Let’s begin this discussion by placing the question in the correct category—whether an individual chooses to use psychiatric medication in his struggle with mental illness is a wisdom decision, not a moral decision. If someone is thinking, “Would it be bad for me to consider medication? Is it a sign of weak faith? Am I taking a shortcut in my walk with God?” then he is asking important questions (the potential use of medication) but placing them in the wrong category (morality instead of wisdom).1
Better questions would be:
- How do I determine if medication would be a good fit for me and my struggle?
- What types of relief should I expect medication to provide, and what responsibilities would I still bear?
- How would I determine if the relief I’m receiving warrants the side effects I may experience?
- How do I determine the initial length of time I should be on medication?
In order to answer these kinds of questions, I would recommend a six-step process. This process will, in most cases, take six months or more to complete. But it often takes many months for doctors and patients to arrive at the most effective medication option, so this process does not elongate the normal duration of finding satisfactory medical treatment.
Having an intentional process is much more effective than making reactionary choices when the emotional pain (getting on medication) or unpleasant side effects (getting off medication) push a person to “just want to do something different.” With a process in place, it is much more likely that what is done will provide the necessary information to make important decisions about the continuation or cessation of medication.
Preface: This six-step process assumes that the individual considering medication is not a threat to self or others, and is capable of fulfilling basic life responsibilities related to personal care, family, school, and work. If this is not the case, then a more prompt medical intervention or residential care would be warranted.
If you are unsure how well your church member is functioning, then encourage him to begin with a medical consultation or counseling relationship. If he would like more time with his doctor than a diagnostic and prescription visit, suggest that he ask the receptionist if he can schedule an extended time with the physician for consultation on his symptoms and options.
Step 1: Assess life and struggle
Most struggles known as mental illness do not have a body-fluid test (i.e., blood, saliva, or urine) to verify their presence. We do not know a “normal range” for neurotransmitters like we do for cholesterol. The activity of the brain is too dynamic to make this kind of simple number test easy to obtain. Gaining neurological fluid samples would be highly intrusive and more traumatic than the information would be beneficial. Brain scans are not currently cost-effective for this kind of medical screening and cannot yet give us the neurotransmitter differentiation we would need.
For these reasons, the diagnosis for whether a mental illness has a biological cause is currently a diagnosis-by-elimination in most cases. However, an important part of your church member’s initial assessment should be a visit to his primary care physician. Encourage your church member to:
- Clearly describe the struggles/symptoms he is experiencing.
- Describe when each struggle/symptom began.
- Describe the current severity of each struggle/symptom and how it developed.
As the person prepares for this medical visit, it would be important for him to also consider:
- What important life events, transitions, or stressors occurred around the time his struggle began?
- What is the level of life-interference he is experiencing as a result of his struggle?
- What lifestyle or relational changes would significantly impact the struggle that he’s facing?
Step 2: Make needed nonmedical changes
Medication will never make us healthier than our current choices allow. Our lifestyle is the “ceiling” for our mental health; we will never be sustainably happier than our beliefs and choices allow. Medication can correct some biological causes and diminish the impact of environmental causes to our struggles. But medication cannot raise one’s mental health potential above what that person’s lifestyle allows.
Too often people want medication to make over their unhealthy life choices in the same way they expect a multivitamin to transform an unhealthy diet. They assume that the first step toward feeling better is receiving a diagnosis and prescription. This may be the case, and there is no shame if it is, but it need not be the guiding assumption.
Encourage your church member to look at the lifestyle, beliefs, and relational changes that his assessment in step 1 would require. If there are choices he could make to reduce the intensity of his struggle, is he willing to make them? Undoubtedly these changes will be hard, or he would have already done so. But let him know that they are essential if he wants to use medication wisely.
As your church member identifies these changes, he should assess the areas of sleep, diet, and exercise. Sleep is vital to the replenishing of the brain. Diet is the beginning of brain chemistry—our body can create neurotransmitters only from the nutrition we provide it. Exercise, particularly cardiovascular, has many benefits for countering the biological stress response (a primary contributor to poor mental health). The first “prescription” should be eight hours of sleep, a balanced diet high in antioxidants, and cardiovascular exercise for at least thirty minutes three days a week.2
A key indicator of whether your church member is using psychiatric medication wisely is whether he is using medication (a) as a tool to assist him in making needed lifestyle and relational changes, or (b) as an alternative to having to make these changes. Option A is wise. Option B results in overmedication or feeling like “medication didn’t work either” as he continually tries to compensate medically for the volitional neglect of his mental health.
Step 3: Determine the nonmedicated baseline for mood and life functioning
This is an important, and often neglected, step. Any medication is going to have side effects. The most frequent reason people stop taking psychiatric medications, other than cost, is because of their side effects.
If your church member is not careful, he will merely want to feel better than he does “now.” Initially “now” will be how he feels without medication. Later “now” will be how he feels with medication’s side effects. In order to avoid this unending cycle, there needs to be a baseline of how he feels when he lives optimally off of medication.
