Have you ever wondered if taking psychiatric medications could be beneficial for you? Have questions about what these drugs do, what they’re for, and whether they’re effective? I definitely don’t have all the answers, but I hope I can answer a little more personally than Google. This post is going to be a little more “clinical mental health” than a lot of what I share on Ivory & Pine. So I totally get if this seems a little dry for you, but I’ve also had a lot of readers reach out and want more clinical information regarding this topic. I hope it’s helpful for you!
As a therapist in a hospital, I get questions almost every day from patients and family members about whether they should start medications for a mental health concern. They usually want a “yes” or a “no,” but the answer is rarely that simple. If you’ve ever wondered about whether starting psychiatric medications would be helpful for you, here are a few factors to consider…
Note: This information is not intended to be medical advice or prescribing recommendations, as I am not a medical doctor. It is also not intended to be specific counseling or psychotherapy advice to you as an individual. Rather, this information speaks to general, known facts about various psychotropic medications and mental illnesses, in order to give you a basic understanding. While I have more experience with psychiatric medications than the average person due to my profession, the information in this article could be found by anyone willing to do a little research. Please seek medical advice from your medical provider, and psychotherapy or diagnostic testing from a mental health professional.
It Depends on the Diagnosis
Mood Disorders and Psychotic Disorders
The reality is that some mental illnesses are almost always organically-rooted and that people who suffer from them can benefit from medication. People with Bipolar Disorder (both Type I and II) appear to have physical differences in their brain makeup from people who don’t have the disorder, suggesting a biological cause. And you’re much more likely to get Bipolar Disorder if a sibling, parent, or other relative struggles with it. Many people with Bipolar Disorder take psychiatric medications, specifically mood stabilizers. Lithium is the “classic” medication for Bipolar Disorder, but certainly not the only one. Other mood stabilizers have been synthesized and are used in place of Lithium for various reasons. Psychotic disorders, such as Schizophrenia, also typically have a genetic component and are highly hereditary. Psychotropic medications such as Seroquel, Zyprexa, and Risperdal are commonly used, and can be of significant benefit if taken correctly under a doctor’s supervision. If you are diagnosed with a mood disorder or a psychotic disorder, it is best to seek out a medical provider, especially a psychiatrist if possible, to complete a medication evaluation.
Anxiety and Depression: SSRIs
Now, let’s discuss medications used for anxiety and depression. Depression may have a biological component, such as a serotonin imbalance, in which case an SSRI (most antidepressants, like Prozac, Zoloft, Cymbalta, Effexor, and Lexapro) can be helpful. Serotonin is a chemical that gets released in the brain. It affects mood, social interactions, sexual desire, appetite, digestion, memory, and sleep. It also helps constrict certain muscles and regulates body processes. Serotonin is released out into the brain in order to regulate all of these functions, and excess is reabsorbed back into the brain tissue. In the biologically depressed brain, serotonin is still released, but the re-absorption process is working overtime, so that not enough serotonin stays out in the brain. SSRIs inhibit this re-uptake process, allowing normal levels of serotonin to be in the brain, which then improves the aforementioned functions. Many SSRIs are used for both anxiety and depression. They generally do not have addictive properties, although some can cause difficult withdrawals. Always consult with a doctor to start or stop an SSRI.
Anxiety and Depression: Benzodiazepines
The other most commonly used medications for anxiety are benzodiazepines, like Ativan and Xanax. Benzodiazepines depress the central nervous system, having a calming and even sedating effect. They primarily affect GABA, which is like a natural tranquilizer. They can also help with seizures, which is why you may see them used for alcohol withdrawal. They help with anxiety and panic attacks almost immediately, but they’re intended for short or infrequent use only. Why? Because of the high addiction rate. Your body can build up a tolerance to the effects of benzos, causing increased tolerance and dependence. They’re also often used as street drugs due to the sedating, calming high effect… so that might clue you in to how quickly they can become addictive.
If prescribed correctly, benzos will almost always be used in conjunction with other medications, often as a PRN, or “as needed,” medication for infrequent use. Even this can get complicated, as every person has a different threshold for when to justify using an emergency medication. Basically, benzos can be very useful, but be wary about using them long-term or as your main medication. Always speak with a doctor before starting or stopping a benzo, as benzo withdrawal can be very dangerous.
Are Meds Needed at All for My Anxiety or Depression?
Unlike Bipolar disorder or Schizophrenia (just two examples), anxiety and depressive disorders are not always caused by some kind of organic deficiency. These disorders could be caused by trauma, changing life circumstances, grief, chronic or severe stress, other environmental stressors, tendencies in personality, and any combination of these factors.
