Medicines aren’t Magic, but they can Boost Mental Health Treatment
Perhaps nothing is more misunderstood in mental health treatment than the role of medications – the advantages they can provide, the potential progress that can be made, and the importance of partnering with your provider to manage their use.
Working hand in hand with your psychiatrist or physician may seem like common sense, especially when it comes to medication management, but preconceived notions, perceptions about prescription drugs, and misguided expectations can all play a role in interfering with a successful treatment plan.
Something to take into consideration when it comes to considering effective treatment for depressive disorders or other mental health struggles: we are all unique in our experiences, our thoughts, and our struggles.
So naturally, what might work for one person may not work for another.
That goes for the question of medications in mental health treatment as well. Whether it is trauma, substance abuse, anxiety, or depression, psychotherapy can be effective, and for many people, talk therapy alone works.
So, what role do medications have in the mix?
Studies have repeatedly shown that talk therapy and medication therapy are essentially equivalent when evaluated head-to-head, and it has been proven that there is an added benefit when the two are used in combination.[1] So, when is it right to begin considering medications?
The most obvious indicator is when individuals experience insufficient results from seeking out psychotherapy alone. Introducing medications as an option provides a combination therapy that can prove beneficial.
Where we typically see medications being most effective is for physical symptoms such as fatigue, insomnia, apathy, restlessness/anxiety, and racing thought patterns. The other area is trauma response for those who experience flashbacks, nightmares, or a heightened sense of fear/arousal. There are a variety of good medication options that can calm those experiences down!
While medications won’t turn on a magic light switch and usher in a good mood overnight, for someone with depressive disorder, they can lighten the load by helping with the day-to-day limitations that can feel burdensome – such as apathy or lack of energy. Targeting those experiences can give someone the latitude they need to reengage in a sense of purpose and to recognize the value in their relationships. Quite simply it can give someone the energy to make the required effort.
It’s an important point of education! Medications can help clients experience indirect effects that help better manage their symptoms of anxiety and depression. I like to say that living life with trauma or other mental health struggle is like wearing a 60-lb backpack!
The medications won’t unbuckle the heavy pack and lift it completely off your shoulders. But they can lighten the load.
Suddenly that hill isn’t as challenging to climb and your endurance to hike another mile is markedly improved. Medications create the scenario that you can suddenly do things in your daily life that you haven’t been able to do in a while. Little by little, the gains made will alter someone’s internal experience so they can suddenly take bigger steps and go further.
A Flexible Brain is a Hopeful Brain
I sometimes get asked if people who experience depression may have a chemical imbalance. That term refers to lower levels of serotonin. This serotonin theory of treating depression was developed because it was noticed that medications can improve serotonin levels; consequently, a hypothesis developed that low levels of serotonin must have been the cause for the depression in the first place. But that’s a risky oversimplification. Mental health symptom management is more complex than that[2].
While it was an interesting discovery that medications can increase levels of serotonin, it was a bigger breakthrough that revealed that the chemical reaction medications create can actually help the human brain make new connections and pathways.
It was proven through a series of brain imaging studies where scientists saw this happen with their own eyes. Those pathways are like new bridges built to traverse the river rather than relying on the well-worn and arduous route overgrown with hazardous entanglements of vines, weeds, and rocks that made the route unpassable.
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This new series of roads and pathways is known as neuroplasticity. By helping the brain adapt or change over time, new neurons and new networks are built. The idea of neuroplasticity has challenged the historic belief that the brain stops growing after childhood.[3] But current research, which supports the idea of medications having equal impact to psychotherapy, is that our brains continue to grow and change throughout our lifespan. So, the effectiveness of medications is much more than the idea of having more serotonin, and therefore quite simply, the depression is treated.
So, if psychotherapy is equal to medication therapy and has the same ability to create new brain pathways to allow for new ideas, habits, skills, and abilities, along with new ways of thinking, then why doesn’t psychotherapy simply work alone when it comes to moderate to severe depression? Why bother boosting with meds at all?
After all, we know that psychotherapy interventions can target experiences quite precisely. We also know that the effect can be far longer lasting than medications themselves because it can help someone engage with and learn new skills and learn to use tools to manage thought patterns that are ultimately more sustainable and long-term.
Think about it – the idea of neuroplasticity is the idea of our brains being flexible. The more we can create flexibility in the brain, the better chance someone has to create better habits and new approaches to life’s challenges.
