And I didn’t want to say that was truly who she was, even though some people would probably say that it was (my parents did not want me on antidepressants because of how that went against gods’ intention—I am only grateful that my grandmother and grandfather did not feel the same way). But then could I really say that a personality she had only really ever inhabited for a small portion of her life—a mere 20 of her 80 years, plus the rare moments when she was unmedicated and wasn’t manic or depressed—represented who my grandma was? It’s possible that’s who my grandpa fell in love with, but it’s not who he loved for most of his life. It’s not who I knew or loved, either.

The last I saw her was in a manic episode. She passed away a few weeks later. In remembering her life I experienced a lot of anguish for a while as I tried to figure out who she “really” was. A lot of the anxiety was over the fact that I was in the prime age for developing bipolar disorder, and it made me afraid of how medication might change me. In the end I decided I don’t really need to know who she “truly” was. I just need to know what I loved about her. Given time, there are things I would likely have loved about the personality I saw briefly but never got to know. I don’t think it matters. And if I end up needing a medication that changes something significant about how I interact with the world, I can only hope the people who love me as I am now will love me then. I’ve made my peace with the possibility, at least. Clinging to a true self, a “real” personality... for me, at least, does no good.
posted by brook horse at 8:41 PM on January 11, 2020 [166 favorites]

I think this article is a little over the top, but I also wish doctors would take me seriously when I have complaints about my Asthma medications. Like I have to breathe but Oh my god it is a miserable experience and I am a totally different person. Albuterol makes me so so anxious. I pace, worry and have pressured speach and my hands shake . It is awful. I have taken the medication off and on for years as needed. It's always the same. I avoid it because it's so hard on me emotionally. Steriods bursts are awful as well and combined with the albuterol is a complete mess.
posted by AlexiaSky at 9:28 PM on January 11, 2020 [16 favorites]

Clinging to a true self, a “real” personality... for me, at least, does no good.

Fact is, your true self is exactly that body you walk around with, no more and no less. All the rest, personality included, is stuff your true self does, not is.

Chemicals can make some of us do things we don't usually do. Many of those things are not even perceptible to others though they might feel quite profoundly unusual from the inside.

I don't enjoy how I feel inside after a therapeutic dose of paracetamol. Most of the time I'd far rather put up with a bit of pain. Ask me to describe why - and people have - and I'm scratching for anything that sounds even vaguely relatable. It's just not as good in here.
posted by flabdablet at 9:28 PM on January 11, 2020 [10 favorites]

I have a close family member who has been on personality-changing medication for most of her life. We've discussed this exact issue, and here is how she frames it:

'There is me when I am on meds, and me when I'm off meds. Neither one is the 'true' me. They're different people, even though they're both me. I think I like the 'on meds' version more, and she's certainly easier to live with.'
posted by ®@ at 9:31 PM on January 11, 2020 [36 favorites]

I take blood pressure meds. I have tried a few and most of the have a crazy impact on mood. Like angry, dark, depressive kinda effects. I have a suspicion that a lot of the angry old men we see nowadays are from that. No basis or data for this, just a hunch because of how dramatic of an impact it has with me.

Personally i take it at night. It kinda helps.
posted by Lord_Pall at 12:18 AM on January 12, 2020 [13 favorites]

Yeah, this article is a Mess, in a way that is pretty irresponsible given that it's written on a medical topic and is about medications that definitely save lives in some instances. To break it down:
- if antidepressants DIDN'T decrease neuroticism, which is just a measure for how vulnerable you are to negative emotion and worry, then they wouldn't be very effective. Finding some studies that indicate that sometimes neuroticism is helpful just suggests to me that the author has no experience of or knowledge about depression and its effects.
- it is well known that L-dopa can affect risk taking behaviour, because of its effect on dopamine. Parkinson's can also affect risk taking behaviour, because of its effect on dopamine. (look up 'Parkinson's personality'). For most people, these effects are not life-changing, but in some rare cases they are. Parkinson's is a horrible disease that is currently hard to treat without affecting the system in other ways.
- The stuff about paracetamol is interesting, in the sense that it sheds some light on how much we somatise emotion (a lot). But the author says that it's a bad idea to take paracetamol before comforting a friend, which is garbage. You know what has a greater effect on empathy capacity than paracetamol? PAIN. ffs.
- it is just like, not true that researchers are uninterested in personality effects of statins. I have just done a quick search and there are actually a Whole Bunch of papers about the personality effects of statins. The data are kind of unclear at the moment; it seems very possible that this is a real thing for some people (which is important to establish: with a class of drugs that is as widely-used as statins, you're going to get plenty of coincidences, so you need to look at hard data in large numbers to establish some kind of causality) but there definitely isn't enough clarity to make solid recommendations besides that if people are having a hard time on a statin, they should consider switching to another statin (especially a non-lipophilic one if they're on a lipophilic one) or working out the risk/benefit of them being on one at all if it's just a cautionary measure.
Mainly I'm angry at the whataboutism of this article, its scientific and medical illiteracy, its irresponsibility, just. Agh. It is bad.
posted by Acheman at 2:44 AM on January 12, 2020 [44 favorites]

