Who or what makes up this holy trifecta? 

The foundation of the quality of my life is the trifecta of my psychiatrist, my therapist and my medicines. There is an ongoing debate about whether one should take antidepressants or not. I have heard many people reject medicines because they make them feel sleepy or listless etc.

In my experience and for my illness, Bipolar II, medicines are necessary because what is basically making me feel depressed or hypomanic is the imbalance of chemicals in my brain. The right medicines have helped me achieve a base balance. You need to consult a psychiatrist to figure out if you need medication.*

I want to stress on the words ‘foundation’ and ‘base’ because these three things alone are not enough. Mind you, this balance needs a fair amount of work to keep it that way. The trifecta is just the base, the foundation. In order to have stability, one needs to work on keeping all other aspects in balance like relationships, work, exercise, adequate sleep, diet etc. Let’s look at the trifecta today and how it has helped me. 

Psychiatrist 

Since my diagnosis, I have gone through about five psychiatrists that I can remember. The first psychiatrist only treated critical patients in emergency situations so I needed to look for someone who would treat me on a regular basis. 

A psychiatrist was giving a lecture in my college and spoke about the seriousness of teenage problems and angst. I knew instantly that he was right for me at that time. He treated me for a few years till I left home. After leaving home, I managed to find psychiatrists every place I lived in. They weren’t always ideal for one reason or another. 

On one of my visits home, I met with a different psychiatrist. In addition to being a doctor, he has a strong spiritual background, so his treatment is always holistic and not just heavily dependent on medication. He gives each of his patients a full hour. I still consult him. Here is a list of some key qualities I came up with which I think are important in a psychiatrist. 

• Good listener
• Takes you seriously
• Asks questions about what is happening in your life, whether there have been any changes, good or bad
• Lists side effects of all medicines he/she is prescribing and asks to follow up on new meds
• Does not over or under medicate. Does a thorough medical background check before changing or adding medicines
• Makes sure you do additional tests on time (blood lithium level in my case)
• Advices lifestyle changes if necessary

Medication

Finding medicines that work for you may take a long time. Personally, I don’t think there is any way to figure this out other than through trial and error. If you ask me, I won’t be able to tell you how many medicines I have taken over the years. Some worked, some did not work, some had side effects, some did not work in combination with other medicines, the dosage of some was not right… and other myriad reasons. 

About ten years ago, I had moved to a new city and so consulted a new doctor. The medicine he prescribed worked well but before I realised it, I had put on 8 kilos (about 17 pounds)! I was horrified and immediately stopped taking that medicine**. Fortunately I could consult my old psychiatrist and have been with him since. 

Each person may have a different reaction to a medicine. What works for me, may not work for you. Or it may work but with some disastrous side effects. There is no fool proof way of knowing this until you try a variety of meds. You’d be amazed at how much difference half a dose here or there can make.

Patience is key. I learnt to be aware of changes that came with taking new medicines. I would immediately report them back to the psychiatrist. As we grow older, our bodies change, our behaviour and habits change and these too make a difference in the effectiveness of medicines. My medicines have changed over the years for these reasons too. It took me nearly 20 years to get the right dosage and right combination of medicines.

Therapist 

It took me longer to find a good therapist. The kind of therapist you are comfortable with is quite subjective so again it requires a bit of trial and error before you find the right therapist.  

Therapy is not going to solve all your problems but a good therapist will give you tools to deal with problems you encounter like anxiety, mood swings, anger etc. I don’t always hear things I like from my therapist. It is difficult when he points out things I need to change about myself or when I am in the wrong. But this has been necessary to help me progress. In the long run, therapy has helped me to become more self aware, about my illness, about what goes on in my mind and body and about my close relationships. 

A good therapist, according to me, is also well read and current in the field of psychology and psychiatry. My therapist knows the latest in medicines and psychiatric treatment and this helps because he and my psychiatrist can be on the same page where my treatment is concerned. 

If you are able to find a doctor and a therapist who work with each other, that is an ideal situation. You will typically meet the therapist more often than the psychiatrist. So, for instance, if you are not doing well and your dosage needs adjustment, it is advantageous if both parties are in agreement. This may not seem like a big deal on a day to day basis but it definitely matters in a moment of crisis. 

This might sound overwhelming right now, especially to someone who has yet to take the first step. But remember it has taken me decades to get to where I am and there is still a lot more work to be done. So hang tight and don’t give up! 

**You should never stop your meds cold turkey. It can lead to disastrous consequences. Consult your doctor immediately if you notice any side effects. 

Disclaimers

*DO NOT SELF MEDICATE. 

I am not a mental health professional. The views expressed above are strictly subjective.