Picture this scenario: you are seeing your primary care doctor for your annual checkup and your doctor tells you that your blood pressure is high. You are frustrated as your blood pressure has been high over the last several years despite following your doctor’s recommendations of improving your diet and increasing your exercise. Your doctor now recommends that you take an anti-hypertensive medication.
Now picture this scenario: you are seeing a psychiatrist because you have been struggling with a depressed mood, which has negatively impacted your relationship, your friendships, and your job performance. You have been depressed for a long time, and have tried to feel better by exercising more, taking supplements, pursuing meditation and yoga, and you have even seen a therapist for a few months. Nothing has really made a significant difference in your mood. Your psychiatrist recommends that you take an antidepressant medication.
Are these two scenarios really any different? In the former, deciding to take an anti-hypertensive medication can be viewed as taking care of a potentially life threatening condition affecting your heart. In the latter, deciding to take an antidepressant medication can be viewed as taking care of a potentially life threatening condition affecting your brain.
So, why do these two scenarios feel so different to many people? Unfortunately, mental health continues to carry a major stigma. We do not view depression and hypertension in the same way. Many people continue to think that depression is a sign of weakness rather than a legitimate medical condition. If you would only “pull yourself up by your bootstraps” you would feel better. People often fear antidepressants will change their personalities, make them violent, or make them feel drugged. While every medication has its adverse effects, the media often exaggerates and sensationalizes all of the things that can possibly go wrong when taking a medication.
As a psychiatrist, I do not consider myself a psychopharmacologist or “pill pusher.” I take time to get to know the patient’s story, and develop a treatment plan that may or may not include medication. In psychiatry, we often refer to the word biopsychosocial. The bio refers to our genetics and the way our brains are wired. It refers to the fact that the mental illnesses that our loved ones and friends struggle with are disorders of the brain, and they are not psychological defects that we should feel guilty about.
When a patient is experiencing minor or mild symptoms of a psychiatric condition such as anxiety or depression, I typically recommend trying non-pharmacologic treatment strategies such as psychotherapy. When these strategies have been tried with no improvement, then it is reasonable to think about medication. When a patient is struggling with more moderate to severe symptoms, I typically recommend starting medication right away as the chances of symptom reduction are greater with combined treatments. Medication can often make it easier for people to employ other strategies to feel better. Of course, medication should always be prescribed and monitored by a qualified physician.
I view medication as one tool that can be used on the journey to mental wellness. Just as there is no shame in taking a pill to help your heart function better, there is no shame in taking a pill to take care of your brain.
- Meds for Mental Health? - March 12, 2014
