The 30-something dark-haired woman started her fourth therapy session with an unusual exuberance. Curious about this sudden improvement in her otherwise melancholy demeanor, the therapist probed. “You seem quite upbeat today compared to the past few weeks. What’s different in your life that’s causing you to smile?” The client replied, “I went to see a psychiatrist a few days ago regarding medication for my depression. She said I have a chemical imbalance and started me on Zoloft. I think I’m already feeling better!”
“Not only that”, she went on to say, “I don’t think I’ll be needing therapy anymore!”
While the above scenario may seem a bit exaggerated, it’s not really that uncommon. In our pill-loving, quick-fix-seeking society, it’s no surprise that most people would rather take a pill for whatever ails them than do the hard work (e.g. going to therapy or making healthy lifestyle changes) that’s required to adequately address the underlying issues.
Popping a pill is so much easier; not to mention usually far less expensive and certainly less time-consuming.
Therapy isn’t easy, and, at times, can be painful as deep wounds are exposed and explored.
Ditching old, unhealthy habits and establishing new ones is also quite challenging for most individuals, considering the plethora of resolutions that are broken within days, if not hours, of ringing in each New Year.
Taking medication, on the other hand, is so much less of a hassle. No probing therapist. No uncomfortable, hour-long sessions. No real need for discipline or hard work or introspection. Just get the prescription filled, take as instructed, and wait for the magic to happen. Goodbye depression (or anxiety, ADHD, paranoia, panic attacks, etc.).
Of course, don’t forget the one-thousand-plus potential side effects listed in ridiculously small print on a paper insert.
The Medication-as-Sole-Treatment Dilemma
While medication often does have a legitimate place in many individual’s mental health treatment, it’s generally not recommended as the primary or sole form of treatment. Not to mention, it’s often unnecessary when symptoms of some disorders, such as depression and anxiety, are mild to moderate.
That being said, psychotropics can play a significant role in helping someone get better. This is especially true when symptoms are severe; i.e., the person is struggling to function on a day-to-day basis or too impaired to engage in the therapy process. In those cases, medication may need to take the forefront (sometimes along with inpatient treatment) until the person is more stable. This is particularly true for patients who are psychotic, manic, or severely depressed.
The problem, however, is when treatment providers (and patients) become over reliant on medications. When pills are regarded as a “cure” or “solution to the problem”, they can quickly take the place of a far more effective treatment approach. This is one of the reasons why most experts recommend medications, such as antidepressants and other psychiatric drugs, as an “adjunct” part of treatment. They’re intended to be used in addition to therapy and lifestyle changes, not in lieu of.
Chemical Imbalance – Only Part of the Problem
Like the therapy client scenario above, too many people put too much emphasis on the notion of “chemical imbalance”. They fail to recognize or understand that that’s just one possible piece of the puzzle. And focusing on one piece, rather than the whole picture, rarely works. The medication may bring some improvement. But, in many cases, as soon as the medication is discontinued, the symptoms come back.
Why does that happen?
Underlying Issues Must be Addressed
It could be due to different factors. For example, a lot of people who struggle with anxiety and depression have irrational beliefs and negative thought patterns that fuel their symptoms. If those are never addressed and replaced with healthier, more-empowering thoughts and beliefs, medication is going to provide temporary benefits, at best. It’s akin to the overweight person who goes on a diet for a few weeks or months, only to eventually gain the weight back (and often more) once the diet ends and old, unhealthy eating habits are resumed. If the underlying issues aren’t addressed, dieting is a temporary fix at best.
Personal Responsibility Removed
Another reason is that attributing everything to a chemical imbalance removes all responsibility from the patient. This isn’t to suggest that most people choose to have a mental illness (although some do get a “payoff” that makes getting better unappealing on at least a subconscious level). Removing responsibility removes motivation to do any of the healing work (like the woman in the above scenario). Why go through all the hard work of gaining insight and understanding, or developing better coping skills and reprogramming maladaptive thought patterns, if all that really needs to happen is getting serotonin levels back to where they should be?
Patients are Disempowered
Relying primarily or solely on medication shortchanges every patient, from the individual who’s been battling OCD for 10 years to the person who’s been struggling with depression for several weeks. Sending them on their way with a prescription and nothing more is sadly disempowering. It gives the very strong message: “You must rely on something outside of yourself (medication) in order to get better.” The more subtle message: “There’s nothing else you can do.” Is that the message mental health patients should be given? Ever?
People are much more likely to heal (or at least make significant progress) when they believe they have the power to bring about desired changes. Now, does this mean OCD or schizophrenia or bipolar disorder can be completely overcome? Not necessarily, as these tend to be lifelong illnesses. But it does mean that patients are more likely to be proactive in their treatment if they believe doing so will make a difference.
Medications Often Don’t Even Work
Another problem with the overreliance on psychiatric drugs is that they often don’t even work or provide very limited benefits. Significant trial and error is often involved to find the right medication at the right dose. Considering that it can take weeks for many medications to reach a therapeutic level, it can be very discouraging and frustrating to have to keep starting over with yet another medication. For someone battling depression, this can cause feelings of hopelessness to worsen. Many patients also eventually get tired of feeling like a human guinea pig.
Troubling Side Effects
Another problem with an overreliance on medications is that they come with a long list of potential side effects. For example, one common side effect of several antidepressants and antipsychotic medications is weight gain. For patients who are already battling low self-esteem or feelings of worthlessness, gaining unwanted pounds can feel like one more blow, exacerbating their problems rather than helping them. Other side effects can wreak all sorts of havoc in the lives of those who so desperately want to get better, adding insult to injury.
Putting Medication in Perspective
Psychiatric medications definitely benefit many patients. In some cases, they are literally life-saving. They can reduce the chances and severity of future manic episodes in patients with bipolar I disorder. They can alleviate severely disabling psychotic symptoms in patients with schizophrenia. And they can help pull a severely depressed person back from the brink of suicide and enable him or her to function normally once again.
However, they should never take the place of proper therapy as a general rule. One of the reasons Cognitive Behavioral Therapy is so effective for many disorders is because it helps people identify and change faulty beliefs and unhealthy thought patterns. Therapy also helps patients gain insight, develop effective coping strategies, and improve their interpersonal relationship skills. Medication can’t do those things.
Medication should also not be relied upon at the exclusion of making lifestyle changes and establishing healthy habits that can help reduce symptoms and enhance emotional wellbeing naturally. For example, there have been many studies that have shown that regular aerobic exercise (e.g. brisk walking, jogging, swimming laps) is just as effective in reducing symptoms of mild to moderate depression as antidepressant medication. Practicing good sleep hygiene helps ensure restorative sleep, which also greatly benefits mood and overall wellbeing.
If you’re seeking treatment for a mental health condition, don’t look to medication as the sole solution. Be wary if your treatment provider does nothing more than write you a prescription and send you on your way, without any discussion of other treatment options – particularly psychotherapy. The fact is you may not even need medication. And if you do, it’s almost always far more effective when combined with psychotherapy and healthy lifestyle changes.