Some of My Thoughts on Medications

In this day and age medications are such a mixed bag. There’s the idea that they are an overused cure-all dispensed at the drop of a hat, or that we, as a nation, are a bunch of medicated zombies, afraid to feel or experience our pain—even though pain, it is often believed, necessary to stimulate change. Just consider the Nike slogan: Just do it. On a more personal note, individuals often view taking medications, such as anti-depressants, as a sign of weakness, an admission that one can’t handle things on their own, or that medications will change or alter who they are.

But medications have their place in psychotherapy. While I am not an advocate—in the sense that I “push” for their use, in my clinical experience I have definitely seen the benefits of their use. I try and see the use of medications as a tool, whether it be for long term treatment of depression and/or  anxiety, or whether time-limited use to get a leg up on a depressive episode, physiological or situational. And yet, I am also a firm believer in self determination—that is, one’s wish to try and over come depression and/or anxiety on their own, albeit proactively, such as exercise, change in diet, monitoring or stopping alcohol and drug use, as well as monitoring thought patterns and their emotional reactions.

If medications are necessary, I strongly recommended an evaluation by a psychiatrist or psycho-pharmacologist before seriously considering trying any medication. Often times individuals receive prescriptions from General Practitioners who may not have the necessary training, knowledge or experience with psychotropic medications. Often times these medications must be “tailored” to the individual, and follow up is a necessary part of the procedure. With every diagnosis, such as depression, there are various, related clusters of symptoms that particular medications correspond to. For example one medication may treat a depression that presents with anxiety, another with more sluggish symptoms.

Clinical studies have shown medications on their own have limited effects, but provide greater benefits when used in tandem with psychotherapy.

The example I most often give patients is that I once worked with a woman who came in with very definite symptoms of depression. In addition to these she complained that she hated her job, had difficulties with her relationship, couldn’t get along with her family, and suffered from low self esteem. After about a month of working together, the symptoms of depression weren’t lessoning, and in fact made it difficult for her to genuinely attend to the other issues in her life, so I suggested she get evaluated for medication. As it turned out, she was put on an anti-depressant. Within a month her symptoms had markedly abated and she was able to make real progress in therapy, and began to feel better about her circumstances. In the third month her medication ran out, but she put off refilling her prescription. On the first day she felt ok, on the second she began to feel slightly depressed, and by the third and fourth day she felt down right bad. Looking back on her life in session, she exclaimed, “I still hate my job, I still have issues in my relationship, and I don’t get along with my family! Why am I taking these things?” When asked how she’d felt while she was on the medications, she answered she had felt much better, more capable of tackling these issues, but now she didn’t. Then something dawned on her: she had a choice. It was one thing to have these issues in her life,  another to have them and feel bad, and still another, to have them but be in a place to better deal with them–which, she had been doing. It came down to a “simple” shift in perspective—while she was actively trying to remedy these issues, wouldn’t it better, if not more helpful, to feel “better” as she did so. So she went back on her medications, and sure enough, she went right back to tackling her issues. Now, I’d be lying if I said she resolved each of these perfectly. But the medications gave her a leg up on the negative feelings she was experiencing either as a result of her issues/circumstances, or due to the symptoms of depression. They also allowed her to experience what it was like to be without depression, to at least know what sort of state she was striving towards in her therapy.

I don’t relate this to necessarily advocate for medications (the antidote in many ways highlights a particular paradox), but instead I use it to demonstrate how medications might be used for a particular, perhaps time-limited, purpose, rather than some magic cure-all.

Again, my point of view is based on what I have seen in my practice.

By the same token, some “depressions” may be better viewed as  the psyches’ way of alerting the individual to take a closer look at their life—possibly an existential crisis, and this case wouldn’t call for medications, and can be “treated” through psychotherapy, or in combination with some life style changes. Alcohol and drug use, careless nutrition, a lack of exercise, and sometimes a lack of determination can all contribute to depressive symptoms. Dare I repeat, “All roads lead to Rome?”