Why Psychiatric Medications Sometimes Make You Feel Worse
There’s a version of psychiatric treatment that works, and a version that technically works but leaves you wondering if treatment was worth it. You’re not manic and you’re out of the hospital. So, by every clinical measure, your medications are doing their job. However, you don’t recognize yourself anymore. You don’t care about what you once did the same way. You feel like you’re watching your own life through a window rather than actively participating in it. You’re stable but you’re also not really there. This is what people in the field call zombification, and it happens often enough to deserve more than a footnote in a pamphlet about side effects.
What Zombification Actually Is
Zombification is what happens when medications produce sedation, emotional blunting, and cognitive slowing that goes beyond what stability actually requires. [1] This can potentially leave someone functionally disabled not by their illness, but by the treatment itself. The person isn’t in crisis but they’re also not functioning as they could be or could expect to be. They’re flat and sedated in a stubborn way. You can notice that they’re speaking and thinking slower and are more emotionally unreachable.
In modern psychiatric practice, this is not an acceptable long-term outcome. It’s sometimes necessary during acute psychiatric emergencies but if it persists long after that emergency has ended, it’s often a sign that something in the treatment plan needs to change.
I want to be careful here, because there’s a version of this concern that’s used the wrong way. Some people interpret any emotional blunting, or any reduction in the highs, as evidence that the medication is robbing them of who they are. That’s a different situation than zombification. Bipolar people who are genuinely stabilized will sometimes miss the intensity of mania, and it can be easy to confuse that grief with a medication problem.
What I’m describing is something more specific: a person who is clearly overmedicated, or is on the wrong medications, or is on the right medications but at the wrong dose for their current phase. They’re not grieving their mania, they’re unable to get out of bed. They’ve lost the capacity to enjoy anything and their families don’t recognize them.
Why It Happens
There are a few distinct ways the mental health system produces zombification, and understanding them can help figure out the solution.
Not Adjusting Medications Post-Episode
During a manic episode, medication doses often need to go up to bring things under control. [2] That’s appropriate, it makes sense, it works, and it’s common practice. What’s less appropriate is leaving those high doses in place long after the episode ends. The higher doses that are necessary for acute mania are not the right doses for the maintenance phase. You simply don’t need to be sedated when you’re well in comparison to when you’re manic.
A good psychiatrist sees their patients more frequently during and after an episode specifically to track when their medication adjustment should take place. Excessive sedation isn’t helpful for a post-episode recovery. The medication adjustment may not happen for a few reasons. It could be because of infrequent appointments or an excessive fear of another episode coming up from the patient’s or psychiatrist’s perspective. The result is simply too much medication being used at baseline.
Accumulating Medications Over Years
This second reason is slower and harder to see. The accumulation problem is when you see multiple psychiatrists over the years and each adds another medication rather than reassessing and tinkering with the ones you’re currently on. The average bipolar person is going to see more than one psychiatrist in their lifetime. Doctors retire, public services may have a deadline for discharge, and people move. The issue here is when there is a lack of continuity of care.
For example, let’s say your first psychiatrist helped you find your baseline and the medications required to maintain it. Years later, your second psychiatrist may notice a new symptom and will add a medication to address it rather than adjusting your current medications’ doses. A third psychiatrist then gives you another medication to treat the side effect of the second medication. Then, another medication is added because of the negative interaction two of the new medications have with each other.
At no point does anyone sit down and ask whether everything on the current medication list is still necessary, whether all of it is working together well, or whether some of it is now doing more harm than good. Over years, I’ve seen people end up on five or six medications they likely didn’t need to be on. Each medication was added for a reason that made sense at the time when the greater context of the medication picture wasn’t being looked at. The side effects compound and the quality of life declines. And it all happened through a series of individually reasonable decisions.
Wrong Diagnosis and Medication
Sometimes, bipolar people are zombified because they’ve received the wrong diagnosis and therefore the wrong medication. It’s very easy to wrongfully diagnose a bipolar person with something they don’t have because symptoms can overlap with a large pool of other conditions. Symptoms can overlap with major depression, ADHD, anxiety disorders, and borderline personality disorder. Additionally, depending on the timeframe a psychiatrist is looking at, they may come to a different conclusion about the diagnosis. I’ve seen bipolar people wrongfully diagnosed with borderline personality disorder for this reason. The social instability that’s seen in mania is wrongfully generalized to be a baseline state. This naturally delays getting the appropriate diagnosis and treatment.
