By Azeeza Rawat
Edited by Imaan Moosa
Psychiatric medication helps countless people live normal and healthy lives. Why then, and how, has psychiatric medication obtained a bad reputation in society. Dr Rizwana Gaffoor, general practitioner, and Dr Sherona Rawat, clinical psychologist, discuss the stigma around psychiatric medication, as well as the potential benefits and costs of starting psychiatric treatment.
Diabetics take insulin.
Cancer patients go for chemotherapy.
If you have a headache, the doctor recommends painkillers.
But, if you’re anxious, you should just try to relax.
If you’re depressed, just smile more.
If you can’t concentrate, well, are you even trying hard enough?
Why do people believe that mental ill-health does not require medical interventions? There are biological and chemical imbalances that cause mental ill-health which have been scientifically proven.
I’ve never heard someone say, don’t think about it, be strong, your arthritis will go away. Maybe you shouldn’t take your heart medication, you don’t want to get addicted.
Why is psychiatric medication treated like the problem, instead of the solution, for so many people who suffer without it. People who can’t sleep, who have debilitating anxiety, who can’t function for reasons that are not in their control.
Dr. Rizwana Gaffoor, a medical practitioner practising in family medicine, shares her expertise on psychiatric medication. Furthermore, Dr. Sherona Rawat, clinical psychologist, provides her experience and insight into psychiatric treatment. Both practitioners explain the basics of psychiatric medication, the stigma around it and the pros and cons of taking these medications to To EmpowHER.
The basics of psychiatric treatment
Dr. Gaffoor explains the role of a general practitioner in the treatment of mental ill-health. “I will treat patients within my scope of practice, i.e., treating more common psychiatric conditions such as anxiety and depression, along with a psychologist. If a patient does not respond to first line therapy, I will then refer to a psychiatrist for further management.
“I would refer all complicated patients, i.e., depression with psychotic features and/or
with suicidal ideations to a psychiatrist. I also prefer referring all Bipolar Mood Disorder and patients with psychosis to a psychiatrist for a proper initial assessment and once the patient is stable, I can continue management when referred back from the psychiatrist.”
Dr. Rizwana Gaffoor
It is vital to consult with a medical practitioner as there are various types of psychiatric medications used to treat a multitude of conditions. However, Dr. Gaffoor shares that in her experience, the most commonly prescribed psychiatric medications would be antidepressants and benzodiazepines.
Often a patient may also see a psychologist first before being referred to a psychiatrist for medication. Dr. Sherona Rawat explains her role as a clinical psychologist in psychiatric treatment, and at what stage she refers her patients to a psychiatrist for medication:
“When they have psychological symptoms that have escalated beyond the reasonable consequences of their current situation; if their current situation is not resolved and if they are unable to leave or change or remain in a bad situation; if they have suffered significant trauma from a psychological point of view and if their mood is catastrophically low and/or they are suicidal.”
Dr Sherona Rawat
Stigma around psychiatric medication
While there are many reasons why patients may be referred to a psychiatrist for medication, a stigma, a cloud of shame, still hangs around this treatment.
Dr. Gaffoor is aware of the stigma which surrounds the use of psychiatric medication and shares her perspective as a general practitioner.
“Society has created this stigma, as they have labelled patients requiring psychiatric medication as weak (unable to deal with their conditions on their own, for example Major Depressive Disorder) or that these patients are inferior to the rest of humanity because they require pharmacological assistance to help them function better in life.
“Unfortunately, people overlook the actual medical reason why people are predisposed to psychiatric conditions – neurotransmitter imbalances that need to be corrected pharmacologically for certain conditions.”
As a clinical psychologist, Dr. Rawat shares her outlook on the stigma around psychiatric medication.
It is because [psychiatric medication] is overused; it is seen as a quick fix, it is viewed as a cure-all. It is used in place of good psychotherapy and the doctors who prescribe it either are not very good at pharmacology, do not take time to understand the patient’s condition properly, and most importantly that the doctor does not value or understand the value of psychotherapy on resolving mental illness. They may not refer to or discourage the patient from seeking a clinical psychologist, refer to the wrong kind of psychologist or try to provide therapy to him or herself.
