MEDICATIONS
My intention in this essay is twofold. First, I hope to provide information which can help you become a collaborator with the mental-health provider who prescribes medications for you. Second, I hope you will learn some of the basics, so that you can make more informed choices about the use of psychiatric medications. Of course none of the following can take the place of finding a mental-health provider who you trust, who is knowledgeable, and from whom you can get all your questions answered.
The vast majority of psychiatric medications used in the United States today are not prescribed by psychiatrists. Rather, the majority of these medications are prescribed by primary care physicians, and many times these medications are used correctly and with good results. If you are now taking medications, and your various symptoms have resolved completely in response to the use of medications, and you also do not have troublesome side effects, then you probably don't need to try a different approach.
Unfortunately, there are many pitfalls to avoid. Psychiatry is a specialty and psychiatrists have special expertise, beyond that of most generalists, just like in the case of a cardiologist, for example. One common mistake is that general practitioners may prescribe the right medication, but at too low dose. As a result, the patients only gets a partial response. Patients don't know that the appropriate target is total resolution of symptoms, and many of them are not assertive enough to complain. Some general practitioners do not themselves know that the current appropriate goal associated with the use of psychiatric medications is complete elimination of symptoms, without troublesome side effects. Technically this is called a "complete remission." Not knowing any better, many patients are settling for improvement only.
In my clinical experience, nonpsychiatrists are also not as skillful at avoiding or treating side effects. Patients with potentially avoidable side effects may then discontinue these medications, and therefore not obtain relief. Many side effects can be completely eliminated, without losing any of the benefit of the drug. If need be you may have to force your doctor to listen to your feedback. You don't have to settle just for improvement. Ask for a one-time consultation with a psychiatrist. Seeing a psychiatrist doesn't mean you are crazy! In these days of "mangled care", you may have to be quite assertive with your general practitioner to obtain a referral to a psychiatrist.
Why should anyone consider taking psychiatric medications? In order to answer this question, you should take a good look at your ability to function in your daily life. You can break this down into an evaluation of the various roles that you have chosen for yourself; for example, parent, spouse, worker, friends, etc. Most psychological problems involve too much anxiety or too much depression or both. Just struggling against these unpleasant emotions, "costs a great deal of psychic energy". It's possible for these psychological problems to drain away so much of your energy, that you do not have any left over to be a good mother, a good spouse, or an effective worker at your job. Many people's psychological problems increase slowly over the course of time, and they don't even realize how dysfunctional they have become. Let's define "normal for you" as your ability to function, before you became noticeably anxious or depressed or otherwise symptomatic. Assuming that it is now obvious that you currently have significant psychological symptoms, ask yourself the following question; "am I now able to function exactly as well as a parent as I did before I became depressed? Am I being as effective a mother as I used to be? Am I giving the same amount of loving energy to my spouse now that I’m depressed? Am I caring for myself as well as I did before?"
A specific example may be useful. Consider the period of acute grief after the death of a loved one. If you yourself haven't experienced a loss like that, perhaps you are close to someone who has. During the second week after a loved one's death, how much psychic energy did you have to give to your children or to give to your spouse? Many people find that just getting out of bed during that time frame can be extremely difficult. They experience very low energy and loss of willpower. In addition there may be problems with memory, concentration, and maintaining attention. Sleep is usually abnormal (either too much or too little.) These symptoms are what I mean by functional impairment.
Many people have a negative attitude about relying on psychiatric medications. They struggle courageously to cope with psychological symptoms all by themselves, even though they are getting worse. After functional impairment has persisted for a while, many people develop a secondary loss of their sense of self-worth. They realize that they are not doing a good job as a parent, spouse, or worker, and they get down on themselves. A negative vicious circle can result, causing more severe anxiety and depression, and worse functional impairment.
I've learned that there are several specific kinds of attitudes and beliefs which make it difficult for people to take psychiatric medications when they might be helpful. Clients are understandably very protective about their brains. They don't want anything to mess with their brain chemistry. Also, they have probably seen movies in which psychiatric patients walked around like zombies. It's time to tell yourself the truth, the whole truth, and nothing but the truth. Do you really believe that the brain chemistry of a severely depressed patient is normal? Do you think that the brain chemistry of a patient with psychotic behavior is normal? Guess what... it's not!
We now have various new scientific methods which can study the brain without causing any damage. So-called "functional imaging methods” (for example, PET scan) have demonstrated biochemical abnormalities in clients with different psychiatric diagnoses. More importantly, psychiatric drugs have been shown to reverse or improve abnormal brain functioning, back towards normal. This situation shouldn't be surprising. Do you consider a diabetic to be more normal or less normal when they take insulin shots? Clearly they are abnormal until they use insulin replacement treatment.
I've learned that many people also believe that taking psychiatric medications proves that they are weak or defective. Mentally, they give themselves demerits for being so weak that they have to take medication. Ask yourself honestly whether or not the universe cares whether or not you take medication. I'm quite sure that the universe won't give you any merit badges for trying to tough things out on your own. I'm also sure that you won't get any demerits for deciding to take a medication. You are just not that important in the grand scheme of things. Even though you may not have these negative attitudes, your relatives and friends may criticize you for thinking about taking medications. At the very time when you are needing their support the most, they are making you feel an adequate and cutting you off from potential help. Remember, they are not walking in your shoes, no matter what they think. Stand up for yourself! It's your body... your life... your happiness that I’m talking about. You have the right to make your own choices. In fact as an adult it's a copout, if you don't make your own choices.
