Psychiatric medication is a really controversial topic for some people. Where mental health seems to be ‘in your head,’ it’s easy for people to assume you can outthink psychiatric symptoms. While therapy, a good support system, and great coping mechanisms can be SO helpful, there are times when medication is necessary.
I’m going to write about medication from my own personal experience and research, but I am not a psychiatrist. I have, however, done quite a bit of training around psychiatric medication and I’ve seen the good, bad and ugly of many meds. Please consult a licensed psychiatrist or physician to discuss the complete ins and outs of psychiatric medication. Or talk to a trusted pharmacist. I love chatting with pharmacists about medication because they’re well versed in the different medications, side effects, and interactions.
I wanted to cover this topic because I DO often recommend people consult with a psychiatrist and I feel like medical professionals aren’t always very good at dumbing it down for us and making us feel safe and confident about taking medication- or even harder, giving our children medication. They’re on a tight schedule and there is a LOT of information to cover.
Please make an appointment through the patient portal or call 443-300-6094 if you’re interested in pursuing therapy in Howard County, Maryland through Happy Honeysuckle Healing Center. If you have a psychiatric or medical emergency, please contact 911 or go to your nearest emergency room.
This blog is for educational purposes only. This information is best case scenario, at least within the scope of my knowledge and experience at the time I write the post. Not only does everyone have different approaches to parenting and life- and my way may not be your cup of tea, but also- I am not perfect, nor do I want anyone to imagine that I am. Despite being a therapist and having a whole host of really cool techniques for all the mental health related things, I am constantly learning and trying to do better.
I’m hoping that this blog can help you. When we share what works for us, we can help others develop their own toolkit for improving their mental health.
While therapy can be extremely beneficial for coping with psychiatric symptoms, it’s important to understand when medication AND therapy may be the mental health dream team.
We all deserve to feel at peace in the world and fighting against your own brain can be really painful.
It’s All In Your Head
Those people who told you that your mental health symptoms were all in your head? They were right! And you can let them know that. It’s all right there in your brain. Messing with you.
Now… I think most people would say that the brain is a pretty important part of your body… it’s sort of like the engine of the vehicle. Let’s say something is up with your car’s performance… you think it’s probably related to the oil, based on the symptoms you’re seeing. You might check to see if there are other fixes that help your car run better, but ultimately, you’re going to check the level of oil.
If your car was low on oil, would you refill it? Or tell it to make its own? You’d probably refill the oil.
If your car didn’t perform well with that particular brand of oil, you’d change the brand. You’d tweak things and try to figure out what really worked well for your vehicle. You wouldn’t drive down the road without oil in your car (our brains are not an EV in this scenario).
Without oil, your car would BREAK. The engine would be absolutely destroyed. Your car would be a big giant paperweight.
We need to apply the same idea to depression, ADHD, and other mental health diagnoses.
Medication is the replacement oil when NOTHING ELSE IS WORKING or when we are a few drops of oil away from complete engine failure. If our engine is about to fail, we aren’t messing around to figure out the best oil. We are going to use whatever oil brand we find at the gas station, fill it up, and figure the rest out after it’s not an emergency.
If it’s just having some minor issues, we might mess around and see if anything else works. We might start with a little extra of one brand of oil or try a different oil if that isn’t helpful. We have more time to tweak it all.
So the engine is your brain and medication is the oil… because medication is related to the neurotransmitters (natural chemicals in your brain) that aren’t functioning properly in your brain. Medication is fixing the neurotransmitters that your brain isn’t properly managing.
So. Yes. It’s all in your head. It’s all in your brain. Your brain is important. Take care of it and ignore the people who think they (or you) can wiggle their fingers, yell “abracadabra,” and have your mental health symptoms disappear. Or let them try for 5 minutes, let them know if it worked or not, and then say “Well I guess you don’t have the magical unicorn dust after all…” Then go see a psychiatrist.
Wibbly Wobbly Psychiatric Science
Medications attempt to target neurotransmitters that our disorder tends to impact. It’s NOT perfect yet. Doctors have a good idea where to start based on your symptoms and diagnosis. But there are a variety of different medications for each psychiatric disorder, and some of the medications target different neurotransmitters.
For example, depression is thought to be caused by the depletion of the neurotransmitters serotonin, norepinephrine or dopamine. Have issues with Dopamine? You take a medication like Wellbutrin which increase dopamine in your brain. SSRIs such as Prozac and Zoloft target serotonin. SNRIs target both serotonin and norepinephrine. It’s a bit more complicated than this and some medications are used for more than one neurotransmitter, but you get the general idea.