Combination therapy nets a far greater impact on someone’s day-to-day life by more effectively managing their symptoms. It is especially true that psychotherapy interventions take some time to unfold. That’s where medications can be helpful in short-term management. Effects can be seen sometimes within a few weeks and then the psychotherapy engagement over weeks and months can sustain the results long-term. That’s how encouraging both psychotherapeutic interventions as well as medication management in combination can have a more robust result than either one individually.
Obstacles to Taking and Staying on Medications
In our practice, I have found that it is best to transition clients to combination therapy by setting expectations upfront. First, know that medications are not perfect! There is no golden pill glowing with the promise of fixing every issue and magically snapping everything back into place.
What is really promising in treatment today are all the options available to help individuals with various mental health conditions. Yet, individuals can still be apprehensive about starting medications and remaining on them. Here are a few reasons why:
1. Worry about side effects – If someone has had previous adverse effects or knows someone who has, they may be more hesitant to try that route. By working closely with them to understand their history, our team can go forward with some options and monitor their use, helping them move past this concern.
2. Reinforces feelings of inadequacy – Individuals may feel that by needing to take medications that they are somehow weak or don’t have the skills or tools that others possess to manage their symptoms to help themselves. Many times, clients don’t recognize that this psychological deterrent is a flawed belief and shouldn’t stop them from trying the potential benefits of medication therapy.
3. Fear of emotional numbness – A common misconception is that medications will keep someone from feeling normal feelings and emotions and that they will end up going through life unfeeling and dispassionate, This inaccurate portrayal keeps them fearful and may convince them that they will somehow lose their identity if they take them.
4. Losing control – Not understanding how a medication will alter someone’s behavior is another concern. The fear that they will lose their sense of control can often grow into a concern that they will also be hopelessly dependent on taking the medication for the rest of their lives and that they won’t be able to live their lives without it. Statistics prove a different outcome, however. A majority of people who take medications do not need to remain on them long-term.
5. Dynamic versus static risk factors – When we sit down with clients to suggest medication therapy, we take an inventory of the risks of them adhering to the guidance we provide. We give careful thought to what can we influence and can change (dynamic factors), and what factors are outside of our control at this time (static factors).
Medication Management Made Easy
Some clients leave my office in earnest, wanting to be faithful to taking their medications every day but there may be some barriers that come into play that keep them from that consistency.
How can you avoid this problem? Work together with your provider and identify up front what those things could be so you can both proactively address them:
Create a Routine: Some clients just aren’t good at remembering to take their medicines. This is a dynamic factor, and we can do some things to help change that. For example, I will try to help someone think differently about how their daily routine can support the new habit of taking meds. For example, if they brew a pot of coffee every morning, setting aside their pills next to their coffeemaker can be an easy reminder to take them daily.
Communication: Keeping an open line of communication with your provider is key to managing consistency in taking medications. Worried about side effects? That’s an important conversation to have. You should feel comfortable bringing those concerns to your doctor and letting him/her know what you are experiencing. That will provide an opportunity to either adjust the dosage or prescribe a different medication to limit potential side effects and improve consistency.
Empowering Patients Through Education: Helping you feel in control is one of the best ways to ensure you will not only take the medication as prescribed but also feel that you have some say over your treatment. For instance, I may introduce three medication management options to them. I discuss what to expect and what the trade-offs are then let them make the choice that is the best fit for them.
Change How You Perceive your Care Provider: Instead of looking at your physician as an imposing figure in your life that holds all the cards, instead, alter your perspective to see them as walking the path of recovery along with you as your guide. I approach my clients with the idea that they are partnering with me in their care in a way that creates trust and helps them progress faster.
Stay True to your Regular Appointments: Appointments with your provider are where care decisions are made. There is a harmonious partnership in finding solutions together that work for both the short and long term. It is a time for conversations that evaluate the risk/benefit tradeoff of each medication to ensure that the benefits of the interventions are outweighing the risks.
Experts at Clarity Behavioral Health understand that it is important to meet clients where they are in their journey. We are trained to educate and partner with our clients to help them understand the alternatives available to them in treating their mental health concerns. We understand that we all come from different places and our experiences and our perceptions matter. Whether through psychotherapy or medications or through a combination of each, we can support our clients because we believe there’s no obstacle too big to overcome to not live your best life.