Another common complaint I have heard from clients is that they feel like guinea pigs, because their doctors seem to be experimenting on them. It's definitely true that there is a kind of experimentation process involved in discovering the right medication for a certain patient. However, that doesn't mean that the drugs themselves, or the treatment method is experimental. Each person's biochemistry is totally unique. Understandably, it may take a trial and error process to find the best medication for you. Also, don't apply a double standard against psychiatry. There are many different medications used to treat high blood pressure, and doctors often do not pick the best medication for a given patient, the first time. Exactly the same is true for cancer, infectious disease, and diabetes to name just a few diseases. Seen from a different point of view, it's really good news that there are around 40 different antidepressant medications to choose from. Because of that, it's much more likely that your doctor can find one that is helpful for you, without unacceptable side effects.
Notice that I said help, not necessarily cure. As I've said before, the desired and appropriate target in mental health care should be complete remission, but that's not always attainable. Psychiatric clients tend to demand perfection from their psychiatric medications. This seems to happen more than in other areas of medicine. For example, if you had very high blood pressure, and medications could only lower your pressure, but not make it normal, wouldn’t that still be a desirable result, even though not a perfect result. Another point to remember is that psychiatric medications are not supposed to eliminate normal sadness or normal worry. Because patients will inevitably continue to experience these normal emotions, they may dismiss or overlook the real and significant improvement caused by taking psychiatric medications. Commonly, they truly don't remember how bad they felt in the past. I've worked with some patients who have later tried stopping the medications on their own, only to be surprised that they become depressed again. Only then do they realize how much the medication had been helping them.
Establishing a good treatment relationship with your mental health professional can help a great deal in terms of resolving these technical difficulties. Find someone you trust and who listens carefully to you. It's important that you feel understood by your doctor, and that you have confidence that your doctor can help you. Your doctor can help you distinguish between normal sadness and severe depression or anxiety. They can help you decide whether you are functioning well enough without medications. If you remain ambivalent, you could consider a therapeutic trial of taking medications. You may be surprised to discover how much you improve. You can then judge the difference for yourself. When a person is severely depressed or anxious, it can be very difficult to make necessary changes in a person's life. The medications can help you take risks and establish new relationships or find a new job. After those changes are made, you have a much better chance of getting off the medications.
Many people worry about psychiatric medications becoming addictive. Only a few psychiatric medications are potentially addicting. Examples are Valium and the other benzodiazepines (Xanax, klonopin, to name a few). However, millions of people take even these drugs appropriately, never have any addiction problems, and experience great relief from anxiety disorders. I don't own stock in any pharmaceutical companies, and I really don't care whether or not a person takes a psychiatric medication. I am, however, on the side of brutal honesty. Do you find yourself being short tempered with your spouse. Do you forget about washing and grooming yourself. Are you forgetful or even dangerous at work. Are you considering a permanent solution to a temporary problem (suicide). Please don't indulge in false pride, by taking pride in the fact that you are getting by without medications when in fact you are not fulfilling your obligations. More importantly tried to avoid shaming your self, if you are considering getting some relief by medications. It's only human to want to be happy. People who truly have mental illnesses are continuously struggling with severe, ongoing symptoms. Very likely there still will be occasional moments when they feel happy and do not feel depressed. However it's a fruitless, relentless, and usually impossible struggle to maintain those brief moments of happiness.
It's also important to be honest with yourself about whether or not you may be using "over the counter drugs" to self- Medicate. Be honest with yourself about your use of alcohol, caffeine, sugar, sex, ice cream, et cetera… or if you have stopped exercising, because it takes just too much effort now.
A very commonly used class of psychiatric medications are the antidepressants. More accurately these should be called anti-anxiety/antidepressant drugs, because they simultaneously treat both symptoms. These drugs are definitely not addicting. However you may experience flu-like symptoms during the first day or two after you stop these medications all at once. That can be easily avoided by gradually decreasing the dose. Further details about the use of these drugs should be discussed with your doctor.
All humans are "a bag of chemicals". We're about 65% salt water. We all choose to ingest a variety of chemicals every day. Make no mistake that caffeine, sugar, salt, and herbs are all chemicals. Herbs are complicated chemicals which do not have a consistent composition, because they are grown in different soils, with different amounts of sun, and getting different amounts of water. I'm not at all against herbs. However it is sloppy "doublethink" to think that herbs are somehow not chemicals. My point is that you should be smart and honest with yourself about the choices you are making about what chemicals you are putting in your body.
Psychiatric drugs rarely cause permanent damage. All drugs can cause unpredictable side effects. For example, drugs can cause temporary rashes. Many people in the United States die each year from taking a single aspirin. We know for a fact that alcohol kills off brain cells and kills off liver cells, and yet that doesn’t stop people from drinking. My point is that when you look at the issue rationally, and consider all the information, psychiatric drugs should be used with the same cautions as for other medications, no more, no less.