Doctors can map out what parts of the brain each mental health diagnosis impacts… we can see this all on an MRI. This is not the video/image that I wanted, but it’s the best I could find with a comparison. Our brains look different than the neurotypical brain.
I’ve seen MRIs of comparisons between the brains of people with multiple different diagnoses in trainings- and yet I couldn’t find any of these on the internet today.
I remember completing a training on the neurology behind psychiatric medication in 2005 or thereabouts and being REVVED UP, thinking we were going to have some really easy ways to diagnose in a few years. It was a nice thought, but yikes… I just did the math and it’s been 18 years. Medical science takes a long time, and getting health insurance companies to recognize the science takes even longer.
Someday… maybe… we’ll be able to diagnose based on an MRI or blood tests or something else that’s easy. But for now, the science isn’t quite there. Fortunately, we live in an era where we can STILL get help. I’m pretty thankful that electroshock therapy, lobotomization, and exorcism aren’t being used any more. Yay science.
What To Consider Before Choosing Medication
Whether or not to take medication is a personal choice, but I think it is NECESSARY in the following situations:
- If you are thinking about hurting yourself or other people.
- If you think people are out to get you.
- If you feel like giving up.
- If your symptoms prevent you from safely driving (if you need to drive).
- If you’re abusing or causing harm to others due to your symptoms being out of control.
- If your symptoms are impacting your ability to get to school/work, get out of bed, or just generally function.
- If your symptoms are keeping you from learning and applying healthy coping mechanisms.
I also think that OCD, Bipolar, and Schizophrenia tend to have symptoms that make taking medication pretty important. Sometimes with OCD you can work on some coping mechanisms and be okay, but medication may be helpful to give you the initial mental break to start applying those skills.
I’m not as familiar with medication management for bipolar disorder and schizophrenia, but I don’t get the sense that it’s feasible to avoid some pretty unpleasant impacts on your life without taking medication.
Just remember that there isn’t a prize for being ‘brave’ and not taking medication. Life is short. Try not to make it miserable. Yes, medications have side effects, but ideally you find a pharmacist and psychiatrist that you trust and you work towards finding a medication that works for you. Even if the best you can do is a TINY dose of something that takes the edge off, that’s something.
ADHD Medications
I read recently that ADHD’ers who are late diagnosed or who didn’t get medication as a young person usually go through the stages of grief once they’re an adult and making those choices for themselves. I’m there.
Medication doesn’t make me a different person, but it really helps me function better overall. I’ve paid a lot of ADHD tax in my life and medication and/or good coping mechanisms might have been able to prevent that. It’s hard not to have some regrets.
ADHD symptoms can:
- Cause difficulty with peer relationships
- Make you a victim of bullying
- Cause anxiety and/or depressive symptoms
- Make driving safely a problem
- Make you more likely to experiment with illegal substances (due to impulsiveness, self medicating, etc.)
- Make it difficult to perform at your grade level
- Makes it more difficult to learn and implement executive functioning skills at the same rate as NT peers.
- Increase your chances of having an accident or getting injured.
In terms of education, one boring teacher early in your education may result in a lifetime of deficits in a subject area such as math that builds on previous skills.
We have some pretty icky statistics. Our life expectancy is shorter than peers, possibly up to as much as 25 years shorter in people with severe ADHD. We are prone to injuries, particularly concussions and head injuries. I was told in an ADHD training that we should see if a client has a family history of ADHD by asking if they have any family members who died young. The presenter, who has ADHD, has tracked her family history back to colonial America.
More statistical information about ADHD | Treated ADHD vs Untreated ADHD: Risk of Substance Abuse
If you have an ADHD child, you can probably think of some times where they took your breath away. We do dumb stuff. We also do really cool stuff. But we do a lot of dumb stuff. Over my life, I developed coping mechanisms for my personal safety. For example, I enjoy woodworking. If I’m having a day where my ADHD symptoms are particularly bad, I don’t use sharp tools. Why? Because I don’t like going to the hospital. But it took me a lot of mistakes to learn those lessons and I was lucky none of them caused permanent harm.
I used to be a bit ambivalent about medication for ADHD. I grew up in the generation where Ritalin was a bad word. I was worried about the potential for addiction, potentially needing a higher and higher dose for it to work, and about the side effects.
