Mental Musings
Our therapy team shares their thoughts on creativity, psychology, human behavior, and living better

To Be or Not To Be....Medicated

Monday, August 15 1:06 PM

In a recent discussion with friends, the issue of mental illness came up, and as is often the case, there was much lamentation about how prevalent it is becoming, and how diagnosis and treatment are often pushed by money-hungry pharmaceutical companies hell-bent on convincing us that everyone is mentally ill and that they have the pill that can cure us.

As someone who has reformed their anti-medication ways, through years of experience both personal and professional seeing the right drug do wonders and give people their lives and sanity back, I stayed quiet and contemplative as my friends extolled the virtues of herbs and rose compresses, and the shame of 4 year-olds on prozac committing suicide.

What to make of all of this? We know that the stigma of mental illness is waning. No more do we believe in epilepsy or psychosis as being the work of the devil (at least most of us don’t), yet ironically, now that we know that many symptoms have chemical and neurological causes, it seems that we stigmatize those who choose to use western medicine to treat them. You won’t get ostracized for having bouts of depression, or even mania, but your friends and family may disapprove if you choose to treat them with a pill. Ironic.

Studies show that the best course of treatment for most mood disorders is a combination of therapy and medication. The question is, why does it take people so long to be willing to try something that may help? What are the real caveats to taking psychotropic medication? And what is the responsible approach to taking it?

Mind over medicine
When a therapist recommends psychopharmacology as a part of treatment, many patients shudder. One of the problems patients have, is the sense that taking medication means they are “giving up”. They experience a sense of failure at not being able to overcome their symptoms on their own. However, this kind of thinking is akin to a diabetic wanting to lower their blood sugar level simply by willing it to go down. The inability to affect change in your condition is one of the markers of having a mental disorder in the first place. If you could just shake a bad mood, it wouldn’t be depression. If you could talk yourself out of dangerous behavior, you’d just be having a momentary lapse of judgement. If you can simply talk yourself into being able to focus on a complicated task, you probably don’t really have ADHD.

The Evil Empire
Another reason people often give for resisting medical treatent for mental issues, is their abhorrance of the pharmaceutical industry. And to be fair, some of the practices out there are worth raising an eyebrow or two. However, we don’t stop putting our money into banks, even though we know they don’t always have our best interests at heart. And we still fill our tanks with gas. Rather, we hope to be informed consumers of goods that can significantly improve our quality of life, by choosing to use those goods responsibly and with self-awareness. Taking medication requires the same amount of self-education and responsibility. All other options should be explored. Accurate diagnosis should be obtained. And medication should only be administered under strict supervision from a medical professional, and never used recreationally, or for performance enhancement alone. I always try to remember that the researchers developing the drugs that we use for epilepsy, ADHD, and depression are usually brilliant and compassionate individuals who have devoted their careers to alleviate human suffering. I’ve often imagined the excitement they must feel at having found a viable treatment or cure for a condition. The politics that go into marketing those discoveries and inventions should not prevent a patient from receiving medication that could be beneficial. Empowerement should not come at the cost of effective treatment.

More Harm than Good
Many patients worry about the side-effects of medication. The well-known effect that anti-depressants have on the sex drive, as well as the weight gain that accompanies certain medications, are usually top concerns. These concerns are valid and real. They must be carefully weighed, not only with the help of the internet, but with the imput of a competent medical professional. The rule of thumb is that the benefits should outweigh the risks. Patients often forget that they can stop taking medication that does not agree with them. People often feel like they are committing to a pill for life. This is rarely the case, and when it is, it is because the relief that comes from taking it is too great to pass up. Taking medication can be frightening, and patients are especially concerned about drugs that affect brain functioning. They worry about losing their identity, control over their thoughts, feelings, and actions. However, when one is at the point of considering medication for a mental disorder, it is because one has already been robbed of one’s identity, because one already has lost control of one’s thoughts, feelings, or actions. The medication aims to restore the patient to their true self, to undo the damage of the disorder, not change them into someone else.

Where to Turn?
Another very valid reason for being resistant to taking medication for mental disorders is how difficult it is to find a medical professional trustworthy enough to undertake the process with. Not to say that they aren’t out there. But the channels to them are unclear. Psychiatrists who do good, ethical, comprehensive work, often work outside of insurance panels and are therefore hard to find, and they can be expensive. When choosing someone within a plan, we often aren’t sure what to look for, how to determine if someone is going to be able to understand and help us. Even us therapists have a difficult time forming solid working referral networks with good psychiatrists or NPs who can prescribe medication for our patients. This can sometimes be an arduous and frustrating part of the process. However, there are many skilled professionals, and if we can overcome the shame and stigma of asking for help, good referrals can sometimes come from unexpected sources.

If you are to consider medication for a mental disorder
The step to taking medication is one that should be taken carefully and with much consideration. I do believe that all other options should be explored first. This not only serves to maximize the potential for recovery, because many non-medical options are also effective, it also serves the diagnostic process. It can take a full year or more of being in therapy, or trying alternative treatments, for someone to decide that they need medication, and indeed that journey is often the most convincing path to accepting the reality of one’s diagnosis. Many disorders can be effectively cured through being in therapy. If you are not feeling relief after a considerable amount of time and energy spent with a competent therapist, this may be the sign that medication may be warranted. By the same token, I would be wary of a therapist who recommended medication early on in the treatment.

Get a good referral. This may sound elitist, but if you need to pay out of pocket for the best care, do it. Having your mental health, and good guidance to restoring it, is priceless. Do not bargain-hunt if you can afford not to. This being said, the cost of a profesional is not necessarily commensurate with their competence. Trust your instincts and go with someone who listens to your concerns and addresses them in a satisfactory way. Shop around for a psychiatrist as you would for a car or another important purchase.

Don’t expect a magic bullet. And don’t expect it to work right away. Most medications will alleviate symptoms when they are working, but you will still be human, with your ups and downs, your struggles and frustrations. And many times, the first medication won’t be the best one for you, so don’t give up, and don’t be afraid to ask for a change in prescription, or dosage, if you are not satisfied with the results.

Do your homework. When you get a prescription from your doctor, read the pamphlet, do additional research, ask questions. But always check your sources: the internet is full of information, and full of propaganda too. Make sure that you are gathering information from reputable websites that have facts checked by professionals, not from laypeople or disgruntled customers.

Finally, don’t give up on all the other things that are helping you. In conjunction with your medication, all the practices you have been using to manage your symptoms will continue to help, if not become even more effective.

Prinicples are important, but so is quality of life.
Today’s field of mental health is fractured and fragmented at best. It is a patchwork of medical, and more esoteric models trying…and sometimes failing…to fit into a continuum of care. With advances in neuroscience, we see a movement towards medicalization in the field, yet there are so many forms of treatment that have not been empirically proven, but that have anecdotal evidence of working. I see it everyday in my practice. If you feel strongly one way or the other about medication, ask yourself what your motivation is: are you looking for a quick fix? Are you punishing or depriving yourself because of low self-worth? What is informing your decision? Check your values and get existential if you need to: what do you want to get out of this life? Are you doing the best that you can? It always saddens me to see clients denying themselves any opportunity to improve their quality of life. No-one deserves to suffer. Medication is a tool, it is not inherently “good” or “evil”. We must stop imbuing it with powers beyond those it possesses, namely, the potential to move someone out of a place of frustration and despair, into growth, and the ability to fully participate in life.