March Topic: Prescription Medication and Mental Illness
Mental illness is a condition in the brain that changes thinking, emotions, behavior, or a combination of these. When a person struggles with a mental illness, they will often begin to struggle with personal relationships, work, and school. Those who struggle with mental illness have trouble with daily life and activities. No two mental health problems are alike, even when two people receive the same diagnosis – their experiences of these conditions will vary.
What Is Mental Illness?
Multiple underlying causes are associated with the development of mental illness. Genetics, environmental factors, life stress, trauma, and even certain substances can all cause or trigger a mental illness.
Although mental illness can be very disruptive to a person’s life, these brain changes are very common. The National Alliance on Mental Illness (NAMI) reports that 1 in 5 US adults experiences a mental illness every year, and 1 in 17 lives with a severe mental illness, such as schizophrenia or bipolar disorder. Half of these mental conditions develop in adolescence, often around age 14, while others develop in adulthood. Around 75 percent of mental illnesses present by 24 years old.
The Substance Abuse and Mental Health Services Administration (SAMHSA) found that, in 2014, about 4.1 percent of people ages 18 and older (about 9.8 million adults), had a serious mental illness. Between 1 percent and 20 percent of children struggled with a serious emotional disturbance (SED), which may develop into a later substance abuse or mental health disorder if left untreated.
Categories of mental illnesses include:
· Anxiety disorders: General anxiety disorder, panic disorders, specific phobias, social phobia, and post-traumatic stress disorder all fall into this category.
· Depression: Major depression, dysthymic disorder, clinical depression, postpartum depression, and unipolar depression are all forms of depressive disorders.
· Bipolar disorder: There are three primary forms of bipolar disorder – bipolar disorder I, II, and cyclothymic disorder. However, the DSM-5 also recognizes unspecified bipolar disorder, and many clinical psychologists are debating the place of seasonal affective disorder, which is a mood disorder like both depression and bipolar disorders.
· Personality disorders: These disorders involve a rigid, uncompromising view of the world and the inability to deal socially with others. These include:
· Cluster A: schizoid personality disorder, paranoid personality disorder, and schizotypal personality disorder
· Cluster B: antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder
· Cluster C: avoidant personality disorder, dependent personality disorder, and obsessive-compulsive disorder
· Psychotic disorders: This is a broader, vaguer category for mental health compared to other listed mental illnesses, and they are primarily characterized by psychotic episodes. Some conditions that fall under psychotic disorders include postpartum psychosis, schizoaffective disorder, and schizophrenia.
1 in 12 people who struggle with a mental illness also struggle with a substance use disorder.
Treating these conditions with specific medications, alongside regular talk therapy sessions, is very important to help these individuals maintain normal, healthy lives. People with both a mental illness and a substance use disorder – a combination called co-occurring disorders – often begin to abuse substances to self-medicate or regulate their brain chemistry. Sometimes, an individual with a substance use disorder will develop a mental health problem due to brain chemistry changes from intoxicating substances. Prescribed medication with the oversight of a psychiatrist, and therapy with a psychologist or counselor, is safe and effective; self-medicating is dangerous and can lead to death.
Getting a great team of medical professionals to treat mental illness and co-occurring substance abuse helps many people live well by managing these chronic conditions. The team will include: Primary care physicians, Nurses and physician assistants, Psychiatrists, Psychotherapists, Pharmacists, Social workers, and Family and close friends.
1 in 6 Americans Takes a Psychiatric Drug
Antidepressants were most common, followed by anxiety relievers and antipsychotics. One in six U.S. adults reported taking a psychiatric drug, such as an antidepressant or a sedative, in 2013, a new study found. The new data comes from an analysis of the 2013 Medical Expenditure Panel Survey (MEPS), which gathered information on the cost and use of health care in the United States.
An earlier government report, from 2011, found that just over one in 10 adults reported taking prescription drugs for "problems with emotions, nerves or mental health," JAMA Internal Medicine.
