Questions of Medication

As a non-prescribing therapist, I find myself being asked to counsel people on using medication to effect their mood very, very often.  People want to know if I think medication might help them, if it might harm them, what kind of medication might be useful, as well as how much.  The most frequent question I get from clients and others, though, is simply about whether or not I agree with the idea of medicating a person’s mood.  Make no mistake, this is a very popular topic in the therapeutic community.  And while I think the answer is simple, I don’t think it’s obvious.

There are a lot of factors to consider when thinking about starting on any kind of psychoactive medication.  The first, of course, is the question of safety - these drugs are very powerful, often stay in the body for a long time after a person stops taking them, and haven’t been around long enough for anyone to know what, if any, long-term effects they may have on the brain. On the other hand, these drugs may be the only thing keeping a person safe from themselves.  The celebrated writer David Foster Wallace committed suicide at the height of his career and with a life full of people he loved and who loved him back, while in the midst of a deep depression that had overtaken him after he switched medications to try and reduce the side-effects they were having on his life.

There’s also the issue of not overdoing things - medications are often seen as an extremely powerful intervention of last resort.  The nuclear option.  Knowing about the various hazards of medications listed above, it makes sense to start with more self-contained options.  Things like exercise, healthy diet, activating social supports, and spending time in nature have all been shown to have strong positive effects on the mood for many, though not all, people.  Something to keep in mind when working at this level, though, is that many people find it much easier and more nourishing to engage in these activities after starting a course in medication.  So while I always recommend trying to enact mood change on this level first, I have to be simultaneously aware that sometimes this is putting the cart before the horse.

In addition to the above factors, though, people run in to more nebulous sorts of questions, questions that hinge on systems of ethics, beliefs, hopes, and fears.  I’ve had so many clients who look at their depression, their anxiety, their OCD, etc., as problems they need to solve.  Which of course I understand: we all want to rise above our challenges.  We see dragons and want to slay them.  But often this desire gets wrapped up in a deep and unnoticed self aggression, this quiet need to prove we are not this thing that has held us back and made us feel so bad for so long.  This kind of impulse, to prove that we are not the thing that everyone thinks we are, is often not only counterproductive by itself but also conspires to keep real solutions away from us.

Those of you who have been on meds or know someone who has have probably had some conversation about this phenomenon, this idea that a person needs to “just snap out of it”.  I try and hold every approach as a viable option in my mind, to consider these things without judgment, but I have to admit to having a really nasty reaction to the “just snap out of it” plan.  It’s just so unkind to people who are in tremendous pain.  We like to distance ourselves from how we feel in Western culture, but the fact is that your mood is as much a part of who you are as the body you live in.  Some people have some success with just changing their mind, telling themselves that depression or anxiety aren’t who they are and to just get over it, but that approach often leads to a kind of emotional relapse.  It’s the equivalent of people who white-knuckle their way through sobriety - it can work, sometimes for a long time, but it rarely leads to lasting happiness and satisfaction.  As a therapist I want my clients to love and accept themselves, not bury and shame the parts that aren’t rewarded by society.

In my own life, I have found medications to be both problematic and helpful.  As a teen I was misdiagnosed with ADHD and ended up on Adderall for nearly a decade.  While this did help me stay awake through class, it also wreaked havoc on my sleep and overall health, and never really accomplished the initial goal of helping me get organized and stop procrastinating.  As a young man, I went through a period of overwhelming depression and sought out medication.  I was prescribed Zoloft, which I stayed on for about a year.  Though I found some of the side effects to be really frustrating, I also was able to pierce the veil of my depression while prescribed.  This allowed me to begin the kinds of healthy habits that allowed me to stay out of my depression when I got off the prescription.

And that’s what I really want to get to with this post: that feeling good is good enough.  Sure, on an absolute level we would all benefit from getting over our addiction to feeling good, but on the relative level we all deserve the option, at least, to feel happy!  People hurt themselves or take their own lives every day because our culture has such an exclusionary system of granting people the right to feel happy and fulfilled, and judgments around medication are part of that system.  I don’t know where they came from, but I wish they would go away.

If you spend every day weighed down by depression, harried by anxiety, taunted by paranoia, enchanted by psychosis, you deserve to get free any way you can that doesn’t hurt others.  You don’t have to live that way!  And, sure, in a perfect world people would be able to use medication as a brief intervention to lifelong happiness, but we don’t live in a perfect world.  Not everyone has the option to be medication free and have an appropriately functioning brain.  So yes, the answer about whether it’s a good idea to use psychoactive medications is a simple one, but it needs to be come to through some deeper thought.