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.
Medication and I definitely have a love/hate relationship. One day I hope to be without them, but right now I depend on them
Makes sense. xo
I am most definitely pro meds.
I take:
Zyprexa 17 mg
Prozac 25mg
Trazodone 200mg
Lamictal 200mg
Gabapentin 900mg
Levothyroxine (for an underachieve thyroid which can lead to depression)
In addition to these I take various other meds for the maladies of middle age like blood pressure and acid reflux.
This combination has allowed me to stay out of the hospital for over 2 years and allowed me to live fairly independently in the community with weekly supervision from a case worker. Starting July 1st I transfer into a completely independent housing program.
I have a love/hate relationship with Zyprexa. Out of all the different antipsychotic medications I have tried it has been to most effective in controlling my symptoms. That being said, I do have some side effects that are troublesome. Some days my hands shake so badly that I can’t hold a cup of coffee. Forget about even trying to put contact lenses in. Recently I have has issues with involuntary movements of my face and tongue. My psychiatrist thinks that I may be in the early stages of tardive dyskinesia.
As much as I want to tell myself that I am doing better and don’t need the meds anymore, I know deep down that there is no way I could go completely unmedicated. Last time I tried that I was standing on a freeway overpass screaming at blue cars. I don’t want to repeat that.
Yeah meds are a necessity for me too. Lithium is my love-hate med. It definitely helps a lot, but the tremor can be quite bad sometimes. Still, going without meds is never going to be an option.
I have been hesitant/resistant to try medication myself, and this has helped put it into proper perspective for me. Thanks for writing this! 🙂
I’m glad it was helpful 🙂
Over the years I have struggled with the idea of taking meds for something which in my case was triggered by adverse life events, I felt like a failure for not being able to handle these difficulties on my own. I wasn’t against meds, I just felt (in my perfectionist world) that I was better than that and could manage on my own.
Now, I am very much in agreement with my doctors that meds are essential for me right now, and for the next few years at least. And that’s ok. And I’ll deal with withdrawal as and when.
On the subject of venlafaxine, I have heard similar tales about coming off it, to the point that had I not been in such a bad place I wouldn’t have even considered taking it. But with so many anti depressants clashing with tamoxifen, my options were limited.
I’ve come off of venlafaxine a couple of times before and didn’t have any problems.
That’s very reassuring, thank you. But as I’ll be on it for, and I quote, “at least three years after I’m feeling better”, it’s not something I need to worry about just yet… although I might start counting my three years from now! Heavens I’ll be 49 before I’m off it!!!
I like that you point out it is different for everyone. I hate that the horror stories online turn into a one size fits all X medication is evil. Speaking specifics on my case only. Prozac was not working anymore (if it ever really did). I gained weight enough to go up 4 sizes in 2 years (I do not know my actual weight because I will not step on a scale). I am not positive Prozac caused the weight gain because I am not physically active and my food choices are poor. My PCP took me off Prozac when I told her it was no longer helping. I am now taking Zoloft. So far no reactions in about 3-4 weeks. I go back 7/2 to discuss further. I am not sure if Zoloft is better but I wanted so much for it is be, I have told myself it is working. In the meantime I got a job and I am doing well at it. This alone has lifted my spirits and I feel good. Better than I have in years. Is that Zoloft or positive self-esteem? I also worry that my PCP is not the best for this but finding a psychiatrist in my area is almost impossible. Not seeing new patients or 6 month wait to see new patients. The ones available are walking freak shows. The stories I could tell but won’t.
Yeah there’s some pretty damn scary psychiatrists out there. I find it’s often hard to figure out what’s making things better – Meds? Wishful thinking? The moon aligned with Aquarius? All of the above? But hey, whatever works!
I’m going with all of the above 😊
This post is like my brain most weeks. I take medication but I’m so scared of it & the medical team don’t help by often disagreeing with each other what’s best. With Borderline Personality Disorder they all agree therapy is best, it’s just such a long wait. Thank you for sharing. Glad it’s not just me that gets confused x
It’s really unfortunate that wait times for therapy tend to be so long.
I know but thank goodness we all have each other & blogging to keep going x
Definitely. xo
I will be the first to admit that I struggle with taking the amount of meds that I do. I am asking for a reduction in them overall because I feel over medicated but I take a variety of meds for a variety of reasons. I personally believe that the less meds the better for me as long as I can remain stable.
That makes sense.
Totally agree, and another massive problem is people who take them for a few days and immediately disregard them as rubbish. In my experience I’ve started medications that have actually sent me the other way than they were supposed to for two weeks and after some perseverance they have helped.
Excellent point.
I used to hate medication and was non-compliant because half the time I believed I was doing great and didn’t need it, the other half of the time I thought they were poisoning me and trying to kill me. This wasn’t helped by the fact that one of my doctors when I was 18 prescribed 1800mg Lithium and wasn’t checking my blood levels. I ended up in the ICU for a week with severe Lithium toxicity, my levels were like 4.6 which is insane. Started shutting my kidneys down, seizures. It was a nightmare. And she didn’t seem to notice before I ended up in the hospital that I was shaking like a leaf and walking like I was drunk. She was a very nice woman but it’s a little scary that there are some professionals who don’t seem to know what they’re doing, it can be dangerous
Aside from that, I’ve had mostly positive or neutral experiences with them. Some bad, but nothing to that extent again. I realized that I really need them and one of the medications I was on for 5 years probably kept me from ending up in a residential hospital.
Right now, I’m a little frustrated with my current meds. I’m not entirely sure what’s been going on but something needs to be changed. Overall, I believe medications can be life-saving and are definitely helpful for many people.
Wow, that is really frightening what happened to you – both what happened and that the doctor was so irresponsible.