The problem is that a lot of the warnings about stimulants are related to off label use. Substance abuse isn’t my specialty and I have no idea what the off label use is for a stimulant (and the internet wasn’t helpful). The highest typical prescribed dose for Adderall, however, is 40 mg once per day for adults (or twice if you don’t take extended release) and the amount that drug users take is far above that.
I worried about getting addicted, but ADHD’ers are notorious for forgetting to take their “addictive” medication. This is one of the reasons that extended release medication is so helpful for us. We struggle to take an afternoon dose on time, particularly when we aren’t kids who have a school nurse or parent to BE the executive functioning that we so badly need. As far as I’ve read and studied, people with ADHD take a low enough dose that they aren’t experiencing the same type of symptoms that you’d find in someone who was abusing drugs.
In terms of needing a higher and higher dose, my understanding is that generally this doesn’t apply to people who take this medication as prescribed. Children may need a higher dose as they grow, and it usually takes some time to find the correct dose for a patient, but once the dosage is correct, my understanding is that you can typically stay at that dose.
These are all questions and concerns to bring up with a psychiatrist.
I know many people think that rates of ADHD diagnoses are higher these days and blame the schools, food, etc.. It’s important to realize, however, that someone with mild or moderate ADHD symptoms has a MUCH better chance of passing as neurotypical in certain environments. Our current American public school system isn’t really optimal for most children, and it’s really tough for the neurodivergent ones. The workplace, similarly, isn’t always a great fit. There’s not a lot of breaks or movement, there’s a lot of sitting still, and you’re expected to focus- even when EVERYBODY IN THE ENTIRE ROOM IS BORED. Small classroom sizes are helpful for ALL children, but they’re VITAL for kids with ADHD.
My functioning is VASTLY different depending on the environment that I’m in. The pandemic (and having my entire family home) LIT MY ADHD ON FIRE. And I took a training once where the instructor got MAD that I was taking notes- but taking notes is how I keep from falling out of my chair. Otherwise I’m trying not to bounce up and down in the back of the classroom. Sitting still is hard.
When I have a decent amount of quiet time, plenty of physical work, and a variety of interesting activities to do, I tend to be pretty happy. I do well working for myself and there’s a reason I run three different businesses part-time. I saw a cute video the other day that said ADHD’ers pick a career that is their forever hyper fixation.
I’m pretty sure that while they probably get in a ton of unnecessary accidents, there have been plenty of successful farmers and workers in other physical type jobs who were ADHD and unmedicated. And in the past, many professions were learned by DOING and not by sitting in a classroom. Someone who was a doctor, midwife, or veterinarian, would do a lot of hands on work before they practiced solo. The job itself is active. And while some ADHD people do jobs that aren’t active, they tend to be in areas that the person is INTERESTED IN. We have excellent attention spans when we’re interested in something. It just may be tough for us to get through the prerequisite education to do the job.
This is why it’s SO important for classrooms to offer more hands-on and interactive education. Not only can we engage children and adults in BETTER learning and support neurodivergent kids, but the result is people who are better prepared to go into their chosen fields. Book learning isn’t real preparation.
Everything Has Side Effects- Even That OTC Vitamin
Before you try every vitamin on the market, thinking that they might be a good option before trying psychiatric medication, understand that EVERYTHING has side effects. You can overdose on some vitamins, have significant side effects with others, and there is also very little research or oversight on some of these supplements. Even if the particular vitamin has a good amount of research into its benefits, you need to find a company that provides a quality vitamin. And it’s the wild wild west out there.
Here’s my thought- if you think that a particularly vitamin is missing in your diet, try to meet that need by eating foods that have it. Vitamins are, as far as I’ve heard, absorbed better if you get them naturally. You also aren’t likely to overdose if you get the vitamins this way.
Honestly, it’s a healthy idea to add nutrients to your diet to improve your health and mental health. Cutting processed foods, artificial food dyes, and adding in more vegetables, water, fish, and fruit to your diet is probably going to benefit you in some way.
I’m really bad at all of this because executive functioning is a struggle, but I’ve managed to meal plan so that we have at least 1 beef, 1 chicken, 1 fish, and 1 vegetarian meal per week. My ultimate goal is to diversify my diet as much as possible.
If I had the money and energy, I’d probably hire a dietician who is experienced in this to meal plan for us. Instead, I do what I can and adding things is easier than taking them away.
