Ask a Therapist: What About Meds?

Since the beginning of the pandemic, the number of people taking medications for their mental health has risen sharply. If you struggle with anxiety or depression, you may be wondering if medications could work for you. Here at Alexandria Art Therapy, our clinicians aren’t prescribers, so we won’t get into the specifics of particular medications or make a medical recommendation. However, your therapist can be your first line of support as you consider the decision to start medication. Today we’re talking with Associate Art Therapist Laura Miles and Clinical Director Adele Stuckey about medication stigma, questions we should be asking, and what we should expect if we want to explore medication. 

A disclaimer: This blog is for informational purposes only. It is not a substitute for professional medical advice. Always seek the guidance of a qualified prescribing provider to discuss medical interventions, like medication. 

HOW MIGHT I KNOW IF I SHOULD EXPLORE TAKING MEDICATION FOR MY MENTAL HEALTH? IS THERE ANYTHING I SHOULD TRY FIRST? 

LAURA MILES, LPC, ATR-BC: I operate under the framework of “let’s try the least-invasive things first” when it comes to making changes. Trying different coping strategies (breathing, meditation, grounding exercises, sleep hygiene, soothing hobbies, acupuncture, etc.) is a great way to notice shifts in mood, frustration tolerance, and ability to cope with change. Some people really benefit from new routines. Others notice some improvement or it wears off pretty quickly. I start to consider medication when I notice the same things coming up over and over again in sessions that don’t always respond to changing habits–poor sleep, ruminating thoughts, overwhelm, increased thoughts of self-harm, to name a few. If what we’re working on in therapy doesn’t feel like enough, I will recommend a client make an appointment with their doctor to explore if medication is a good option for them. 

ADELE STUCKEY, LPC, ATR-BC: When a client continues to experience symptoms that affect their ability to access daily life, it can be a cue that something more will be helpful. I work from a client-centered framework, meaning that I first explore how a client feels about a variety of strategies that may be useful in better accessing a fulfilling life. It’s not uncommon for a client to come to me with the question of, “Do you think medication could help?”. 

As a perinatal provider, working with people in their reproductive years, I am especially attentive to experiences like increased anxiety, intrusive thoughts, ability to sleep, and intense feelings of anger. These experiences (often referred to as symptoms), can be a cue that medication may be helpful. Those are times that I recommend my clients consult with a reproductive psychiatrist, someone who is trained to support perinatal mental health. 

One topic that I explore with clients is the timeline for exploring options versus safety. For example, if a postpartum client is experiencing the inability to sleep or intrusive, scary thoughts, I will take a more active approach in connecting the client to a reproductive psychiatrist, midwife, or OB/GYN. 

An important note: Some people do not respond well to psychotropic medications used to support mental health and can have adverse responses. This is why it is essential to speak to your prescribing provider about any previous experience with medications and closely monitor your experiences as you start a new medication. Your therapist can help track this with you. 

WHY IS THERE SUCH A STIGMA AROUND STARTING MEDS? IS THERE ANOTHER WAY I SHOULD BE THINKING ABOUT THIS? 

LAURA: You might have heard this before: are you a person who wears glasses or contacts to help your vision? Have you received medical care after breaking a bone? Do you use aloe vera when you have a sunburn, or use over-the-counter medications for everyday aches and pains? Do you take a daily vitamin or supplement? We care for these bodily disruptions regularly, and yet we still feel like there’s something bad about taking medication for mental health. When we think about physical health, we often forget that our brains are included in that, as well!

It’s not your fault if your hormones and/or neurotransmitters are out of balance. Some factors outside of your control that can have an impact include genetics, intergenerational trauma, chronic stress due to social systems, and…being a human from 2020 until now. It’s important to consider your thought patterns, emotions, and moods in your overall health–there are strong correlations between our different body systems, and when one isn’t working in a healthy way, the others can shift to account for this.

