I can’t think of any other type of health condition that has such polarized relationships with medications as mental illness. In some ways, to medicate or not to medicate has become a moral issue, with various involved parties taking a stance based on principle. Often, this stance is very broad, making sweeping generalizations.
Public misconceptions
I recently reviewed the book Lost Connections, which argues that all depression is situational and medications should not be used. Some people connect psychiatric medication use to violence; for example, the incoming director of the National Rifle Association (NRA)suggested a link between school shootings and Ritalin (methylphenidate). I’ve seen Twitter comments blasting people who wrote about the positive effects they experienced from medication.
We would never hear any of this kind of thing if we were talking about blood pressure medication, so why are there so many eager to shout from the rooftops when it comes to psychiatric meds?
Being pro-medication
My professional training has significantly influenced my own pro-medication view; I used to be a pharmacist, and now I’ve been a mental health nurse for 13 years. That means I understand how medications produce the effects (both positive and negative) that they do. I also have the research literacy to separate the BS from legitimate information. And just as importantly, I’ve taken a lot of different meds to try to manage my depression.
I look at medication as a tool. Any given medication may or may not a) work for, or b) be tolerated by, any given individual. I’ve seen medication be life-saving for people, and it’s certainly made a positive difference in my own illness. In the past, it was instrumental in getting me into full remission between episodes of depression.
The negatives tend to get talked about
In general, it seems like people speak up more often about things that go badly than things that go well. It’s the negative relationships with medications that get the most air time.
I’m a bit fuzzy remembering the details, but not too long ago someone had written a post about antidepressant withdrawal, and someone else commented about how venlafaxine is a garbage drug that no one should take because of the withdrawal effects. I’m sure that individual’s experience was very negative, but it’s easy to see remarks like this about side effects and overgeneralize, making the assumption that they occur for all/most people taking the drug.
Unfortunately, we don’t yet have a way of predicting who will respond to or tolerate particular drugs (although I’m sure the science will get there as the role of pharmacogenomics expands), but to allow treatment decisions to be based on people’s negative comments online doesn’t seem particularly helpful.
Poor clinical practice
I suspect that some of the time meds are demonized because of poor clinical practice by prescribers. If physicians aren’t responsive to the side effects people are having, ordering any necessary bloodwork, or prescribing drugs that are actually appropriate and effective for the condition being treated, those things don’t mean the drug itself is inherently bad. Instead, it means that the prescriber is being irresponsible.
I can’t help but think of a blogger with bipolar disorder who was treated for many years with high-dose clonazepam (a benzodiazepine) and then had it discontinued abruptly. In my mind, that’s shocking malpractice and a gross misuse of a medication that is not even indicated for the treatment of bipolar disorder (but can be very useful when used carefully and appropriately).
It’s also problematic when doctors prescribe a medication and make it out to be a sort of panacea that will fix everything. We all know there are a lot of different things involved in getting well, whether we’re on medication or not. Psychosocial stressors and underlying trauma aren’t going to disappear with a wave of the SSRI wand, and that’s fine, but doctors should be open with their patients about what medications will and will not do. If patients are coming in misinformed and expecting to pop a happy pill, the health professional has a responsibility to educate them about the nature of mental illness and its treatment.
So what do we do?
As Shakespeare’s Hamlet might say:
To medicate, or not to medicate: that is the question:
Whether ‘tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?
Our relationships with medications are seldom simple.
Where do you stand when it comes to medications?
Want to know more about psych meds and how they work? Psych Meds Made Simple is everything you didn’t realize you wanted to know about medications.
It’s available on Amazon and Google Play.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I’m scared of meds with all the horror-stories one hears. I am not informed like you are. The addiction part of it scares me the most, then the side effects. Having seen people walk around like zombies, switched off, I try as long as I can to not have to get on meds.
I think part of the problem is when doctors keep people on medications when people are having bad side effects rather than making changes to try to relieve the side effects.
Yes, and because the doc is the expert but is letting people down so bad. I rather try without meds as long as possible. I had a conversation online with a mother who lost her daughter who was only 10 yrs old. We were speaking on an online bereavement website about antidepressants because I was then (2015) in the beginning of my traumatic bereavement and was contemplating getting on antidepressants.