Here's where I had to stop: "We’re all familiar with the mind-bending properties of psychedelic drugs – but it turns out ordinary medications can be just as potent."
posted by Obscure Reference at 5:48 AM on January 12, 2020 [10 favorites]

A while on prednisone made me a raging asshole who even got ridiculously mad at doors that doors didn't swing open fast enough. The effects lasted for months after stopping as if they had unlocked something.

Which I knew about steroids but prednisone is cortical rather than anabolic.
posted by srboisvert at 6:13 AM on January 12, 2020 [4 favorites]

A while on prednisone made me a raging asshole who even got ridiculously mad at doors that doors didn't swing open fast enough.

I spent a summer (fortunately before I worked here) on a low daily dose of prednisone (we're talking 1-2mg) for my arthritis and after a month I started having a panic attack at the same time every day. Every day, only time-shifted if I slept in on the weekends. I had previously had maybe one panic attack in my life, when I was an adolescent.

Now I only take it for flares, for a few days/week, and I alert the rest of the team and make no ban-level moderation decisions without a cross-check while I'm on it, because it absolutely makes me an aggressive asshole.
posted by restless_nomad at 6:30 AM on January 12, 2020 [6 favorites]

Whether or not the article is crap -- I have taken ibuprofen before stressful social situations, and it helps, because emotional pain is still pain.
posted by seanmpuckett at 6:41 AM on January 12, 2020 [4 favorites]

I'm also on asthma meds. For a large portion of my life, I was not. During that time I had high ADHD difficulties, bursts of anger, poor impulse control, etc. One semester, I managed (with the help of my ex wife) to get on an ADHD med. Because I didn't have insurance, It was only for a semester. I didn't notice any changes but my classmates did. Finally, when I ended up in my current position I got insurance and a primary physician. I've been on everyday doses of steroids. We change them up every few years. This has been life changing for me, I am much more active, I run, am involved in various outdoor activities and such. I have albuterol, just in case, but rarely use it. I hadn't previously put this down to medication, but I suppose it's possible that the medication has affected my moods. I'm much less impulsive, harder to anger, and generally, a more pleasant person to be around. Or it's just that I'm old. I should add here, that I've never bothered to get ADHD meds since, not that I no longer seem to have ADHD, I have just decided that I will live with that facet of my personality, and try to regulate with coffee, and exercise. YMMV
posted by evilDoug at 7:26 AM on January 12, 2020

Everything we ingest effects us somehow.

"You are what you eat."

To so much of an extent, this is true. With how often the cells in our body split to create new cells and die, they need a constant influx of new material (food, air, water, etc) to sustain the system, and as we flush waste, that waste has to be replaced with new mass. That new mass is pulled from things we ingest. Those things become a part of us. It's what allows us to shed dead skins cells, grow hair, fingernails, and so on, if we shed them without adding new cells, new mass, we would slowly shrink to nothing.

Now, as for the claims of the article, I think they are just pushing the envelope a little too much in claiming that there are outsized effects. However, as for the bottom-line, this is true, humans are a lot more predisposed to being influenced by their environment and what they ingest than most would like to admit about themselves. Mostly because this pushes up hard against our notions of free will and whether or not we are really "in control" of ourselves (which is a BIG existential question since basically every justice system on the planet is based on an assumption of rational free will amongst humans.), and makes us face the reality that we are in far less control of ourselves and what we do than we think we are. Our "rational mind" spends a lot more time rationalizing what we just did than it does making a plan for what we are about to do, and most of us assume it's the other way around.
posted by deadaluspark at 7:28 AM on January 12, 2020 [1 favorite]

I think it can simultaneously be true that drugs are needed and important and can help you and that even over-the-counter drugs can cause personality changes you might not expect.

