Psychotropic Medications: The Only Option or Is There More? 

By Wasim Kakroo

I frequently receive questions from my clients seeking my opinion as a clinical psychologist regarding psychotropic medications. I’m frequently asked if I advise taking medicine to treat mental health issues including anxiety, depression, and other such problems. After evaluating the severity of the condition, if I find that the severity of the client’s condition is greater than a moderate level, I advise them to consult a psychiatrist to decide upon the medications. I want to clearly state my opinion on the usage of psychotropic medicines for mental disorders in this article and offer my point of view based on what I observe and understand about the role of medications in treating mental disorders.

1. Medicines can be beneficial. For some who suffer from crippling anxiety, for instance, medicines can lower down the severity of emotions and bodily sensations caused due to anxiety. Medication can give someone a “kick-start” if depression has robbed them of all motivation and they are unable to get out of bed in the morning. Additionally, medication may be necessary for stability and/or safety in those with severe mental health conditions including schizophrenia and Bipolar Affective Disorder and in such cases the patient may have to take such medicines the whole life. Therefore, depending on the individual circumstances, some persons may benefit from taking psychotropic medications that a psychiatrist has prescribed. For instance, a National Institute of Mental Health-funded study found that some patients who were prescribed the SSRI Paxil for moderate to severe depression also experienced improvements in their depressive symptoms, as well as decreases in neuroticism and increases in extroversion. These personality traits changed roughly twice as much in eight weeks after taking medications as they do for most adults over the course of their lifetime. In addition, psychotropic medicines can be a life saver especially in those with suicidal intent and can help have a better quality of life in those who have developed some organic mental illnesses such as Dementia, Alzheimer’s Disease, Traumatic brain injury etc. Psychotropic medications can be very essential part of treatment for those who have developed substance use disorder.

2. The psychotherapy process can be assisted by medication. As is understood, most people find it challenging to concentrate on symptom alleviation and personal growth when they are in crisis or are dealing with anxiety, depression, or other mental health issues. In such instances, medication can help in symptomatic relief, allowing them to put efforts they are expected by their therapist and hence it may increase their progress in psychotherapy. For instance, a study that was published in the Journal of the American Medical Association demonstrates that patient’s attention deficit hyperactivity (ADHD) symptoms tend to significantly improve when cognitive behavioral therapy (CBT) is used in conjunction with specific psychotropic medication. However, the need for psychotropic and other medications is, of course, frequently reduced or eliminated as a result of effective psychotherapy.
3. Medication may turn out to be harmful. We acknowledge that for some people, taking medicine is a critical component of the therapeutic process. However, like all drugs, psychotropic medications can have risks and side effects. These include physical side effects like dizziness, drowsiness, changes in appetite, disturbed sleep, and/or weight gain, as well as emotional and psychological side effects like mood swings, lack of interest in activities, or emotional numbness.

Antipsychotics can harm the brain permanently by causing Parkinsonism or Tardive Dyskinesia, or they can even be fatal if taken for too long or at the wrong dosage. This is corroborated by a 2005 Harvard Mental Health Letter article that describes the growing understanding of the dangers of SSRI antidepressants, including the potential rise in suicidal thoughts and behaviors in adolescents under the age of 24.

While studies have shown that some people benefit from taking these drugs, they have also revealed that other people may suffer long-term harm as a result of using antidepressants.

For those who keep on taking Benzodiazepenes for years together to deal with their anxiety or any other such mental health issue, they need to know that it creates more problems than solves it. Benzodiazepines are generally safe when taken as prescribed for short periods of time—no more than a few weeks. The chronic use of benzodiazepines can develop tolerance with repeated usage over time, which can manifest in one of two ways: either the person needs to use more benzodiazepines to get the desired effect, or the impact is noticeably lessened with continuing use of the same dose of benzodiazepines. Benzodiazepines increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fracture. The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol. Thus, patients need to discuss the potential side effects of medication use with their consultant psychiatrist so that one may weigh the dangers against the potential benefits and determine whether an alternate form or parallel form of treatment such as psychotherapy would be more appropriate.

4. It’s not always necessary to take medicine. While some mental illnesses may benefit from the use of psychotropic medicines, researchers at University of Pennsylvania found that a 16-month course of cognitive therapy was found to be both more affordable and marginally more effective at preventing a relapse into depression than antidepressants alone when used for the same amount of time. According to a study that was published in the Journal of the American Medical Association, while antidepressants were beneficial for those with severe depression, people with mild to moderate depression benefited more from other types of treatment, such as counseling, than they did from medication.

5. Medications may not be at all a treatment of choice. Research has shown that no psychiatric medicine can treat personality disorders such as Borderline Personality Disorder, Schizoid Personality Disorder etc. per se, though they may treat the depression, anxiety, mood dysregulation that develop alongside personality disorders. It has been found that psychotherapies of different modalities such as Dialectical Behavior Therapy, Schema Therapy, Psychodynamic Psychotherapy etc. is more beneficial in such cases than medicines.

6. Both the emotional process and the psychotherapy process might be hampered by medication. Once the medicine accumulates in a person’s system over a long period of time, the patient may develop inability to feel certain emotions. For instance, a lot of people complain about their diminished capacity to laugh or cry or their diminished libido. Research from Evolutionary Cognitive Neuroscience shows how SSRI side effects, including decreased sexual interest, may alter one’s sexuality and romantic relationships. Medication may also make it difficult for certain people to understand their emotions, masking underlying problems and delaying or preventing the effects of psychotherapy.

Role of Psychotherapy:

Many emotional and mental health problems cannot be reduced to a physiological/chemical imbalance. It would be quite immature to reduce psychological problems to just a chemical imbalance. Events in our lives—things that happen to us and around us—often serve as the source of and effect on psychological problems. Medication alone cannot “cure” every psychological condition because it does not alter how people mentally relate to their experiences. Medication-as the only therapy has the potential to be as ineffective as bandaging a bullet wound without first removing the bullet.

Focusing too much on psychotropic medications such as antidepressants as the only cure makes treatment of mental disorders such as depression too mechanical. Psychotherapy, as an add on, on the other hand, is frequently able to identify and treat some of the mental health issues, such as problems in temperament, abuses of different kinds, psychological trauma and anxiety, that may contribute to depression.

Through psychotherapy, a patient may be able to understand what they are battling with and hence it may eliminate confusion in their minds about their mental health issues. It may also make them well equipped to handle their life despite having symptoms of various emotional disorders and hence increase their quality of life. It may also eliminate the victim’s attitude from their lives as just relying on medicines only decreases their self esteem and self confidence as they consider themselves victim of their mental illnesses.

As a conclusion to this article, I may say that we as a society need to be more mature in understanding the role of medications and psychotherapy while treating and receiving treatment for mental disorders so that we don’t skew to only one side of treatment and hence pay huge prices. It is always better to start with psychotherapy and if the condition is severe enough to warrant the use of psychiatric medication, the patient should still be referred for psychotherapy so that basic root cause of the illness is addressed while medicines treat the symptoms.

• The author is a licensed clinical psychologist (alumni of Govt. Medical College Srinagar) and works as a consultant clinical psychologist at Centre for Mental Health Services (CMHS) at Rambagh Srinagar. He can be reached at 8825067196

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