When to Consider Medication

Guest Blog Post by James Morgan, DNP, AGACNP-BC, PMHNP-BC, Owner of Anchored Psychiatric Nursing Services

When Treating the Root Cause of Mental Disorders with Talk Therapy Is Not Enough: How Medication Can Improve Mental Health Alongside Psychotherapy

Ok, so elephant in the room, make a living mainly off of prescribing, but I’ll be the first to tell you that you will get more out of therapy than just medications alone. This might be a terrible business model, but it is the truth and my practice philosophy.

Keeping patients engaged in treatment has been a significant challenge of the healthcare system. Accessing adequate mental health support is often impaired by the accompanying stigma attached to mental illness and to prescribed medication alike. Many patients refuse to comply with medical treatment for various reasons: inconvenience, other co-morbid illness, the perceived ineffectiveness of medication, or possible side-effects. A recent report published by the American Psychological Association found that mental health patients are three times less likely to adhere to prescribed treatment in the form of psychotropic medicine compared to psychotherapy. However, despite the collective reluctance against prescribed medication, research data clearly indicates that medication is a powerful tool in combination with talk therapy and other therapeutic modalities when treating mental disorders. Are there substantial benefits of medication therapy that many patients seem to be unaware of?

Medication Addresses the Biological Component of Mental Disorders

Mental illness is not limited to emotional dysregulation and to decreased wellbeing. According to the medical model of mental disorders, disturbances in normal functioning are caused by a cluster of different causes such as change in the activity of neurotransmitters, genetics, altered neurophysiology and neuroanatomy. Patients who are given a diagnosis of mental illness often display impaired cognitive functioning and changes in their mental well-being.

Medication is a highly effective adjuvant in the treatment of mental disorders because it targets the biological aspects of mental illness and it addresses abnormal neurotransmitter functioning. For example, depression is associated with abnormal brain chemistry and impaired functioning of key neurotransmitters such as dopamine, norepinephrine, and serotonin. Medication aims to regulate this imbalance and to alleviate symptoms in order for the individual to be able to engage, process, and thrive in other types of treatment, such as psychotherapy.

Adherence to Medication Treatment Decreases Risks Associated With Mental Disorders

Studies have shown that failure to adhere to prescribed medication treatment can increase the risk of relapse, violence, and suicide. Medication is particularly useful for individuals with a high risk of harmful behaviors both to themselves and other people. Research also found that individuals with psychotic disorders who follow medical treatment show reduced symptoms and improved functioning. Therefore, medication does not just improve mental well-being by increasing the right neurotransmitters, but also contributes to the prevention of harmful behaviors.

Demonstrable Effectiveness of Psychotherapy in Combination with Medication

There is an increasing volume of research which shows that psychotherapy, when delivered alongside medication, can yield positive changes in the reduction of various mental health disorders, such as bipolar disorder and depression. Mental illnesses are complex ailments that affect the cognitive, psychological, biological, and social components of the human existence. Prescribed medication can be a reliable short-term solution for patients who are at high risk of self-harm or who show little compliance or progress with psychotherapy. It is also a great go-to solution when other means of treatment have proven otherwise ineffective.

How Long Should Someone Be on Medication?

There is no direct answer to this as everyone should be on an individualized care plan from their prescriber. Remember, you are the star of your show and it is important to have a team, or ?supporting cast,? that is there to have your best interests as a priority. One thought process that I support when it comes to medication management is:

Use it as a tool for therapy– once you build up enough tools in your toolbox? (i.e. coping skills, strategies, and insights from therapy), then it is time to have the conversation with your prescriber (while you are still going to therapy) about lowering medications to see if it would be appropriate to your care plan. My usual gauge to have this conversation is to wait until you get to a point in therapy where you really are not talking about a whole lot, which usually means you’ve progressed significantly. If appropriate, lowering medications to possibly come off of them* will allow you to put the other tools that you’ve learned through therapy to the test.

Is medication right for you? It is always worth the conversation?

*Never, ever, ever, ever abruptly stop taking a medication. Discuss with your healthcare provider.

James Morgan, DNP, AGACNP-BC, PMHNP-BC

Anchored Psychiatric Nursing Services