Currently I'm taking an antihistamine three times a day as one of the only ways to control extremely severe morning sickness that landed me in urgent care very dehydrated and needing iv fluids. I can simultaneously be grateful that these drugs exist and I don't need to suffer the way my foremothers presumably did (vomiting all day every day is no joke) and recognize that it comes with some unwanted changes to personality - I'm feeling completely "flat" and lethargic, with few desires to do anything and little motivation. And this basically started when I started taking this regularly.
posted by peacheater at 7:39 AM on January 12, 2020 [1 favorite]

A prescription for guanfacine turned me into a wild-eyed panic addled madman for five days, and I had never experienced anything remotely resembling a panic attack before. I Googled the hell out of this drug beforehand and it seemed relatively benign.

I suspect a lot of these stories are isolated because brain chemistry is a lot more complex and varied than medical science currently understands. It is my hope that 22cnd century medicine will look back on our "throwing darts blindfolded" approach to drug prescription with derision.
posted by CynicalKnight at 8:01 AM on January 12, 2020 [3 favorites]

I wish the article hadn't mentioned antihistamines in the opening paragraphs and yet didn't address antihistamines as a class of medication ever again.
posted by Faintdreams at 8:46 AM on January 12, 2020 [2 favorites]

Another aspect of this that’s rarely talked about — traces of these drugs are highly prevalent in the drinking water of most metro areas. Largely because of their popularity, also because our filtration mechanisms were designed long before anybody thought this could be a problem. What happens to a society when everybody is “on” tiny amounts of literally every prescription drug?
posted by panama joe at 9:18 AM on January 12, 2020 [4 favorites]

Rare risks of statin drugs

Rare until you have an adverse effect. I had to stop taking Atorvastatin because it made me depressed. Really depressed. The doctor switched me to Rosuvastatin, and the depression lifted.

Don't get me started on antibiotics. Please.
posted by Kirth Gerson at 9:18 AM on January 12, 2020 [4 favorites]

I was always wary of antidepressants (and of alcohol and other recreational drugs) because I felt like whatever effect they had would be taking me away from whatever my true essence is, but the past several months have made clear to me that a lot of what I thought was my essential nature is just a reaction to what chemicals happen to be present at any given moment. I spent so much time angry, but it wasn't because the world was getting worse, it was because my thyroid wasn't producing enough thyroid hormone any more. My brain still isn't right, but if it ever is right again, it's going to be from finding the right mix of additives, not from any sort of return to a naturally occurring condition.
posted by enf at 9:27 AM on January 12, 2020 [13 favorites]

I take blood pressure meds. I have tried a few and most of the have a crazy impact on mood. Like angry, dark, depressive kinda effects. I have a suspicion that a lot of the angry old men we see nowadays are from that. No basis or data for this, just a hunch because of how dramatic of an impact it has with me.
People are kind of bad at estimating rates and probabilities and things, and it is way harder when it is something that you are directly experiencing. Old books clearly use the "aren't old guys are crabby" trope, so I am guessing it isn't much different today. Something that I have experienced is that when I am in pain (which--knock on wood--seldom happens), I am much crabbier. And older people experience more chronic pain than younger people on average.

I think this article is part of the overreaction industry. If we can't keep people worrying about rare drug effects, rare flesh-eating infections, and nonexistent ills caused by aerosolized poop spraying out onto their toothbrush when the toilet flushes, how will we sell them stuff? I am being a little hyperbolic, but I really think there is an incredible amount of this kind of thing going on (sometime just in the quest for eyeballs, not the quest to sell other stuff), and it makes it hard to determine what to really be worried about.
posted by Gilgamesh's Chauffeur at 10:11 AM on January 12, 2020 [10 favorites]

I was being treated for Asthma. At a point a few months later, maybe a year, I was started on the next level of drug treatments, that were prescribed by a Pulmonologist to treat the symptoms given to me by the first tier of Asthma medications. The second tier was proton pump inhibitor, to quell reflux, a blood pressure medicine to quell high blood pressure, an anti depressant to quell dysphoria as a side effect from the first tier. When all of this hit me I was 45 years old and felt like maybe I was 65 or 85, I was totaled.

