Why are we still afraid of psychiatric medications?

During my clinical practice as a psychiatrist, i’ve faced the following statements several times: “is this medicine addictive?”; “I don’t wanna get hooked on anything, doctor”; “if I feel good, why should I keep on taking this medication?”

These and other questions seem to center themselves more around medication and psychiatric treatments than what happens in any other health field. Let’s try to answer these doubts and then understand why they are more common for psychological and psychiatric treatments than for any other “traditional” medical treatments. We’ll begin our journey by the brain…

The brain, as well as other vital organs such as the heart, liver and kidney, eventually goes through changes, alterations, disorders and diseases.
The imbalances that we might notice in one’s heart can, for instance, lead to issues that people refer to as “palpitations”, “chest pains”, “cardiac insufficiency”, “myocardial infarction”, among other expressions. These disorders require specific treatments to restore the heart balance, allow it to recover and avoid further complications.

In this simple heart scenario, we are guided to engage in good practices like physical activities, a healthy diet, a sleeping routine and, when necessary, take medication such as antihypertensives for blood pressure and hypoglycemics for Diabetes, just to name a few. In comparison to the heart, brain issues might be referred to as “sadness”, “anxiety”, “delusions”, “hallucinations”, “depression”, “bipolarity”, “obsessions and compulsions”, and many others. And just like we saw in our heart example, these disorders also demand specific treatments for the brain to recover and in order for us to fell good again, have a greater well being perception, happiness, balance and, of course, avoid further complications.

To do so, alongside the good practices above listed, there’s also psychotherapy, meditation and, of course, medications. Some of the most common examples of treatments are antidepressants(for depression and anxiety), mood stabilizers for bipolarity and antipsychotics for delusions and hallucinations.

“Nevertheless, we must understand that psychological and psychiatric treatments exist to restore the balance and well function of the brain. An essential organ to all human beings, it must get full attention in case of unbalance, just like it would happen for any other organ such as the heart, kidney and liver”

But why does it seem so hard for us to acknowledge the need for antidepressants, antipsychotics and other medications set to treat our emotional and behavioral disorders?

The ideas of dependence or addiction commonly related to psychiatric medicines are founded on prejudice against any illness that might alter our emotions, feelings and behavior. These illnesses are either considered less relevant and fundamental than other disorders that affect our “external self” and “body” or even have their acknowledgement denied.

Devaluation and denial of human feelings result on people repressing themselves when in need of help, as well as the creation of a vicious cycle of prejudice and suffering that brings sayings such as: “You don’t need those types of medication. Just be strong!” , “quit being lazy and do something”. As if being weak or lazy could ever be connected to depressive disorder, anxiety disorder or schizophrenia. Ironically, I’ve never heard of a Diabetes patient being told anything like “quit being weak and lower your blood sugar level!”. It might sound funny but unfortunately many people still think like that when it comes to mental disorders.

It must be said that some psychiatric medicines might cause dependence just like other treatments do in other health fields. Prescription drugs have a particularity to enable abusive, tolerance and dependence mechanisms in some people. That’s the case for the following categories:

- Benzodiazepines: Alprazolam (Xanax), chlordiazepoxide (Librium), chlorazepate (Tranxene), diazepam (Valium), to list some.
- Psychostimulants: lisdexamfetamine, methylphenidate, modafinil, etc
- Opioids: morphine, oxycodone and tramadol, for example. Used for treating pain , thus fentanyl for anesthetic purposes.

Despite this intrinsic property, in the vast majority of cases in which dependence or “addiction” to these drugs occurs, it is commonly due to misuse of the medication without medical consent or guidance, which should not occur with any type of medication.

Finally, let’s analyze the following situation: “John Doe with high blood pressure goes to the doctor who prescribes an antihypertensive drug to keep his blood pressure adequate and, thus, avoid future complications and increase his quality of life. After 10 years using the medication, maintaining normal pressure and without other related complications, the person wonders why he is taking this antihypertensive drug, since his pressure has been normal for 10 years. He then decides to stop the medication.”

It is easy to imagine that in a short time this person’s blood pressure will get high again and he will need to return to the use of medication again, not to mention all the risks of complications that he put himself in during this period. Here comes the question: is this person addicted to this antihypertensive? Is he dependent on it? Does it make sense to stop this medication if it is exactly what is maintaining normal pressure?

We should think about psychological and psychiatric treatments in the same way. There is no mention of dependence or addictions to medicines that help treat functional damage to our body, bringing health back. And just like with antihypertensive drugs, if for example a person stops using, without medical advice, an antidepressant to treat a depressive disorder, he or she is likely to start a new depressive episode, possibly more intense, severe, lasting and refractory, and may even progress to psychotic conditions (hallucinations and delusions), suicide, among other complications.

“Don’t keep this vicious cycle of prejudice and suffering! Try to understand your feelings and ask for psychological and psychiatric help when necessary!”

Mental disorders can disable and harm as much as “physical” diseases and, like them, they also have effective treatments to restore health, balance and well-being.

***

Dr Ricardo Jonathan Feldman

Psychiatrist at Centro Feldman de Saúde, founded in 2012, at Hospital Israelita Albert Einstein (HIAE), at Residencial Israelita Albert Einstein and professor at the Postgraduate Program in Psychiatry at HIAE, works in the diagnosis, treatment and teaching of various psychiatric disorders, focusing on improvement of quality of life, feeling of well-being and physical, mental, social and spiritual balance.