[Please note: I am not a mental health nor medical professional – I’m drawing on personal experience and am citing resources for your own referral in this discussion.]
Last year I was prescribed a new anti-depressant which I had a very bad response to, significantly worsening my depression and sending me into one of the darkest periods of my life. If I had not had a prior positive experience with psychiatric medication before this one, I likely wouldn’t still maintain a relatively positive outlook towards them. The first antidepressant I was prescribed was likely life-saving and a big part of the reason I was able to move away to attend university and live on my own.
That being said, from my personal experience, my studies in biology and psychology, research, and discussions with others, I think psychiatric medications can have great potential to help people and significantly improve mental health treatment but they must obviously be closely monitored and require further research.
One thing to remember is that medication is not the only approach to treating mental illness but can play a role in this process. Many studies suggest that if you were to pick one treatment option – psychotherapy alone might be the best choice for treatment in many cases. However, psychotherapy in conjunction with pharmacological intervention to help manage symptoms, has been shown to be increasingly effective.
A little background
The introduction of psychiatric medication in the mid-20th century dramatically changed the treatment of mental illness by reducing the need for prolonged hospitalization of patients (1).
The names given to medications doesn’t define the limitations of their use – so the labels can be misleading. For example, while anti-depressants are commonly used to treat depression they are also used to treat pain, anxiety, and insomnia.
ANTIDEPRESSANTS: Older antidepressant medications include tetracyclines, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOI’s). While these older medications have been thought to treat a narrower range of disorders and may have more potential side-effects, they may still be the best option for many people (2). Now, the most common types of antidepressants are selective-serotonin re-uptake inhibitors (SSRI’s) (like Sertraline, Paroxetine, Fluoxetine, Escitalopram, and Citalopram) a similar category of serotonin and norepinephrine re-uptake inhibitors (SNRI’s). Another common antidepressant yet is bupropion.
ANTI-ANXIETY MEDICATIONS: These medications are intended to reduce symptoms of anxiety including feelings of fear, worry, and panic attacks. The most common anti-anxiety meds are benzodiazepines, however SSRI’s are usually the first route of pharmacological treatment. Short-acting benzodiazepines can include beta-blockers that help manage acute physical symptoms of anxiety including trembling, elevated heart rate, and sweating for example for use on an as-needed basis.
STIMULANTS: These medications increase blood pressure, improve attention and energy levels. They are often used to treat ADHD and occasionally narcolepsy and depression in some cases that have been treatment-resistant. There is little evidence that proper use of stimulant medication leads to dependence (2).
ANTIPSYCHOTICS: These are primarily used to manage psychosis (including symptoms of delusions and hallucinations). Antipsychotics are often used in combination with other medications to treat a variety of conditions including ADHD, depression, eating disorders, PTSD, OCD, schizophrenia, bipolar disorder, and GAD. They don’t cure these conditions but are meant to help manage symptoms.
MOOD STABILIZERS: These medications are primarily used to treat bipolar disorder and include anti-convulsants like valproic acid (originally used to treat seizures) and lithium. If you are prescribed these you may need further monitoring for kidney function and to ensure no drug interactions if you are taking other medication.
As I mentioned, personally I have had both a very positive and a very negative experience with medication. The reality is, much of the underlying mechanism of anti-depressants, anti-psychotics, or anti-anxiety medication is still unknown, so obviously this means their efficacy might be slightly unpredictable. While this may seem unnerving, there’s no denying that these medications have been life-saving for many, likely myself included. In contrast, you’ve likely also heard “horror stories” of people who may have had bad experiences with them. I hope this (very general) summary is helpful to clarify some things.
It’s important to be closely monitored.
Choosing the right treatment plan, including whether or not to include psychiatric medication, is based on your own individual needs and situation and should always be done under a mental health professional’s care. Most doctors aren’t likely to prescribe new medication unless they are able to regularly check in with you following your new prescription. While they know more of what to look out for, they also only know as much as you tell them, so its therefore important to be honest but also forthcoming.
A few important points from the National Institute of Mental Health (NIMH)
“If you are prescribed a medication, be sure that you:
- Tell the doctor about all medications and vitamin supplements you are already taking.
- Remind your doctor about any allergies and any problems you have had with medicines.
- Understand how to take the medicine before you start using it and take your medicine as instructed.
- Don’t take medicines prescribed for another person or give yours to someone else.
- Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.”
As your doctor will likely tell you:
Depending on the medication, they can take 4-6 weeks to “kick in”.
So be patient. Follow your doctor’s instructions and take them regularly and as directed.I urge you to try and be conscious of how you’re feeling – physically and mentally with the start of your new prescription.
Even if you start feeling better – don’t stop taking the medication without consulting your doctor. While you don’t get “hooked”, abruptly stopping medication can cause withdrawal symptoms. If you’re concerned about the side-effects of the medication, talk to your doctor as soon as possible to discuss discontinuing it.
Anti-anxiety medications, like benzodiazepines as I mentioned before, may be quicker-acting for more immediate relief of symptoms. A draw-back to this however is that people can become dependent on these drugs and may also develop a tolerance to them, needing increasing dosage over time. Often these medications are prescribed on a short-term basis and other options are better explored for longer-term treatment.
There can be other side effects.
As with all medication, there are potential side-effects of psychiatric medications as well. These vary with the drug and the person, so finding a balance of what medication is best to manage your symptoms, while minimizing the side-effects, can take some time and will be relatively personal.
Discuss any concerns you may have with your doctor in addition to what medications you are currently taking and have had adverse responses to in the past.
Here is a short list of some potential side-effects of anti-depressants.
It might take a while to find the right one.
For reasons we don’t yet fully understand, different people respond better to different medications than others. So the first medication you try may not necessarily be the “right one”. According to NIMH, some people may respond well to a medication for a while but have their symptoms return (2). There is a chance that the medications you try may not work, but there not all hope is lost – there are other treatment options. While pharmacological intervention is helpful to manage symptoms, they obviously don’t cure you of your mental illness. The combination of psychotherapy and medication can be the most effective treatment path but psychotherapy alone is thought to be more helpful than medication alone.
The choice of treatment is entirely personal and guided by your situation and your mental health care team. If you have any other questions about my own experiences with medication feel free to shoot me a message.
2 – https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml