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To Medicate or not to Medicate

To Medicate or not to Medicate December 12, 2014

How does one decide to medicate themselves or their child when other professionals are recommending they do so? Currently, many people go in search for alternatives to medications due to side effects, worry of long-term effects, or stigma –especially where psychiatric medications are concerned. And we are all acutely aware of the pharmaceutical industry’s push towards medicating any and all discomforts or ailments for us and our children. It sure can be simpler to take a pill, as opposed to changing behaviors. Sometimes medication works and can be helpful, and sometimes the side effects are worse than the symptoms. Maybe there are things we can do to learn to combat our brain chemistry naturally. Then again sometimes the natural approaches work, and sometimes they don’t. It can be frustrating to even think about. In this brief article, I will present experiential steps to finding comfort and an answer that will help weigh out the pros and cons to the question of whether to medicate or not to medicate.

Though I am not a Psychiatrist and it is out of my scope of practice as a licensed Marriage and Family Therapist to prescribe or administer medications, I often recommend my clients to consider medications if:

  1. They or their child is feeling suicidal or showing risks and warning signs of suicide.
  2. They or their child is self-medicating or abusing substances, including food.
  3. They or their child are unable to manage their symptoms through interventions.

I like to re-frame medication as a “band-aid” of sorts. However this depends on the severity of a person’s symptoms, circumstances, or diagnosis. For example, Bipolar Disorder or Schizophrenia are two diagnoses where medications are almost always helpful without question. Depression or anxiety, depending again on severity, can also benefit from some pharmaceutical brain chemistry support. Still many people will prolong making a decision of whether to take medications or not, even when suffering with severity. So the real question is: when does one feel comfortable enough with the idea to try medications for themselves or their child? Obviously the answer is subjective to the individual but below are steps to help in the process:

  1. Feeling unsafe is scary | Dark thoughts are normal for all of us. When these dark thoughts cross over to formulating a plan to kill one’s self and/or finding and having the means to carry out the plan –They need support and a safety plan, ASAP. The risk factors and warning signs associated with suicide include: depression, the use of drugs or alcohol, previous suicide attempts, recent losses, and frequent thoughts about death. Research has shown that more than 90% of people who commit suicide have depression or another diagnosable mental or substance abuse disorder. Research also indicates that alterations in neurotransmitters such as serotonin are associated with the risk for suicide. (Source: Medicinenet, www.medicinenet.com, accessed December 10, 2014) Suicide is the third leading cause of death among 15-to-24-year-olds. Within this same age group, suicide accounts for 12.3% of all deaths, according to the American Academy of Child and Adolescent Psychiatry (AACAP). (Source: AACAP, www.aacap.org, accessed December 9, 2014) When considering loss of life versus trying a medication to help alleviate symptoms caused by chemical imbalances in the brain, this simplifies the choice for whether to medicate or not medicate with pharmaceuticals, even if only for a relatively short period of time.
  2. Self-Medicating | Self-medicating is also fairly common for us all at some point in our lives, whether through substances or food. There are a host of ways to avoid our emotions and numb them out. However, self-medicating and abusing one’s self is simply a slower more avoidant form of suicide, no matter how you slice it. Too much of a good thing is always a bad thing when it comes to substances and foods. Considering our health and the intricacy of our bodily systems, overloading our body causes long-term damage. More than likely the damage is worse than medicating through a pharmaceutical, again, even if only for a relatively short period of time such as 6 months to a year versus 10-15 years of abuse and addiction. As for children or teens, self-medicating and abuse of substances can lead to a life-time of problems such as a general failure to launch due to developmental and emotional stunting, problems in relationships, functional difficulties in academia and occupation, and/or more serious clinical diagnoses in the future. Not to mention the increased risk of suicide among teens (and adults) who abuse substances. Clearly, this information simplifies the choice of whether to pursue medications for your child. Remember trying medications even if only for a relatively short period of time would decrease the risk of losing them forever or to a host of life difficulties. Meeting with a psychiatrist to discuss any concerns is at least a step in a life affirming direction.
  3. Self-Motivation through Intervention | Seeking therapy to learn new ways to think or re-frame current circumstances toward emotional processing and supportive behavioral change with take-home skills can help manage and alleviate symptoms. Supports can be gained to address substance issues and search for alternative behaviors to that of using. Setting treatment goals are important to keep focus, discipline, and a time table. For example, a goal might be “Reduce symptoms of depression or anxiety from daily to 3 times per week for 6 months” or “Increase use of alternative/replacement behaviors to that of using alcohol to 4 days per week from 4 days per month for 6 months”. If symptoms or negative behaviors persist and one is rendered unable to find self-motivation to incorporate these interventions with the support of their therapist, then their brain chemistry might benefit from alternative aids.
  4. Homeopathic/ Naturopathic Remedies in tandem | Adding the aid of homeopathic or naturopathic remedies such as herbs and/or specific foods can help as ancillaries to boost specific brain chemistry. One can gain a referral for a professional in these fields, in efforts to safely and efficiently tailor a plan for their needs. Trying Homeopathic or naturopathic remedies might aid brain chemistry and help with motivation and incorporation of interventions in tandem with therapy and goals. Also with the additional intervention of logging or journaling one can develop a measure of how they are doing and feeling related to their symptoms, use of interventions, along with the base line comparison of pre/post use of remedies. Should symptoms not start to improve after a reasonable period of time, say another 3 months, this is suggestive of a need for what I call “band-aid” support.
  5. Band-Aid Support | Holding the idea of pharmaceutical medications as a “band-aid” while utilizing a referral for a psychiatrist to consult about concerns can be helpful to easing the discomfort of trying medication. By following the same process as mentioned above: Setting a reasonable goal for symptom improvement with the psychiatrist’s support (such as 3-6 months) in attempts to get over the “brain chemistry hump”; find the motivation to practice and generalize the necessary interventions simultaneously with medications and therapy; and continuing to log their symptoms, interventions, and medications as prescribed. Throughout this process remembering that this is only a “moment of time investment”. Once improvements become apparent, it would be time to consider lifting the “band-aid” to test for continued consistency of abated symptoms and continued use of generalized emotional and behavioral skills.
  6. Titrating or Discontinuing with Psychiatrist support | Should one’s symptoms appear manageable one can consult with their psychiatrist to begin to titrate off their medications while continuing to utilize their generalized skills. Again, keep in mind, if the diagnosis is severe such as Bipolar, Schizophrenia, or Chronic Major Depression a psychiatrist will most likely not recommend titrating or discontinuing medications. As with the more severe diagnoses, there is a tendency for people to believe they are fine and stop taking their medications, only to be met with a triggering event such the Mania of Bipolar (risky behavior, insomnia, rapid speech, excessive energy). However the point of this article is to highlight a process for whether to medicate or not to medicate. If a person has followed these steps they will have found out for themselves through their own experience of pros and cons, and have record of these experiences to remind them of whether or not they, or their child, should reside on medications.

Aaron Foster

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