What’s so Bad - or so Good - about Medication? - Amy Meyers,PhD, LCSW-R Psychotherapy

What’s so Bad - or so Good - about Medication?

3/7/2023

There are those who believe medication is the cure to mental health, and those who are deeply opposed. Who should take medication? I believe that it is a deeply personal decision. Everyone and anyone has the right to self-determine if medication is for them. There are a lot of potential side effects and it's not a one-size fits all industry. This means that even though there are specific and multiple medications aimed to treat depression, what works for one person may not work for another. And therefore, someone may have to go through several trials of various medications to identify the one that works best. This, and potential side effects can make this route overwhelming, and unpleasant. For example, medications can cause dry mouth, a low sex drive, and shaky hands, or jittery legs. This may be so uncomfortable that someone chooses to live with their mental health symptoms. It reminds me of the mantra "my body, my choice". As long as someone is not suicidal or homicidal, I believe that decision should be theirs.

As a helping professional, my perspective has shifted over the years. Once upon a time, I was not one to recommend meds to clients unless they were part of the SPMI population - seriously, persistently mentally ill, ie: schizophrenic, bipolar. Hearing voices and being manic are not something one can work on in therapy. However, there are many other disorders from depression to anxiety to attention-deficit disorder that can make functioning extremely difficult. So why not alleviate the pain? If you have a headache, you take an aspirin. I know we are a society that emphasizes medication, if not pushes it. I'm not saying it's a lifetime solution. But, I have come to believe that if functioning is impaired, and medication can help to reduce symptoms and activate functioning, it can be very useful... in conjunction with therapy. Otherwise, the medication is a band-aid that can become the cure-all for a lifetime. It can be healthier (medically and mentally) to learn coping mechanisms and techniques to address the symptoms of disorders. Now, if we look at those disorders that are physiological (due to brain chemistry), then this is another reason why medication may be helpful. But it doesn't mean those feelings can't be addressed in other ways. Let's focus on anxiety and depression as examples. These are two mental health diagnoses that can be bio-chemically based or situationally ignited. Either way, medication can be useful. In the case of situational anxiety or depression, perhaps there should be a period of time before medication is considered the key determinant. But also the intensity of anxiety or depression should be considered. Even if it's a short duration (3 months; 6 months), but it is hindering functioning (ie: difficulty getting out of bed; unable to control crying at work; panic attacks; paralyzing anxiety), medication may take off the "edge" enough to be able to address coping skills in therapy. When someone is so consumed by difficult emotions (ie: obsessional thoughts), sometimes the therapy does not help if the "work" can't be done.

Concrete skills, shifting thought patterns; and behavioral interventions can be a powerful tool as an alternative to medication. I work from a psychodynamic lens. This means that I tend to focus on how we developed; our parenting; our environment; our experiences; and how that has shaped who we are, how we think the way we do, and how we behave and relate the way we do. I also believe that clients should be given feedback, and that they learn and can change how they relate in the world, by becoming aware of how they are relating to the therapist. We can learn a lot about someone from the client-therapist relationship. Psychodynamic therapists also do a lot of re-parenting. And, with the understanding of where the client's emotions and perceptions come from, we can work on healing those emotions and shifting those perspectives. That being said, working on shifting irrational thought processes and working with concrete interventions is important. And, if medication is needed as a supplemental tool, it is something to be discussed. With always in mind, the client is the captain of the ship.

What is the conclusion on medication?
- Do your own research; learn about side effects and the risk/reward ratio
- Consult with your therapist
- A medical doctor will prescribe medication but is not trained in emotions; so consider who will be monitoring your meds
- Consider alternate ways of working on your issue/disorder and determine what you are most at ease with
- This is your decision to make

If you want to hear more about this subject, tune in to episode #20 of "What Would Dr. Meyers Do?" on apple, google, or spotify... or this website under the tab "podcast".