But that report, from the Substance Abuse and Mental Health Services Administration, didn't "provide information on which specific medications were more commonly used " or on how long they were used, said authors of the new study, Thomas Moore, a senior scientist at the Pennsylvania-based nonprofit organization the Institute for Safe Medication Practices, and Dr. Donald Mattison, the chief medical officer at the Canadian consulting company Risk Sciences International. Moore and Mattison found that nearly 17 percent of adults in the U.S. reported filling at least one prescription for a psychiatric drug in 2013.
Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs, the study said. In addition, 8.3 percent of adults were prescribed drugs from a group that included sedatives, hypnotics and anti-anxiety drugs, and 1.6 percent of adults were given antipsychotics, the researchers found.
Psychiatric drug use differed among adults of different ages, sex and race, the researchers found. For example, nearly 21 percent of white adults reported taking a psychiatric drug, compared with less than 9 percent of Hispanic adults, according to the report.
Older adults also reported a higher rate of psychiatric drug use. One-quarter of adults ages 60 to 85 reported taking at least one of these drugs, compared with less than 10 percent of adults ages 18 to 39, the researchers found. In addition, nearly twice as many women as men reported taking psychiatric drugs: 21 percent compared with 12 percent, according to the report.
Mental Health Medications Overview
Medications can play a role in treating several mental disorders and conditions. Treatment may also include psychotherapy (also called “talk therapy”) and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person's individual needs and medical situation and under a mental health professional’s care.
Understanding Your Medications
If you are prescribed a medication, be sure that you:
· Tell the doctor about all medications and vitamin supplements you are already taking.
· Remind your doctor about any allergies and any problems you have had with medicines.
· Understand how to take the medicine before you start using it and take your medicine as instructed.
· Don't take medicines prescribed for another person or give yours to someone else.
· Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.
· Report serious side effects to the FDA MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088]. You or your doctor may send a report.
What are antidepressants? Antidepressants are medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults.
The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include: Fluoxetine, Citalopram, Sertraline, Paroxetine and Escitalopram.
Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine and duloxetine. Another antidepressant that is commonly used is bupropion. Bupropion is a third type of antidepressant which works differently than either SSRIs or SNRIs. Bupropion is also used to treat seasonal affective disorder and to help people stop smoking.
SSRIs, SNRIs, and bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.
How do people respond to antidepressants? According to a research review by the Agency for Healthcare Research and Quality, all antidepressant medications work about as well as each other to improve symptoms of depression and to keep depression symptoms from coming back. For reasons not yet well understood, some people respond better to some antidepressant medications than to others.
Therefore, it is important to know that some people may not feel better with the first medicine they try and may need to try several medicines to find the one that works for them. Others may find that a medicine helped for a while, but their symptoms came back. It is important to carefully follow your doctor’s directions for taking your medicine at an adequate dose and over an extended period of time (often 4 to 6 weeks) for it to work.
Once a person begins taking antidepressants, it is important to not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It's important to give the body time to adjust to the change. People don't get addicted (or "hooked") on these medications, but stopping them abruptly may also cause withdrawal symptoms.
What are the possible side effects of antidepressants? Some antidepressants may cause more side effects than others. You may need to try several different antidepressant medications before finding the one that improves your symptoms and that causes side effects that you can manage.
The most common side effects listed by the FDA include: Nausea and vomiting, Weight gain, Diarrhea, Sleepiness and Sexual problems.
Call your doctor right away if you have any of the following symptoms, especially if they are new, worsening, or worry you(U.S. Food and Drug Administration, 2011):
· Thoughts about suicide or dying
· Attempts to commit suicide
· New or worsening depression
· New or worsening anxiety
· Feeling very agitated or restless
· Panic attacks
· Trouble sleeping (insomnia)
· New or worsening irritability
· Acting aggressively, being angry, or violent
· Acting on dangerous impulses
· An extreme increase in activity and talking (mania)
· Other unusual changes in behavior or mood
Combining the newer SSRI or SNRI antidepressants with one of the commonly-used "triptan" medications used to treat migraine headaches could cause a life-threatening illness called "serotonin syndrome." A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications.
