Ask The Therapist: To Medicate or Not


Q: I don’t like taking any kinds of drugs, including psychotropics, is it always necessary to take medicine for psychiatric conditions or emotional distress?  L., female, 34 year-old

A: That’s a great question and the one that’s probably asked the most as it encompasses the biggest fear of many clients “what if I become addicted, or I have serious side effects, or the medicine will alter my mind to the point that I’ll lose a sense of myself”.

Let’s examine this topic from the point of a client who has either a chronic or acute condition, and let’s remove psychiatric specification of that condition and generalize this situation the way we usually view medical issues. Imagine you just had a major surgery, as you lay in a recovery room, the doctor would probably prescribe you some potent painkiller like morphine, the nurse would fill the IV bag with the medicine and give you the button to push any time you feel pain so that morphine could be delivered (yet at the same time, the IV is calibrated in a way that it won’t deliver the dose that it’s too high or too frequent, to protect you from the most obvious overdose and serious side effects). You have a total control of when and how often to push that button, and you have been informed of all the possible side effects that morphine intake could entail. And, chances are, you’ll be pushing that button pretty often to make the recovery as tolerable as possible because you just had a major surgery, and you understand that “it’s how medicine works”, plus you don’t want to experience any bigger physical distress from pain than the surgery in itself already put your body through. And, later on, you will probably be switched to some oral painkillers, and, most likely you’ll take them too depending on your recovery process and a multitude of other factors.

Now let’s translate that to some possible psychological distress, as grief, for example. Not every grief process is complicated and requires intervention of a mental health professional, but, if let’s say, death of a loved one was unexpected or surrounded with some traumatic events, your emotional state may feel as your whole being has just undergone some major (and traumatic) surgery. Wouldn’t you say it’s at least beneficial, if not warranted, that you may see a mental health professional and take some psychotropic medicine to help you cope with the very worst of it? And, once you feel more stable, and a proper bereavement therapy is always recommended too (just like a physical therapy would be if you had some orthopedic surgery), you can work with your doctor to taper off and then discontinue the medicine. Important: never quit psychotropic medications “cold turkey “, you may get serious withdrawal effects, always consult the doctor when you want to change or discontinue your medicine.

Let’s examine a different situation where a condition is chronic, as it happens when a client has a heart disease or diabetes. Most people would agree that a daily medicine is necessary to keep the condition at bay, along with diet, exercise and other corresponding life style changes, and do realize that certain flare ups and re-adjustments will probably happen on a way too. The same happens if you have a chronic psychiatric illness such as schizophrenia, bipolar disorder or certain types of depression and anxiety disorders, a daily medicine is what keeps these conditions stable and allows for adequate functioning of a client.

The most fear-based issue in this is the potential addiction factor. In reality, it’s not the medicine that makes people get addicted, it’s the maladaptive personality traits and inadequate coping styles what usually prompt certain individuals to seek pharmaceutical means to mitigate their emotional distress.

At the end, it is always your choice whether or not you want to take any psychotropic medications. If you feel you’re in a great psychological distress, especially after certain traumatic events or periods of intense stress, have a thorough evaluation by a mental health professional who may suggest certain medicine along with psychotherapy and other support means. It’s up to you to take that advice or not, do not base your decision on fear of the unknown, make an informed choice.

I always say, if your condition is chronic, a daily medicine should be part of your routine. Or if the distress is acute and unbearable, just give medicine a short trial period and see how you feel. Most psychotropics require initial adjustment period of at least 3-4 weeks, and may often be switched or changed in the beginning before you can see a full effect of the medicine. Just be patient and work with your doctor to find the best dosage and a type that’d work for you.

Mental health is part of your overall health so be proactive and stay informed.

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