9 Things to Know About Medication Management for Mental Health, by Caroline Whitaker, MS, NCC
Mental health has long been a spot of contention in our social discourse, a source of misunderstanding, fear, discrimination, and injustice. As a mental health professional, I take my role as an advocate very seriously when it comes to debunking the stigma around seeking help for mental illness. Perhaps no issue is more stigmatized than medication management: simply stated, the use of medication to treat symptoms of mental illness.
I’ve the most common med management conversations I have with clients and expanded on each point to provide insight and support for anyone out there considering seeking help. The more we know, the less we fear!
1. Medication won’t change who you are
A common concern when beginning medication stems from a fear of the unknown: "What if my medication changes me? I've been this way for so long, I don't know who I would be if I wasn't (depressed/anxious/manic/etc.)."
I like to shift the question ever so slightly, but it makes all the difference in the world: What if your medication helps empower you to be more of yourself?
It is true that many people on mental health medications report changes in the way they experience life... and for many people, that's a good thing! Mental health medication is designed primarily to address the physiological symptoms of the disorder. Those are the symptoms that affect parts of you beyond your control: changes in sleep, appetite, fatigue, loss of motivation, feeling restless and on edge, racing heart, seeing or hearing things that aren't there, etc. Those symptoms have nothing to do with who you are - that's just your body functioning the way it is physically designed to function. Research shows that most changes in personality that arise from medication management are typically associated with the reduction of these symptoms, and are usually positive (assuming the medication is correct).
It can be scary to imagine yourself living a life without your mental illness holding you back - when you have struggled for so long, it can be easy to over-familiarize yourself with your symptoms because they are familiar, comfortable, and safe. However, we are not our brains (I’ll say it again: we are not our brains). We are affected by the way our brains function, but we are not forever defined by what our brains do.
2. There is nothing weak, weird, or abnormal about needing medication
I often hear a lot of self-criticism and frustration for “depending on a pill” to be a "normal person". We live in a culture that unreasonably demands total control over every aspect of our being - our thoughts, our behaviors, our accomplishments - and when we encounter something uncontrollable, like a mental disorder, many people blame themselves for not being able to force themselves to feel better.
My favorite way of explaining it is this: everyone depends on a healthy flow of neurotransmitters to function and thrive. Everyone on earth needs the right balance serotonin, dopamine, norepinephrine, adrenaline, etc., to live full, productive, adaptive lives. Some brains produce it naturally, other brains require assistance - just like some bodies can produce their own insulin, other bodies require supplementation. If someone was in your shoes, they would need some more neurotransmitters, too.
3. Not every medication works the same for every person
Like many medications, mental health meds are not an exact science (seems like an oxymoron, doesn't it?). Because no two bodies work exactly the same way, no two medications will work the same for one person as they do for another. The key with medication management is patience and persistence. Just because your neighbor had a quick, positive reaction to his antidepressant doesn't mean that you will - and just because your coworker had a terrible experience with her anti-anxiety meds doesn't mean that you will, either. You are not a failure if your medication isn't working. It takes careful collaboration with a prescriber to help determine what unique combination of medicines your body needs to function and thrive. It can take months to find the right balance. Be open with your doctor about what you need.
4. Be wary of prescribers that don’t emphasize the importance of mental health
Research consistently shows that medication alone is not enough to fully manage mental health symptoms, yet all too often, some prescribers are willing to write a prescription for a medication without requiring follow-up from a mental health professional.
Mental health medications require oversight in order to determine if they're addressing what they need to address. A mental health professional can help you track changes in symptoms, provide insight about whether your symptoms or side effects are normal, and help you communicate with your prescriber about your needs. Because some mental health medications have potentially serious side-effects, it's important that you have someone help you in tracking your reaction to these meds until you know you are safe.
5. Medication is not an “easy fix”. It’s not supposed to be.
Often, some people become upset or angry if their mental health medication doesn't completely eradicate their symptoms. Medications may remove some of the unpleasantness of your mental illness, but they do not provide you with the coping skills and education you need to make lasting changes to your lifestyle and environment. Medication doesn't catapult you to the finish line - it merely sets you up at the starting line.
The truth is that people develop lifestyle adaptations to better cope with mental health struggles and compensate for things in life that might be lacking as a result of their mental health. Cognitive and behavioral patterns of functioning in the world become habitual, to the point where neural pathways are rewired to enforce these patterns. Fortunately, that's what counseling is for! Mental health professionals utilize multiple therapeutic orientations and techniques to help unlearn old ways of coping and instill newer, more adaptive ways of being.
I know it takes a lot more work to seek out regular counseling than it does to pop into your doctor once every six months for a refill. But for meaningful, lasting changes, it is important to commit to the hard work.
6. Addictions to mental health drugs are not as common as you think
Often I encounter clients who report anxiety about becoming “addicted” to their medication, and thus refuse to put themselves in the way of temptation. I want to validate that fear - for anyone who has previously struggled with addiction, or perhaps has seen a loved one struggle, the idea of using a drug to regulate yourself can seem too dangerous to risk.