What are anti-anxiety medications? Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants.
Benzodiazepines used to treat anxiety disorders include: Clonazepam, Alprazolam, and Lorazepam.
Short half-life (or short-acting) benzodiazepines (such as Lorazepam) and beta-blockers are used to treat the short-term symptoms of anxiety. Beta-blockers help manage physical symptoms of anxiety, such as trembling, rapid heartbeat, and sweating that people with phobias (an overwhelming and unreasonable fear of an object or situation, such as public speaking) experience in difficult situations. Taking these medications for a short period of time can help the person keep physical symptoms under control and can be used “as needed” to reduce acute anxiety. Buspirone (which is unrelated to the benzodiazepines) is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. It is not useful on an “as-needed” basis.
How do people respond to anti-anxiety medications? Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may even become dependent on them. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults (read the NIMH article: Despite Risks, Benzodiazepine Use Highest in Older People), people who have substance abuse problems and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly.
What are the possible side effects of anti-anxiety medications? Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include: Nausea, Blurred vision, Headache, Confusion, Tiredness and Nightmares.
Tell your doctor if any of these symptoms are severe or do not go away: Drowsiness, Dizziness, Unsteadiness, Problems with coordination, Difficulty thinking or remembering, Increased saliva, Muscle or joint pain, Frequent urination, Blurred vision, and Changes in sex drive or ability (The American Society of Health-System Pharmacists, Inc, 2010).
Common side effects of beta-blockers include: Fatigue, Cold hands, Dizziness or light-headedness and Weakness.
Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both. Possible side effects from buspirone include: Dizziness, Headaches, Nausea, Nervousness, Lightheadedness, Excitement and Trouble sleeping. Anti-anxiety medications may cause other side effects that are not included in the lists above.
What are Stimulants? As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014). Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD. Stimulants used to treat ADHD include: Methylphenidate, Amphetamine, Dextroamphetamine, Lisdexamfetamine and Dimesylate.
Stimulants are also prescribed to treat other health conditions, including narcolepsy, and occasionally depression (especially in older or chronically medically ill people and in those who have not responded to other treatments).
How do people respond to stimulants? Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. Stimulant medications are safe when given under a doctor's supervision. Some children taking them may feel slightly different or "funny."
Some parents worry that stimulant medications may lead to drug abuse or dependence, but there is little evidence of this when they are used properly as prescribed. Additionally, research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications.
What are the possible side effects of stimulants? Stimulants may cause side effects. Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include: Difficulty falling asleep or staying asleep, Loss of appetite, Stomach pain, and Headache. Less common side effects include: Motor tics or verbal tics (sudden, repetitive movements or sounds), Personality changes, such as appearing “flat” or without emotion
Call your doctor right away if you have any of these symptoms, especially if they are new, become worse, or worry you. Stimulants may cause other side effects that are not included in the list above.
What are antipsychotics? Antipsychotic medicines are primarily used to manage psychosis. The word “psychosis” is used to describe conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there). It can be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as “psychotic depression”). Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including: Attention-Deficit Hyperactivity Disorder (ADHD), Severe Depression, Eating Disorders, Post-traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Generalized Anxiety Disorder. Antipsychotic medicines do not cure these conditions. They are used to help relieve symptoms and improve quality of life.
According to a 2013 research review by the Agency for Healthcare Research and Quality, typical and atypical antipsychotics both work to treat symptoms of schizophrenia and the manic phase of bipolar disorder. Several atypical antipsychotics have a “broader spectrum” of action than the older medications, and are used for treating bipolar depression or depression that has not responded to an antidepressant medication alone.