“Medication is only required in certain situations and not for everyone. However, the current thinking is that if you feel unwell emotionally you need to see a medical doctor and medical doctors feed into this kind of thinking. In this way people feel that you must be clinically sick if you use psychotropic medications. They tend to feel as if it will become a permanent chronic situation with the medications, given their experience with the medical fraternity. In addition, society looks down upon individuals who admit to having difficulties emotionally.”
Source: pbs.twimg.com
Dr. Rawat agrees with Dr. Gaffoor: [Requiring psychiatric medication] is often perceived socially as a weakness and tends to be viewed again as a permanent condition which when medication is added to the equation, makes the person feel as if there is something catastrophically wrong with them. Unlike physical illness, mental illness is viewed as a permanent state by society and the labels often linger, raising its head during times of conflict most often.
Many people would prefer to think that they are strong enough and sane enough to come out of their situation themselves with no help from anyone, including medication. Sadly, while they refrain from the use of appropriate and carefully measured medication from a psychiatrist, they opt for self-medicating which is ultimately worse and often much more damaging.
Cons of psychiatric medication
It should be known that psychiatric medication does have side effects, however, most pharmaceutical medications have side effects, even those treating physical illnesses. It is not a consequence of psychiatric medication specifically.
Dr. Gaffoor says that depending on the medication, there are a vast amount of side effects that each class of drug has. Different classes of psychiatric treatment have different side effects.
There are other possible disadvantages of taking psychiatric medication. “Patients live with the stigma of being a psychiatric patient. Also, the cost of medication is high. There’s also the issue of patient compliance.”
From her experience, Dr. Gaffoor explains that the most common psychiatric medication that she deals with are anti-depressants, or SSRI’s. However, “patients complain of initial worsened anxiety for two weeks (that is why we add benzodiazepines and therapy, which is normal). There are also other common side effects of SSRI’s, such as “dry mouth, loss of libido, loss of appetite, headaches, GI symptoms - diarrhoea or constipation.”
Different classes of psychiatric medication may come with different side effects. Dr. Gaffoor talks about benzodiazepines and their side effects.
“There’s the issue of addiction, which is why we try to use the newer generation of benzodiazepines, and then slowly wean off. I do not like patients relying on benzodiazepines for insomnia. Also, the traditional benzodiazepine classes used, like alprazolam, can hinder daily performance because of sedation. Patients feel tired.”
“I believe in always treating holistically and considering natural supplementation too to boost GABA and serotonin levels. I believe benzodiazepines should not be long-term.”
Often people assume that medication will fix all their problems. Yet, Dr. Rawat explains that medication is not an easy fix and usually does not have the effect one would hope for. The only sure way to resolve a person's problems that are resulting in their emotional distress is by helping them develop insight and building the emotional strength to change their current situation to something more conducive to their healthy needs.
Source: elliementalhealth.com
Pros of psychiatric medication
Dr. Gaffoor also gives examples of the positives of treating psychiatric medication.
“It helps to correct neurotransmitter imbalances to help patients manage their conditions better, so that they can live healthier lives, allowing patients to function in society. This not only helps the patient be productive in all spheres of life, but it helps improve the lives of families around them who are caring for them.”
Once again, Dr. Gaffoor mentions that the newer generation of psychiatric medications have less side effects and can be better for patients.
“Patients do not gain weight and feel tired, like older generation antidepressants, like Trepiline. Also, the newer non-benzodiazepine classes, like Zolpidem, are more expensive but less addictive.”
Dr. Rawat goes on to explain how psychiatric treatment helps her patients.
Medication is a means to assist the patient by medicating some of his or her debilitating symptoms while continuing to work on his or her emotional, psychological, and environmental problems. It helps me help my patients be more comfortable, feel supported and have some of the debilitating symptoms mitigated by, for instance, reducing anxiety and helping with sleep.
Reducing the stigma around psychiatric medication is important
It does not promote substance abuse. It does not promote neglecting your therapy and ignoring solutions in your environment that may assist in alleviating mental distress.
It is acknowledging that psychiatric medication helps some people, and that psychiatric medication, when prescribed by informed medical practitioners, can improve the lives of some.
But don’t just resist psychiatric treatment out of shame. There’s nothing shameful in doing what is best for yourself.
This is something to explore with your medical and mental health practitioners.
Comments