One of the reasons postulated for why placebos often have as beneficial an effect as psychiatric medication is the absence of side effects. Those who take a placebo get all the benefits of hope (doing something they expect to improve their life) without any unpleasant side effects. Getting the baseline measurement of how life goes when one simply practices “good mental hygiene” is an important way to account for this effect.
“As I practice medicine these days, my first question when a patient comes with a new problem is not what new disease he has. Now I wonder what side effects he is having and which drug is causing it,” says Charles D. Hodges, MD, in his book Good Mood Bad Mood.3
There is another often overlooked benefit of step 3. Frequently people get serious about living more healthily at the same time life has gotten hard enough to begin taking medication. This introduces two interventions (medication and new life practices), maybe three or four (often people also begin counseling or being more open with friends who offer care and support), at the same time. It becomes very difficult to discern which intervention accounts for their improvements.
Writing out his answers to the following questions will help your church member discern if he needs to move on to step 4 and make the needed assessment in step 5.
- What were the struggles that initially made me think I might benefit from medication?
- How intense were these struggles, and how did they manifest themselves?
- What changes did I make in my lifestyle and relationships to alleviate these struggles?
- How effective was I at being able to make the needed changes?
- How much relief did the lifestyle and relational changes provide for my struggles?
- How do I anticipate medication would assist me in being more effective at these changes?
Step 4: Begin a medication trial
If your church member’s struggles persist to a degree that is impairing his day-to-day functioning, then you should encourage him to seek out a psychiatrist or other physician for advisement about medical options. In this conversation, he should consider asking the physician the following questions:
- What are the different medication options available for the struggle I’m facing?
- What does each medication do that impacts this struggle?
- What are the most common side effects for each medication?
- How long does it take this medication before it is in full effect?
- If I choose to come off this medication, what is the process for doing so?
- What have been the most common affirmations and complaints of other patients on this medication?
These questions should help him work with his doctor to determine which medication would be best for him. Remind your church member that he has a voice in this process and should seek to be an informed consumer with his medical treatment, in the same way he would for any other product or service.
In this consultation your church member will also want to decide upon the initial period of time to remain on the medication (unless he experiences a significant side effect from it). In determining this length of time, he would want to consider:
- His physician or psychiatrist will make recommendations based upon additional factors (beyond the scope of this article)
- Staying on the medication a minimum of at least twice the length of time it takes to reach its full effect
- Significant life stressors that would predictably arise during this trial period (e.g., planning a wedding)
- How long it would take to make and solidify changes that were difficult to make without medication (see step 3)
Once this set period of time is determined, your church member’s goal is to continue implementing the changes he began in step 3 while monitoring (a) the level of progress in his area of struggle and (b) any side effects from the medication.
Step 5: Assess level of progress against medication side effects
Near the end of the trial period, your church member should return to the life assessment questions he answered at the end of step 3. He should compare his ability to enjoy and engage life at this point with his answers then. The questions to ask are:
- What benefits have I seen while on medication?
- What side effects have I experienced?
- Is there reason to believe my continued improvement is contingent upon my continued use of medication?
- Are the side effects of medication worth the benefit it provides?
The more specific he was in his answers at the end of step 3, the easier it will be for him to evaluate his experience at the end of step 5. At this point, encourage him to try to be neither pro-medication nor anti-medication. His goal is to live as full and enjoyable a life as possible. It is neither better nor worse if medication is part of that optimal life.
Step 6: Determine whether to remain on medication
At this point in the process there are several options available to the individual; this is more than a yes/no decision. But any option should be decided in consultation with the prescribing physician or psychiatrist. Your church member can decide to:
- Remain on medication because the effects are beneficial and the side effects are minimal or worth it.
- Opt to stage off the medication because the benefits were minimal or the side effects were worse than the benefits.
- Stage off the medication to see if the progress he made can be maintained without medication, knowing that if not, he is free to resume the medication without any sense of failure.
- Opt to try a different medication for another set period of time based on what he learned from the initial experience.
Regardless of what he chooses, by following this process he can have the assurance that he is making an informed decision about what is the best choice for him.
For the various counseling options available from this material, visit www.summitrdu.com/counseling.
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- For more on understanding the choice about psychiatric medications as a wisdom issue, I would recommend the lecture “Understanding Psychiatric Treatments” by Michael Emlet, MD, at the 2011 CCEF conference on Psychiatric Disorders, which can be found at http://www.ccef.org/understanding-psychiatric-treatments.
- Additional guidance on this kind of “life hygiene” can be found at www.bradhambrick.com/burnout.
- Charles D. Hodges, MD, Good Mood Bad Mood: Help and Hope for Depression and Bipolar Disorder (Wapwallopen, PA: Shepherd Press, 2013), 191..
This article 6 steps to wise decision making about psychotropic medications first appeared on bradhambrick.com, June 9, 2014. Adapted for CareLeader.org with permission by author.
Copyright © 2016 Brad Hambrick.