Psychiatric Medications: The Importance of Why, Who, and How
Many people express apprehension and even fear of psychiatric medications, for a variety of reasons which I have detailed below. The reality is that all medications, psychiatric and non-psychiatric, can be highly beneficial when prescribed at appropriate dosages and for the right reasons. Similarly, all medications can be harmful when prescribed incorrectly.
This is why it is very important to receive psychiatric treatment from a ABPN board-certified psychiatrist.
The concern that the medication will change who someone is as a person.
In fact, many non-psychiatric medications can also interfere with mood, emotions, and cognition, including asthma medications, decongestants, antihistamines, blood pressure medications, corticosteroids, and thyroid medications. These possible side-effects can be avoided or mitigated through careful prescribing and appropriate dosing.
Perceived lack of autonomy when receiving treatment from a psychiatrist.
Psychiatrists, like all physicians, are bound by the Hippocratic Oath and the AMA Code of Medical Ethics. Medical ethics rests on the four core pillars of autonomy, beneficence, non-maleficence, and justice.
Concerns that medications will change ones brain in irreversible ways.
Available research on this topic is mixed but it generally indicates that most structural changes observed during treatment are reversible and adaptive, meaning that they are linked to symptom resolution and healing. Benzodiazepines are the psychiatric medications with the clearest evidence of negative long-term, persistent effects on cognition and increased risk for dementia. For this reason, most psychiatrists use benzodiazepines judiciously and only for short-term treatment.
Greater scrutiny by patients when reading about or experiencing potential side-effects.
Psychiatric medications cause side-effects that are very similar to many other non-psychiatric medications. However, the subjective experience of these side-effects is frequently amplified by the illness itself (feelings of anxiety/fear, hopelessness, and cognitive clouding), family and societal fear and stigma toward psychiatric medications, and a disproportionate focus on rare side-effects before even trying the medication (e.g., suicidal thoughts).
Side-effect related worries being amplified by the internet.
Online discussion boards can generate disproportionate concern because they preferentially amplify negative, self-selected experiences with these medications. People are generally more motivated to post about negative experiences. Furthermore, these online anecdotes frequently lack important information, particularly who made the psychiatric diagnosis, who prescribed the medication, and how was the dose determined and adjusted. Non-psychiatrists prescribe the majority of psychiatric medications in the U.S., which increases the likelihood of misdiagnosis and erroneous prescribing. In the case of antidepressants, approximately 80% of these treatments are initiated by primary care practitioners.
Fears about withdrawal and dependency.
Many psychiatric medications are easy to discontinue, though there are some medication classes — namely benzodiazepines and z-dugs — which do have the potential to cause dependence and withdrawal. There are also psychiatric medications that do not cause dependence, but do need to be tapered correctly (generally by a psychiatrist) in order to avoid rebound psychiatric symptoms, such as anxiety or insomnia. As stated above, many psychiatric treatment protocols are initiated by non-psychiatrists and this can lead to negative experiences and negative perception of these otherwise-safe treatments.
Negative attitudes and stereotypes placed on psychiatric illness and psychiatric treatments.
Stigma toward psychiatric diagnoses and treatments comes from society, family, and even other healthcare professionals. Society also tends to view psychiatry in ways that are not consistent with how other brain-related illnesses and treatments are viewed (e.g., seizures or migraines do not receive the same degree of stigma). In fact, some medications used for migraines or seizures are also used to treat psychiatric illness, but patients are not usually hesitant to use these medications when they are prescribed for non-psychiatric reasons.
Concerns about being dependent on psychiatric medications in order to function.
Many psychiatric illnesses are chronic in nature. For this reason, psychiatric treatment can often be lifelong, because psychiatric medications manage the illness rather than cure it. Many people who are prescribed these treatments could live life without them, but the treatments usually produce significant improvement in quality of life and functioning. If we disregard the stigma associated with psychiatric treatment, psychiatric medications are no different than treatment for asthma or diabetes, which are also chronic illnesses that worsen quality of life and functioning, and can lead to severe complications if left untreated.