Is Medication Really Necessary for Mental Health Disorders?
Often clients come in to see me and wonder if they need to take prescription medication. This is especially true when I am working with children/adolescents as there is concern about how certain drugs will affect the child's development. The truth is, medication is usually not necessary. However, there are several instances in which a prescription is a must or should be strongly considered. A list, along with reasons why treating those conditions with medicine is necessary/beneficial, follows below. Please keep in mind this is a very simplified overview of the listed conditions and how medications are helpful.
How Do I Know if I Need Medication?
It's important to keep in mind that most of us get sad or feel nervous from time to time. These emotions are usually responses to typical experiences such as the death of a loved one, a break up of a relationship, having to give a presentation, or meeting someone new. Such situations rarely have an impact on our behavior and any impact that does occur is minimal. Sure, we might not want to go to work on the day of the presentation, or we might have a hard time getting out of bed after a break-up—but we can still do these things without much effort. The fact that you can still function without feeling like you have to "force" yourself to do so is a sign that you likely don't need a prescription to help with your issues. Another way to help determine the need for medication is to rate how intense your symptoms feel. You can use a scale of one (1) to ten (10), where one represents minimal or no issue and ten is the most intense. If you score most of your symptoms at a five (5) or lower, you probably don't need any medicine to help treat your condition.
No Medicine Required
Definitely Need Medicine
Nervous about presentation at work/school
Sad because loved one/pet died
Symptoms rated 5 or lower on scale 1 to 10
Still functioning (e.g. going to work, taking care of children, etc)
Symptoms rate 6 or higher on scale 1 to 10
Symptoms impacting functioning: (e.g. can't get out of bed, avoiding situations, etc)
When Is Medication Necessary?
Use of prescribed medicine is typically necessary for the following conditions: ADHD (attention deficit hyperactivity disorder), bipolar disorder, schizophrenia/schizoaffective disorder, and when experiencing hallucinations or delusions. Why? The breakdown follows below.
ADHD consists of inattentive symptoms, hyperactive/impulsive symptoms, or a combination of these symptoms. These behaviors don't exist simply because someone "can't control themselves". In reality, there is a part of the brain that is under stimulated. Essentially this part of the brain is taking a nap and therefore it can't do its job, which it to help us focus, sit still, and think through decisions before acting. Hence, a stimulant medication is prescribed in order to "wake up" that part of the brain. This allows that area of the brain to work more like it should. Treatment with use of a stimulant medicine is effective for 70 to 80% of people who use it (U.S. Department of Health and Human Services). Once issues with attention/concentration and excessive fidgetiness are controlled, it becomes easier for someone with ADHD to learn the skills to help them manage the rest of their symptoms (such as poor organization, which will not be fixed with medication).
2. Bipolar Disorder
Bipolar disorder is diagnosed when a person experiences alternating periods of elevated mood states, referred to as mania, and depressive mood states. There are two forms of bipolar disorder, I and II. The only difference is in how long the manic symptoms last. Regardless of the type of bipolar disorder someone has, the medication prescribed is typically the same. He/she will be given a mood stabilizer to help decrease the frequency/intensity of the elevated mood states as it is often during these times when a person is more likely to engage in behaviors that could negatively impact their functioning. In addition, a person with bipolar disorder may be prescribed an anti-depressant medication to help with the depressive symptoms.
Schizophrenia is a condition in which a person sees or hears things that are not real (hallucinations), believes odd things, speaks incoherently, lacks emotional expression, and is either very rigid in their behavior (catatonic) or very childlike/goofy/irritable in their behavior. Schizoaffective disorder means a person has a mood disorder in combination with above-listed symptoms. Medication for both disorders typically consists of an antipsychotic, which helps control the odd beliefs and hallucinations. Without medication, the hallucinations and odd beliefs make it hard for a person to hold a job and have successful, healthy relationships with others.
Hallucinations can be auditory (heard) or visual (seen). They are not perceived by anyone other than the person who is experiencing them. Delusions are distorted thoughts such as believing the government is watching you, someone is following you, others are trying to read your thoughts, you are God, etc. A person experiencing delusions believes these thoughts to be true and cannot be convinced otherwise. Living with hallucinations and/or delusions can be extremely disruptive as they can impact daily functioning by impairing problem-solving/decision-making skills. Therefore, medication is important to help reduce the strength of the hallucinations/delusions so that daily life is less disrupted.
Other Circumstances for Which Medication Should Be Considered
While medication for anxiety, depression, or other issues may not be necessary, it can be helpful when the symptoms are so severe that they are impacting functioning. Here are a few instances when it would be good to consider talking to your doctor about trying medicine:
- You are crying every day for no reason - meaning you cry even when nothing sad has happened and there is no exposure to stimulus that might cause sadness such as a movie or song.
- You are so exhausted you can't get out of bed. Sometimes this can feel like your body is too physically heavy for you to move.
- You have frequent thoughts of wanting to kill yourself or have made attempts at killing yourself.
- You have thoughts of or have engaged in self-harming behaviors such as intentionally cutting yourself, burning yourself, etc.
- You are having frequent panic attacks, which consist of symptoms such as trouble breathing, feeling dizzy, sweating, rapid heartbeat, etc.
- You worry a lot and find it hard to stop/control the worry thoughts because there are some many of them and they keep coming rapidly.
- You avoid going to parties, concerts, or other social gatherings because of anxiety.
In these cases, medication will reduce the severity of symptoms. For example, instead of crying daily you are only crying once or twice a week. Or you now have the energy to get out of bed even when you still feel fatigued. Often times the changes are small and sometimes people have a hard time noticing the improvements, which might be more obvious to others.
Remember, if you have any questions about whether or not medications are right for you, consult a trained professional for advice.
U.S. Department of Health and Human Services. (31, May 2017). Attention Deficit Hyperactivity Disorder (ADHD).