10 Comments

Danielle DelVecchio

3/11/2023 01:23:20 pm

I found this to be a very interesting topic. I have often thought on the topic of medication and whether it's good or bad. I agree with your statement that medication is completely a personal choice. It is most definitely not a one size fits all industry. I think there is a lot of trial and error when it comes to medication. Personally, I feel medication is a backup method and can be balanced with other alternative coping strategies. This can include holistic approaches as well. I noticed your example of "if you have a headache, you take an aspirin" and I wanted to touch on it. I feel this can be the case for certain individuals and proven to be effective. However, I feel there are alternatives such as drinking more water, needing to eat the proper meals each day, and massaging techniques that alleviate the pain. I feel aspirin should not be relied on nor should be the go to fix every time. I think it's important to try the alternate methods first and if all else fails then lean to aspirin. I drag out this example to say I think for medication there should be multiple alternatives and methods attempted before one goes to medication. Additionally, I think once one identifies alternative strategies they can move to also combining these strategies with medication. I don't think it needs to be one or the other. I also feel some tend to rely on medications due to a lack of knowledge or awareness of alternative strategies that can be done. I also feel sometimes medications may not be as effective if that's the only "fix" being relied on. Have you had a moment where you have a headache, take an aspirin and your headache is still there? I think this happens because there are deeper roots and alternatives to be explored first. I also think it's important to acknowledge as you mentioned that medication may make it easier to utilize the coping strategies one learned in therapy. To conclude, I think balance is important and it's not always one or the other. I also think it's important to acknowledge that trial and error is normal and we should not always lean towards a quick bandaid fix. Sometimes we need both, sometimes we need one or the other; It really comes down to the individual and their experiences at hand.

Amy Meyers

4/14/2023 12:21:55 pm

Danielle,
Love your critical thinking. Yes, there are always considerations and alternatives. Definitely not an either/or and I like your rationale.

Leora Keehn

11/20/2023 11:30:52 am

Confrontation is not an easy idea to grasp. It is often a topic people shy away from. I agree that it is a form of communication. However, some perceive it as a scary form of communication. The negative connotations that are linked with confrontation are ones that we should gear away from. Confrontation is a necessity to having a successful career. When we do something wrong or there is something we can do better, it is vital to be aware of it. This is especially true as social work students. The purpose of our internships is to learn and grow. Part of learning in an internship is learning how to take that confrontation without being hurt by it. I agree that we must learn how to tolerate the uncomfortable feelings that come with confrontation. It is hard, but there are coping mechanisms that help reduce that anxiety. The examples that would be most helpful to me would be to sit and understand the content and context. In addition, timing is everything. When someone is upset or you catch them off guard, it isn't the right time. Ultimately, it is important to do all this in a healthy and productive way.

Christian DiConsiglio

3/11/2023 05:55:28 pm

Dr. Meyers I am really glad you wrote a blog post about this topic, medication. Especially since it is one of my favorite topics to discuss, and we haven't really ever discussed it in any of our classes. I am guessing it is more so a graduate school discussion because it can be a very difficult discussion to participate in. It was so nice reading your opinion in this blog post because I honestly share the same opinion as well as the same previous opinion you wrote about in the first paragraph. I honestly felt like I was reading something I wrote while reading that entire first paragraph. When I first started school in SCCC Human Service program I had a very anti medication stance and approach to any type of therapeutic practice except if the individual had been diagnosed with a disorder that involved symptoms such as physical or auditory hallucinations. But as time went on and I encountered more practice whether it was in the classroom, work, or field, I began to see the importance in medication for other disorders. Especially the one's you mentioned, anxiety, depression, and ADHD. I also share the same answer as to why, "why not ease the pain a little." However, I do think a person should proceed with caution since a lot of medications utilized for these disorders can be controlled substances with severe side effects such as withdrawal symptoms, which as I am sure you know can be fatal with certain medications prescribed for anxiety and depression due to the possibility of becoming physically dependent. But again as I said, easing the pain can be very positive. I support that opinion because if a person cannot leave the house as a result of panic form anxiety, or cannot get out of bed as a result from the severe sadness they are feeling from their depression, how can they even begin to think about attending therapy, let alone, leave their home to go to therapy and begin working on their struggles. Extreme examples, I know, but still easy way to support what I am attempting to say.

Something I found interesting was that you did not mention anything about MAT and your thoughts and feelings about medication being used to treat, aid, assist, help, etc. in addiction in this blog post. I am definitely interested in your opinion of that area of this topic. Especially when it comes to medications that assist in withdrawal from opiates such as Methadone and Suboxone. I have a mixed view of this form of treatment. It cannot be the only form of treatment, some type of therapy (preferably individual and group), and some type of self-help program should definitely be a part of the treatment plan along with medication. But how long do you think someone should be prescribed these medications? When does it change from being prescribed treatment, to becoming prescribed prolonging of the inevitable?
I do believe these medications can help because the hardest part in my opinion for a substance user is getting started stopping and medications can be very helpful in assisting a substance user to finally getting their foot in the door so to speak. Like I said interested in your thoughts and again, really glad you wrote about this topic, and I would actually like to see you publish something in this area.

