Patients who are experiencing strong emotional distress will often ask about taking medication. Questions about depression or anxiety medications are often accompanied by strong ambivalence: patients recognize that something is wrong and want to feel better, and at the same time express doubt that a pill will be effective. Others would rather take a pill and be done with it; they believe that talking about their problems is ineffective, that therapy is a waste of time.
Medications can help. But there are a number of questions that need to be explored before making decisions about trying a psychotropic medication.
· How long have you felt the distress?
· How intense is the distress? How is the distress impacting your ability to function?
· If the distress is arising in response to a life situation, how have you managed similar situations in the past?
· How well are you sleeping? How well are you eating?
· Are you using alcohol or other substances to cope? If so, what, how much, and how often are you using them? (Please be honest with yourself and your therapist!)
· Will medication facilitate the deeper work of psychotherapy?
It’s important to talk through these questions and share any concerns you have about medications and their possible side-effects with your doctor or therapist. A good assessment is essential before any medication is considered. How these questions and others are answered are all part of a good evaluation—an important first step toward making an informed decision.
That said, here are a few thoughts:
Acute distress clouds thinking. When you’re in distress, your attention narrows and focuses on those factors that either create or contribute to your distress. When you’re acutely uncomfortable, it’s harder to see the bigger picture. Decision-making can become impaired by acute distress: it’s harder to clearly see the issues and all the factors impacting those issues. It's harder to discern the consequences of the decisions you might have to make. Everything is experienced through the fog of distress. Depressed clients often report that their thinking slows down when their depression is acute, and one of the hallmarks of depression is the inability to make decisions. Anxious clients report that they feel unsettled, distractible, hyper-vigilant, and afraid to act.
Anti-depressant or anti-anxiety medications can take the edge off of acute emotional distress. Anti-psychotic medications are essential for managing schizophrenias or other psychotic disorders. The right medication(s), prescribed and monitored by a psychiatrist who has evaluated and understands your distress, can be very helpful. But medication alone is rarely the sole answer to psychological problems. However, medication used in conjunction with psychotherapy, especially Cognitive Therapies, has been shown to be very effective. (Indeed, there is a great deal of research literature in support of combining medications with psychotherapies.)
As a therapist, I want you to have your feelings, but I don’t want to you become flooded, overwhelmed or disabled by them. Emotional distress signals problems that need to be addressed. Therapy is about working with your thoughts and feelings. And meaningful psychotherapy asks that you be willing to experience enough of your distress (without being overwhelmed by it) so that you can work through it. Finding a medication at an effective dosage that allows you to have your feelings and think clearly can certainly support our work together.
The idea is not to avoid distress but to work through it.