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.
Evidence-based treatment
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 a 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.
Stigma
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:
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 remember when I had first goten out of the hospital, I wanted to attend AA, after two meetings and obtaining a sponsor… I was told that I didn’t belong there because I was taking medication. I was so turned off of AA for stigmatizing he fact that I needed to be on medication.
My attitude since then, is Eff them!
Absolutely!
I’ve heard that from so many people. I don’t get it, why can’t they (AA) see that not all medication is an addiction. In 2019, almost 2020, this is mindbloggling to me!
I have no idea why they cannot accept that even through addiction, that is a mental illness too.
I was so insulted when my so-called sponsor said she couldn’t be my sponsor because I took anti-psych medication.
I threw it in her face and replied… You wouldn’t like me much without it… I could go crazy! And made wild looking face at her.
Funny thing, I did better without AA anyway.
This same sponsor Facebooked me once, (When I still had FB), and said she was so impressed at my recovery… Again, my wise ass response was, “Yeah, I’m doing great, no thanks to you.”
Can’t understand why I never heard from her again. LOL!
You did a good job there! Some people just don’t get it.
Luckily we don’t need to take all of them on our journey!
So very true, indeed!
Such narrow-minded attitudes are so unhelpful.
I was better off without them. It was a win-win for me. LOL! 😁
Most people wouldn’t have an issue with meds for high blood pressure or other “physical” issues, but to me mental issues are also physical in that they are caused by chemical imbalances same as other bodily problems. The brain is an organ like any other and we can’t “will” it to get better same as we can’t will our pancreas to work properly when it doesn’t. I can’t will my migraines away by thinking good thoughts either!
Exactly! What’s inside the head deserves treating just as much as things going on anywhere else in the body.
“But I don’t think that’s a problem with Abilify in general, I think it’s a problem of the very specific combination of me and Abilify.”
I think, this is the most important statement because of it’s underlying message. The human body and it’s mind are incredibly complex, hence any form of treatment will meet innumerable variables. Just because someone experiences severe side effects or didn’t get the help from meds they expected, doesn’t mean they are useless in general. I was on a couple of different medications for several years but nothing really worked, probably mainly because the initial diagnosis was wrong, so I stopped taking them. But during that time I also had access to strong benzos which prevented me from going full crazy mode sometimes.
For some people meds might be a good way to kick things of and work on their issues, for others there are probably more helpful ways. In the end, it usually comes down to a lot of trial and error.
Absolutely. And hopefully science will eventually get us to a point where less trial and error is required, but for now we’ve just got to muddle along as best we can.
On a side note: I thought my first comment got somehow lost in the aether, so you can delete the second one if you want 😀
WordPress does funny things sometimes…
In my early 20s I resisted for a long time in taking meds, but a psychiatrist told me that his opinion is bipolar disorder is physical, with mental side effects. That went a long way toward making me feel OK about it. I totally believe going off my meds got me into a heap of trouble, so I am a huge advocate for people getting, and staying, on their medication. Yes, there’s adjustments, tweaks, side effects and the like, but once you find that perfect cocktail, it can make life so much better.
Yes, it can make a huge difference.
“That was the end of me and Abilify. But I don’t think that’s a problem with Abilify in general, I think it’s a problem of the very specific combination of me and Abilify.”
I think that’s the most important statement because of it’s underlying message. The human body and its mind are incredibly complex, hence every form of treatment will meet innumerable variables which might help or discourage it. I took meds for several years without any improvement but quite the opposite, but that was probably mainly because the initial diagnosis was wrong. On the bright side: during that time I had access to strong benzos which prevented me from going full crazy mode sometimes.
Only because one form of treatment doesn’t work for a person, doesn’t mean it’s not going to work for others as well. There are so many individual sets of conditions and adjusting a treatment to them is quite difficult.
In the end it usually comes down to a lot of trial and error. What worked for me is most likely not going to work for many others, but that’s just life.
The side effects can be really hard to deal with, they can impair your social functioning. I think the conversation should be open from both sides the patient and the doctor.
Sometimes it is so difficult to find the right combination that an adjustment can throw the whole balance out of the window.