Anthony Gaetani

3/21/2023 04:29:27 pm

Hey Christian, I really like your response to this podcast. Particularly, I like your reference to MAT. I definitely have to agree with you. Where I work, clients are encouraged to meet with our onsite physician for an MAT assessment. Clients however are encouraged that if they do agree to MAT, they must also be coming to treatment and meeting with their counselor at least once a week in addition to their MAT. I often question the same thing, how long can a person be prescribed the medication? If a person stops taking it, will they relapse? Many view addiction as a disease, and when a person is diagnosed with a disease, they take medications to manage it. I think individuals who are using MAT should also be encouraged to work through their treatment with a mental health professional to help navigate their feelings associated with their substance use. Great post, it was very thought provoking

4/14/2023 12:28:27 pm

Hi Christian,
You raise an important and interesting question regarding medication use in the treatment of substance use. I am not an expert in this area and I believe the controversy is regarding substituting dependency. It's a tough question. I suppose I would weigh on the benefit of it's use to address withdrawal and other symptoms that the self-medication of substance use is covering (ie: depression, anxiety, self-esteem). However, I would think that it would be important to monitor the use of prescribed medication, and in conjunction with other therapies - with the goal of using meds as a transition to sober living and the development of coping strategies.

3/21/2023 04:24:20 pm

This was a very interesting podcast to listen to and it was one that I resonate with a lot. Personally, I have always struggled with the idea of medicine and I was always very hesitant to start medication. I feared feeling like a "robot" and not having any emotions. There was a time not too long ago when I decided I needed my own therapy, so I started working with a therapist and it was not until about 6 months into treatment when my therapist recommended medication to help manage symptoms of depression and anxiety. I was very reluctant at first. After this and some time considering it, I met with a provider and decided to try medication. I spoke with my provider and she explained the medication, how it works, and any side effects. This was very helpful for me. Medication, along with therapy, was transformative for me in my ability to manage my symptoms and live with the feelings I was living with. My feelings of becoming dependent on medication and not being able to live "normally" diminished as I continued to stick to my medication, go to therapy, and partake in holistic exercises that were helpful for me.
I'd like to acknowledge the fact that there are other measures that can be taken - for example, holistic approaches that can be taken to help cope and manage symptoms and different diagnoses. I think these can work well and can only improve the symptoms, in addition to a medication regime and therapeutic relationship.
Working and interning in an outpatient substance abuse clinic, I am often tasked with clients who are looking to abstain from using substances and many expressed their lack of interest in using medication to assist with their treatment. Many clients in the clinic are not only living with substance abuse, but also with mental health conditions that require medication to manage their diagnoses. I think medication to handle diagnoses should be encouraged. We would not tell a diabetic patient for example to avoid taking their insulin; diabetes is a disease that must be treated. Holistic approaches cannot and will not help a client manage their symptoms and their disease. Similarly, individuals with psychiatric conditions should be encouraged to take medication.

4/14/2023 12:30:27 pm

Hi Anthony,
Perhaps the point is that the client has the right to self-determination and it is our job as clinicians to provide psychoeducation so that they can make the most informed decision. Someone can always shift their view depending on how they are coping.

Joy McCallion

5/8/2023 12:00:36 am

Dr Meyers,
I really enjoyed reading your blog on this topic! I initially agreed with your first thought on recommending medication to those who are in the SPMI population. I felt this way because I grew up in a household where medication was frowned upon unless it was a life threatening circumstance. As many know, I was diagnosed with ADHD at the age of eight and I have never taken medication because my parents did not allow it. Sometimes I wonder what it would have been like if I were taking medication since the time if my diagnosis. At this point, I would not consider medication because I feel that my ADHD is part of who I am and my personality. Up until now, I have not thought of medication as "my body, my choice" because many doctors push medication when something is wrong, or at least in my experience. I think this was a really healthy way of talking about a subject that some students may not have explored like myself.

5/8/2023 10:55:37 am

Joy, you raise an interesting perspective about embracing your ADHD and personality attributes you have. Perhaps you will explore medication in the future if you feel the impact of your diagnosis is impacting you in a way that is intrusive, perhaps not. But I'm glad you now know the decision is yours and yours only to make.

What’s so Bad - or so Good - about Medication?

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