Welcome back to DIRT FROM THE ROOTS, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. This month, we will give a brief overview of psychiatric medications and hopefully help to give a little insight into how they are different from both one another as well as from typical medications that we may take for physical problems.
TOPIC OF THE MONTH
PSYCHIATRIC MEDICATION
“People aren’t crazy, they’re just reacting normally to an abnormally crazy world.”
—- J.S.B. Morse
Drugs: perhaps one of the more, if not most, controversial topics we see in modern day society.
Many individuals have likely experienced a range of experiences with drugs. Perhaps you have seen the near “magical” ability of an antibiotic or anti-inflammatory chemical reducing or removing a symptom, but unfortunately it is also likely that you have seen or heard of a situation in which narcotic usage led to irreparable damage or death to an individual, whether mentally, physically, or emotionally.
Perhaps understandably given these polarizing extremes, the societal understanding of psychotropic substances is extremely ambivalent– at best. While we can recognize the lifesaving properties and symptomatic relief benefits of many chemicals, we also seem to hold great fear around the negative extremes that, while entirely valid, may convolute our general understandings and create great stigma and acceptable oppressive behaviors. On the other side of the spectrum, we may be too careless with substances such as alcohol or prescription opiates due to legal status disguising risks in the very same way that illegal status can suppress benefits.
At the end of the day, a good metaphor for drugs might be the ocean: while we have found incredible usage and reliance on appropriately interacting with it, that does not mean that we won't be swallowed up entirely in an instant if we interact with it inappropriately. The solution to this danger is therefore not to avoid the ocean entirely, but rather highlights the need to give great respect, understanding and caution when we do go in.
I would like to clarify that I am not a psychiatrist and therefore have no actual license to prescribe these medications. This being stated, a large focus of my specialization classes in school focused around deeper understanding of psychiatric medications, and it is a strong tenet of my own approach that when used properly as tools, can create a more fulfilling and manageable unmedicated life.
DRUGS AND PERCEPTION
A large determinant of how we perceive drug usage derives directly from stigma. For example, if I were to tell you that an individual relies on a drug to get them going every single morning, can’t function properly without it, and will suffer withdrawal consequences if they break this pattern, you would probably show concern. If I told you this drug was crack cocaine, you might have a large reaction and feel that this person needs to stop immediately for their health. If I told you this drug was caffeine, or even better, scrolling on a phone every morning, you would probably laugh it off, maybe even tell me "Oh I do that! Call me an addict!" and not take me nearly as seriously.
The truth is, though each individual substance may pose higher or lower risk in the physical, mental, and legal departments, and this does create vast differences in consequence/risk, the IDEA of using a substance as a tool is generally universal and quick to be forgotten when stigma is involved. If it is acceptable to use phrases such as “don’t talk to me before coffee” or “it’s 5 ‘o’clock somewhere” to justify using more “appropriate” drugs such as caffeine or alcohol as tools to get ourselves to a different place, it is then hypocritical to not see heroin or methamphetamine usage with the same motivation of coping. If we fail to see why someone “would do such a thing”, we are possibly also failing to consider that a large swath of the population and perhaps ourselves are doing the exact same thing, just to a smaller degree.
While it is an overarching perception to think that humans “should” be able to function at a completely sober and unaffected baseline, there are very objective examples of life which show that this is simply not true in reality, not to mention that we are far from the only species on earth to utilize psychotropic substances. This statement by no means suggests that we should rely on chemicals which can change our perceptions, but rather counters the harsh stigma that prevents many from getting adequate treatment. As I say frequently in the case of ADHD: we would function WONDERFULLY in a world that was designed for an ADHD brain; the reality that the world is not designed for the condition makes it more clear how medication can be seen as a tool to integrate a personal set of wants and needs into society as it presently stands.
PSYCHIATRIC MEDICATION USAGE
Going back to my last statement of the introduction, the best way to look at psychiatric medications is as a tool. A very common negative perception of drugs is often described as “a crutch”-- this meaning that the substances are used as an ‘excuse’-- to avoid, to blame, or to rely on in replacement of healthy coping mechanisms. While I do not need to give examples that lead to where this stereotype derives, I will compromise and say that it is partially correct: medication should be used like a crutch would be used– to support something damaged while it heals.
