As a therapist, 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’s what you need to know.
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, but rather this information speaks to general, known facts about various psychotropic medications and mental illnesses, in order to give you a basic understanding. 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 probably the med you've heard of 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, such as Lamictal.
Psychotic disorders, such as Schizophrenia, also typically have a genetic component and are highly hereditary. Psychotropic medications such as Seroquel and Risperdal are very commonly used, and can be of significant benefit. 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 and SNRI's
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, and Lexapro) can be helpful.
The neurotransmitter serotonin is a chemical 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, regulating all of these functions, and excess is reabsorbed back into the brain tissue. In the biologically depressed brain, serotonin is still released, but the reabsorption process is working overtime, so that not enough serotonin stays out in the brain. SSRIs inhibit this reuptake process, allowing normal levels of serotonin to be in the brain and improving the aforementioned functions. Many SSRIs are used for both anxiety and depression.
SNRI's (like Cymbalta and Effexor) work on norepinephrine, rather than serotonin, but provide a similar effect and are also used for depression.
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 to 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.
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 Your 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.
Who Do I Talk To?
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:
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.
Meeting with a therapist is always a great start for your mental health journey. Some people who participate in therapy find that they don’t need to add in medications. But a therapist can 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.
Intensive Group Therapy
Group therapy 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.
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 MDs have the ability to prescribe them, and only psychiatrists have a mental health speciality. So they take a lot of patients and don’t spend as much time with them as a therapist. This also means many of them have a long wait list. If you’re willing to go private pay, you can likely get in more quickly.
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 what combination works for you. Make sure you have regular appointments while trying a new medication, so that if you have rough side effects they can help you make adjustments.
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 used to 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.
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. Most patients aren’t crazy, just like you’re not crazy. They’re 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.