I figured out the primary cause of the Asthma, and bagged it. It turned out to be the TB Tine test I had to have yearly, because I worked in a hospital. I walked in to my department one month after my yearly test date, and said that they would have to give me a chest xray yearly if they needed it, but I would not have the tine test ever again. The whole thing went away, for the very most part, and all the meds. I am allergic to Mycoplasma Pneumonia infection.

I have refused all meds since, except for antibiotics, if absolutely necessary, none since 2013; ibuprofen to forestall migraine, virtually none, since probiotics that seem to have increased gut bacteria that break down Tyramine, most of my triggers are gone.

I was in the ER this was the dialogue.
What medications do you take?
What drugs do you take?
What medicines does your doctor prescribe?
Do you take off the shelf meds?
Do you smoke marijuana or take herbal remedies?
Do you use street drugs?
How many alcoholic beverages do you consume per day?
1/30th of one, on average.
Then I asked, you seem very concerned about this, what is the problem you perceive?

We just never see anyone your age that is not on medications, and in fact, usually a lot of medications.

The other things I also avoid is preservatives, food dyes, flavor enhancers, teflon, aluminum
pans. I was in the ER for a severe injury, I got over it. I have relatives who are currently being slowly murdered by drug profiteering, well and don't get me started on the Ethanol industry. Particularly the statins are ubiquitous, and highly profitable.

I had to say no many times, many times to be clear of auto-prescriptions for people of a certain age, weight, or medical history. And, one size or lab value doesn't fit all. The industry of pre-diabetes is a massive money maker for the drug, and medicare rip off industry. I am not in denial, I have been diagnosed as pre-diabetic since I was 37 years old, and I have never taken drugs, and never developed diabetes.

The industry to fake treat the symptoms of aging, and pre-dementia with ubiquitous drugs, is booming. Metformin is the new magic word, it will keep you from normal life processes, such as **shriek** aging. This is crap, if a person is going to sit in a recliner and passively live a life by proxy, and behave like a coma victim, maybe Metformin will help...
posted by Oyéah at 11:01 AM on January 12, 2020 [4 favorites]

I've recently discovered that vitamin B12 can lift me out of the depression that's been dogging me since my early teens, giving me the ability to actually have feelings and experience pleasure. Yes, the pills we take can change who we are, and that can be a good thing.
posted by LindsayIrene at 11:19 AM on January 12, 2020 [3 favorites]

> It turns out many ordinary medications don’t just affect our bodies – they affect our brains.

I supposed we have thousands of years of philosophy and religion enforcing a mind/body separation to thank for this sentence, but the brain is literally part of the body ffs.
posted by Basil Stag Hare at 12:46 PM on January 12, 2020 [28 favorites]

Everything we ingest effects us somehow.

"You are what you eat."

You are even what you don't eat!

Hangry is real thing.
posted by srboisvert at 1:31 PM on January 12, 2020 [8 favorites]

Then I asked, you seem very concerned about this, what is the problem you perceive?

We just never see anyone your age that is not on medications, and in fact, usually a lot of medications.

Part of the reason for the long rigamarole of questions is that people (like me) sometimes forget that the things we take are medications! I have an empty medicine cabinet at 52 and am weirdly proud of it (when really it is mostly luck) but I do take an antihistamine every day. It's so automatic that I never mention it when asked if I am on medication until specifically prompted about allergies. Doctors know about this kind of forgetfulness so they prompt for every specific daily med that you could forget about.
posted by srboisvert at 1:35 PM on January 12, 2020 [6 favorites]

I think this article is part of the overreaction industry.

When I first saw the article I googled to see if the author had known Scientology ties. (Didn't find any)
posted by srboisvert at 1:38 PM on January 12, 2020 [3 favorites]

I wish the article hadn't mentioned antihistamines in the opening paragraphs and yet didn't address antihistamines as a class of medication ever again.

They may have expected people to be familiar with reports of correlations between Benadryl and dementia. Generally, it seems as though the second generation antihistamines are comparatively safer.
posted by Comrade_robot at 3:44 PM on January 12, 2020 [1 favorite]

Oh well that's good to find out... fortunately I've just switched off of it but I told several doctors that I was taking diphenhydramine / generic Benadryl regularly for sleep in case of exactly that sort of danger from long-term use and none of them mentioned a connection to dementia.

