I have found over the years that although I am not a psychiatrist, a significant part of my conversations with clients in therapy revolves around medications. Common concerns range from worries about addiction and side-effects to worries about losing parts of self because of the medication. I am not a doctor and recommend that you consult with a medical provider about any specific medication concerns, but I hope that this post can provide you with some pointers about how and when to have conversations with your medical provider and set realistic expectations about medications and medication management.

If you haven’t had a physical exam in over a year and are experiencing low energy, insomnia, hypersomnia, sudden changes in appetite, and/or digestive issues it’s a good idea to schedule a physical exam first to rule out physical health issues that could be contributing to mental health symptoms such as thyroid issues, anemia, and premenstrual dysphoric disorder.

Signs you may want to consider psychiatric medication:

If you are consistently working on trying to implement behavioral changes and failing due to emotional overwhelm.
You’ve implemented behavioral changes, but mood symptoms are continuing to significantly impact daily functioning.
Your symptoms are so severe you are unable to attend to daily tasks, you are experiencing manic symptoms, psychosis, and/or suicidal thoughts.

Topics to address with your psychiatrist/medication provider:

Side effects of medications being prescribed and any previous experience with psychiatric medication.
Expected benefits and timeline to see changes with medication. The most common medications prescribed tend to be anti-depressants, usually the SSRI kind (Selective Serotonin Reuptake Inhibitor), which take about a month to build up enough in your system for you to see changes. It’s important to have an accurate idea about the impact of medications so that you can accurately gauge whether the medication is working.
Process for increasing or decreasing dosages and how to communicate concerns with your psychiatrist.
Any other substances you might be using. This includes other prescription medications, marijuana, alcohol, caffeine, or any other drugs. Effectiveness and risks associated with psychiatric medications will be impacted based on whatever else you’re taking.
Discuss any blood testing or other medical testing that might be needed with heavier duty medications. This usually applies to heavy duty mood stabilizers or anti-psychotics.
Discuss any effects medications may have on appetite and sleep, particularly if you are taking stimulants or medications that might induce nausea for the first few days/weeks of taking them.
Always consult with your provider before discontinuing medication or adjusting dosage.

What medications can do:

Medications can help reduce the barrier to accessing behavioral changes needed to make lasting improvements in your life and ease long-term symptom management.
Medications can reduce severity of mood symptoms biologically in order to allow you to make better cognitive decisions about your health.
Medications can reduce frequency and intensity of very severe symptoms such as psychosis, mania, and panic attacks.
Medications can help improve quality of sleep which will improve symptoms of depression, anxiety, PTSD, and ADHD.

What medications cannot do:

Medications cannot address the quality of your interpersonal relationships.
Medications cannot instantly make you feel happy all the time.
Medications may not eliminate all mental health symptoms forever.
Medications may not work the same way at the same dose forever.
Medications impact different people in different ways, so what works for a friend or loved one may not work for you.
Medications alone will not be enough if you are not also working to implement lifestyle changes.

Depending on your needs you may need medication for a short while to address a temporary situation or you may need a low or even high dose of medication depending on symptom severity, lifestyle changes, and chronic nature of your mental health condition. The reality is that there is no way to know for certain, but if you work closely with a trusted provider that you feel comfortable having open conversations with you can drastically improve your outcomes.

I want you to know that needing medication does not make you crazy, weak, incapable, or unreliable. Taking medications appropriately and with active support means that you are taking a necessary step to take care of and improve your health. Psychiatric medication is meant to be a supportive part of your journey. Unfortunately the stigma associated with it often prevents people from seeking necessary care which does a disservice to everyone. Remember that your journey will be unique to you and don’t hesitate to reach out for support if you want to learn more about how therapy can help!

I spend a lot of my day talking about feelings. I get to observe people sifting through their feelings, getting stuck, and trying to problem solve. It strikes me that a lot of our relationship with our emotions is centered around trying to change them, control them, or blaming ourselves for having them. For many of us, the only acceptable states to be in are happy, calm, and attentive to the needs of others. Probably one of the most common questions I get asked about feelings boils down to something along the lines of: “How do I make this feeling go away?”

Feelings are sort of like Ikea furniture: confusing, awkwardly constructed, sometimes surprisingly heavy, and, more often than not, just a pile of nonsensical, disconnected pieces until you finally put them all together. You might discover that you have to go back to the store to get some missing parts. You might need tools that weren’t included in the kit. You might need someone to hold up the other end of whatever thing you’re building at just the right angle for you to put it together. A great many of them may have odd names in a language you don’t quite understand. But if you want them to make sense, you’re going to have to slow down enough to read the instructions, organize the pieces, and move forward intentionally rather than just going ham with that tiny Allen wrench.

Somewhere along the way we got it into our heads that instructions are not important, that we can just power through; work harder, be stronger. Under those conditions it’s your fault if the MALM you were trying to build falls apart or looks nothing like the picture on the box. “Just hide the extra bits that didn’t fit, lean it against the wall, and pretend it’s fine.”

But here’s the thing: no amount of hard work and Allen wrenches will suffice if what you actually need is a hammer, a drill, and a friend to hold the other end of the thing you’re building so it doesn’t fall and crush you. No amount of strength will make up for the random dowel you’re missing.

If we keep leaving these things out the whole thing falls apart. We fall apart and it’s not our fault. It’s not because we’re not strong or smart or hardworking. It’s because we don’t permit ourselves and others the time, compassion, and support to put our feelings together in a way that is safe and coherent.

So, to whoever needs to hear this today: you’re enough and it’s not your fault that MALMs are a pain to assemble.

If you’d like support holding up the heavy pieces, or just want some new tools for your toolbox please don’t hesitate to reach out for support!

When should you consider psychiatric medication?

Therapy, Feelings, and Ikea