The foremost way that I like to look at the function of any substance use is simply determining what the purpose is. In some cases, things are too extreme in our body– our pain is unbearable, our emotions are dysregulated, our brain cannot rest, we are chemically imbalanced. These situations require acute treatment– taking ourselves out of this mindset will give immediate and temporary relief, which may not be attainable through any other measure. While taking diazepam (Valium) with no anxiety is certainly abusing a substance and can lead down very problematic pathways, it is also extremely helpful in de-escalating someone from a panic attack. In other cases, our natural mental state is too overwhelmed/not equipped to manage itself in our current environment, and using medication may help make it easier to work with society and more effectively create patterns. An example of this would be stimulant usage for ADHD or anti-anxiety medications– the goal is not necessarily to take these medications every day in order to function, the goal is that if we take these medications for a long period of time, we will more easily create patterns which will eventually become ingrained into us, medicated or not.
The following will go through the many types of medications used for mental health issues. While these will list the intended functions and evidenced results that we have seen, it is also crucial to remember that many of these medications are relatively new and primitive, and therefore the benefits, effectiveness, and perceptions of each have and will continue to change as we learn more and more.
ANTI-ANXIETY + ANTIDEPRESSANTS
TREATMENTS: wide ranges of anxiety and depression related disorders, PTSD, and other specific cases
In what was described once as the medications du jour during their rise in popularity through the 2010s, antidepressants/anti-anxiety medications are perhaps one of the more discussed and mainstream psychiatric drugs of the present day. These meds typically fall into a few drug classes known as SSRIs, SNRIs, MAOIs, and others– basically just indicating they work with the neurotransmitters of serotonin and norepinephrine. Put in most simple terms, the function is loosely to balance chemicals so that the individual taking the medication can feel less anxious/depressed at a baseline, hopefully creating space to develop new routines and behaviors that allow the individual to respond better to their environment.
The goal of these medications is to regulate serotonin levels, though in earnest, we do not know the full or precise details of how this process completes. There also are a few distinctions that come along with this class of medications that are also helpful to know:
Antidepressants/anxiety take time to begin working, typically 4-8 weeks. While most substances will have instant or quick effects, these medications take time to notice full body changes. Given the nature of SSRIs, we may feel many different ways while things settle in, and this can also create complications in clear assessment
It is paramount to monitor side effects. Unfortunately, these medications are far from a completely finished product, and while they can be absolutely life-changing effective, they are also vulnerable to create additional issues due to side effects. Three of the most common things seen in unwanted reaction are headache, stomachache, and sexual dysfunction, typically loss of libido. The goal is to find a medication which has a good balance of mental benefit with maintenance of how potential side effects may create more problems than necessary.
Most importantly: THEY CANNOT BE STOPPED “COLD TURKEY”. MOST CRUCIALLY, these medications CANNOT be stopped immediately. Not only will the reaction be severely uncomfortable and very negative in response, but there is a rare but serious risk of serotonin syndrome in these cases.
An additional type of medication used to treat anxiety would be considered a beta blocker, these work to calm the physiological aspects of anxiety such as sweating, tension, and heart rate by essentially reducing or muting the signals from the brain that are causing the anxious reaction.
A final class which is best separated here would be benzodiazepines, which may hold the most notoriety as they are extremely addictive and hold many similarities to opiates in regards to potential risk of problematic usage. These drugs, known more commonly as xanax, valium, klonopin, and others, are used for extreme anxiety and panic as well as anticonvulsants. When used on an “as-needed” basis, these medications can be very effective in managing dangerously or unbearably high levels of anxiety.
ANTIPSYCHOTICS
TREATMENTS: schizo-based disorders, paranoia, delusions, psychosis, dementia
Antipsychotics are an intensively-acting class of medication used in cases of individuals suffering from psychosis, hallucinations, delusions, dementia, and other symptoms that will predominantly take a person out of reality. While these medications can be extremely helpful in treating some of the most severe escalations of human emotion that can be seen, they naturally can have a very disorienting and tolling recovery period and should be seen with such respect. These medications result in some of the hardest recoil damage on the body.
There are two “generations” of antipsychotics: “typical” ones, which were developed first chronologically, and “atypical” ones, which are newer and treat a wider range of symptoms. The first generation seemed to require more management of side effects, most notably tardive dyskinesia, or uncontrollable muscle movements. Newer ‘atypical’ generation medications seem to have more of a variety in what can be treated, but it could be argued that we are still furthest from understanding this class as compared to the others.