So if you have low resources (mentally or financially), trying to do ONE THING for your health is a good start. Ie. Set a goal to eat more kale or to drink more water. Get your probiotics by having Greek yogurt each day. Pick something that’s easy for you.
If you just really want to try supplements, here is what you need to do:
- Research research research. Find quality research that say the supplement is helpful.
- Identify any risks and side effects to the supplement.
- Find a quality provider for the supplement.
- CHECK THE DRUG INTERACTIONS. There are some vitamins that are fairly low risk, but others, such as St. Johns Wort, have a HUGE list of possible drug interactions and side effects.
- Run it all by your doctor and pharmacist before starting it.
- Keep track of any changes and side effects, just like you should with any medication.
Also, medical marijuana is the SAME DEAL. I am frustrated by how quickly legalization has progressed without much in the way of solid information about side effects, drug interactions, and best practices for taking it. It could potentially be helpful for some people and illnesses, but if those patients don’t get good guidance, then it is a matter of luck in terms of whether if it’s helpful or harmful.
Who Should Prescribe Psychiatric Medication?
Psychiatrist vs. PCP/Pediatrician
I really prefer to have a psychiatrist managing psychiatric medication, unless you’re in a situation where you have gone that route before and know what works or doesn’t work. A PCP or pediatrician can easily help you continue to manage medication after you go through the initial process with a psychiatrist to find the right medicine.
Also, many people have success getting medication for a mild depressive episode or mild anxiety from a primary care provider. But I really cringe when someone comes into therapy and says their PCP is the one in charge of their bipolar medication and sees them once a year to check in. Then they drop that they’re experiencing some really serious side effects.
As a non psychiatric example, if you have well controlled asthma and use a rescue inhaler, you probably don’t need an allergic/asthma specialist to prescribe it. If you’re still having asthma attacks and hospital trips, you NEED a specialist.
The benefit to using a PCP or pediatrician is that you can get care more quickly. You also may have a relationship with them and they may spend more time with you. Many psychiatrists have long waiting lists which can be a barrier to treatment (and also why you shouldn’t wait until it’s an emergency to seek help). Having people who use their PCP for medication management means that there is more room on psychiatrist caseloads for patients with more complicated issues.
I think a psychiatrist is usually the best option if the client:
- Has multiple diagnoses.
- Needs more than one medication to treat their diagnosis.
- Is on any of the less typical or more intensive medications.
- Needs routine monitoring for their medication, ie. mood stabilizers may require routine blood tests.
- Has a medical condition that may be problematic in regard to the drugs they need to manage their psychiatric symptoms. Ie. If you have heart issues, but need an ADHD medication, or have seizures and also have a bipolar diagnosis.
- Is experiencing a lot of side effects, or unusual side effects.
I have seen clients do really well on medication prescribed by a primary care doctor, but they are ALWAYS the people who have a very clear cut diagnosis and are able to be treated with a low dose of one medication.
Genetic Testing
Genetic testing via an oral cheek swab is available to test to see how a person will react to psychiatric medication. I don’t think this is a medical miracle yet, but it’s a useful tool.
It’s worth asking your psychiatrist or PCP about genetic testing if you haven’t had good luck on medication. If you are an easy patient and the first medication that they try works and has low side effects, you don’t really need the testing.
If you get the testing, you will receive a report card with green, yellow, and red light drugs for each disorder (including ones you may not be diagnosed with).
- Green drugs are drugs that you genetically are a good match for. These can be taken as typically prescribed.
- Yellow light drugs are drugs that might be okay with some caveats- ie. maybe you need a lower or higher dose for it to work.
- Red light drugs are the drugs that you probably shouldn’t bother trying.
You can still have side effects with green light drugs though and they still may not work for you. It’s just a nice starting point if you’re struggling to find the right medication.
Dosing
Medication dose is determined by quite a few factors such as age, weight, and how you metabolize the medication. You can metabolize different medications at different rates. I’ve also heard that different racial groups metabolize medications at different rates. This is important because not all racial groups are well represented in the studies for medication dosing/effectiveness.
When you start a psychiatric medication and you ARE NOT in a relative state of emergency, usually the doctor starts the dose low and you work up to the correct dose. When you have a psychiatric emergency, you often get a higher dose because they want to get you stabilized so you’re safe.
This is why it’s VERY IMPORTANT to seek help before your symptoms become an emergency.
Keep Track of Side Effects
One of the best times to take medication is when you’re a kid. Why? Because you have at least one grown up keeping an eye out for side effects.
