One of the most common questions about mental health problems is whether people need medication to deal with them, or whether they can be simply dealt with through therapy. Mental health problems can range from the not so severe – such as mild anxiety – to more severe problems like long-term depression. There are some that see medication as a short term, quick fix solution – it will give relief fast, but it doesn’t really teach one to deal with the heart of the problem – hence the suggestion of therapy and counselling. Yet there are those that remain convinced that while therapy re-educates the patient and deals with mental health difficulties on a long term basis, sometimes medication provides a greater level of immediacy in providing a solution, that its role cannot be denied. Should I take medication for _______” is one of the most frequent queries received. The ideal solution is probably a combination of medication and therapy, whilst gradually reducing the level of medication and therapy as the patient progresses.
Medication can be useful. For example, for those with paralysing anxiety, medication can minimise the stress and anxiety placed upon an individual by these stressors until the level of anxiety is at a comfortable and manageable level, enabling one to live their daily life while keeping their anxiety at a level they can control. However, for individuals with a severe mental health condition such as schizophrenia, the use of medication may be necessary in order to attain a level of mental stability and hence safety.
But medication is not just for a stabilising calm influence. For those, however, for whom facing the day is a burden, and who remain unable to get out of bed in the morning because depression has stolen all motivation, mental health medication can provide a jumpstart, an impetus to face the day. Certain people may benefit from taking psychotropic medication. For example, a study funded by the National Institute of Mental Health found that some individuals who were prescribed the selective serotonin reuptake inhibitor (SSRI) Paxil, because they experienced moderate to severe depression, experienced positive changes in mood, together with significant improvements in depressive symptoms. There was a marked decrease in the level of neuroticism and a similar increase in extroversion. These effects occured over a period of eight weeks and were nearly equivalent to the changes most adults experience in the course of a lifetime.
According to Maslow’s hierarchy of needs, human beings must satisfy more basic needs such as food and shelter before they attend to more self-actualising needs. It is difficult for most people to focus on avenues of self-growth when they are in crisis or struggling with anxiety, depression, or other mental health conditions. In some cases the polarisation can even lead them further into depression. In this instance, medication can support the psychotherapy process, and a stabilised person can progress further in psychotherapy having had the needs at the lower end of the hierarchy addressed. For example, a study published in the Journal of the American Medical Association shows that cognitive behavioural therapy combined with targeted medication tends to lead to significant improvement of attention deficit hyperactivity symptoms in adults. And in the long term, of course, a common outcome of successful psychotherapy is the reduction or elimination of the need for medications, so medication can be viewed as a temporary measure.
And while we have to recognise its benefits for the short term, we have to realise that medication can be harmful for some individuals if taken over a prolonged period. Most, if not all, drugs come with potential risks and side effects. Some can be minimal and tolerable while others carry disadvantages best considered as trade-offs. The side effects range from physical ones to emotional and psychological ones. Physical side effects range from dizziness, drowsiness, or changes in appetite, and/or weight gain. Emotional and psychological side effects may range from mood swings, disinterest in activities, or emotional numbness and a lack of empathy. Prescribed over a long term, antipsychotics may cause permanent damage by leading to conditions such as tardive dyskinesia or Parkinsonism, and may even cause death. The death may not be triggered by physical caused, but by mental irrational thinking. A 2005 article in the Harvard Mental Health Letter spelt out in detail the increasing awareness of risks associated with SSRI antidepressants, such as a potential increase in suicidal thinking and behaviours for adults and children under 24 years of age. One could, however, speculate if the suicidal thoughts were triggered by the medication directly, or whether it was the prospect of lifetime medication without an apparent cure that caused these feelings of hopelessness. Whichever you look at it, it is fair to say that there are people who will benefit from taking these medications, but also people who may experience lasting harm as a result of antidepressant use. The use of medication remains a double-edged sword.
But there are lines of thought that ascribe that medication is not always a necessary process. While medication may be effective for treating certain conditions, researchers at the University of Pennsylvania and Vanderbilt University suggested that, over a period of 16 months, cognitive therapy was a more effective means of preventing a relapse into depression than antidepressants alone. Research findings published in the Journal of the Amercan Medical Association found that while antidepressants were helpful for those experiencing severe depression, milder to moderate forms of depression derived more benefit from other treatment options, such as therapy. A 2010 article published in Newsweek arrived at the same conclusions, suggesting that, for some individuals, antidepressants are little more than a placebo.
To summarise what I’ve said so far: mental health is best addressed through a combination of therapy and medication. Severe forms of mental depression, which require more immediate intervention, would benefit from prescription drugs and therapy, while therapy alone may be sufficient enough for milder forms. Medication provides short-term benefit, especially in higher forms of depression, but we must be cautious over its long-term use because it can have side effects.