Because of this possibility, I typically recommend starting with lifestyle changes and therapy for any anxious or depressive symptoms. Working with the right therapist can help you make positive changes, increase feelings of empowerment, learn and utilize coping skills, and manage your symptoms without medication. Your therapist should recommend you to a psychiatrist if they feel medications could be warranted.
Where Should I Seek Treatment?
Please know that I only scratched the surface on mental illnesses that people struggle with, as well as medication options. If you’re struggling with any mental health related symptoms, especially if they last more than 6 months or are starting to affect other parts of your life, here is who to talk to, and a general order of who to talk to first:
1. Your Current Providers
Talk to any medical or mental health professional you already see, especially if they know you well. They can likely make recommendations as to who to talk to next. Some primary care doctors are also willing to prescribe psychotropic medications, but some are honestly too loosey-goosey with these meds. If your doctor seems to be willing to prescribe you anything, or seems unsure of what could be helpful, make an appointment with a psychiatrist. And of course, if your doctor believes that psychotropic medications are out of their scope of practice, they’ll recommend a psychiatrist as well.
2. A Therapist
Meeting with a therapist is always a great start for your mental health journey. Many people who participate in therapy find that they don’t need to add in medications. But if it’s not quite enough, a therapist could provide a diagnostic impression, refer you to a professional who could make a fully-assessed diagnosis, refer you to groups or substance abuse treatment, and recommend whether seeing a provider for medications would be helpful. If you’re looking for a therapist, Psychology Today is a great resource. Using their therapist finder tool, you can plug in your preferences for your therapist, such as insurance accepted, clinical specialties, location, faith affiliation, and more. It’s a really easy way to find potential therapists who will likely be a good fit for you.
3. Intensive Group Therapy
Group therapies can be highly effective for anyone who is finding that once-a-week therapy is not enough, but who doesn’t need hospitalization. Some groups are based on support between members, and may not meet more than once a weekly. But other groups, often called intensive outpatient programs, meet multiple times a week and for a few hours each session. If you can invest the time, you’ll get an arsenal of coping skills and processing time that would literally take years to accomplish meeting with a therapist once a week. Groups are also a really effective way to treat substance abuse and promote relapse prevention.
4. A Psychiatrist
The modern day psychiatrist’s main job is to prescribe medications. Do not count on or expect your psychiatrist to provide therapy. The reality of today’s mental health system is that lots of people need medications, and only medical doctors have the ability to prescribe them, and only psychiatrists have a mental health specialty. So they take a lot of patients and don’t spend as much time with them as a therapist, in order to get as many people the medications they need as possible. This also means many of them have a long wait list. If you’re willing to go private pay (not use your insurance), you may be able to get in more quickly. Please be aware that if you have Medicaid, most states prohibit you using private pay, so you’ll need to go through a Medicaid-approved provider.
Psychiatrists can also evaluate for mental illness and manage medications. If you’ve never been on meds, they are probably the best people to help you figure out if you do need them and what combination will be most effective. Make sure you have regular appointments while trying a new medication, so that they can make adjustments if you have negative side effects.
5. A Hospital
In my state, most psychiatric hospitals accept patients after they have gone through medical clearance and an assessment at an emergency room or local crisis center. I actually work in an ER doing these assessments. The ER staff determine if you need to go to a hospital, detox facility, or home with outpatient resources. Just like with medical patients, the ER is triage for patients struggling with mental health concerns. This could be different in other states. If you find yourself in a crisis situation, here are a few resources for where to find mental health facilities. You can also always call 911 and they can get you to the right place.
I do not recommend going to the ER if you’re out of a medication or want to talk to someone about outpatient treatment. They likely won’t be able to help you immediately, and they’ll give you referrals that you could’ve found on Google for free. Most ER staff can’t pull strings to get you into an appointment, and the ER counselors cannot prescribe medications. Go to the ER for immediate crises, such as suicidal thoughts, thoughts about hurting others, or acute psychosis.
If you are assessed and do need inpatient treatment, they’ll facilitate that. Being in the hospital can feel scary, but it’s not as bad as it sounds. Inpatient hospitals help you get back on meds or adjust incorrect ones, help you stabilize and feel more like yourself, and give you a safe place to process crisis. The hospital is not a looney bin. Every patient there is struggling with a tough situation, and the hospital can often help. Life after the hospital can be really difficult, don’t get me wrong, but that’s for another article.
I hope this helped give you a brief overview of the types of psychiatric medications and when you may to look into an evaluation. Again, this barely scratched the surface, but my goal is for this information to give you a direction and know who to talk to about next steps. Wishing you success and a full life throughout your journey.