As the patient, it can be difficult to notice some side effects (or to notice if medication is working), particularly for medications that take time to get into your system. For example, antidepressants can take 6-8 weeks to take effect… and the side effects may not occur right away either.
Likewise, a low dose of a medication may not cause a noticeable side effect, but when your dose is increased, you may start to see those issues.
Some side effects will occur when you first try a medication, but then after a few days you don’t experience them anymore.
It’s really helpful to keep a log of mood (or whatever symptoms you’re treating) to see if the medication is helpful and to keep track of any potential side effects. If you have someone such as a spouse or roommate who lives with you, they may be able to let you know if they’re noticing any abnormal side effects as well.
Lock Up Medication
Medication should be locked up and kept away from children and pets.
If you take a controlled medication such as stimulants for ADHD, you want to be VERY careful about who you inform and how much access others have to your medication. People MAY steal it. If someone steals it, you need to file a police report.
DO Take Your Medication Correctly
Apparently compliance rates for medications are pretty bad: about 1/3 of people take their medication as prescribed. Ask questions if you have questions- and take your medication EXACTLY AS INTENDED. Read the manuals, read the labels.
Don’t drink alcohol- most of these medications don’t play well with alcohol.
DO NOT lie about taking meds if you aren’t taking them. BE HONEST WITH YOUR PRESCRIBING DOCTOR AND YOUR THERAPIST.
When your doctor wants to know if medication is working or not, they need to know if you’re taking it as prescribed. Because here’s what happens…
Doctor: Are you taking this as prescribed?
Patient: Yes.
Doctor: And you’re not feeling better?
Patient: No.
Doctor: Hmmm maybe we should raise the dose.
Patient: Ok!
Doctor raises dose, client has SIGNIFICANT SIDE EFFECTS or overdoses on the medication. Too much of a medication can cause MAJOR issues that result in HOSPITALIZATION OR DEATH.
DO NOT Go Off Medication Without Talking to Your Doctor
Do you want to go off your medication? Talk to your doctor.
You NEED to have a plan to go off many medications, and many medications require that you wean off them to avoid health issues and significant side effects.
If your hope is to learn coping mechanisms and eventually go off your medication, talk to your psychiatrist and therapist about this plan. Come up with a reasonable timeline.
Work with your therapist on making a PHYSICAL DOCUMENT for yourself that includes:
1. A list of your coping mechanisms, preferably in the order they should be implemented.
2. Signs and symptoms that will tell you that you need to go back to a psychiatrist… in order of least severe to most severe.
3. Any emergency numbers that you may need if you relapse.
I think it’s helpful to have a trusted person in your life who knows what is going on and can help you identify when you may need help. You want to catch a relapse BEFORE you’re in an emergency state and being able to identify the smaller signs of a relapse is extremely helpful.
Talk to Your Therapist about Medication
I questioned whether or not to write this post because in our profession we talk SO much about practicing within “our scope of practice.” And I’m not a psychiatrist.
And yet- my therapy notes need to include information about the client’s medication changes and prescribing doctor. So someone in the universe thinks we should be a little bit involved.
I can’t speak for all therapists, but I’ve completed training to learn about psychiatric medication. While I can’t prescribe medication or tell you what dose to take, nor do I have side effects memorized, I MAY catch something that your doctor misses because I see my clients every week. I CAN tell you when I think you need to call your psychiatrist or pharmacist about a side effect. I find that sometimes people are a little shy about calling their doctors about side effects and having your therapist say, “Oh you should DEFINITELY call” is helpful.
We won’t always catch side effects (#notadoctor), but if you keep us aware of any medication changes and then mention dealing with some significant health problems, we may be able to say, “Wait, didn’t you just start X medication? Did you check to see if that’s a side effect? Let’s look that up together.”
I hope this information is helpful to you. Remember- you aren’t a hero for being medication-free. There’s no prize. If you don’t take it, you may not have side effects of medication, but you may have symptoms of the disorder instead.
If you can manage your symptoms with exercise and diet changes, that’s great. Not everyone can. One person’s Depression/Anxiety/ADHD/Etc. can be completely different from another person’s. Our support system can impact how easily we bounce back after a diagnosis- and not everyone has a robust support system. Some people don’t have healthy supports in their life. Our socioeconomic status can make bouncing back easier or harder as well. Additional stressors related to finances are NOT helpful when in recovery. Those of us who don’t need to worry about affording rent or food are in a privileged position… we have one less barrier to success.
Be kind to yourself and others.
