Should We Use Medication for Mental Disorders?

Many wonder whether, when faced with mental suffering such as profound sadness, excessive anxiety, panic attacks, phobias, etc., they should seek drug treatment or psychotherapy. To answer this question, we need to think about several things.

First, it’s important to assess whether the person has the emotional resources to deal with suffering. Do they take good care of their health or are they negligent? Are they emotionally dependent or not? Do they enjoy life or do they complain about everything? Do they like taking medication or do they only use it when necessary?

Other questions to ask to determine whether the treatment is medication or psychotherapy might include: What is the diagnosis of the illness the person has? If it’s depression, is it mild, moderate, or severe? If they suffer from excessive anxiety, is it a phobia? Is it panic attacks or generalized anxiety? If the person has panic attacks, do they occur every six months or every week? Is the phobia, i.e. the exaggerated fear, well managed by the person, or does this phobia hold them back and limit their social life, causing significant damage to their studies and work?

So, you see, you can’t answer the question of whether a person should begin treatment for mental suffering with medication or therapy without getting information about their emotional structure and these other factors I mentioned.

It’s one thing for a patient to say: “Doctor, I came here because I suffer from anxiety, I’d rather not use medication, but learn to deal with my anxiety. But if I need to, I will.” Another thing is for the patient to say: “Doctor, I suffer from anxiety and I want you to prescribe my medication. Which medicine is good for me?”

In the first case, the person says that they would accept if needed taking medication for anxiety, but shows a willingness to learn to deal with their difficulties, which prompted the consultation, and, if possible, without having to use medication. In the second case, the person talks about their desire to use medication. They come to the appointment already thinking about how to get it, wanting to receive a prescription for some medication, without thinking that it might be necessary to learn to deal with the feelings and thoughts that cause emotional pain.

With this differentiation, we see that the same drugs, with the same dosages, produce different results in different people. Why? Because people with the same suffering react differently to their emotional pain and also have a different mindset about what they expect from medical advice. One wants to learn how to deal with their excessive anxiety, while the other wants to get well with medication alone. And sometimes it’s hard to convince someone that they don’t need psychiatric drugs and that it can be enough to work on themselves psychologically, with professional support.

Generally, we want quick results for mental suffering, but it’s important to understand that the problem that brought the person to the consultation may have taken many years to establish itself in their personality structure. It can therefore be difficult to find a quick cure. Faced with the question “Should I treat myself with medication or psychological therapy?”, let’s think about depression.

Depression can be mild, moderate or severe. In severe depression, the person can remain in reality or have a type of depression in which they get out of reality. This is called psychotic depression, which will then require medication, some of which is different from what the person with severe depression, but who remains in reality, uses. In severe depression, where the person is lucid, aware, connected to reality, oriented in time and space, they need antidepressants and psychological support from their family. In psychotic severe depression, where the person leaves reality, they need medication for psychotic changes, such as hallucinations, delusions and agitation.

In cases of mild depression, there is no need for antidepressant medication. All it takes is family support, venting to someone who can listen and who encourages the depressed person to talk, because talking relieves and can heal. It could be talking to a non-professional who is attentive, welcoming and knows how to listen. Professional treatment will be necessary if the depressed person can’t get relief by talking to friends and relatives, even if they are caring people.

In cases of moderate to severe depression, psychotherapy and some antidepressant medication are necessary if the person doesn’t improve with psychological therapy alone. Some psychiatrists only prescribe medication and don’t do psychotherapy. They then refer the person for psychological therapy with a clinical psychologist. The psychiatrist advises on medication, while the psychologist carries out the psychotherapeutic treatment.

One type of therapy that has good results for depression is called CBT (cognitive-behavioral therapy). It assesses the thoughts of the depressed person, who generally tends to cultivate thoughts of pessimism, hopelessness, tragedy, self-deprecation, guilt and suicidal thoughts. In this CBT therapy, the person is helped to notice their most habitual, most frequent thoughts, which are in their consciousness, to see if what predominates are bad, negative thoughts. He will be helped to question these thoughts, see their root, get them off his chest and learn to eliminate those that make him worse and cultivate new, better thoughts. He will be helped to see how to regain hope, take better care of himself, stop belittling, devaluing and blaming himself.

It’s common in depression for people to have thoughts like: “I don’t think there’s any way out of this situation for me”. Or they think: “I’m a burden to others.” Or they’ll think: “I’d better die, then I won’t bother anyone any more.” Or you’ll think: “Life no longer makes sense to me.” By nurturing these kinds of pessimistic thoughts, depression is maintained or worsens. So, in therapy, the person is helped on how to get rid of these thoughts, understand their causes and how to think positively and realistically in order to get better.

If the depressed person maintains these types of thoughts, even when taking an antidepressant, the medication won’t necessarily stop them from continuing with this way of thinking. Therefore, medication alone may not be enough for recovery. It seems that, in the case of moderate to severe depression, the combination of medication and psychotherapy works better than one alone, but it depends on how the depressed individual reacts to psychological help. This is because individuals who are more proactive in life in general, who have good psychological resources in the face of stressors, who are more willing to face emotional pain, achieve better results than those who are pessimistic and do not cooperate with their own recovery, expecting too much from others and from medication.

Depressed people with serious suicidal ideation need constant monitoring, and if they have already attempted suicide, they need to be admitted to hospital for as long as it takes to stop the suicidal thoughts. It doesn’t have to be in a psychiatric hospital, it can be in a mental health unit in a general hospital. There are depressed people who talk about dying, but when they are asked about their suicidal ideas, they say they would never have the courage to kill themselves. These people cause less worry for the family and the professional. On the other hand, depressed people who talk about suicide and have suicidal intent, who even think of a way to kill themselves, need monitoring and, in some cases, temporary hospitalization to protect their lives.

It is important that the depressed person, at whatever level, understands that medication comes secondary. First comes learning about their mental suffering: understanding the losses that produced the sadness, being helped to accept them, living with grief, understanding if the depressive symptoms have arisen not necessarily because they have lost someone, whether through death, divorce or separation, but understanding the meaning of this loss in their life. This is the most important step for recovery.