The Case for Psychiatric Medicines
For years we have been hearing that we are a pill-popping nation. In some ways this is true. Witness those who demand an antibiotic from their doctor even though their infections are viral and will not be helped by the drug. But when it comes to psychiatric medications for anxiety and mood disorders, I have yet to run into a patient who is anxious to take them. In fact, many people begin taking them only to stop as soon as they feel better and suffer a relapse. Some patients view these drugs as crutches and consider that they should be tough enough to cope with life without such help. Others are too afraid of side effects or long-term problems to try them at all. And the media, when not covering juicy stories like the OJ trial or Monica, latches on to any hint of a problem with these drugs and hypes it for good copy. What is the truth? Who should take these medications, when and why?
To begin with, it is essential to understand that what we call mental illness is actually a chemical imbalance that causes disturbances in thoughts or emotions. Specifically, chemical imbalances in the brain cause the melancholy and low self-esteem of depression or the fretfulness of obsessive-compulsive disorder. But did you realize that there are other physical illnesses that can create depression such as diabetes or hypothyroidism? When the mood disorder is caused by an inability to produce insulin or thyroid hormone it is not considered mental illness; nor do people tend to question whether medication is necessary. However, if the imbalance is in the brain, the label is mental illness and people suddenly think they should be able to think their way out of the problem. But just as you cannot think your way out of diabetes, you cannot think your way out of depression or anxiety.
Our approach to psychiatric medications is interesting. New drugs are constantly coming down the pike Ė new antibiotics, pain medications, and other disease-modifying drugs Ė and patients are happy to take them even though they do not yet have a track record, and there is no way to know the long-term effects. People take them because they cure disease, moderate the effects of a disease, or alleviate pain and, especially in the first two instances, do not think much about side effects because they know the effects of the illness, if left untreated, will be debilitating.
As a side note, herbal remedies are also popular even though there is often little research to support their safety and efficacy. Take the Echinacea craze in the late 1990s. American cold sufferers jumped on the Echinacea bandwagon only to find out later that studies showed it was no more effective than a placebo.1 St. Johnís Wort was touted as the ďnaturalĒ alternative to drugs for the treatment of depression. Not only is it not as effective as the drugs available, but it interacts in a dangerous way with far more of the other medications that many people take, such as some heart medications.
What individuals often fail to realize is that the effects of untreated depression and anxiety, like many other physical illnesses, can be serious, even deadly. First there are the effects of stress on the body. The stress response originally evolved to help humans deal with intense, but brief periods
of danger. Today, however, instead of coping with immediate threats, like the attack of a wild animal, many of us are faced with challenges that are ongoing, like earning enough money or juggling family needs. That extended stress, manifesting in the form of anxiety and/or depression, takes a toll. Robert M. Sapolsky, author of Why Zebras Donít Get Ulcers has shown that stress and depression are highly correlated with illnesses such as heart disease, diabetes and colitis.
Second, depression and anxiety often lead to isolation. The depressed person often avoids social situations because of the energy required or stress involved. Often the individualís work suffers, both from the desire to isolate and from lapses in concentration and memory due to depression. In general, depressed people behave in ways that do anything but bring people closer. The result is that support networks disappear, which only feeds the downward spiral. The danger here comes not only from overt consequences, such as feelings of worthlessness and possibly even suicidal tendencies, but also from more subtle sources, such as the negative, long-term health effects of living an isolated life. Isolation increases the risk of death from a range of medical disorders.2
Among the concerns that many people have with mood order medications is the fear that taking an anti-depressant or an anti-anxiety drug will change who they are. This isnít just an esoteric question, but one that people take very personally. My response to patients with this question has always been to point out that you are the person who decides to be well by taking medication. Medications donít change who you are because it is you who has made the conscious choice to improve your mental health. Another way to look at it is to consider how you would live your life if it werenít crowded by fear and/or hopelessness. That is the baseline which therapeutic drugs are meant to provide.
As with any drugs, itís important to have all the facts before deciding whether or not to take psychiatric medications. There are reasons not to take certain drugs, and you should always consider what factors in your life might render treatment ineffective or unsafe (such as family history, a medical condition, etc.). However, it is equally important to recognize the potential negative results of not taking medication. This side of the argument is too often neglected, and the result is that a lot of people miss out on the chance to lead happier, healthier lives. Ultimately it is your responsibility to achieve the best mental health possible. Medication is not a crutch, but a tool to help you achieve that goal.
1. Turner RB et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. NEJM. 2005; 353:341-348.
2. House JS et al. Social relationships and health. Science 1988; 241;540-545