Many people ask psychologists about medication for anxiety and depression. In fact I often think that people are more inclined to ask there counselor or psychologist than to their prescriber. From the outset clinical psychologists are not medical doctors and do not prescribe medications (in some America States they can prescribe).
Aware, the organisation supports awareness and solutions to depression, estimates 450,000 are affected by depression in Ireland, the equivalent of one in 10, at any one time. On top of this are tens of thousands who are restricted and exhausted by disabling anxiety, the most common mental health difficulty along with depression. Many times depression & anxiety travel together just like a train with different coaches. The challenge as a psychologist is to figure out which coach is driving the train and targeting the treatment.
Now when it comes to prescribing medication in Ireland we are not slow as over 2 million prescriptions for the top five anti-depressant & anti-anxiety written per year. For example in Limerick, prescriptions were written for 10% of the total population, the highest in the country. Now it’s worth looking at how these facts enter the therapy room. Up and down the county as people are having the ‘medication’ conversation with their counsellor or psychologist. It’s a very common conversation. I figure this is because of practical reasons as time is crunched in the GP setting and with the extra time in the therapy room there is space to explore concerns.
People often ask “Eddie, what’s your stance on medication? Are you against them?” Here’s how I answer; “I see medication like a life-jacket in stormy water, this can be helpful for some people. Counselling tries to figure out how you fell out of the boat and give you some strong swimming strokes that gives you choices to swim back to the boat or to new shores. The key point is that it’s important for someone to developed a healthy replacement for any life-jacket (defence) before removing it.
The Three most common questions
- Anne who is on medication for my anxiety and is planning to come off it. What do you think? It’s wise to discuss this decision with your prescribing doctor. What’s important is that it would be very helpful for Anne to build her skill base to tackle her anxiety, e.g., not drinking, exercising, yoga, nutrition, CBT and mindfulness.
- Sean, “I have been given this prescription for depression. It is in my pocket. Do you think I should start on them?” For many people starting medication can be difficult as they sit in judgment of themselves as being weak Pat said to me ‘I can’t believe it’s come to the point where I have to take medication; I thought I was a strong person’. These are based on beliefs about being strong or weak. So many factors come into play
- Is the depression within the severe range?
- Have you had experience of medication before and, if so, what were the side-effects like?
- Have you tried therapy before? If so, what type was it? Was it passive counselling in the talk-and-listen format or dynamic active psychotherapy that gave you lifelong skills?
- What strategies have you tried to manage your depression?
- If you decide to go on anti-depressants, will you also be committing to therapy?
- Joan; I was prescribed medication for my depression, and I have come off it. What do you think? Don’t stop taking your medication as soon as you feel better without first discussing it with your prescribing doctor. This can cause unpleasant withdrawals symptoms, such as agitation, crying spells, fatigue, depression, anxiety, etc. Stopping abruptly is not advised. Ideally try to choose a time when there are fewer stressful life events happening and a lot of stability in your home, work and relationships.
The key thing around medication is to have trusting and open conversations with your GP/Prescriber and your therapist. Working in collaboration all three individuals and most importantly you, will get to the better solution. Regardless you are best advised to figure out how you fell out of the boat and to develop strong swimming strokes.
One thing I don’t believe in is ‘Forever medication’. I believe there are excellent options to tackle emotional difficulties and indeed to get to a point where you can move towards mental health and then to mental fitness where you are resilient.
Just as we are having conversations about reducing antibiotic use we need to have conversations about coming up with alternatives to antidepressants particularly for mild to moderate depression for example;
- Using self-help books for therapeutic purposes – The book Prescription Schemes in your local libraries.
- Online cognitive behavioural therapy programmes. – such as the MoodGYM (www.moodgym.anu.edu.au) to assist individuals in addressing depression.
- There is increasing evidence to support the role of exercise in overcoming mild to moderate depression. Exercise such as walking, jogging, cycling, dancing or swimming all help to release endorphins. These are our bodies’ ‘feel good’ hormones.
- A word on alcohol: don’t. Alcohol is a depressant. Using alcohol is the equivalent of digging a deeper pit for your depression. Stopping drinking can have an incredibly positive effect on low mood.
Reach higher. Medication alone is not enough. Medication may reduce the symptoms of depression and anxiety, but it doesn’t address what’s keeping the problem going. Not only have countless studies shown that therapy works just as well as medication in the treatment of depression and anxiety, but, significantly, it’s also better at preventing relapse once treatment ends. Medication is something external to you. But imagine being able to carry all the tools needed to take on your depression or anxiety inside of you. Tools that aren’t made of chemicals and that have no side-effects, that empower you, give you confidence and that fundamentally say, ‘I trust you to be able to manage your life.’