The mother strongly advised me not to, because she went rather quickly on antidepressants shortly after her daughter died and was on it for 7 yrs. She said to me that when she got off it THAT is then when her grief started, because for 7 yrs she couldn’t grieve because she was in a blur on meds. I was glad for her advise because I went into full force trauma and grief without “delay” so-to-speak.
Even though antidepressants may be helpful during grief, they should just “bridge” the intense time, and not take away from the importance of grieving.
Yes they should be used in a way that helps rather than hinders healing.
I steer clear of them in truth. I was prescribed something or the other last year after the previous something or the other wasn’t working, nor the previous one to that. What l don’t like is how it switches me off and flattens me like some kind of loose rogue elephant. So l opted for no more meds.
During my 9/10 year breakdown, the docs prescribed me everything they could think of, and l hated losing my ability to think for myself. In order to beat that, l started self-harming and that kept me awake mentally. It is NOT the answer, but l don’t like what the chemical giants do to keep sufferers at bay.
There is a much bigger game strategy in this subject than just the premise of this excellent post Ashley. I try where possible to not take any medication for anything.
Even now l am in a lot of physical pain, and l have been prescribed to take 2 tablets of solpadol every four hours, but l can’t. yesterday was a nightmare, zombiefied, couldn’t function properly. So now l have only taken one this morning at 8, and l will take 2 before l go to sleep.
I would rather have the pain and know l am alive and functioning in comparison to being unable to move properly and so called pain free.
I think it’s important to be able to find that balance and figure out what level of both symptoms and side effects we’re willing to tolerate.
That’s true, and it is so important to have transparent info about the meds to be able to weigh out that decision.
Definitely.
“l don’t like what the chemical giants do to keep sufferers at bay.”
Same here!
I have to say, I think my position on meds is changing. I’ve been trying for ages to find something that works and nothing for work the way I thought it should. Now I’m starting to think the problem was my perception of how the meds should he working. I have to remember they aren’t a magic cure, even if they just make things a little more bearable, that’s something.
I used to think that meds should be enough, but as my illness has evolved I’ve realized that just wasn’t going ti happen.
I always wonder if my medication is actually helping me or hindering me. I’m still depressed even when I take the damn stuff. Plus it just makes me feel numb most of the time.
Great post!
Yeah it can be hard to tell sometimes.
Thanks for the tag!
You’re welcome. 🙂
Even though I have a few of my own medication nightmare stories, I am pro-medication when it comes to bipolar disorder. I think the reason it was such a rough road was, as you said, “poor clinical practice”. If i knew back then what I know now, I would of been able to better advocate for myself. I feel pretty strongly about people coming off of their meds for bipolar. It’s so common to not want to be medication compliant , that I worry when I read posts about going medication free, that it could influence someone to stop their meds. I’ve been know to get pretty upset with people. It’s a brain disorder and requires medication. I think we are responsible for managing our illness, and medication is part of that. So there is my point of view, it’s a strong one, and probably controversial. I’m not speaking to depression medication, as I think that is a much more complicated subject and is more individualized.
Yes that worries me too. I think if doctors were more responsive people would be less likely to go that route.
I’m pro-meds. I’ve never felt like a zombie while on them. Sure, I’ve experienced side effects, but I’d rather be myself than depressed all the time.
Me too.
I can’t talk for psychiatric medicines or their prescribing but I did have to take a lot of painkillers during the past two years. I was on such high doses of fentanyl, oxycodone, tramadol and pregabalin all at the same time and it really affected my mental health. I couldn’t concentrate and was sent into a spiral of utter despair over the slightest thing.
After being on them all for about a year and feeling pretty suicidal I couldn’t take it any longer so came off the lot and went ‘cold turkey’.
Best days work I ever did, although it’s not something I would advocate for everyone as the side effects were horrific for months.
It seems like pain meds are similar to psych meds in that the battle between pros and cons can be quite intense.
I’m fairly pro-meds, which may be a bit surprising given that most of them do nothing whatsoever for me and the small number that do seem to work OK for a while then suddenly massively decrease in effectiveness or stop working altogether as soon as I’ve started trying to get my life back together. But I think they can be literal life-savers for some people, as they have been for me at one or two points.
