Balancing Act: Negotiating Mental Health and Medication

A few weeks ago, the New York Times published a powerfully emotive essay by Jamie Lowe describing her long and complex relationship with lithium. At 17, Lowe received a diagnosis of bipolar disorder after being thrown into a manic episode that left her sleepless, paranoid, and harboring grand delusions that she was the only one capable of preventing the quickly approaching end of the world. Her psychiatrist put her on lithium, a remarkable mood stabilizer whose exact mechanism of action remains unclear, despite having been used to improve psychological well-being since the days of ancient Greece. Lithium kept Lowe stable for seven years before she, with her psychiatrist’s blessing, decided to explore life without medication. In the months following lithium discontinuation, she descended into a mania that culminated in professional disintegration, contacting MTV to debate prominent politicians, and proposing to a man she had known for a month on a rooftop in New York as the sun fell from the horizon. It was lithium that once again brought her back.

Lithium carbonate is most notorious for causing weight gain and unquenchable thirst. It can also affect memory, thyroid function, and lead to severe lethargy that impacts daily functioning. However, it was permanent, lithium-related kidney damage that finally got Lowe. After years of ingesting the potent salt, her kidney function had deteriorated to the point where her options were few and simple: she could either switch medications or she could remain on lithium and count the days until she needed dialysis and a kidney transplant. The choice was obvious, but it was not easy. The medication that saved her is now threatening her life, and she can only wait to see if new treatment will allow her to remain stable, or if she will end up back in the throes of mania. She writes:

[T]he idea of waiting for that terrifies me. My boyfriend of three and a half years doesn’t know what I’m like when I’m manic. There’s nothing that I can say that will prepare him. If it happens again, I’m worried I’ll run off and ride the rails or that I’ll be accidentally unfaithful or that I’ll insist on wearing metallic unitards and Mexican wrestling masks or that, worst of all, I just won’t be me, and he won’t be able to remember who I am or that I’m in there somewhere. I worry that without lithium I will lose my job, my partner, my home, my mind … because I’ve been through all this. I don’t believe in God, but I believe in lithium.