One of them did inform me that it was the generic version of Benadryl I was taking, so I guess I have to thank him as well as Comrade_robot. And thank you Lexica for posting the thread.
posted by XMLicious at 4:17 PM on January 12, 2020

I have seasonal allergies and loratidine (Claritin) wasn’t working so my doctor suggested fexofenadine (Allegra). A few days in to taking it and I became extremely depressed. Like, I would come home and just lay on the couch for hours. I felt completely empty inside and had zero desire to do anything, I felt like there was no point to life anymore. It was really scary, and as soon as I stopped taking the fexofenadine those feelings went away.

It makes sense that messing with your biochemistry is going to affect your whole person, not just the thing you are trying to treat. These studies are important and I hope scientists continue to research these things so we can have a better understanding of how our bodies work, especially in relation to lifesaving medicines.
posted by Doleful Creature at 8:41 PM on January 12, 2020 [1 favorite]

As a physician, I did not find the article alarmist at all. I find it useful to know about this very rare potential side effect of statins, for example. I've so far read the first linked case series report and it appears well balanced. I'm certainly not going to change the way I prescribe statins (and to be fair to the author, that's not what they recommend) but it's a useful bit of info to put away in my brain - it's easier to recognize something if you're aware it exists.
posted by M. at 5:28 AM on January 13, 2020 [6 favorites]

I have been taking all kinds of antihistamines (Claritin, Zertec, benadryl, etc.) for allergies since I was a little kid. Last fall, I came to the realization that nothing has been working for a while. So a few months ago, I just stopped taking everything and let the snot fall where it may. I was shocked when two things happened: First, my allergies got much, much better. We'll see what happens in the spring, but my fall was more comfortable than it has been in years. Second, my depression lifted. I'm still not what you would call a bubbly person, but I can experience emotions besides bleak despair again.
posted by vibrotronica at 8:15 AM on January 13, 2020 [1 favorite]

I really appreciated brooke horse's comment above. It was my bipolar disorder that did away with my belief in a true self. My very thoughts and opinions - my convictions - often change depending on my mood. The most extreme case in point is that the right meds or an increase will make suicidal thoughts just go away. How can a medication make thoughts go away? But it can. Sometimes I find this distressing. In fact, reading this article was distressing because I was like "yeah, I've known this forever, must be nice for this to be novel." But mostly, it's no longer distressing at all.
posted by kitcat at 8:41 AM on January 13, 2020 [4 favorites]

The potential for statins to make people more impatient and angry, and less empathetic...this hits very close to home when I think about my father. I had been putting it down to his "engineer's disease," lifelong untreated anxiety issues, and aging, but maybe it has been worse since he's been on statins? It's difficult to sort out whether this might be confirmation bias. But lately, his behavior toward everyone has become significantly angrier and less filtered, and while there are some other major stressors that definitely explain this, I now wonder if statins are exacerbating it.

But ugh, if I try to alert his doctor to my concern because of an article I read on the internet, I'm pretty darn sure I know how that'll go over. Besides, it's clear that he really does medically require statins to prevent further cardiovascular disease.
posted by desuetude at 8:53 AM on January 13, 2020 [1 favorite]

And now I have to wonder about myself. When I first got married, my wife would marvel at my patience with our eldest. Our 10-years-younger child, not so much. Now, he's got a big set of issues that do lead to him being particularly trying, and I've gone through some stuff that in general I feel has led to me not being the person I used to be, but along with all that, I went on statins for my cholesterol. of the above? All?
posted by Four Ds at 10:28 AM on January 13, 2020

Having a slightly-hard-time parsing and finding a response to comments in the thread.

I, also, am bipolar. Started pretty hard in middle school, gone through quite a few phases and medications, experienced a lot of different things. Was originally diagnosed with depression, put on Zoloft, turned ultra-manic. I noticed it. It felt wrong. Took myself off of that (unwise) and, after a couple of years of dangerous depression and mania swings, was rediagnosed as bipolar and put on something else. That worked. Kept me stable. For about 10 years, anyway, when either the medicine stopped being as effective or I just got to a new doctor who told me (correctly) that I was still depressed (with the occasional manic swing), I was just too used to it to even consider it an issue.