Likewise, there are situations where someone with borderline personality disorder is wrongfully diagnosed with bipolar disorder. This often means that they’re on medications that they shouldn’t be on and may be a net negative. That’s why the right diagnosis is so important – it’s not just about getting the label right, it’s about pairing the right treatment with the right label.
Genetic Factors
People metabolize medications differently, and sometimes genetics play a meaningful part. Some people can break down a particular drug too slowly, which means it accumulates in their system at higher levels than intended. This has the potential to produce more sedation or blunting than would be expected at a standard dose. Others may metabolize it too quickly and get less of its therapeutic effect and fewer side effects as a result. This is why psychiatry needs a personal touch. We can’t always go blindly with statistics because everybody is different.
When it’s Not Zombification
Sometimes bipolar people will wrongfully mistake their depressive symptoms for side effects of a medication. This makes sense when you consider that zombification can occur when medication doesn’t adjust to the person’s state post-manic state. However, it’s often the case that after a manic episode comes a depressed one. It’s sometimes harder to admit that one is depressed and so I’ve seen many bipolar people may blame their medication for their illness’s cycle.
Depression has a lot of overlapping symptoms with zombification. Both can include fatigue, emotional flatness, cognitive slowing, low motivation, and a sense of disconnection from life. [3] It therefore makes sense that somebody who’s in that state, and has the cognitive impairments associated with it, may confuse the cause of the state with being one due to medications.
I find that this is not something many people in that situation like to hear upfront. It means that it’ll be harder for them to become well again because the problem is not as simple as adjusting medications. It means they have to overcome another depressive episode. Everyone likes a quick fix but removing medications that could be preventing further depressive symptoms, due to the presence of some depressive symptoms, could be a recipe for a longer and harder depressive episode.
What You Can Actually Do
If you recognize yourself in any of this, the path forward starts with saying it out loud to your psychiatrist. This is where self-advocacy comes into play. Your psychiatrist is not going to know what you’re experiencing unless you say something. Even when you say something, they may not know the full severity of the issue until you paint a picture for them. So do that, psychiatry is a collaborative process and you need to play your part as well.
A good psychiatrist will take your concerns seriously. They’ll review your full medication list, assess whether any adjustments are warranted, and if they’re not sure, they’ll tell you why. If your psychiatrist dismisses your concerns, you can always get a second opinion – that’s allowed.
Never stop or reduce medications on your own. I understand that people have issues with their psychiatrists but stopping medications abruptly is like cutting off your nose to spite your face. The withdrawal effects from some of these drugs are absolutely horrible and should not be gone through alone. That’s not even including the risk of an episode returning. Changes to psychiatric medications should happen gradually, with monitoring, and in collaboration with whoever is prescribing.
What the adjustment might look like depends on what’s driving the problem. If it’s an episode dose that never came down, the solution is a dose reduction. If it’s an accumulation of medications over time, the solution is a structured review to see what can be simplified. If it’s the wrong diagnosis entirely, that’s a harder conversation – but one worth having, potentially with a second opinion. There are solutions to the zombification problem, it’s not a permanent state that we accept as a good treatment outcome these days.
If you’d like to talk about your bipolar treatment or recovery, book a free call here.
Sources
- International Journal of Bipolar Disorders – Alibrahim, Giosue, et al. “Behavioral and Emotional Adverse Events of Drugs Frequently Used in the Treatment of Bipolar Disorders: Clinical and Theoretical Implications.” Vol. 4, no. 6, 2016. PMC. Link.
- Tees, Esk and Wear Valleys NHS Foundation Trust – “Bipolar Disorder: Medication Pathway for Adults.” TEWV NHS, 2021. Link.
- Frontiers in Psychiatry – Soorya, Latha, et al. “Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research.” Vol. 12, 2021. PMC. Link.