Antipsychotics are intended to work in the short and long term– many will reduce symptoms such as agitation and hallucinations immediately, but can take up to 6 weeks or more to begin regulating the individual out of delusions or other false perceptions. It is also very important to note that these medications being some of the heaviest also require the most monitoring from a doctor. Failure to reduce dosage properly or stopping “cold turkey” can result in rebound psychosis, and antipsychotic medications additionally have some of the most severe interactions with other drugs.
Perhaps to put most simply, these medications require utmost caution and awareness when taking them.
MOOD STABILIZERS
TREATMENTS: bipolar disorders, sometimes used for mood-related features of depression of schizoaffective disorder
With its poster medication of Lithium, mood stabilizers are possibly one of the better known psychiatric medications within societal awareness. These medications are pretty straightforward to their namesake: they shorten the emotional range to prevent individuals from feeling too strongly one way or another, most commonly to combat swings of mania and depression. One of the most consistently reported uses for mood stabilizers centers around many studies that suggest it lowers risk of suicide. Anticonvulsants, medications used to treat seizures, are also included in this category.
However, important as they may be, mood stabilizers are perhaps the most challenging psychiatric medication from the perspective of the individual with the condition, as they are unfortunately repeatedly reported as the class which brings the least perceived benefit to the individual. While all other medications seem to provide those taking them some relief emotionally along with improved functioning/quality of life, mood stabilizers are far more focused on maintaining the latter. This can leave individuals feeling resentful or even oppositional towards taking the medication, as managing manic-depressive swings can often be perceived as still favored over the effects of mood stabilizers, which can result in a bland, depersonalized perception. A common perception would be that these medications are taken not for the benefit of the individual, but for the relief of others around them-- obviously, not a comfortable way to look at such a large life choice!
On a– perhaps strange– bright side, newer viewpoints suggest some of these issues may stem from the fact that bipolar is one of the most misdiagnosed conditions in all of mental health and that very few understand how to manage mood stabilizers outside of psychiatrists. With more awareness and education that spreads to medical doctors and nurses along with a more clear understanding of bipolar disorders, more effective usage of this class could produce less user disapproval in the future.
STIMULANTS
TREATMENTS: ADHD, eating and feeding disorders, geriatric care, others
Stimulants, which include amphetamines and similar medications, are perhaps the most misunderstood psychiatric medication, although awareness has seemed to shift in recent years. Foremost, there is a general idea that stimulants create an excess of energy– a more precise view is that stimulants create... stimulation! If we are already naturally regulated emotionally, this creates the stereotypical “speed” reaction– or manifestation in forms of an unwanted increase of energy, restlessness, and anxiety. But to view this as the expected result is to assume that a person is naturally regulated, as again, the lack of emotional regulation can be seen as an oversimplified explanation of ADHD. Looking at stimulants from this perception is actually assuming that the neurotypical reaction is the standard one.
Alas, individuals who do have ADHD find stimulants to be calming, regulating, and manageable. Two opposite but common reactions to people misinterpreting their experience of stimulants are that “they found it fun but had a hard time with [side effect]” or that the person “did not like it because they did not feel a thing”. In the former example, the stimulant user likely does not have the condition, and is perceiving the euphoric response from added dopamine in a pleasurable, but not therapeutic fashion. In the latter, the user likely does have the condition, and perceptions of “not feeling effects” is likely from expectation that the added chemicals would make them feel more energetic and overregulated. Side effects are also minimal in long term due to the nature of the chemical passing through the body, but can create major issues with appetite and insomnia. On the opposite side of this coin, we can see why stimulants are also used for binge eating and narcolepsy.
Speaking personally as someone who has taken stimulant medications for almost a decade, I have a few observations that seem to resonate with the many other individuals I speak with through sessions and will share them as such. The first is that stimulant medications are more effective in moments lacking structure rather than structured activities. While almost every psychiatrist I have spoken to has inferred how much work was required of myself that month would directly result in whether my dosage would raise, it is times when I have nothing to do in which motivation becomes hardest to conjure. Secondly, and this is just in line with my views of ADHD overall, the benefit is not focus, but emotional regulation. If the medication dysregulates someone– even if that is perceived as positive– it is probably being misprescribed. But third and most prominent, though I absolutely perceive relief and improved quality of life from taking medication, I also do relate to the perceptions of Lithium in the sense that I myself would be alright not taking the medication, but can much more easily upkeep my standard of life if I do.
