Psychiatric Medications

Taking medication seems to be a very “hot” topic. There are the extremes: the folks who have/take a pill for everything, and the folks who will not even take an aspirin or a vitamin. I have had people say to me “I’m not a pill taker” and I’ve wanted to ask them “What does that mean? Is your throat too narrow? Do you see taking pills as a moral issue? Would you wear a cast if you broke your leg? Would you take insulin if you had diabetes?” I admit to getting flummoxed when someone refuses help because it comes in the form of a pill.

Another “hot” topic about psychiatric medications is that many people who take prescription medications are being prescribed them by their primary care physicians (PCP) who may or may not have advanced training in psychopharmacology (great word, huh?). So for the “garden variety” anxiety or depression that people present to their docs, the “garden variety” standard medications work just fine in conjunction with counseling, according to studies of successful outcomes. If a doctor just sends a patient off with a prescription and no regular follow-up with a counselor, that is poor medical care, in my not-so-humble opinion. The biology of mental disorders is only half the problem and half the solution.

Now what about the people who have unique situations or needs? Does the standard medication regime work? Sometimes yes, sometimes no. Maybe the medications aren’t effective, maybe the patient is taking other medications that could interfere with the new one, maybe there are intolerable side-effects, or maybe the person needs a specialized combination of medications to address their symptoms. It is the insurance companies who give the permission to the doctors to refer to a specialist – or not.

So let’s take an example. Say you are a person who has spent much of this last winter depressed, no energy and now Spring has come and you are feeling EXTREMELY GREAT to the point where people are asking you if you are OK. You then do something you know you should not do (spend money like crazy, drive 50 mph over the speed limit, think everyone who is not feeling like you is stupid) and something happens and someone says to you “I think you need help.” With great reluctance you call a therapist and demand an immediate appointment and then miss the first two appointments you are given and when you finally get yourself to an appointment and tell your story the therapist confirms that you need counseling and you need some medications to help you calm down so that you can focus on the counseling work you need to do.

So you get all indignant and say you can “do it without your pills, thank you” and you storm off, only to find out, after 2 more incidents that you can’t do it on your own. When you return to therapy your therapist insists you call your PCP for an evaluation. You say to her “I’m not a pill taker” and she says to you “I’m not a magician” and tells you to make a choice. You go to your PCP, you get a prescription, you don’t fill it for 2 weeks while you think about it. Finally you start on the medication and in a few weeks you begin to feel better. You get support in therapy to deal with the initial side-effects which do mostly subside and then one day you realize “I feel good. I can think. I have control over myself. I’m back to being me”. Now the real work of therapy begins to help you achieve deeper understanding and control over yourself.

But suppose the pills don’t work for you. That is when you need to see a specialist, either a psychiatrist or a psychopharmacologist who will take a detailed history of your problem and work closely with you to help you get the results you need. It might mean trying different pills until one works or a combination of pills work. It is important to work with a specialist who can give you the best care with the newest information.

I will leave to your imagination what would happen if the person does not get at least temporary help from medications while the initial work of therapy is going on. You may know people like this and see how they suffer and cause the people around them to suffer, too. If you know anyone who is needlessly suffering from a mental illness that could be helped by medication, please urge them to call their doctor or a mental health professional.