The research suggests that most mental health medications have low abuse potential. When people speak of “depending on a medication”, they are usually referring to the positive changes that the medication brings about - improvements in mood, relationships, appetite, sleep, etc. If you stop taking a medication and experience a re-emergence of symptoms, that is not a symptom of addiction - that is simply your brain reacting to negative and uncomfortable thoughts and feelings that it hasn’t had to deal with in a long time, and wants to get away from. Working with a mental health professional can help you develop cognitive skills and coping tools to help decrease the distress you feel when unpleasant thoughts/feelings emerge.
There are some medications that produce withdrawal effects when not taken regularly, including shaking, cold sweats, irritability, nausea, etc. As I’ll talk about later, mental health medications affect more than just the brain due to the neurotransmitters involved, so the experience of withdrawal is simply your body adjusting to a sudden change in neurotransmitter transmissions. Be sure to take your medication as prescribed, and if you experience any withdrawal symptoms, contact your doctor to help manage your weaning process.
Now, it is important to note that there ARE some psychotherapeutic drugs that can foster physical or psychological dependence akin to addiction, and may produce severe withdrawal symptoms when discontinued. Typically, these medications are used as short-term interventions (i.e., they should not be prescribed for long-term, daily use), and there is a carefully-monitored process for weaning off of these medications in order to transition to different, more long-term drugs. If you are concerned about abuse potential, don’t hesitate to ask your doctor about alternative options.
7. Please do not discontinue your medication when you feel better
I absolutely cannot stress this enough. Other kinds of medications designed for the body are meant to be short-lived interventions, to be discontinued as soon as symptoms remit… this is not the case with mental health meds. Mental health medicines help your brain regulate the flow of neurotransmitters, a function that your brain cannot do all by itself. It’s the same way an inhaler helps you breathe, or insulin supports your pancreas - your body needs help, and your medication is the helper. When your helper is gone, your symptoms may come back - and if you haven’t been working with a counselor on coping skills and self-care strategies, the symptoms may feel even worse than before.
While it is true that some people may use medication and therapy for a short time to successfully manage symptoms and move forward, this is not the case for all people. Some people may require medication long-term, others may require multiple changes in medication over the years as their symptoms and bodies change.
Of course, it is absolutely your choice to decide whether or not you will continue with your course of medication. If you are ready to discontinue your meds, or if you are considering a change, I urge you to contact your prescriber to help manage the titration process. Some medications require a meticulous step-down process in order to prevent withdrawal symptoms.
And the way I see it, if the medication is helping you feel better, why take it away?
8. Don’t let the side-effects of a drug turn you off from seeking help
Mental health medications are unfortunately notorious for having a long list of potential side-effects. One of the reasons mental health meds affect you so much differently than other medications is the sheer number of neurotransmitter receptors throughout your body. The same chemicals that regulate mood, attention, and motivation are the same chemicals that regulate hunger, sleep cycles, and motor movements - at any given time of day, you've got chemicals all over your body! So it makes sense that when you take medication that changes the way your brain transmits neurotransmitters, the rest of your body needs time to adjust, too.
Many side-effects are temporary as your system grows accustomed to your medication. Your doctor should give you specifics on what to expect, and how long it might last. Your therapist can help you process the discomfort and develop coping strategies to help wait out the storm. Some side-effects may last longer, and will require lifestyle adjustments or additional medications to cope with these changes - changes in appetite, sleep, and libido are among the most distressing for many folks. This is another great opportunity for mental health counseling - your therapist can help you learn new ways of adjusting to these changes.
Remember: At the end of the day, you decide whether or not you are comfortable taking a medication. In my experience, it comes down to a cost-benefit analysis: Are these side-effects worth the improvements your mental health? If you are unhappy with the side effects, or if you don't like how you feel on a new medication, talk to your doctor ASAP about alternative medication possibilities. As stated earlier, please do not take yourself off of any medication unless instructed by a doctor.
9. Holistic approaches to mental health are great - just know your limits
We live in an age that is seeing a resurgence of natural, homeopathic, holistic treatments for mental and physical ailments. Hooray for this beautiful integration of healing techniques! We at Focus believe strongly in a multidisciplinary approach to wellness.
There is a time and place for all things. While it is true that natural approaches to mental health can be useful in managing symptoms and increasing vitality in life, there may be some circumstances in which medication is the only way to safely and effectively reduce symptoms.
The basic rule of thumb in mental health is to look for "global functioning" and "level of distress". Mental health providers are experts at listening for cues that suggest your symptoms are significantly reducing your quality of life, impacting your activities of daily living (ADLs), and potentially putting you in danger. If your attempts at naturalistic coping are not improving your symptoms, it may be time to consider medication - especially in the case of self-harm and suicidal ideation.
This doesn’t mean you have to abandon your naturalistic coping skills! I believe strongly that medication, counseling, and holistic treatment are beautiful remedies when used together. But how much easier would it be to go to that yoga class, or meet up with friends at the mall, or go grocery shopping for the week, if you weren’t so fatigued that you can’t get out of bed, or so anxious that you want to crawl out of your skin? That’s where medication can make a big difference.
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