Medication and Therapy

In my last post, I touched on the topic of medications and mental illness. This post will attempt to address some of the issues connected with this vast topic…

Psychotropic medications have always been a controversial topic in many different societies. I have had much experience working with people on all kinds of medications, as well as working with people in the midst of going off their medications, starting to take medications for the first time, and many who tried out medications and then stopped them without finding a medication that was helpful. In addition, I have encountered people suffering from various emotional and mental difficulties and disorders who were vehemently opposed to taking any form of medications but were willing to try alternative forms of healing instead of medications.

I try as a therapist and person to be open to all points of view about this topic. What one chooses to put in one’s body is a very often private and vulnerable personal topic. While psychiatrists that I have talked to about this admit that we know very little about what makes a medication work and why and how, we also know a lot more now than ever before, and there are a lot more choices of meds than ever before…

As I mentioned in my last post, I have found that people struggling with and suffering from such issues/disorders as schizophrenia, schizoaffective disorder and bipolar disorder (both 1 and 2 as they appear in the DSM), really benefit from regular medication for an extended length of time. Often the reason for a re hospitalization or “relapse” with one of these serious disorders is caused directly by the person stopping taking their medications, usually because the person feels a lot better and thus thinks, “Oh, now I can stop taking these medications,” which makes some sense, as very often when our suffering is relieved by medication, it makes sense to stop taking it. But these disorders are more like diabetes. You don’t stop taking your insulin because you feel better. When I worked at a Continuing Day Treatment Center for adults and also at a residence for emotionally disturbed children, I saw how the medications really helped people with these serious types of disorders. Almost all the adults at the CDT were taking some kind of psychotropic medication, and a lot of but not all of the children I worked with at the residence were also on medication. The topic of medication and diagnosis and children is a complicated topic better addressed in a separate post. Suffice it to say that I saw children also helped by medications, especially those with ADHD and other behavioral disorders.

While Bipolar Disorder is a serious and sometimes even deadly illness, it is amazing how much medication taken regularly can really transform someone and their ability to function, such that people who continue to take their medications on a regular basis can function and thrive. Sometimes one or sometimes a combination of medications, and there are now many different mood stabilizers whereas a while ago it was mostly lithium, anyway these meds can really help balance the fluctuation of moods from manic to depressive. Most people have to learn the hard way that they need to accept their biology and that they suffer from Bipolar Disorder, by going off their medications, having a relapse or even two or three, and then accepting it and staying on the medications that work for them. Luckily there are now a variety of mood stabilizers, and these medications don’t all take away a person’s creativity and liveliness; they just help an individual to manage their mood disorder.

Schizophrenia and schizoaffective disorder are much more debilitating than bipolar disorder. However, I witnessed many of my patients healing with a combination of therapy, day treatment which provides structure and socialization, and medication. This combination of approaches really help people with severe symptoms, such that the voices they are plagued by can disappear, or at least subside to the extent that the individual can function on some level and receive some relief. It is very unusual for an individual suffering from these illnesses to be able to not take any medications. There are many good medications out there that work; unfortunately many of these  st cause weight gain, and I saw my patients suffer with the side effects of weight gain as well as worse side effects. Some people manage to be careful with their diet and are able to take these very potent medications without experiencing weight gain. However, I saw many of my patients at the program who were on Medicaid and had poor dietary habits; still for many to be able to socialize with others, even to be able to leave their house or residence and attend the program was a big step towards healing. The medications were only one part of this; therapy, groups, meeting others with similar issues, having a structure to their day — all of this was necessary for some or partial recovery.

Depression, including both major depressive disorders and other less serious depressions, is much trickier in terms of medication management. I have certainly seen people with bipolar disorder take medication for depression along with a mood stabilizer and be helped by the extra medication. I have also seen people get out of a terrible depressive period with the help of anti-depressants. Some of these people were helped by taking some  kind of anti-depressant for several months to a year and then were able to stop their medications and use other means for their daily self care to avoid slipping back into a depression. I have also seen people with depression who continue to take their medication even when they are not depressed, and these people find it helps them to combat the return of depression. Any person taking anti-depressants temporarily or permanently is greatly helped by having  some form of therapy, as well as a support group or yoga or regular exercise or any other number of  “non medications” that help with healing. In fact, sometimes the medication helps the person to be able to be motivated to do these other things that they were too depressed to do for themselves before taking medications.

On the other hand, I have seen some people struggle with taking anti-depressants, even to the point that they are willing to try a few different ones, looking for one that works, only to be defeated. These people sometimes can find no medication that works for them ,and they often make a valiant effort to find one. However, the good news is that there are other ways to shift depressive brain chemistry. Art therapy is especially effective in that the act of making art and being creative in the moment does have a positive effect on the brain. With the support of the art therapist or the group therapy, a person with depression can begin to shift his/her mood towards feeling better. Regular exercise has been proven to help with depression as does yoga. With good support from friends, family, a therapist, a support group or therapy group, some people are able to combat their depression without the help of any psychotropic medication.

Of the people who refuse to try any of this kind of medication for their depression, many do self medicate and even are aware they are doing so. Some use drugs or alcohol, which of course actually physiologically contribute to depression, but the slight lift or high at the beginning of injesting substances can outweigh the crash for many people caught in a cycle of addiction or dependence. Even limiting food intake to an extreme is known to produce a high, so restricting food intake can be another form of self medicating. The challenge for this group of people is to become aware that they are self medicating in an unhealthy way and after that to change these behaviors.

There are people who do not self medicate with unhealthy behaviors who believe alternative medecine is the way to go. These people really work hard to combat their depression with positive self caring behaviors such as regular yoga, massage, reiki, some kind of creative endeavor or creative arts therapy, as well as writing and using some of the cognitive behavioral therapy techniches as well as creative visualization, acupuncture, and even being careful with their diet, as it is true that certain foods contribute to depression.  Often it can become a vicious cycle where depression leads to eating unhealthy foods or bingeing on unhealthy foods, then becoming more depressed and continuing to take bad care of oneself. So changing one’s diet can really help with depression.

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One thought on “Medication and Therapy

  1. I find the part about alternative therapies particularly interesting. Oftentimes people don’t consider these and give control of their mental health to others – doctors, prescription medications, self-medication. these have their own benefits (even the self-medication 😉 but having more options that people are more fully aware of and actually include in their considerations of how to proceed to get help is invaluable to empower mental health patients.

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