You’re right that people don’t view any kind of other meds the same way; as many people have pointed out, no one says that diabetics taking insulin are using a “crutch” or, worse, are victims of Big Pharma making up placebo treatments for fake illnesses. I know some people have bad experiences, but they shouldn’t generalise from their experience. Also, people tend to see meds, therapy and alternative medicine as either/or, which I’m not sure is helpful either, although price and interactions can make them either/or, I suppose.
My worst anti-med experience was when I told my dentist I was still on meds (because they always ask that) and he asked why I’m still on them and why my religion doesn’t help me get over the depression. I should have asked him if I should stop brushing and flossing and just pray to God for good teeth…
I think it’s so inappropriate when health professionals voice an anti-medication stance like that. Perhaps we should throw the fields of medicine and dentistry out the window entirely and hit ourselves over the head with whatever holy book we happen to subscribe to…
I am lucky…my dentist is also Mental
Haha
For me…meds have been a lifesaver. And my team of brilliant doctors have kept me alive and functioning….through raising two girls and keep running a business.
So…there you go.
That’s good 🙂
Wow, your dentist’s said that? Hope he’s not your dentist’s any longer. Going through something similar, the religious views on us and meds. Ty for sharing.
This is a really, really important issue. For myself, medication has only been helpful when my OCD was debilitating, but I eased off of it as soon as I could. For others—like one of my friends who has bipolar disorder—medication is necessary. They tried several “natural remedies” and meditation and yoga and eventually had to reckon that their natural lifestyle and medication could coexist, that it was best for their continued survival. A complicated conversation, and one that is far from over. Excellent points!
Thanks! I think sometimes it takes a while for people to realize that medication and non-medication strategies often work best when they’re combined.
Cool thanks!
I am pro-meds. I always have been, but at the beginning of my diagnosis my husband was anti-meds and wanted me to treat the bipolar with vitamins. So, I stupidly went off of my meds to prove a point. Vitamins are NOT going to help me. And after a year of being off meds, I of course had to go back on them. But my point was made. He doesn’t give me a hard time about my meds anymore. I don’t recommend anyone do that. That is just my story. It infuriates me when people think you can “cure” a mental illness holistically. But if that is how they want to approach their illness, so be it.
I think a holistic approach is good if it involves coming at the illness from multiple angles (including meds as appropriate), but the idea of vitamins as a cure-all for serious mental illness is such a load of crap.
I just wish that years (and years) ago I had been educated about depression … educated that there is more to it than a pill. But this was way before the internet where now we have all the information at our fingertips. I have learnt, mostly, what works for me and clearly for others too about self-help. But the problem is that in a ten minute slot at the doctors surgery there is no time to really talk through it all and educate the patients, and sometimes that’s when the patient is at their lowest and that’s not always the best time anyway. I remember practically putting my hands around the throat of one doctor who suggested that I read a leaflet and take a walk outside in the fresh air! Great post, as ever. Katie x
Thanks 🙂 Good old take-a-walk therapy… The most brilliant cure-all ever invented!
I finally realized that I cannot live without them and don’t play “doctor” by changing anything to the treatment without my doctor’s okay.
Yes it’s good to have that impartial input before making any changes.
I don’t know about you but my treatments are changed very frequently as I get used to the drugs very quickly
I’ve been on the same combo of meds for a while now, but we play around with the doses.
I wish it would be the same for me because every time I am introduced to a new drug I feel it creates a shock to my body. Like this new one that I have been taking for the past two months is still creating problems.
Oh that’s unfortunate.
Thanks but it’s not the end of the world.
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This was a great post. I remember when I first ‘came out’ with the ‘hey Im on meds’ talk with my friends. Mostly I had a really good response. So this was interesting: The best responses (some exceptions always) were from people who saw me having intense panic attacks. The mediocre responses were from people who knew in-depth the severity of my bad mental health. The worst responses were from people who never saw it happen even once. And it really kinda sucks to have a best friend not even do sufficient research (or do a biased research) on medication, before telling me to stop taking meds and that it’s pointless and bad for me and to stop using my mental illness as a scapegoat.
Great bloody post <3
Thanks! Yeah people should definitely do at least a little bit of research before they decide they’re qualified to give medical advice…
No worries <3 aw im glad to see you agree haha