Over the past 5 years or so I've been running the gamut of medications. Lithium was perfect for me: I just felt like myself, like what I was 'supposed' to--I don't mean a change in personality, I just mean if I wanted to do something (go to the gym, check the mail, go to the grocery store) I just could. But it made me feel horrifically ill to take. So now I'm off it and have been bouncing around trying to find something that gets me close. I mourn that. I laugh about it because it's interesting, how one thing can work so perfectly, but I'd be lying if I said it didn't frustrate the hell out of me as well. The cocktail I'm on now, well. It works alright, except I haven't kicked the depression yet. It kicks my ass on a seasonal scale. We're still working on it.

Anyway. Maybe it's because of who I am (although I guess that's part of the question?) but even at a young age I knew something was wrong. I didn't have a word for any kind of mental illness, let alone bipolar disorder (although I still think it's hilarious that I learned what 'depression' was from a Garfield comic), but I would write things down, sort of a proto-mood-journal I guess. What set me off saying things I didn't mean to say. Things that felt like a compulsion rather than an actual decision I was making. I told my mom once that I was "angry because I didn't have anything to be angry about", trying to explain that I knew I was acting irrationally and didn't want to be acting the way that I was, and that it made me even more frustrated because of it.

I did things, also. When I was manic I would sneak out of the house and steal the family car, putting it in neutral and rolling it down the driveway before starting it up so no one would notice. I would drive out to the country and run all night on the empty roads for no reason except that I felt like I would explode if I stopped. And I knew then, also, that it was a potentially dangerous thing to be doing. Just like riding my bike with no jacket in the winter rain 8 miles to the grocery store and back. Like breaking out of a hotel I was staying in in France in the middle of the night and--again--running dark streets.

I felt like I always knew those things weren't 'me'. Like the actions, at least, weren't 'me', but there was a 'me' there underneath everything. My choice of expressing some of it and the manifestations of it might have been related to me, my personality, who I was/am, but I've always felt like I had a 'me' all the same, one that, granted, changes with time just like anybody else does. My underlying convictions and opinions don't change whether I'm depressed or manic, just whether I feel that they're futile or full of possibility.

At any rate. I've felt this way, hard, my entire life. I wanted it to be a tattoo but I finally settled on a ring engraved with "despite everything", short for "despite everything, it's still you". (Yes, it's a quote from Undertale, hush.)

I'm sure it's possible that there's a medication out there that I would take and not notice that something was 'off', or not have some conscious awareness that I had changed in some larger way, but I haven't hit one yet. Or maybe that's the question--is the 'me' the person that people saw, the one expressed outwardly back when I had those massive mood swings? Or is the 'me' the conscious part inside of me that was stuck watching? Obviously I have my own opinion, and it's nice that the two align better now that I'm on medication that--at the very least--helps.

But I guess it's always good to be reminded that your experience is not universal. I suppose I can always count on MeFi for that.
posted by good luck, we're all counting on you at 10:02 AM on January 14, 2020 [4 favorites]

Having a slightly-hard-time parsing and finding a response to comments in the thread

Me too, good luck, and I was about to just close the tab without commenting when your comment popped up.

You may not see this, but I wanted you to know that you're not the only person who has issues with the comments.

This article was speculation not fact. Anecdotes are not data. Case studies are not applicable to populations. And people are suggestable as heck. We leap to conclusions, we love our biases, we cling to our rationalizations. We are bad at being objective.

Many people need to take meds to feel like or be the person that they prefer to or need to be. This is the me that can have conversations with others and remember to pay bills and leave the house and even type this comment. Unmedicated me is a total nonfunctional mess. I have ADHD, and a bunch of other stuff that goes along with it because everything is connected.

All medications essentially change behavior. That's the point of a lot of them, and the unintended consequence of others. And it is a series of trade offs, because they all have systemic effects, even if it is just changing the one thing you're taking it for. We are, each of us, a system.

I know that's not what the author was talking about, but it is just as valid. Because for drugs other than psych meds, the trials that are done for drugs don't cover mood and behavior. They're about safety and efficacy for the condition that they are meant to treat. But don't for a second think that drug trials mean anything other than that, or that you aren't the beta tester, because you are. We all are.

How can we separate fact from opinion? How can we account for other changes that are coincidental? Are we even asking the right questions? Does it matter?

I think that this piece is fear-inducing, bias-confirming, and click bait that is getting taken more seriously than it should because it was published on BBC instead of Buzzfeed. The author of the article found a potentially attention grabbing way of saying that all medications have side effects, some of which might be surprising (number 2 will shock you!). (It doesn't help that almost nobody reads even the consumer info or wikipedia pages about medications that they take. Beyond that, even if they do, the available research is sometimes astonishingly piss poor when you start to look at the studies themselves. But I digress.) Unfortunately, she brought philosophy of self, and legal issues, and a mountain of random fact-like assertions.

