"I hate meds!!!!!!!!!!!!!!" Sunnyday writes. "My life sucks. I have no sex drive, gained almost 100 lbs, my body feels numb all of the time, and I'm more depressed now because my doc doesn't want me to be manic and every time I try a new antidepressant, it hypes me up too much........ugh!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"

Sunnyday was responding to a recent sharepost by Dr Jerry Kennard, here at BipolarConnect, entitled "Adherence to Medication and Coping with Side Effects."

Sunnyday had a lot more to say:

"Is this really what life is supposed to be like, fat, unsexy, and depressed all of the time? I'm only 26 for gosh sakes! I will not do this forever. ... What's the point of taking meds to make me feel 'normal' when all it does is make me feel worse??"

I hear you loud and clear, Sunnyday. In a recent sharepost I wrote:

No one enjoys being turned into a eunuch. ... In short, losing one's sex drive is not an acceptable side effect. Neither is gaining excess weight, feeling cognitively dull, losing motivation, or anything else that adversely affects one's quality of life. The whole purpose of meds treatment, after all, is to make us feel better, not worse. ...

Is this it? the patient wonders. Is this the best I can expect? To be stuck, like this? For the rest of my life?

Let me tell you, Sunnyday, when you wrote, "I will not do this forever," it really struck home. You are perfectly justified thinking this way, and psychiatry is stupid for not listening. You speak for an awful lot of us, judging from reader input all over this site.

On the issue of meds compliance and meds side effects, there is a huge disconnect between psychiatrists and their patients. In a study published in the May 2003 Journal of Affective Disorders, clinicians reported that they felt their patients quit lithium owing to "missing highs." The patients who quit cited other reasons.

Psychiatrists are in extreme denial about this. Last year, I presented a grand rounds lecture to a psychiatric hospital in Princeton on the topic of meds compliance.
"Sending a patient out the door with just a prescription is not treatment," I told them. No sooner had I stopped speaking than they cleared the room faster than if someone had pulled the fire alarm.

The issues are complex, but we are talking about a perfect storm of problem patients, problem meds, and problem clinicians, exacerbated by a healthcare system from hell.

Physician logic is very different from patient logic. Physician logic assumes that patients will willingly fill their prescriptions because they don't want to go back into crisis. A patient, however, may have rational and irrational fears about taking meds and issues with authority, not to mention cognitive difficulties associated with his or her illness, plus no end of complications. A physician ignores these issues at the patient's risk, and in this era of 10-minute meds checks an awful lot of ignoring is going on.

Then there are the meds. They are based on technology dating from six and seven decades ago, with no substantial improvements. They are built primarily for crisis situations, with little knowledge on how to apply them over the long term. The one unambiguous finding from the few long-term studies to date show that patients have great difficulty tolerating them.