Medication can interfere with the emotions as well as the psychotherapy process. One of the most common side effects of psychotropic medication is difficulty feeling certain emotions, perhaps even a lack of empathy, once enough doseage of a drug accumulates in a person’s system. When we consume too much of a drug that is meant to limit our nerves, for example, many people complain of losing the feelings they used to have, report a reduction in their ability to laugh or cry, or experience a decrease in libido. These are the effects of medicines with a calming influence. Other side effects extend to one’s sexuality and love relationships, such as diminished sexual interest. Medication can also limit hyperactivity in the brain, acting as an emotional relaxant, but this slows emotional processing for some, and in doing so, covering up underlying issues and causing the psychotherapy process to be slowed down. A possible consequence of taking too much medication and becoming numb to feelings is the increased likelihood that a person will not become conscious of the emotional or somatic burdens which can cause of stress and suicidal feelings. It may be stretching things a little, but if you view medication as a substance, just like we view alcohol – too much consumption leads to physical health problems, as well as a capacity for clear thought processing – we can get a better idea of how the prescription of medication might not always be a clear-cut issue.
Proponents of a little- or no-medication approach to mental health point out that many emotional and mental health issues are not reducible to a biochemical imbalance. Life events — what happens to and around us – can impact on our mental health, and because medications do not change how people relate psychologically to their experiences, medication alone cannot “fix” all psychological issues. In fact, the temporal masking of life circumstances by medication is probably what induces people to overdose in the first place, taking more medication to completely obviate one to one’s surroundings. Treatment with medication alone can be like stitching up a bullet wound without taking the bullet out first – dealing with the effects without dealing with the cause. It is one of the main criticisms of the medical profession.
Furthermore, an over-simplification of what causes depression has led to the development of anti-depressant drugs that are actually designed to treat or minimise stress. These medications are often of little use because they have been tested on animals, and for the laboratory animals such as rats chronic stress does not cause depression. Psychotherapy, on the other hand, is often able to discover and treat some of the mental health issues that may contribute to depression, such as psychological trauma and anxiety. For example, a 1995 Consumer Reports study shows that some individuals experiencing mental health issues were significantly helped by psychotherapy. The study found that long-term therapy had, in general, the most beneficial effect, and that treatment with therapy alone was no less effective than treatment with medication and psychotherapy.
In an article “Mind over Meds,” which appeared in a 2010 issue of The New York Times Magazine, Dr. Daniel Carlat, a psychopharmacologist, found that the individuals he treated responded better to a combination of treatment with psychotherapy and medication together than they did purely with medication alone. The provision of counselling in addition to medication helped them to be better able to understand the true nature of their concerns. His findings are supported by research that therapy can stimulate the growth of neurons and synaptic connections between neurons. However, medication for depression, anxiety, and other emotional problems do not stimulate the brain; instead they dampen the brain’s mental activity. Therapy is capable of healing core problems and facilitating long-term changes, and why medication alone cannot. But medication is important in areas where the mental thoughts of the individual needs to be reduced to a lower level of activity.
Psychotropic drugs are prescribed to treat a variety of mental health issues when those issues cause significant impairment to healthy functioning. They work by changing or balancing the amount of important chemicals in the brain called neurotransmitters. The reduction or increase of neurotransmitters such as dopamine, serotonin, and norepinephrine have shown better mood improvements in some individuals. The ideal s to achieve a tolerable balance of these chemicals in order for the individual to attain a healthy life. Psychotropic drugs are usually prescribed by a psychiatrist, a psychiatric nurse practitioner (PMHNP), or a primary care physician
According to the WHO, one in four individuals will experience a mental health issue at some point in their lives. Depression and anxiety are among the most common issues, and these issues can affect people regardless of age, gender, ethnicity, or background. Researchers cannot point to the triggers of mental health impairment, but they can be attributable to environmental factors, genetics, traumatic events or serious injuries and result in psychological symptoms that persist for years.
As we have seen before, for some individuals psychotropic drugs are often not enough are best used as a supplement, and not a replacement, to therapy. Social support from family and friends, structured therapy, lifestyle changes – all leading to a change of environment – can all be important factors in the recovery process. But in some severe mental health issues may require inpatient rehabilitation before the person experiencing them can return to everyday life.
Certain individuals who are prescribed psychiatric medications may prefer not to take them, or they find that these medications do not improve their symptoms enough to outweigh any side effects or risks. Before you take any medication, it is always advisable to speak with your GP or seek specialist advice.
One major cause of concern regarding mental health and medication is the practice of prescribing medications that were originally developed for adults to children. The increase in diagnoses of psychiatric conditions in children – bipolar in particular – has led to an increase in the amount of children who take psychiatric medications. Many of which have only been fully tested in adults, and children take them in smaller doses, but the long-term impact of medication, as well as the effect on children who have yet to reach puberty needs to be examined.