I think one of the major reasons for the stigma around taking psychiatric medications is the overall attitude in US culture around being “strong enough” or “working hard” or “pulling yourself up by your bootstraps.” We’re a scrappy, resourceful, stubborn bunch, and we don’t like to admit there are problems, let alone talk about them with others. We view the need for support as weakness and forget to be resourceful. Over the last few years, one of the most useful things I’ve learned is this: why, when given the option, would I choose to live life on Hard Mode? Taking medication isn’t an easy way out, but it can give you the resources to feel like you’re more in control of your life. 

ADELE: Like Laura said, we have an incredible amount of stigma and implicit messaging that surrounds us every day. Maybe I can just do more yoga. What if I really focused on my sleep hygiene routine? I think I can hold out a little longer. I’m just not trying hard enough. How hard is this supposed to feel? Maybe I’m just too sensitive.

Often people will recommend medication as a “last ditch effort,” which feeds into the narrative that something is wrong with you. The medical model feeds this narrative further–something is wrong that needs to be fixed.

I believe we can flip this narrative. It’s not that something is wrong–it’s that, just like yoga, acupuncture, hydration, sleep, movement, therapy, and community–medication can be a resource to enhance your life. 

In discussing the option for medication, I talk to clients about removing barriers. I think about the use of medication (or any other treatment) as a tool to turn down the noise or lessen the fog. Imagine if that barrier that is right in front of you could be lessened slightly? Medication won’t remove the stress of life or challenges that you are facing right now, but it can help decrease symptoms so that the skills from therapy are a bit more accessible. 

WHO DO I TALK TO ABOUT STARTING MEDICATION, AND WHAT QUESTIONS OR THINGS SHOULD I CONSIDER WHEN BEGINNING THAT CONVERSATION? 

LAURA: If your therapist brings up the topic of medication with you, you might automatically assume it’s a good option or judge yourself, thinking there’s something wrong with you. There isn’t–therapists want to make sure we’re exploring all options for your health and well-being. Only therapists who have a medical degree, like a psychiatrist, can actually consult and prescribe medication. As an art therapist and counselor, I have a general understanding of what different medications can do, but I can’t technically give medical advice. 

A great place to start the conversation about meds is with your primary care physician. If you make an appointment  with your doctor to talk about depression, they complete a depression screening which includes questions about your mood, hopelessness, and thoughts of hurting yourself. You can specifically request to have a conversation about medications when you make your appointment–that’s what I did when I made an appointment with my doctor for a consultation.

A PCP will be able to discuss the impact and side effects of more generalized medications. If what you’re coping with is more focused (say, a major mood disorder or some type of hallucination), they can refer you to a psychiatrist who will have more extensive knowledge of the medications available to you. I recommend writing down every possible question you have for your doctor before your appointment. It can be hard in the moment to remember everything you want to ask, and they might cover that information in the discussion anyway. Making an appointment with your doctor doesn’t obligate you to take anything–you are still in control of your medical care.

Make a list of information your doctor might need to know– how long have symptoms been going on, how much do they interfere with your daily life, your current and previous medications, and what benefit you’re hoping to get from taking them. Share your concerns with your doctor, too, if you’re worried about side effects.

ADELE: Your therapist can help you determine the best route to move forward, including which type of provider to reach out to. Prescribing providers can include: psychiatrists, primary care physicians, nurse practitioners, psychiatric nurses, midwives, and OB/GYNs. Connecting with a provider who specializes in your needs can be helpful in exploring medication options. Some PCP’s will refer out if psychotropic medication is out of their scope of practice. Before setting an appointment with a provider to discuss medication, it can be helpful to ask in advance if they provide this type of support. 

For perinatal clients, I will assess existing symptoms for perinatal mood and anxiety symptoms, including but not limited to anxiety, depression, and OCD. I will work with my clients to create a list that they can bring to their prescribing provider. The conversation about medication can feel overwhelming when you’re already experiencing mental health stressors. So, having resources to bring to the appointment can be helpful in describing your experience. 