How do people respond to antipsychotics? Certain symptoms, such as feeling agitated and having hallucinations, usually go away within days of starting an antipsychotic medication. Symptoms like delusions usually go away within a few weeks, but the full effects of the medication may not be seen for up to six weeks. Every patient responds differently, so it may take several trials of different antipsychotic medications to find the one that works best.
Some people may have a relapse—meaning their symptoms come back or get worse. Usually relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel that they don't need it anymore, but no one should stop taking an antipsychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off— never stopped suddenly. Many people must stay on an antipsychotic continuously for months or years in order to stay well; treatment should be personalized for each individual.
What are the possible side effects of antipsychotics? Antipsychotics have many side effects (or adverse events) and risks. The FDA lists the following side effects of antipsychotic medicines: Drowsiness, Dizziness, Restlessness, Weight gain (the risk is higher with some atypical antipsychotic medicines), Dry mouth, Constipation, Nausea, Vomiting, Blurred vision, Low blood pressure, Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines), Seizures, and A low number of white blood cells, which fight infections. A person taking an atypical antipsychotic medication should have his or her weight, glucose levels, and lipid levels monitored regularly by a doctor. Typical antipsychotic medications can also cause additional side effects related to physical movement, such as: Rigidity, Persistent muscle spasms, Tremors, and Restlessness.
Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements, commonly around the mouth, that a person can't control. TD can range from mild to severe, and in some people, the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking typical antipsychotic medication. People who think that they might have TD should check with their doctor before stopping their medication. TD rarely occurs while taking atypical antipsychotics. Antipsychotics may cause other side effects that are not included in this list above.
What are mood stabilizers? Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression. Lithium, which is an effective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder. A number of cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat: Depression (usually along with an antidepressant), Schizoaffective Disorder, Disorders of impulse control, and certain mental illnesses in children.
Anticonvulsant medications are also used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control unstable moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid (also called divalproex sodium). For some people, especially those with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than lithium. Other anticonvulsants used as mood stabilizers include: Carbamazepine, Lamotrigine, and Oxcarbazepine.
What are the possible side effects of mood stabilizers?
Mood stabilizers can cause several side effects, and some of them may become serious, especially at excessively high blood levels. These side effects include: Itching, rash, Excessive thirst, Frequent urination, Tremor (shakiness) of the hands, Nausea and vomiting, Slurred speech, Fast, slow, irregular, or pounding heartbeat, Blackouts, Changes in vision, Seizures, Hallucinations (seeing things or hearing voices that do not exist), Loss of coordination and Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.
If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her blood, and make sure the kidneys and the thyroid are working normally. Lithium is eliminated from the body through the kidney, so the dose may need to be lowered in older people with reduced kidney function. Also, loss of water from the body, such as through sweating or diarrhea, can cause the lithium level to rise, requiring a temporary lowering of the daily dose. Although kidney functions are checked periodically during lithium treatment, actual damage of the kidney is uncommon in people whose blood levels of lithium have stayed within the therapeutic range.
Mood stabilizers may cause other side effects that are not included in this list. For more information on the side effects of Carbamazepine, Lamotrigine, and Oxcarbazepine, please visit MedlinePlus Drugs, Herbs and Supplements. Some possible side effects linked anticonvulsants (such as valproic acid) include: Drowsiness, Dizziness, Headache, Diarrhea, Constipation, Changes in appetite, Weight changes, Back pain, Agitation, Mood swings, Abnormal thinking, Uncontrollable shaking of a part of the body, Loss of coordination, Uncontrollable movements of the eyes, Blurred or double vision, Ringing in the ears and Hair loss. These medications may also: Cause damage to the liver or pancreas, so people taking it should see their doctors regularly, Increase testosterone (a male hormone) levels in teenage girls and lead to a condition called polycystic ovarian syndrome (a disease that can affect fertility and make the menstrual cycle become irregular). Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression may interact badly with anticonvulsants. In this case, a doctor can offer other medication options.
