What about Medication (Transcription)
Hi, this is Dr. Ron Kaiser with your Mental Health Gym podcast for February 2012. Today’s podcast is going to be concerned with the issue of psychoactive medications. Now I’d like to start by offering a couple of disclaimers first of all as a psychologist I don’t prescribe medication and I believe that any medication decision should be ultimately made by the patient and his or her doctor who may be prescribing. I’ve often been asked for input and I may have some opinions on it, but I do want to advice that medication is not my ballpark. At the same time I do respect the fact that it may be a necessary component with various types of conditions and treatments. I’d also like to point out that I am not talking about medications for non-psychiatric conditions. In other words it’s certainly well established that some conditions are very much in need of treatment by medication in order to effectively lead to health.
Hopefully to the improvement of health and in some cases the maintenance of a person’s situation. I’m not venturing into the medical areas aside from saying that I believe in medication for medical conditions I’ve seen cases where treatment delay has caused problems and some cases where people have chosen to go outside of the medical system and do themselves damage.
So I’m not trying to suggest anything differently in that area. Also I think it’s important to recognize that kind of a fundamental belief of mine is that individuals are different and anything that we may find out may apply to you specifically because you fit into a general category or you may be one of the outliers.
So I think that individual differences need to me respected but nonetheless I’d like to address the topic keeping those things in mind. First of all a number of you may have been aware of the fact that there has been recent findings that have been published in the journal of the American medical association demonstrating the fact with anti-depressant medications the effectiveness has been pretty well documented for severe depression but when anti-depressants are given to individuals with mild and moderate depression the results are much more iffy.
In fact there has been no real conclusive demonstration that anti-depressants are more effective than placebo, furthermore there have been findings that cognitive behavioral therapy is as or more effective than anti depressants than working with depressed individuals, particularly in terms of maintaining gains. So you think my first point is that I am a believer in psychotherapy and I think that it’s an effective treatment whether it be done by self or in combination with medication.
I think that this issue may be even more relevant when we think about anxiety because some of the anti-anxiety medications are quite difficult to come off of and I think that care must be exercised when making medication decisions in relation to anxiety. We now have treatments such as mindfulness, biofeedback and relaxation training along with psychotherapy that can be very helpful as first line of dealing with anxiety. Again not opposed to the notion of Anxiolytic medication if it is appropriate and thought has gone into the decision keeping in mind that it may be difficult to adjust at some future date.
Now having said that I do wanna emphasize that I’m not anti-medication as I’ve indicated but what I am is anti-passivity. I do think that it is very important in dealing with emotional distress to recognize that a person is not just in kind of an inert vessel who takes in a medication and can expect that tremendous results will occur without any effort on his or her part. I think that it’s first of all psychologically inappropriate and also I think it increases the chances of ineffectiveness. So I do think if somebody is getting to a point of considering a medication that means that there is a degree of distress there that is not comfortable and to make one comfortable and effective requires a degree of effort on the individual’s part. I’m a strong believer in the fact that even of one considers medication, that person also should be considering psychotherapy and life style modification changes. It’s very important to be able to lead a balanced life style that enables one to function and deal with the challenges that are normally faced in today’s society.
So things like exercise, eating healthy and having meaning in one’s life are very important and very often psychotherapy can be basic and help the person determine how to perceive in that direction. I may not always need a formal psychotherapeutic approach in this website and readings and so on may help individuals but my concern is taking a medication passively and doing nothing to make life style changes really decreases the odds of medication working or being successful in overcoming the thing that’s bothering you. So the question is if you’re doing this stuff if you are making some of these lifestyle changes, is it worth including the medication? My general opinion is you want as much going for you as possible while adding the least amount of unnatural substances to your body.
So that again I think that if you’re not on a medication and you can make some reasonable life style adjustments and get some help psychotherapeutically, it’s worth trying that progress, at the same time I could consider things like vitamins as being an analogy, I mean I try to lead a pretty healthy life style, exercising, try and eat normally, try and do things with others and I also take at least a limited amount of vitamins. I know you can talk to some physicians who’ll tell you that if you’ve got a healthy diet, you probably don’t need the supplementations that that vitamins may provide and I don’t take tons of them. But I just as have as much going on for me as possible, and every time I have a physical exam where I get a good report, I’m just kind of a, well enthused about continuing to do that I’m doing. You know at some point may try seeing how it works without the vitamins but I don’t consider the vitamins as being a substitute for exercise or for seeing friends or loving my family or eating healthy.
To some extent I kind of look at anti-depressants and anti-anxiety medications the same way, if you’ve started them and they’ve produced good results, I think it’s worth, you know, trying to wean under appropriate medical conditions if you’re prescribing physician thinks that’s ok. And again this is where psychotherapy can be helpful, but I do know and have observed that regardless what the research findings are, I’ve observed individuals who have tried to get off of an anti-depressant or off anti-anxiety medication or off of a narcoleptic and found that there has been a reverting back to some unpleasant circumstances in feelings. And it’s not worth it. So you know, again I think that the general guideline that I would have is as much as possible you wanna have as much going for you is as necessary but you don’t really want more than that. You make your decisions with your physician but I think that it’s absolutely wrong to do two things one is to disregard possibility that medication can be helpful but at the same time I think it’s wrong to take a medication on basis of the fact that you can passively expect that you’re going to feel better.
It doesn’t usually work that way and I suspect that when future research is done that we’ll find that one of the reasons that you don’t get a whole lot of difference between anti-depressants and placebo is because some of the people who are taking anti-depressants are just taking anti-depressants and not doing anything to change their passivity and I don’t think that mental health is spectator’s sport.
I believe that it’s important to not be passive and to pursue your goals to get better and to that extent I hope that things like this website Mental Health gym will help you in achieving goals. This is Dr. Ron Kaiser and this has been your Mental Health Gym Podcast for February 2012. As usual I’d be happy to hear what you think about it and I will look forward to speaking with you again next month.