Hickey: Getting Help Part 3 — Should you take meds?

Lots of people have very strong opinions about medication as a treatment option for mental illness. Note: When I talk about psychiatric medication in this column, I am referring primarily to selective serotonin re-uptake inhibitors (SSRIs), the most commonly prescribed class of psychiatric medications — a class that includes the brand medications Prozac and Zoloft — that are usually prescribed for depression and anxiety. At this time, I am not knowledgeable enough about antipsychotics, mood stabilizers or ADD medication to advise on those matters.

Here’s what I do feel qualified to tell you.

The summer after my freshman year, two months after I was diagnosed with depression and started seeing a therapist, I began taking an SSRI called Paxil. As of this writing, I’ve been taking 25 mg of Paxil per day for a little over a year. Although I have no plans to discontinue its use in the foreseeable future, I do not intend to be on Paxil for the rest of my life.

My experience taking an antidepressant has been overwhelmingly, even unusually, positive, with a quick response and all side effects subsiding after my first two weeks on the medication. However, mine isn’t the average experience with meds — frankly, there is no average experience. Psychiatry is a new, imprecise science, and we are all special neurochemical snowflakes; different people have radically different experiences on the same drug. To go on meds is to play Russian roulette with efficacy and side effects, and although I believe I made the right decision when I chose to go on Paxil, there are many, many reasons a sensible person might decide medication isn’t the option for him. What’s important is that you actually weigh the options and make the best decision you can make.

Lots of people have very strong opinions about medication as a treatment option for mental illness.

Some people feel that mental illness is first and foremost a disease, a physical imbalance of brain chemicals that requires medical treatment just like any other illness. To these people, saying you want to treat your depression without medication is like saying you want to treat your pneumonia with diet and exercise. Some of these people do work in the medical field, but most of them have simply been influenced by the fantastic success of a friend or loved one with medicated recovery — or have taken the TV ads for antidepressants a bit too literally. Popular acceptance of mental illness as a legitimate medical condition has been hugely beneficial in that it helps people understand that depression or anxiety, like pneumonia, is not something one can simply “snap out of” or “man up and deal with.” However, this understanding is less useful when it leads people to conclude that if a person is mentally ill, the solution is to take a pill and get better — case closed.

On the other end of the spectrum are people who believe all psychiatry is to be avoided. They believe that meds are a cop-out, a quick fix or a brainwashing tool to “correct” divergent thinkers. Or they believe that psychiatry is a pseudoscience and a corporate scam, and the treatments don’t work and can’t be trusted. These people use the phrase “Big Pharma” a lot.

If you belong to either one of these groups, you don’t need to be reading this to decide whether to consider medication — you’ve already made up your mind. But if you’re not one of those people, chances are you know them. They are perfectly entitled to have strong feelings about this subject — but they are not entitled to influence your decision.

Whether to take medication or not is a decision strictly between you and your doctor — and if your doctor is either a psychiatric evangelist or a strident nonbeliever, I’d consider getting a second opinion. You have the right to make this decision based on your own feelings and reliable, comprehensive information that is presented to you in an unbiased fashion. Find a very qualified psychiatrist who believes in medication as one valid option among many, and schedule a consultation: an appointment whose only goal is to discuss all your concerns and ask all your questions. Write down what you consider the important facts, check in about your own feelings, and decide accordingly. That’s the only way to make any difficult decision about your health.

This is only one-half of what I want to say about this subject. I would be utterly remiss if I wrote about meds without addressing myths or side effects. Up next is Part 4, Meds Continued: Don’t Drink the Kool-Aid.

Email Tracey at tbh15@pitt.edu.