Lamictal, Mental Illness Prognosis, and Voluntary Treatment
| 1651 words
| 2026 | Personal | Disability
Content warning: The following article talks about mental health, and briefly mentions topics like suicide and substance abuse/drug addiction.
It's been about a month since I reached the recommended therapeutic dose for Lamictal, and it's changed my life in many ways that I've been eager to discuss in-depth. Psychiatric medication, and psychiatry by extension, are topics I've been very interested in learning about lately—particularly in relation to criticism made towards psychiatry as it exists today. Starting this new chapter in my life made me begin to think about my experiences regarding the psychiatric system, as well as how it operates on a greater scale. Truly, are therapy and medication deserving of being the mainstay treatments for mental illnesses?
Lamictal, also known as Lamotrigine, is an anti-epileptic/anticonvulsant medication, and is most often used to treat Epilepsy and Bipolar Disorder, with off-label use being seen in patients with Unipolar Depression, Depersonalization-Derealization Disorder, Obsessive Compulsive Disorder, cluster headaches and migraines, and neuropathic pain.
I personally don't deal with Epilepsy or Bipolar Disorder, so my prescription for Lamictal is for off-label use for general mood instability, irritability and aggression, and pain, all of which have been issues that I have dealt with for a good part of my life now. My dose began small, as I tend to be pretty sensitive to medications, but I was able to reach the therapeutic dose a few weeks later after I reported little to no side effects that affected my ability to function.
Since reaching the therapeutic dose, Lamictal has made quite a change in my life. I went from being rather pessimistic about my life circumstances and future, to feeling emotionally stable enough to look at my situation through a realistic lens and be willing to work with my symptoms rather than against them. I've since been able to put together a concrete schedule that I've been following for the past few weeks now, and have been able to keep up with for the most part. Life feels pretty good for me right now, and I'm actually putting in the effort to improve the present so that I can be more prepared for what the future holds for me.
With all of this said, I'm not here to sell out to some pharmaceutical company for creating a magic pill that solved all of my problems. I'm still dealing with moderate-to-severe chronic pain and fatigue that affects every part of my life, and I still deal with very difficult thoughts and feelings that do get the best of me. There never has been, and never will be, any medication that'll automatically fix every one of your problems, and it'd not only be disingenuous for me to act like there is, but also dangerous to spread the idea that medication is the solution to everyone's problems.
Because of my positive experiences with Lamictal, I've started pondering a lot about the treatment and prognosis of mental health conditions, and how much more effective I think they'd be if everyone had the opportunity to pick and choose what treatments they wish to partake in. While I am not anti-recovery in any regard, the word 'recovery' isn't necessarily neutral in the context of psychiatry, and usually denotes the goal of ensuring compliance and the ability to work. Our culture pushes a very linear narrative for recovery, with therapy and medication being the end-all-be-all intervention, while not even considering any other methods of support. When they're not user-driven and voluntary, these treatment options serve as another vehicle for producing patients who are compliant and self-policing. On the topic of medications and drugs, in many instances, psych professionals will refuse to treat patients who are not currently sober, regardless of their personal relationship to substances. Under our current system, patients are forced to navigate an addiction script in order to access basic resources (housing, childcare, financial support), gatekept behind a commitment to 'recovery'.
Bearing all of this in mind, it paints a picture where one's prognosis depends on whether or not they have a good team of doctors. This isn't something I'll deny, because a good part of why mental illness happens is due to poor living conditions. But it's important to note that "beating" mental illness is actually the example rather than the exception, and even conditions that are associated with low rates of remission don't make anyone exempt from making improvements in managing their health. To bring up some examples, 93% of BPD patients are able to achieve remission, up to 74% of people with OCD are able to achieve significant improvements in their symptoms, and 80% of those who survive their first suicide attempt never make a second one.. Even conditions with low remission rates (Bipolar Disorder, Schizophrenia, Schizoid Personality Disorder, etc.), generally become easier to manage as one ages, with symptoms typically tapering off after your 20's.
The idea that mental illness is caused by "chemical imbalances in the brain" is the current dominant narrative within the psychiatry sphere. While this does have the upside of promoting the idea that mental illness isn't the person's fault and can impact anyone, it also gives people the impression that mental illness is an unchangeable trait of themselves, rather than just being something shitty that they're going through for a while. Besides the fact that this entire narrative is complete bogus, it does a complete disservice to patients who are legitimately affected by their life circumstances, and makes it more likely for them to believe that they'll be the way they are forever.
Both therapy and medication are forms of treatment that I have seen great improvements from. Much of the progress I've made in my life likely wouldn't have been possible without the support of my therapist and the effects of the medications I'm on. I don't believe holding hostility towards anyone who chooses these forms of treatment is exactly productive, because the whole point of criticising psychiatry as an institution is the lack of opportunities patients have to choose what's right form them. In fact, what's helped me the most in my road to a healthier self is being given the autonomy to make my own choices about my treatment, as well as my healthcare team acknowledging the fact that 'recovery' for me isn't going to conform to societal expectations. These are the same professionals who have worked hard to keep me from being involuntarily committed to an inpatient program, knowing that this line of treatment would likely lead to more damage than it would help me.
Of course, I recognise that this is all a great privilege to have, as many people don't possess the same luxury of having a team of doctors who give their patients the same level of freedom to make their own choices. Many psych professionals would rather find any excuse to frame their patients as being disobedient, lazy, and egotistical, which they use to further justify pushing the one-size-fits-all approach to treatment that turns patient-doctor relationships cold and alienating. It's an all-too-common occurrence to run into professionals who feel they have something to gain from your misery, or are really just in it to get money from the pharmaceutical companies who's medications they prescribe. I've had my own run-ins with these exact type of doctors, where I've been put on a rotation of medications in quick succession after reporting experiencing psychosis, with my doctor at the time not taking into account my medication sensitivities. It's infuriating, and rather humiliating to be reduced to something that needs to be fixed immediately and expected to blend seamlessly back into society, rather than a person who has my own unique needs and desires.I'm lucky to be where I am now, but that wasn't before I went through being disappointed and disrespected by countless professionals.
Because mental illness is highly dependent on someone's life circumstances, allowing patients the flexibility to choose what recovery looks like for them yields the best results in helping themselves to treating these conditions. Mental illness isn't stagnant, and there's plenty of opportunities for your health to improve when you're given a plethora of options and support systems to choose from. But this all stresses the importance of having said support systems in the first place, which are unfortunately limited under capitalism. A better future for mentally ill people includes dismantling psychiatry as an institution and giving everyone the liberty to make their own choices about themselves. Being given the level of autonomy I have has done wonders for my own personal health and wellbeing, and I wish that everyone suffering from mental illness can be given the same level of control in their own lives some day.
Living in peace with your symptoms is possible, and it's in our right to fight for a future where we can choose our options for treatment.
Please visit the Psych Survivor Archive's resources page if you need help with your mental health.