A prescriber with perinatal mental health training will know how to look for nuance in symptoms and prescribe accordingly. They can also make recommendations about the safest medications for pregnant people, those who are chestfeeding, and those who are pumping to bottle feed. (Yes, there are options!)

IF I START MEDICATION, WHAT BENEFITS MIGHT I EXPERIENCE? WHAT ELSE DO I NEED TO KNOW? 

LAURA: You might notice some immediate benefits, depending on which medication you’re starting. There are different formulations that work in various ways, and the dosage might vary depending on your needs. It’s okay if it takes some time to figure out the right dosage for you–lots of meds also require you to taper up or down so that your body can adjust to it. Once at your full dose, you should notice that you have more energy, better concentration, easier problem-solving, and you’ll probably notice improvement in your routines and coping skills. For me, it felt like a weight being lifted off my shoulders, or cleaning a foggy window. Things just felt easier–I didn’t feel so numb, anxious, or apathetic. 

Side effects are usually noticeable right away, and should go away with some time. Ask your doctor how long you should expect to experience side effects.  If they’re lingering beyond the typical adjustment period, let your doctor know if they’re disruptive to your life. You’ll notice them when you’re increasing or decreasing your dosage, for example. 

As much as I would love to say there’s a magical pill out there that will fix all your problems, unfortunately we haven’t developed that technology yet (trust me, if I had access to that, I would be telling everyone I know about it). Nothing is going to be a miracle cure–it takes a combination of healthy habits, medication, good routines, supportive relationships, and using resources to feel more engaged and fulfilled in your life. 

ADELE: Experiences can vary widely. I typically remind clients that decreases in symptoms can be mild and gradual. Assuming a client is able to access a medication that is matched to their needs, the difference is often noticed when a client is experiencing a life stressor and they feel more grounded in it. That thing that would have derailed your day in the past? Hm, it’s not so disruptive now. That previous experience of spiraling “what if” questions is slowed down or occurs less frequently? Maybe the medication helped slow it all down. 

Your prescriber will likely tell you that if anything changes for the worse, like increased suicidal ideation, thoughts of self-harm, or overwhelming anxiety – contact them right away. Your therapist can be there to notice patterns with you. 

Depending on the provider and treatment, your therapist and prescribing provider may consult with each other – with your signed consent. As a clinician supporting a client on a regular basis, I may have additional information to provide that will support your treatment. 

IF I START MEDS, HOW WILL I KNOW IF I SHOULD STOP THEM IN THE FUTURE? 

LAURA: If you decide to begin meds, know that it may be challenging to find the right fit. Nothing is one-size-fits-all, and it might take a couple of trials before you find the thing that works best. Every body is different, and every body will respond in its own way to medications. Just because your friend had success on a medication you’re trying doesn’t mean it’s the right one for you (the reverse is also true–keep an open mind about trying something that someone else didn’t benefit from). The process of finding the right medication is like baking: you have to get the proportion of ingredients right, which takes some adjustment, or else your cake comes out of the oven in a big goopy mess. 

Remember, nothing is permanent. The effects of a medication can change over time, and that’s okay. There is always an ongoing evaluation to see if you’re getting the best possible results from everything you’re doing to support your health. The conversation about meds isn’t a one-time thing, nor does it have to be a forever thing. 

ADELE: I usually recommend that once clients are feeling more grounded, more stable with life stressors, and overall just good – that they ride this out for a period of time. It’s not uncommon for a client to go off medication and realize that symptoms have slowly returned over time. 

That being said, plenty of clients utilize medication to get through a stressful season of life – new baby, perinatal changes, fertility challenges, grief and loss, relationship changes, job stress, or a pandemic that just keeps going. 

Sometimes medication is helpful in getting through that hump so that you can return to your most authentic self, accessing the tools you have built up for yourself, and living a bit more freely.  

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