It honestly sounds like a brain dump that might be being shaped into a book proposal. It's just so inadequate for the topics and unanswerable questions it brings up. It is really really speculative and misleading. It all seems to derive from an interview with someone else who is doing research into research, and indirectly leading the audience draw conclusions by proximity of statements. Though it does seem to be in line with other articles on the website.

I would like to toss out that a lot of the statements made in the article are without context. For all the good it does, in the United States, pill packets do have warnings on them.

(I don't have the $3660 to actually see the global market report on paracetamol, though the seeable info includes that China is second place for kilo MT. Don't know where that 298 tablets per person in the US comes from, though it might be an extrapolation that doesn't account for mixed medications. It also seems a bit "look at those Americans and their drug taking" or something like that. But that $1200 per year per person is from Bloomberg, who gets it from someone else, and it seems to be a simple average of raw prescription and over-the-counter drug costs over the population. Insurance, Medicare, and Medicaid paid out most of the total money. Basically, it's way more complicated. But isn't it a striking number to put in a news or think piece!)

I could ramble for ages about cholesterol, statins (so much about the many problems with statins), asthma meds, steroids, the hilariously non-conclusive and limited in a lot of problematic ways anticholinergics study that has everyone terrified of taking antihistamines because people only read headlines and reporters report info from press releases in the most sensationalistic way possible, the problems with a lot of studies in general and the absence of studies that include women in particular, the problems with media, how little we actually know about how our brains and bodies work, and honestly, when you get down to it, people are stupid and most persons don't like to think about complicated stuff that has no answer when they could be doing something entertaining. But I'm not going to because I have other shit to do, and nobody likes this version of me. Not even me.
posted by monopas at 2:19 PM on January 14, 2020 [4 favorites]

good luck, we're all counting on you: have you read this beautiful book? It’s about the history of psychiatric drugs and would be fantastic on that alone but the author’s experiences have stayed with me ever since I read it. I sent a copy to my mom, who is bipolar and has tried so many meds in her life, and she was similarly moved by it. Your comment made me think of it, especially your experience with lithium and leaving home at night to go for a run. Thanks for sharing here.

This conversation (maybe not so much the article) really helped me today. I’m trying to get meds for recently diagnosed ADHD (thanks to a question I asked on AskMeFi that was really encouraging about trying them) and the first one I tried, just this past week, was just terrible. It made me exhausted — and useless — and also turned me into an angry, emotional mess. Or, rather, it felt like I was observing myself having a bunch of emotions but not really feeling them, as though I was just a horrified observer.

My doctor didn't mention any of these side effects and now I feel guilty, like it's all in my head, except poking around online it sounds like plenty of folks have issues on the medication (Strattera) and that the side effects can be really profound. Not looking forward to what I fear will be her insisting I can just push through these and her assuming that if I can’t, it’s because I’m lying to get stimulants.
posted by the thorn bushes have roses at 3:49 PM on January 14, 2020 [3 favorites]

"Side effects" is of course a lie. They are effects. Some people don't experience them when taking the drug. Just like some people don't experience the beneficial effects when taking the drug.
posted by Kirth Gerson at 7:40 PM on January 14, 2020 [3 favorites]

the thorn bushes have roses - Your description of that feeling--being a horrified observer--resonates hard with me.

After the lithium failure I was put on ADHD medication (comorbidity what now?) and had a somewhat similar reaction in the form of feeling exhausted. No additional mood issues for me, but I was baffled, because how could Ritalin make someone more tired? My doctor, luckily, listened to my feedback, and despite some mild but obvious doubts that my perceptions of the side effects were legitimate (we also didn't discuss side effects before I was put on it) he worked with me to put me on Adderall instead, which in theory supposedly shouldn't be doing anything different. But it is. It works for me where Ritalin didn't (or at least does its part of the job).

I'll have to check the book out. Best of luck to you in your search for something that works... it's not only finding the right medications that can be a struggle but finding the right doctor as well. I hope yours listens to your feedback and works with you.
posted by good luck, we're all counting on you at 10:31 PM on January 15, 2020 [1 favorite]

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