Several different types of medications are used to treat mental health conditions. These include antipsychotics and anti-depressants.
Antipsychotics: These medications are most often prescribed for the treatment of psychotic issues such as schizophrenia. These drugs fall into two categories, typical and atypical antipsychotics.
The brand name is listed first, and the active ingredient is in parentheses.
Typical antipsychotics include:
Thorazine (chlorpromazine)
Trilafon (perphenazine)
Stelazine (trifluoperazine)
Serentil (mesoridazine)
Prolixin (fluphenazine)
Navane (thiothixene)
Moban (molindone)
Mellaril (thioridazine)
Loxitane (loxapine)
Haldol (haloperidol)
Atypical antipsychotics include:
Abilify (aripiprazole)
Clozaril (clozapine)
Geodon (ziprasidone)
Risperdal (risperidone)
Seroquel (quetiapine)
Zyprexa (olanzapine)
Antidepressants are a broad category of psychotropic drugs used for treating depression. There are several different classifications of antidepressants:
Selective serotonin reuptake inhibitors (SSRIs): These medications gradually increase the amount of serotonin, a neurotransmitter, in the brain. Common SSRIs include:
Celexa (citalopram)
Lexapro (escitalopram)
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Monoamine oxidase inhibitors (MAOIs): A less common variety of antidepressant drugs, MAOIs are often a last option with complex, treatment-resistant depression. Common MAOIs include:
Emsam (selegiline)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)
Tricyclics (TCAs): These older antidepressant medications have been pushed to the sidelines by newer, generally safer medications. Still, some people do not respond to the new antidepressants, so TCAs may be prescribed. Tricyclic medications include:
Anafranil (clomipramine)
Asendin (amoxapine)
Elavil (amitriptyline)
Norpramin (desipramine)
Pamelor (nortriptyline)
Sinequan (doxepin)
Surmontil (trimipramine)
Tofranil (imipramine)
Vivactil (protiptyline)
Selective norepinephrine reuptake inhibitors (SNRIs): These medications work by slowly increasing the amount of norepinephrine in the brain. Common SNRIs include:
Pristiq (desvenlafaxine)
Effexor (venlafaxine)
Cymbalta (duloxetine)
Antianxiety/antipanic medications: These medications are used to treat a variety of chronic and acute anxiety issues, from generalized anxiety to panic attacks. Antianxiety and antipanic medications on the market include:
Ativan (lorazepam)
BuSpar (buspirone)
Inderal (propranolol)
Klonopin (clonazepam)
Librium (chlordiazepoxide)
Serax (oxazepam)
Tenormin (atenolol)
Tranxene (clorazepate)
Valium (diazepam)
Xanax (alprazolam)
Stimulants: Typically, stimulants are prescribed to people with attention-deficit hyperactivity (ADHD). They help regulate disorganized thought processes. Psychomotor stimulants include:
Adderall (amphetamine and dextroamphetamine)
Dexedrine (dextroamphetamine)
Ritalin (methylphenidate)
Mood stabilisers: This category of psychotropic medication is typically used to treat intense, repeated shifts in a person’s mood, which may be common for those experiencing bipolar, schizophrenia, or borderline personality. Many mood stabiliser drugs are also commonly categorized as anticonvulsant medications.
Lamictal (lamotrigine)
Lithium
In 2013, the most prescribed psychotropic drugs in the United States (with the number of prescriptions written during the year) were:
Xanax (alprazolam), 48.5 million
Zoloft (sertraline), 41.4 million
Celexa (citalopram), 39.4 million
Prozac (fluoxetine), 28.3 million
Ativan (lorazepam), 27.9 million
Desyrel (trazodone HCL), 26.2 million
Lexapro (escitalopram), 24.9 million
Cymbalta (duloxetine), 18.6 million
Wellbutrin XL (bupropion HCL XL), 16.1 million
Effexor XR (venlafaxine HCL ER), 15.8 million
Should one be dismayed by the number of prescriptions in a YEAR alone, as well as the various types of medications available? However you feel about them, they all point to mental health as a significant issue, one that we cannot ignore. We have, however, to cautiously consider that medications that seem appropriate at this time may not be at a later stage. Ultimately, it is best that we learn to function without additive medication in the long term, not just because of their side effects – but if we are being cynical, under pressures of financial cost, medical research may in time suggest that certain forms of mental health medication were inadequate in the first place, and if funding is withdrawn patients may find themselves dependent on medication that they have to make their own provisions for – or worryingly, do without.
And it would be unfortunately ironic if the concerns over provision for mental health became another life stressor.
