If you’ve read my blog before, you’ve probably noticed that I’m pretty pro-medication when it comes to mental illness. I thought it would be worthwhile, though, to give a little bit more nuanced perspective.
My take on meds comes from my professional training as a pharmacist and then nurse, years of experience, and many hours of continuing education. I’ve seen in clinical settings what a huge difference medications can make for a lot of people. I also have a good understanding of what meds do once they’re inside the body. It’s not a question of a drug going into the mysterious black box of our brain and doing unpredictable things; there’s actually a lot more rhyme and reason to it than that.
I get frustrated when people make negative generalizations about medications without having any knowledge to back that up. One example is the claim that medication is “toxic” or “poison”. If someone doesn’t have any background in pharmacology and toxicology, they’re in no position to judge that.
I wonder if sometimes people might assume that, because I’m pro-medication, it means I think medication should be used in all conditions, all of the time. I’m a firm believer in evidence-based medicine; if a drug is going to be used, it should be because it’s indicated for the particular individual’s condition, with research to back that up.
For many conditions, medication is not indicated as a first-line treatment, but can sometimes play a supporting role. As an example, medication is not indicated as first-line treatment for borderline personality disorder or PTSD, but in some cases may be helpful as an add-on to help manage symptoms.
Managing side effects
Medications have side effects, whether it’s psych meds or anything else. Some people will have no side effects at all, while others will have horrible side effects; unfortunately, that can’t be predicted before trying a particular medication.
I strongly believe that prescribers have a professional responsibility to be responsive and available to their patients. Treatment decisions should be collaborative, not one-way. No one should feel pressured to stay on a medication that’s making them feel awful. If prescriber and patient collaboratively come to the decision that side effects are worth it for the beneficial effects, that’s one thing, but the patient’s concerns absolutely need to be taken seriously. If someone develops severe, intolerable akathisia (restlessness) and their prescriber is unwilling to discontinue the medication, in my view, that’s malpractice.
Certain medications have a pattern of side effects being problematic when initiating treatment and then easing off. While I think it’s very appropriate for a prescriber to share this information, that doesn’t make it okay to expect a patient to put up with extremely distressing side effects just because they might ease off in time maybe kinda sorta.
Sometimes certain medications can cause worsening of psychiatric symptoms, even when the medication being tried is generally considered appropriate for the diagnosis. Just because a medication should work in theory doesn’t mean it should be continued if it ends up doing the opposite. I usually tolerate medications, but when I started Abilify (aripiprazole) I had an abrupt and significant worsening of my depression. That was the end of me and Abilify. But I don’t think that’s a problem with Abilify in general; it’s a problem with the very specific combination of me and Abilify.
What meds can and can’t do
Another big issue is about what medications can and cannot do. Being pro-medication doesn’t mean I think they come with a magic wand attached. Meds don’t produce some artificial version of wellness that makes all our problems go away; they allow the brain to get back to some semblance of normal function after the ass-kicking of illness.
Meds also don’t give you wellness on a silver platter. If you’ve got underlying psychosocial factors contributing to your illness, all the medication in the world isn’t going to make those disappear. What meds may be able to do is get you well enough to do whatever work it is that you as an individual need to do in order to get fully well and keep yourself well. If medication is the only tool in your toolbox, you’re only going to get so far.
A big part of why I’m very vocal about being pro-medication is that there’s a ton of stigma and misinformation out there, which sometimes tries to masquerade as legitimate information.I firmly believe that decisions around medications or any other form of treatment should always be an individualized weighing or pros and cons that happens between you and your treatment team. Making decisions based on stigma and information is doing a huge disservice to yourself. Medication isn’t going to be the right choice all of the time, but that should be an informed decision rather than a misinformed one.
For more posts on psychiatric medications, there’s also a Psych Meds 101 series covering: