Should I take medication for my mental health?
Taking medication for mental health is a very personal decision. Patients tell me of the stigma they feel when on medications classified as antidepressants or antipsychotics.
When deciding to take a medication for mental health, the principals from other realms of medicine apply:
1. Know why you are taking the medication, what symptom(s) or illness it is for.
2. Know what to expect from the medication in terms of side effects and benefits.
3. Aim for the minimum dose that is effective to avoid being over-medicated.
It is also important to know that medication does not have to be what you turn to first in many cases. An example would be targeting weight loss and diet changes for early stages of diabetes to help prevent or delay the need for medication management. In many psychiatric disorders, therapy and lifestyle changes can be equally if not more effective treatments and should be the focus, with medications playing a supportive role. Mental illnesses that fall into this category include mild to moderate obsessive compulsive disorders, post traumatic stress disorder and personality disorders to name only a few.
Psychiatric illnesses where medications are recommended first include bipolar illness and psychotic disorders. In these cases, medication is usually necessary to achieve and maintain stability and often need to be taken for a lifetime.
How to decide between therapy or medication can be a difficult choice. Therapy is time-intensive, costly and difficult. However, it is the best at striking at the heart of an issue and giving you a corrective experience with tools that are long-lasting. Medications need to be taken regularly, usually daily at the very least, and there are side effects to contend with. I have had patients give me feedback that taking medication can be both disempowering and empowering. It is a reminder every day of their illness and some do not like that they depend on medications to function. Others feel that taking medication gives them more control of their disease and this gives them the confidence to push forward in their lives.
What I would want patients to know is that a medication is meant to help you improve your life and/or lengthen your life. If after starting a medication for several months, you do not feel this way, it is reasonable to have the medication and your symptoms reassessed, and to ask your physician if you should in fact continue taking it. Most physicians in Canada do not benefit financially or otherwise from prescribing medications. This comes up quite often in my practice so I think it is important to mention. I do not benefit in any way. But if you are concerned, I encourage you to have a frank conversation with your prescribing physician about this.
The last point I would like to make is that if you believe taking medication will be helpful but have hesitation for whatever reason, in psychiatry there is a lot of choice. Starting a medication does not mean it is permanent. I also tell my patients that they can choose to stop or start whenever they want, but that I would like to be informed so I can guide them how to do it safely. I would also want to know why the patient wants to stop to better guide me in making the next medication suggestion. I see physicians' jobs as telling our patients their options, tailoring recommendations to the patient based on what we know from the evidence, our own clinical experience and what we know about the patient. In my office, you will hear me say quite often, “I can tell you is what works, the side effects and what is safe. The rest of the decision making is up to you. It is your life afterall, not mine.“