When do I Need Medication?

“When do I need medication?” is an often-asked question in psychiatry.  Both patients and providers struggle with this question during the course of treatment. The thought of taking a medication that affects the brain’s function can be initially frightening. “Are there side effects?”, “Are the changes permanent?”, “Will I become addicted?”, “Will it change my personality?”, “Will I be a zombie?”  These are some of the frequently asked questions that indicate patients’ levels of anxiety about taking psychiatric medications.

 The brain is the most complicated and therefore least understood organ of the body.  However, in the last few decades a great deal of knowledge has emerged about the neurochemistry of the brain.  In the field of medicine, many termed the 1990’s as the “Decade of the Brain” because of the advances that were being made in our understanding of brain function.  In large part, this was due to newer technology in imaging the brain and its function.  Despite these advances, the neurochemistry of psychiatric illnesses continues to be a “work in progress.”

So, how does one know when to take a medication to help with a particular symptom such as sadness, anxiety, thought processing difficulty, inattention, sleep disturbances, appetite changes, hopelessness, euphoria, etc.?  The first step is to evaluate the symptom(s) in the context of the individual’s overall functioning.  A thorough review of current and past symptoms, life events, relationships, medical history, family history and past treatment trials helps to give a context to the symptom(s) and to determine the degree to which they are affecting the individual’s functioning. 

The psychiatric field has established some general criteria for diagnosing illnesses and continues to update these criteria as new understandings emerge.  These criteria are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  This method has helped to provide scientific guidance to diagnosis.  However, caution should be used regarding this “cookbook” approach, as each individual experiences symptoms of mental illness in his or her own very unique way.  “No two brains are the same” when it comes to our neurochemistry. 

After a detailed psychiatric evaluation with the psychiatrist and patient working as a team, the patient’s symptom(s) can be fully diagnosed.  At that point, a decision to enter into medication treatment can be much less anxiety-provoking and, if indicated, medications can offer dramatic improvement in symptoms.  As with any other physical ailment, the right medications taken at the right times can dramatically assist in healing.