By Brianna Riddlebarger
“I know that I need help, but…I don’t want to take medications”
This is a very, very common phrase communicated by individuals who know there’s something that’s not working, but are afraid of what the interventions may be. The reality is, we are really good at creating shame and stigma for ourselves. And, the largest barriers to our healing are most frequently: ourselves.
In this article, we are going to break down some of the largest fears regarding medication and how we can make more informed decisions for our care.
1. ”I hate relying on medication”
Medication is a tool - Medication is just that. A tool. Not the only tool, but one of many tools that are helpful in regaining stability. Oftentimes, we stray towards two opposite ends on our view of medication. Some patients struggle with feeling that their only hope is a good medication and that lifestyle or substance use is irrelevant. And others would rather stay focused on lifestyle and want to completely veer away from any psychotropic meds. While there is definitely room for the latter, I typically challenge individuals to consider the middle of the spectrum.
Yes, lifestyle, routine, psychosocial factors and critical. There is no debate in how important those aspects affect our wellbeing. In fact, that’s one of the key psychoeducation points made in each psychiatry appointment! However, sometimes we still need more support beyond our lifestyle and coping skills. That’s where medication can come in.
Medication is a “cushion”. It allows for a little bit of comfort in the acute stress. The goal for medication is to help make overwhelming emotions (such as anger, panic, hopelessness, suicidal ideation) more bearable. Not to take emotions away, or to tranquilize, or to numb. That would be contrary to the goal! Medication is to be used to allow you to feel, but in a safer and more comfortable way. And, more importantly, medications can be used to help your therapy process run smoother and be more effective. Coping skills such as box breathing are a little easier to implement when our baseline state is less in fight or flight. But of course, the medications won’t replace your need for coping and deep breathing… just make them more doable!
2. “I hate the idea of being on something for the rest of my life”
Medications do not need to be permanent - The biggest questions I get from patients are: “how long will I need this?” “Do I need to be on medication for the rest of my life?”
The short answer is - not necessarily! In fact, I would say that the majority of my patients take medications during a temporary season. One of my favorite things is to help patients get off medications, or to need less medications each day. A simplified med regimen is always a win.
The majority of individuals benefit from some sort of mood stabilizing medication during a difficult season of life. This may include during a period of grief, during big life changes (big move, post partum, job change, quarantine, etc), enduring trauma (or becoming more aware of past trauma), or during intensive treatment which brings up a lot of buried emotions. Medication can assist in the treatment process until therapy can bring some clarity and skills.
If it’s temporary, how long is typically long enough to be effective?
The answer to this question is truly variable. A variety of factors can impact how long you would benefit from medications. Some of these questions can help:
- Are you receiving intensive treatment or therapy of some sort?
- Are you prioritizing sleep and nutrition?
- Are you sober? (including marijuana/THC)
- Are you practicing certain skills in your life such as boundary setting, cognitive reframing, healthy communication with your loved one, etc.
- Are you spending more than 2 hours on screens in your free time? Do you have hobbies that are separate from electronics?
- How are you doing at managing the stress in your life?
- Are you getting at least 15 minutes of movement each day?
- Are you currently in an abusive environment? Are you safe?
- Do you feel so impulsive that you do many things that you regret and feel out of control?
- Are you suicidal?
- Are you manic or do you have hallucinations?
The patients who may need medication more long term are those who struggle with psychosis symptoms (hallucinations, delusions, paranoia), bipolar mania, severe substance abuse, or someone with severe TBI. Those aren’t hard and fast rules, but can be an indicator of severity and need.
That being said, there are some people who are really content with how their meds help them feel and prefer to stay on them. The decision to be on or off medication is ultimately up to you, and can be an open discussion between you and your provider.
3. “I’m scared of side effects”
This is a completely valid concern! Side effects are always a risk and definitely something your provider takes into account. When it comes to medication management, it is always a balance of risk versus benefit. If you have never tried medications before, it’s going to be important that your provider chooses a low dose to help you adjust to something new. I always personally reassure my patients that if there are any intolerable side effects within the first week, we don’t have to continue. There’s no reason to force a med that causes more stress than relief. (Note there are some medications that providers will recommend “pushing through” until your body adjusts - so always consult with your provider about side effects). For the person who has had horrible side effects in the past, sometimes it’s a matter of needing a newer medication in that class of meds (that doesn’t produce that side effect), or may consider a whole different class of medications altogether. Other times, it’s a matter of someone being misdiagnosed and needing an updated medication strategy.
The other key is to be very careful about Googling side effects or looking up all the risks online. It’s good to stay informed, but we have to consider how looking certain things up can create more anxiety and the side effects may even become a self-fulfilling prophecy. Placebo effect can work both ways.
The bottom line is that you don’t have to be stuck taking medication that isn’t working for you. Communicate openly and regularly with your provider your concerns, fears, and possible side effects and make informed decisions together. Your provider is your co-pilot!
4. “I feel like choosing the right med is guesswork and I don’t want to be a guinea pig”
Medication management is an art. Unfortunately there isn’t a magic blood panel to tell you “Hey, John is going to feel better by taking Zoloft rather than Prozac”. (Even genetic testing of medication tolerance is just going to tell you if your liver is able to metabolize the medication well - but does not speak to if it will help with your specific mood symptoms.)
A good medical provider will be able to assess your pattern of symptoms and make an educated decision on what may be a good fit for you. When I approach patients, I’m constantly assessing “which hormone in the body is needing support?” And that helps to inform which medications may help, if any.
The reality is, no provider can perfectly predict how you’ll respond to a medication intervention. The decision isn’t guesswork either, though. It’s all about the clinical picture: What does the data show works for patients with certain types of symptoms? What profile of symptoms do you have and how does the mechanism of the medication support them? What experience does that provider have with that medication? How do you feel when you take the medication?
And truth be told, sometimes seeing someone’s negative reaction to a medication is very telling for how they process certain classes of medications and what may be a better fit next time.
But of course, this process is up to you and your trust in your provider and his/her ability to explain their reasoning for recommending certain medications. You should never be a guinea pig. But keep in mind, in any area of medicine, there is always a sense of trial and error in choosing the right fit because each individual is so unique.
5. “I prefer natural supplements”
Supplements can be such a helpful tool to help support someone’s body and mind. We definitely have some favorites that we use that are quite effective! Starting with supplements is not a bad thing, and is often something we’ll do when someone is very medication hesitant. Supplements can also help some patients with the transition of getting off medications.
However, if your mood is still struggling or progress is very slow with the natural route, you may be a candidate for pharmaceutical options.
Getting help is a humbling and difficult process. Whether it’s seeing a therapist or deciding to start medications, we can feel lots of shame or embarrassment for “getting to this point”. But remember to be kind to yourself. Life and relationships are challenging and can take a toll on our emotional state. We’re only human after all. And it’s not an issue about society’s pressures, it’s about your own pressures on yourself. We are our worst enemies with our thoughts toward ourselves. Don’t let that stop you from getting the help that may bring you the relief you’ve been waiting for!
We’re happy to walk you through your options and customize your treatment plan. Are you ready to ask for help?