Children and Adolescents
Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents. Still, a doctor can give a young person an FDA-approved medication on an "off-label" basis. This means that the doctor prescribes the medication to help the patient even though the medicine is not approved for the specific mental disorder that is being treated or for use by patients under a certain age.
· It is important to watch children and adolescents who take these medications on an "off-label: basis.
· Children may have different reactions and side effects than adults.
· Some medications have current FDA warnings about potentially dangerous side effects for younger patients.
In addition to medications, other treatments for children and adolescents should be considered, either to be tried first, with medication added later if necessary, or to be provided along with medication. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with disorders that affect a child’s mental health. Read more about child and adolescent mental health research.
People over 65 have to be careful when taking medications, especially when they’re taking many different drugs. Older adults have a higher risk for experiencing bad drug interactions, missing doses, or overdosing.
Older adults also tend to be more sensitive to medications. Even healthy older people react to medications differently than younger people because older people's bodies process and eliminate medications more slowly. Therefore, lower or less frequent doses may be needed for older adults. Before starting a medication, older people and their family members should talk carefully with a physician about whether a medication can affect alertness, memory, or coordination, and how to help ensure that prescribed medications do not increase the risk of falls.
Sometimes memory problems affect older people who take medications for mental disorders. An older adult may forget his or her regular dose and take too much or not enough. A good way to keep track of medicine is to use a seven-day pill box, which can be bought at any pharmacy. At the beginning of each week, older adults and their caregivers fill the box so that it is easy to remember what medicine to take. Many pharmacies also have pill boxes with sections for medications that must be taken more than once a day.
Women who are pregnant or who may become pregnant
The research on the use of psychiatric medications during pregnancy is limited. The risks are different depending on which medication is taken, and at what point during the pregnancy the medication is taken. Decisions on treatments for all conditions during pregnancy should be based on each woman's needs and circumstances, and based on a careful weighing of the likely benefits and risks of all available options, including psychotherapy (or “watchful waiting” during part or all of the pregnancy), medication, or a combination of the two. While no medication is considered perfectly safe for all women at all stages of pregnancy, this must be balanced for each woman against the fact that untreated serious mental disorders themselves can pose a risk to a pregnant woman and her developing fetus. Medications should be selected based on available scientific research, and they should be taken at the lowest possible dose. Pregnant women should have a medical professional who will watch them closely throughout their pregnancy and after delivery. Most women should avoid certain medications during pregnancy. For example: Mood stabilizers are known to cause birth defects. Benzodiazepines and lithium have been shown to cause "floppy baby syndrome," in which a baby is drowsy and limp, and cannot breathe or feed well. Benzodiazepines may cause birth defects or other infant problems, especially if taken during the first trimester.
In 2004, the FDA issued a warning against the use of certain antidepressants in the late third trimester. The warning said that doctors may want to gradually taper pregnant women off antidepressants in the third trimester so that the baby is not affected. After a woman delivers, she should consult with her doctor to decide whether to return to a full dose during the period when she is most vulnerable to postpartum depression.
After the baby is born, women and their doctors should watch for postpartum depression, especially if a mother stopped taking her medication during pregnancy. In addition, women who nurse while taking psychiatric medications should know that a small amount of the medication passes into the breast milk. However, the medication may or may not affect the baby depending s on the medication and when it is taken. Women taking psychiatric medications and who intend to breastfeed should discuss the potential risks and benefits with their doctors.