Of every condition in all of mental health, stimulant treatment for ADHD is believed to be most effective. 80% of ADHD individuals report improved quality of life after taking stimulants.
PSYCHEDELIC THERAPIES
TREATMENTS: still not fully known, but early success with trauma-related issues, developmental disorders
A final and brand-new (or prehistorically old, depending on your viewpoint!) approach to therapy which still has yet to even fully arrive as a widely offered treatment option would be psychedelic therapy, or psychotherapy administered to individuals taking either psychedelic (such as psilocybin, MDMA or LSD) or dissociative (ketamine) substances with directed intentions of creating new, lasting pathways of thought. Since most of these substances have been federally deemed illegal Class-I narcotics, there is much development still to be done before regulated and official methods become widely available. This being said, much of the research on psychedelic therapy has been accumulating since the early 1960s, and cultures as old as 10,000 BC have been using psychedelic plants such as ayahuasca and salvia for therapeutic purposes.
Perhaps what is most misunderstood about this process is that unlike all other medications listed, the benefits of this form of medication is that it would have extremely long lasting effect without needing to be continuously administered. In the case of psychedelic substances, the brain is simply creating thousands of new, atypical connections while under the influence of the chemical, and realizations made in this state can therefore continue to be applied and administered far after the individual has returned to sobriety. In addition, and also in explanation of the similar usage of ketamine therapy via dissociative principles, the individual may perceive a disconnect from body and mind and find traumatic barriers approachable for the first time in their lives, which under therapeutic supervision can become major shifts in worldview through a very unique form of trauma healing.
While it should be extremely clear that these therapies do have much evidence backing any individual with bipolar or schizophrenic related disorders are at concerning risk of further exacerbating their symptoms, those who do not have genetic predisposition have reported overwhelming success thus far, particularly around trauma and CBT-type behavioral interventions. What is most promising about psychedelic therapy is that it, in theory, requires the least actual chemicals consumed for the longest non-medicated changed mindsets. If we look at the goal of therapy in general as an attempt to slowly recondition our thought pathways and work beyond our emotional barriers and past trauma, successful psychedelic therapy aims to get these same results but in a faster and more comprehensive way than we could typically achieve.
CONCLUSION
I like to think that we do have evidence that behaviors, perceptions and trust can be built from anything– because after all, we know trauma can create perpetual lifelong issues in just a short but impactful period.
One way to look at why the need for extreme psychotropic effects is not in light of dependence, but rather simply that a hard punch requires a hard punch back. While it is idealistic to think that the world should just work out for everyone swimmingly, the reality is that we unfortunately face large crises regularly and medication is one of many ways to cope with this.
One line that constantly comes to mind when discussing the effective usage of medication is the idea that “we cannot unsee what has been seen”-- while the overlying and understandable concern around medication always comes down to wanting to be able to live a life free of continual medicating, I do like to emphasize that taking medication just makes things easier, and when things get easier, we get better at them. Think of taking medication like anyone who has spent 10+ years at any position– there is a reason they are better equipped to handle harder situations than someone who has only done things for a couple of years. If just from my personal experience, years of being medicated has absolutely created habits which I will still follow regardless of if I am taking medication or not. The emotions are still there, I still will feel the same as I did before, but the habit has shifted.
So we will return to the very beginning in re-stating that drugs are certainly one of the most controversial aspects of our society, which is not without valid reason or obvious explanation. But what I do believe should be more prominent is the correlation that the health of a society is also the most significant determining factor in the population’s substance usage. It is important to remember that we are ideally using medication to cope with an environment which we are not presently suited for, not to escape from responsibility, numb ourselves, pure hedonism, nor any other reason which is typically stereotyped.
WHAT’S COOKING FOR NEXT MONTH
MENTAL HEALTH IN MEDIA
I’ve been looking forward to this one– next month, Nick will delve into not only how mental health is (mis)portrayed in media, but also how media can influence our mental health perceptions and understanding more so than potentially any other medium.
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