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Psychotropic Medications

The GoodTherapy.org Position on Psychotropic Medication

As the leading advocate for healthy psychotherapy, we are approached daily by people who want advice about psychotropic medication. The most common question people have is whether GoodTherapy.org recommends medication to deal with mental health concerns such as depression, anxiety, and others. "Should I take medication for ..." is one of the most frequent queries we receive. In all instances we recommend that site visitors discuss medication with their health care providers. GoodTherapy.org is not authorized to make recommendations about medication or serve as a substitute for professional advice. Nonetheless, we aim to provide useful resources about medication to our visitors and clearly outline our position on the use of medication for mental health purposes.

  • Medication can be useful. For example, for those with paralyzing anxiety, medication can "turn the volume down." For those unable to get out of bed in the morning because depression has stolen all motivation, medication can provide a "kick-start." And for those with a severe mental health condition such as schizophrenia, medication can be a necessity for stability and/or safety. Certain people may benefit from taking psychotropic medication, determined by qualified health care providers on a case-by-case basis.

     

  • Medication can support the psychotherapy process. Similar to Maslow's hierarchy of needs, it is difficult for most people to focus on symptom relief and self-growth when they are in crisis or struggling with anxiety, depression, or other mental health conditions. In some cases, medication can help to stabilize a person, allowing him or her to progress in psychotherapy. Of course, a common outcome of successful psychotherapy is the reduction or elimination of the need for psychotropic and other medications.

     

  • Medication can be harmful. We recognize that medication is an important part of the therapy process for some individuals. However, psychotropic medications, like all drugs, do not come without potential risks or side effects. Physical side effects from medication may include, but are not limited to, dizziness, drowsiness, changes in appetite, sleep disturbance, and/or weight gain. Side effects can also be emotional/psychological in presentation, including mood swings, loss of interest, or emotional numbness. Use of certain psychotropic medication(s) can also cause permanent damage, such as tardive dyskinesia or Parkinsonism, and may even result in death. One should always discuss the risks of medication use with a qualified health professional.

     

  • Medication can interfere with the psychotherapy process. A common side effect of psychotropic medication is difficulty feeling typical amounts of emotion. For example, many people complain of losing the feelings they used to have or report a reduction in their ability to laugh or cry. Another common side effect is a decrease in libido. For some, medication can impede emotional processing and serve to cover up underlying issues, thereby slowing or blocking the psychotherapy process. A possible consequence of taking too much medication and becoming numb to feelings is the increased likelihood that a person will not become conscious of the underlying emotional or somatic burdens which often fuel symptoms.

The Gift of Psychotherapy

Many emotional and mental health issues are not reducible to a biochemical imbalance. Often, psychological concerns originate and are influenced by life events-by what happens to and around us. Because medications do not change how people relate psychologically to their experiences, medication alone cannot "fix" all psychological issues. Treatment with medication alone can be like stitching up a bullet wound without taking the bullet out first.

Studies have found that treatment with psychotherapy and medication together is more effective and longer lasting than treatment with medication alone. Research has shown that therapy can stimulate the growth of neurons and synaptic connections between neurons. Medication for depression, anxiety, and other emotional problems does not do this. This is why therapy can heal core problems and create long-term changes, and why medication alone cannot.

For an in-depth comparison of medication and psychotherapy, read Doctor, Do You Think I Need Medication?

 

Overview of Psychotropic Drugs and Mental Illness

Psychotropic drugs are prescribed to treat a variety of mental health issues when these issues cause significant impairment to healthy functioning. Psychotropic drugs typically work by changing the amounts of important chemicals in the brain called neurotransmitters. Some mental health issues show improvement when neurotransmitters are increased or decreased. Psychotropic drugs are usually prescribed by a psychiatrist, a psychiatric nurse practitioner (PMHNP), or a primary care physician; in some areas, clinical psychologists may have prescriptive privileges as well.

Many people will experience a mental health issue at some point. Depression and anxiety are among the most common issues, and these issues can affect people regardless of age, gender, ethnicity, or background. Researchers cannot say with certainty what causes most instances of mental health impairment. Environmental factors and genetics often combine to predispose someone to a particular problem. In other cases, traumatic events or serious injuries result in psychological symptoms that persist for years.

Psychotropic drugs are often not enough by themselves to help someone overcome a mental health issue. Social support from family and friends, structured therapy, lifestyle changes, and other treatment protocols can all be highly important during the recovery process. Severe mental health issues may require inpatient rehabilitation before the person can return to everyday life.

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Type of Psychotropic Drugs

Several different types of medications are used to treat mental health conditions. The following is a list of the major categories of psychotropic medications:

Most Frequently Prescribed Psychotropic Drugs

Based on 2013 data, here is a list of the 10 most prescribed psychotropic drugs in the United States (with the number of prescriptions written during the year):

  1. Xanax (alprazolam), 48.5 million
  2. Zoloft (sertraline), 41.4 million
  3. Celexa (citalopram), 39.4 million
  4. Prozac (fluoxetine), 28.3 million
  5. Ativan (lorazepam), 27.9 million
  6. Desyrel (trazodone HCL), 26.2 million
  7. Lexapro (escitalopram), 24.9 million
  8. Cymbalta (duloxetine), 18.6 million
  9. Wellbutrin XL (bupropion HCL XL), 16.1 million
  10. Effexor XR (venlafaxine HCL ER), 15.8 million

 

Medication that works well for one person may not work well for another. It is important to have an in-depth conversation about your medical history, symptoms, diagnosis, and goals with your medical provider before beginning a psychotropic medication. You cannot legally purchase psychotropic medication without a prescription.

For more information or resources related to psychotropic medication, please visit our Psychotropic Drug Resources and Links page.

 

References:

  1. Gabbard, G. (August, 2000). A neurobiologically informed perspective on psychotherapy. Retrieved from
    http://bjp.rcpsych.org/content/177/2/117.abstract
  2. Grohol, J. M. (2013). Top 25 psychiatric prescriptions for 2013. Retrieved from
    http://psychcentral.com/lib/top-25-psychiatric-medication-prescriptions-for-2013/00019543
  3. Mayo Clinic. (n.d.). Depression (major depression). Retrieved from
    http://www.mayoclinic.com/health/antidepressants/MH00071
  4. National Institute on Drug Abuse. (n.d.). InfoFacts: Stimulant ADHD medications - methylphenidate and amphetamines. Retrieved from
    http://www.drugabuse.gov/publications/infofacts/stimulant-adhd-medications-methylphenidate-amphetamines
  5. National Institute of Mental Health. (n.d.). Mental health medications. Retrieved from
    http://www.nimh.nih.gov/health/publications/mental-health-medications/compelte-index.shtml#pub8
  6. Seligman, M. (1995, December). The effectiveness of psychotherapy: The consumer reports study. Retrieved from
    http://horan.asu.edu/cpy702readings/seligman/seligman.html
 

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