The Pros and Cons of Psychotropic Medications
By Elizabeth Power, MD
Many people think I am anti-medication. In some ways, I am—and in many others, absolutely not. It’s a tricky balance – one that takes into account wanting to feel better quickly, but one that also takes into account the risk and cost of medications and even the risk that comes with feeling too good, too fast. Here’s how I see it:
Here’s where I am “against medication”:
A lot of us are unwilling to “do the work” that is required to not need medication: we won’t lose weight to manage diabetes, arthritis, or heart disease because it’s easier to take a pill. Even though the medications for each of these seemingly benign conditions carry effects no one wants, and some can have fatal consequences, it’s easier to take medications than, say, get up off the couch and walk. Stop eating processed foods. Start drinking more water and going to bed earlier. We’re lazy. Yes, that bothers me. And similar is true of medications prescribed to treat people diagnosed with mental illness. It may be much easier to believe the promise of a pill than it is to do the hard work that would allow you (and me…) to act like other people act without medication.
Some of us have such idiosyncratic reactions to medications that our options are much more limited. We are required, by our hypersensitivities, to do things differently rather than medicating away our troubles. Our bodies cannot tolerate many medications. The effects are much worse than the benefits. For us, many medications—for many things—don’t seem to be an option. We are required by our bodies to work: to exercise, change foods, walk more. This bothers me, too, even though being forced into hard work by the inability to take medication is probably healthier in the long run.
Here’s where I am “for” medication:
Am I against feeling better quickly? Seriously? The answer is NO. I am all for feeling better—and quickly—because I know that when I feel better, I act better. So does everyone else. I don’t think anyone—anyone—wakes up thinking, “Wow! I’d really like to try Zyprexa, or Seroquel, or lithium—yeah—and stay on it for twenty or forty years or maybe the rest of my life.” “Feeling better” and “quickly” are the key phrases.
I believe in neuroplasticity (the brain’s ability to rewire itself to adapt to its surroundings), and I believe in similar behavioral plasticity due to epigenetic changes to DNA and RNA that occur as a result of historic trauma and other environmental influences, something about which we are just now learning. For example, the Episcopal Church’s 1928 Book of Common Prayer writes about “the sins of the father visited upon the children” and epigenetics may be a mechanism to make it happen – how you were parented, what you experienced, how you took care of or neglected your body, and even how your parents cared for their bodies and brains before you were born all make epigenetic changes to the very makeup of how your DNA is expressed. (For another example, do your own research and check out the recent discoveries about the impact of trauma showing up in the short tail of the RNA of a man’s sperm.)
However, these epigenetic changes don’t have to be expressed – your experience needn’t define your RNA, which needn’t define who you are. Just as RNA was changed in our example by a father’s experience, it can be changed by a child’s experience. The two million connections a child’s brain makes every single day in the first five years of life organize themselves according to the child’s experiences. Those patterns are flexible—more so in childhood, still at least a bit so ‘till death. “Feeling better” is a combination of neurochemicals, structural changes in the brain and change in behavior…which, of course, are then turned around and written into the brain.
How do we change these experiences that then become our brain’s new normal, which then in turn influences our future experiences? Well, medication can—and for many—does help, especially when it’s a medication that works without being dulling or causing more toxic side effects. Creating this careful ecosystem of medication takes wise, careful, judicious work—often not the specialty of crowded, underfunded, overworked prescribers who would like to do more, be better, offer more effective help.
The word “Quickly”, the other key phrase, is just as critical as “feeling better”. For people who are depressed in a big way, sometimes the trajectory of “feeling better” isn’t fast enough and trapped in this limbo of slow change, they feel well enough only to do what their depression has been begging them to do—namely, commit suicide.
On the other hand, if you feel too better too quickly, the “mania” as it’s called can be dangerous. Medication can help people “feel better” “quickly” and if they can tolerate feeling better, that’s a good thing. But this immediate sea change in function can be hard to handle – even change for the better if it’s too extreme too quickly can be a dangerous magic.
So am I “against medication” or am I “for” medication? I am for conscious and careful medication that helps more of the people about whom I care live better lives, longer, with fewer effects that cause catastrophic health and life consequences. I am also for increasing functioning, a combination of learning and if needed a little chemical help. I am against over medications of chemical soups that people on limited incomes can’t afford to take or not to take – soups that can have unintended and heartbreaking effects if not carefully managed.