I’m a very happy that medication exists because I know I couldn’t have done it without the extra help. I don’t understand the ‘shaming’ at all. I think people, when shaming, don’t know what they are talking about. Medication is not an ‘easy’ way out bc it won’t make all your ‘it’s-all-between-the-ears-problems’ go away. And when it’s working, isn’t that a clear sign it was needed anyway? Very informative post.
I don’t understand the shaming either. I don’t know if it comes from medications sometimes being given involuntarily or what the source of that is.
I feel like it may stem from massive misinformation. Because in this day and age we are able to cure everything with food and some sun-therapy. They need a selling point, a reason to sell extra supplements or remedies. I believe that is one of the reasons.
But even worse I think are being viewed like ‘not being able to recover on their own, leaning on their own recourses’. Like in AA (see Beckies response), when on meds you’re not ‘clean’.
Implying that when you cannot recover just on willpower, you ‘choose’ to be ill.
Like with anti-vaxxers who say that you can recover from measels, that is no problem at all!
I can rant and write all day. Good topic!
Rants are fun!
I couldn’t agree more. For so long I used anti-depressants as my only tool. Now I’m in counselling and I think it’s a good combination.
That’s good!
I have to admit I find at times I pick up on different attitudes amongst more experienced colleagues with regards to medication in general. Especially in pharmacy. Some doctors and pharmacists seem keen on reducing the amount of regular medication patients are taking. When it comes to mental health, I think there is a different attitude. We know so many patients who have made a lot more progress or found a lot more stability due to medications, and if they have stopped taking that medication before it was advised wise, they have often had serious setbacks.
On a more personal level, I have a number of friends who have taken antidepressants or other medication. I have heard various views from them. Some are grateful for it and clearly feel they could not function as effectively without it. Others have had challenges finding the appropriate medication for them and express some frustration. I know a few people who, despite having mental health issues, are scared of medication and prefer alternative support services such as counselling.
I respect that as in other health care avenues, most patients have a right to self-determination (although I don’t know what happens in serious cases of illness) and it is wise for patients to be well educated about their own symptoms, triggers, diagnosis and the treatment options available. I often think that when someone has confidence in the professionals and the choice of treatments it can be a great aid to how much they benefit from such.
I have a friend who was diagnosed with BDP (although she is unconvinced) and her fears about the healthcare system are very worrying at times. One good thing is that she has opened up to talk more about it. I have a very good friend who is a psychologist, who has tried to support our friend. I have thought a lot about the fears she has had when I developed my fictional character Annabelle.
I still think that some people are still fearful and unsure about mental/emotional illness. It’s so good to see people openly sharing their experiences, especially when they have had positive support from mental health services.
I agree. And having a trusting relationship with a healthcare provider makes such a huge difference regardless of the treatment that ends up being chosen.
Medication is incredibly helpful and people who stigmatize it causes others to stop taking it or not take it. And things like toxic memes spreads that stigma I find like the meme saying it’s better to beat a child with adhd then medicate them.
I turned my back so many people because of their toxic beliefs regarding medication I can’t even count how many
It’s really a shame that people don’t realize just how much damage views like that can have.
I know and it’s not like the information isn’t there which makes it even worse when people stigmatize meds
For sure.
Since I’ve been on escatalopram (sp?) my life has drastically improved. Although my thoughts can still at times be negative or spiral and anxiety doesn’t completely evade me, I feel like I can attack life again without wasting so much energy on just being sad and worried. I’m pro-meds too now. I’ll always recommend doing everything you can before jumping straight in but they definitely help. I wish I tried it years ago…
I’m so glad it’s helped!
I too am a firm believer in medication. It has done me a world of good. Keep an open mind
An open mind is a very good thing.
Medication has helped me a lot. In the beginning, I couldn’t engage in therapy without it. I know side effects are common, and it can be tough to find a workable cocktail. I feel therapy (with a good therapist) alongside meds saved my life.
I think getting people contained enough to be able to do therapy is a very important but under-recognized role that medication can play.
I agree. I was SO jumpy and scared, I could barely talk (would freeze at stare terrified at the counselor) or make eye contact when I did talk.
I am for medication despite not taking it myself. What you said about it not working alone to cure what you have is true. I think this is why I have had troubles with it working for me. I don’t combine it with therapy and other things. I always saw it as being the one thing that will change me completely. When it doesn’t, I stopped taking it.
That makes sense. With all the bullying you went through it’s probably going to take a lot of things combined to work through it.