One of the most common and difficult issues that comes up for my clients is whether to consider using medications to aid them in addressing their issues, and if they decide to do so, how to do so effectively and safely. The set of medications that treat psychological issues have many names, but as a group, they are collectively referred to as psychotropic medications. (I will also use the term mental health medications interchangeably.) Due to the complicated nature of this topic, this will be a multi-part blog-post. Some of the factors that make this a complicated topic are: common misconceptions about medications, stigma, and difficulty using our current healthcare system. Each of these will be addressed.
To attempt to have some structure to this discussion, we will walk through the process of getting on medications in a chronological order. Therefore, if you are at a different phase in this process, you may wish to skip ahead to the stage that applies to you. However, there are likely to be helpful pieces of information even in sections that may not directly apply to you.
As a quick disclaimer: this discussion of medication is designed to be informative but is no substitute for direct medical care and treatment. You should heed the advice and direction of your prescribing doctor when taking or considering the option to take a medication.
The initial question
The most basic question that we can start with is: “are medications going to help me in dealing with what I am experiencing?” To answer this question, it is most helpful to be clear about what issues you are experiencing. While not a comprehensive list, the following issues are the most common things psychotropic medications treat:
- Depression or other mood-related issues including:
- Depressed mood
- Energy level
- Motivation
- Irritability
- Concentration
- Mania (Bipolar Disorder)
- Impulse control issues
- Anxiety
- Psychotic symptoms (delusions, or thoughts that are not based in reality)
- Attention issues/hyperactivity
If you are experiencing issues in any of these areas, medications may be beneficial for you to consider. In addition to medication, counseling and lifestyle changes are also interventions that you should strongly consider. One of the biggest mistakes that can be made is to expect for a medication to fully fix a psychological problem. Very rarely are these issues purely biological (which is the only aspect a medication can address), therefore, only relying on medications leaves multiple contributing aspects unaddressed. A handy way to remember this is the saying that you likely need “skills and pills” to address these issues.
Oftentimes people will prefer to avoid taking medications and there is nothing inherently wrong with this approach. However, if you have given a good faith effort to counseling and lifestyle changes without experiencing a reduction in your symptoms, then you are likely to benefit from considering adding the use of medications to your current interventions.
Confronting stigma
A significant barrier to the effective use of medications is often perceived stigma around using mental health medications. Stigma around mental health issues and the medications used to treat them arises from a time in the not too distant past when mental illness was viewed as a sign of demonic possession which was something that happened primarily to bad people or those who had sinned. While we thankfully have come very far from this perception, the idea that there must be something wrong or bad with someone who is suffering from a mental illness has lingered. With this limited and skewed understanding of mental health issues, it is clear why people would go out of their way to distance themselves from those experiencing these issues or would even go to great lengths to hide them if they were experiencing these issues. Fortunately, we have evolved in our understanding of the nature of mental health issues to be able to view it as a multi-faceted issues that has biological, psychological, behavioral, and social aspects.
Stigma can come in a few varieties:
- Internal – this is your own view and judgment on medications and those who use them. If you view using medications as a sign of weakness, this will be a major barrier for you to consider them. I often encourage people to challenge this by viewing mental health issues the same as you would consider any other medical issue. I often ask the question, “Is it a sign of weakness for someone with diabetes to use insulin or other medications that control blood sugar levels?” This is invariably answered with “no.” It really is no different with psychotropic medications. In fact, it often requires a large degree of bravery to be able to acknowledge and admit the need for help in this area.
- External – these are the views and judgments from others. They can come in two forms:
- Actual – this occurs when others make direct negative comments about your, or other people’s, use of psychotropic medications. This can range from subtle to overt.
- Projected – this is where you assume that another is having a negative evaluation of your use of mental health medications. You may infer this from a facial reaction or some other sign, but the key here is that it is an inference. The important thing to understand about projected stigma is that it is actually your internal stigma that you are projecting onto another. Consider the analogy of a movie projector that projects images onto a blank screen. You are the movie projector, and the other person is the blank screen. So, while the images seem to be on the screen, they are actually originated by the projector. The other person may or may not actually have a negative judgment about medications, but, unless it is actual external stigma as described above, it is important that you recognize and own the stigma as your own.
So how do we combat stigma when it is present? Part of the answer is in education. Education efforts need to take place in three arenas. The first is with the person who is dealing with the mental health issue. Ideally, prescribers take time to educate people when they are initiating treatment, both on the medications and the targeted illness. However, this often does not happen. This is one way in which counseling can be helpful. A counselor is often afforded more time than a prescriber to explore any stigma, either internal or external, that may be present and can provide education on the targeted illness.
The second arena where education is needed is in the family. Family members are one of the most common sources of stigma, either intentionally or unintentionally. Most often, this is due to misperceptions and/or misinformation about medications and mental illness. Family members may also struggle with their own genetic predisposition to mental illness and may be unwilling to acknowledge their own mental health struggles. Organizations like NAMI (National Alliance on Mental Illness) in the USA provide great resources for families to educate themselves.
The final arena is in our communities at large. From our workplace to our friends and any other people with whom we may come into contact, these are all opportunities to educate others on mental illness. While judging the appropriateness of sharing information with certain people (it’s likely not appropriate to share things out of the blue with the clerk at the grocery store), there may be opportunities to educate others. One such opportunity is if you hear someone sharing misinformation or speaking in a stigmatizing fashion. Providing accurate information to correct misconceptions or politely confronting those who stigmatize mental health issues is an important step to continue to make progress in this area.
A good thing to educate yourself and others on is just how widespread mental illness and use of medications are. Searching the websites of NAMI (nami.org) and the National Institute of Mental Health (NIMH, nimh.nih.gov) will provide both overall numbers as well as specific numbers based on certain disorders. Knowing how common these issues are can help to normalize your experience as you confront these issues and knowing that you are not alone in these struggles can be comforting.
At this point, we will assume that you have made the decision to start taking medications due to identifying symptoms that medications can address and have overcome whatever stigma may have been present. The next blog post will delve into how to handle your initial consultation with a psychiatrist.
EDITED BY DR. JACQUELINE FULCHER @ https://paintedowlpsychology.com