I can’t think of any other type of health condition that has as polarized a relationship with Medication as mental illness.  In some ways, to medicate or not to medicate has become a moral issue, with various involved parties taking a stance based on principle.  Often this stance is very broad, making sweeping generalizations.  I recently read and reviewed the book Lost Connections, which argues that all depression is situational and medications should not be used.  Some people connect psychiatric medication use to violence, such as the incoming director of the National Rifle Association (NRA) who has suggested a link between school shootings and Ritalin (methylphenidate).  I’ve seen Twitter comments blasting people who wrote about the positive effects they experienced from medication.  We would never hear any of this kind of thing if we were talking about blood pressure medication, so why are there so many eager to shout from the rooftops when it comes to psychiatric meds?

My own view is certainly shaped by my professional training; I used to be a pharmacist, and now I’ve been practicing as a nurse for 13 years in mental health settings.  I understand how medications produce the effects (both positive and negative) that they do, and have the research literacy to separate the BS from legitimate information.  I look at medication as a tool, and any given medication may or may not work for any given individual, and may or may not be tolerated by that individual.  I have seen medication be life-saving for people, and it certainly has made a huge difference in my own illness.

In general it seems like people tend to speak up, both online and in person, more often about things that go badly for them than things that go well.  The same appears to be true with medication.  I’m a bit fuzzy remembering the details, but not too long ago someone had written a post about antidepressant withdrawal, and someone else commented about how venlafaxine is a garbage drug that no one should take because of the withdrawal effects.  I’m sure that individual’s experience was very negative, but it’s easy to see remarks like this about side effects and overgeneralize, making the assumption that they occur for all/most people taking the drug.  Unfortunately we don’t yet have a way of predicting who will respond to or tolerate particular drugs (although I’m sure the science will get there as the role of pharmacogenomics expands), but to allow treatment decisions to be based on people’s negative comments online doesn’t seem particularly helpful.

I suspect that some of the time meds are demonized because of poor clinical practice by prescribers.  If physicians aren’t responsive to the side effects people are having, ordering any necessary bloodwork, or prescribing drugs that are actually appropriate and effective for the condition being treated, those things don’t mean the drug itself is inherently bad.  Instead, it means that the prescriber is being irresponsible.  I can’t help but think of a blogger with Bipolar Disorder who was treated for many years with high-dose clonazepam, and then had it discontinued abruptly.  In my mind that is shocking malpractice and a gross misuse of a medication that is not even indicated for treatment of bipolar disorder (but can be very useful when used carefully and appropriately).

It’s also problematic when doctors prescribe a medication and make it out to be a sort of panacea that will fix everything.  We all know there’s a lot of different things involved in getting well, whether we’re on medication or not.  Psychosocial stressors and underlying trauma aren’t going to disappear with a wave of the SSRI wand, and that’s fine, but doctors should be open with their patients about what medications will and will not do.  If patients are coming in misinformed and expecting to pop a happy pill, the health professional has a responsibility to educate them about the nature of mental illness and its treatment.

As Shakespeare’s Hamlet might say:

To medicate, or not to medicate: that is the question:
Whether ‘tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?

Where do you stand when it comes to medications?

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