Self-Help: Medications

All of the ideas expressed on this page are my educated thoughts about medication. Before making choices about medications, I urge you to talk with your doctor and to research the medication on the internet and in books. I have provided some good internet sites on my Internet Resources page.

How are mood and thinking related to the brain?

There is much that we do not understand about how the brain works and why it gets off-kilter in the thoughts and moods it produces such as depression, anxiety, panic, paranoia, and mania. Our knowledge is growing rapidly. We do know that certain substances in the brain are related to these problems. Some of these substances are called neurotransmitters. When there is too much or too little of a neurotransmitter, our thoughts, moods, and energy change.

The brain is made up of cells called neurons which have two ends. Thoughts occur by moving from the end of one neuron to the dendrite (or beginning) of the next, to the next, etc. However, these neurons do not quite touch each other. For the thought to move as it should, it must jump from one neuron to the next. Neurotransmitters are the bridge between the cells that makes this happen. When there is not enough or there is too much of one of these neurotransmitters the thinking process is affected.

We also know that certain kinds of traumatic events such as war, death of a loved one, rape, assault, and so on can change the ability of the brain to regulate itself, either temporarily or permanently. After these events, medication may help decrease nightmares, depression, fear, and avoidance of others.

And we know that having negative depressed thoughts can cause neurotransmitters to decrease, which can cause more negative thought...a really crumby feedback loop that can spiral a person into bad depression.

Most medications that are used for mental or emotional problems increase or decrease specific neurotransmitters so that thoughts travel like they should.

I think of them working sort of like a charge to your automobile battery. When a battery gets drained down, it loses its charge. We borrow battery cables and charge it with a friend's car battery. Then we drive the car to get the battery recharged. Once this happens, if everything else is okay, the battery will start the car again. (Too bad we can't buy a new brain like we can a battery!)

With our brain, we use a medication to recharge that part of the brain that produces the right amounts of the neurotransmitter that we need. After we have taken the medications for long enough, we hope that when we stop the medication, the brain will take over making the neurotransmitters we need. There are, however, some disorders where a person will always need medication to keep their brain functioning correctly. And some people probably have inherited brains that may not be able to produce the neurotransmitters they need in the right amount.

Please remember that if you decide to start a medication under a doctor's supervision, you should stop taking it also under supervision. Most doctors will start you at very low doses and build up until you get to the right level. Similarly, they take you off the medication very slowly. If they don't, there can be rebound, a return to the pre-medication problems or some bad side effects that are like the flu.

For many of the medications used to help with mental and emotional states, it takes 2-6 weeks for the effects to be noticed. It takes real commitment to stay with the routine when you can not see obvious changes. In addition, for the first 6-10 days, a person may have some adverse effects-antidepressants for example may cause headaches, nauseous effects, or flu like symptoms. A person should be ready for this and willing to put up with it if they want to use a medication. And then it is a pleasant surprise if this does not happen.


Does a person HAVE to take medications?

NO. However, almost all of the research shows that a combination of psychotherapy and medication is the fastest way to help someone with emotional problems that are affecting their lives in a negative way. Medications work fastest. Psychotherapy lasts longest—it helps prevent a relapse. It turns out that regular routines of meditation can also help prevent relapse.

Some people choose to live with their problems without medication. As long as they are not dangerous to themselves (as in suicidal or mutilative), can care for themselves (as in staying clean and providing adequately for their needs), and are not dangerous to others, this is their right. If a person does not meet these expectations, society may feel it has a right, through the criminal justice or mental health system to make a person take medications if they want to live freely, have the care of their children, etc.

There are also alternatives to medications in some situations. Although herbs do not seem to work for all types of emotional problems, some folks with depression and anxiety have found herbal remedies useful. It is important to know how to use herbs, to use them correctly, and to use herbs where there is some way of measuring their psychoactivity. For instance, the amount of useful substance in an herb is affected by the growing conditions (amount of sun and rain), harvesting conditions, type of soil, and time since harvesting. Herbs are medications should not be mixed with other medications without consulting with your doctor, pharmacist, and herbalist.


Can exercise, sleep, and meditation help?

Exercise that is strenuous enough to make you sweat seems to help with depression and anxiety as well as sexual problems. I usually tell my clients that they need to get to an aerobic level (increased heart rate and sweating) and stay there at least 20 minutes to begin to get good effects. Even when taking medication, a person will benefit from this kind of exercise.

Getting enough sleep is essential: sleep is when neurotransmitters regenerate. Lack of sleep can cause a deficiency. It is interesting, the inability to sleep sometimes is the first sign of a problem starting. For instance, a person with bipolar illness (manic depression) often first notices that they have a lot more energy and do not need to sleep as much. Sometimes a person in a manic phase does not sleep for several days in a row. On the other hand, someone with depression may sleep 12, 18, or more hours each day. Other people with depression, anxiety and PTSD have problems waking in the middle of the night or too early and feel tired all the time.

Learning to control your thoughts can decrease the need for medication. As mentioned before, it appears that negative thinking can cause a decrease in neurotransmitters AND a decrease in neurotransmitters can cause negative thinking. Learning to meditate, relax or self-hypnotize may help. I have information about dealing with thoughts in another article on this web page.


How do street drugs and alcohol affect these decisions?

Drugs and alcohol can interfere with the usefulness of medications. Some totally counteract the effects of the medication. It is best to take a holiday from street drugs (including pot) and alcohol while you are using medication for emotional problems. This can be very hard if you use them regularly, and you should talk with your prescribing medical person about the situation. It is necessary for you to get a certain level of the medication in your body and to maintain that level for the time that you are taking the medication. It may take days or weeks to get your medication level to the needed place. If you then do something to interfere with maintaining this level, you may not know if the medication can work for you. Alcohol, for example, cancels out the benefits of many antidepressants. If you decide to take a medication, try to set up the optimal situation for getting the benefits of the medication.

Also be aware that diarrhea and vomiting can lower the level of medication available to you.


Who can prescribe medications?

Psychologists, social workers, and many other counselors do not prescribe medications. (There is a movement that allows some psychologists to prescribe mediations under very limited conditions and after extra study.) Some counselors work closely with your primary care physician or other healer who can prescribe drugs. Others will refer you to a psychiatrist or nurse practitioner.

When you have other medical problems, are using other medications, have allergies, or are using street drugs and alcohol, it is probably a good idea to see a psychiatrist or mental health nurse practitioner who is specially trained in the interactions of psychoactive drugs with a variety of medical problems and other medications.


How do I make the decision about taking medication?

Research, research, research. Be aware that consumer sites may have more than their share of people who have had bad reactions. (Why is it that we write about the bad reactions but seldom write about the positive ones?)

Talk with your counselor, your doctor, and your pharmacist.

I suggest to people that this decision is made at multiple points:

  • You can see a psychiatrist and accept a prescription or not.
  • You can accept a prescription and fill it or not.
  • You can fill a prescription and take it or not.
  • You can take the prescription and continue to take it or stop.

It is up to you—but do consult with your prescriber at each step.