BCC In this post and the next, Brad Hambrick offers compelling suggestions for thinking through the possible role of psychiatric medicines in dealing with various forms of mental suffering. This post is written to a person who is considering the possibility of taking medication.
Let’s begin this discussion by placing the question in the correct category – whether an individual chooses to use psychotropic medication in their struggle with what is normally categorized as “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 short-cut in my walk with God?” then they are asking important questions (the potential use of medication), but they are placing them in the wrong category (morality instead of wisdom).
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 duration 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 you 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.
Please note: This six-step process assumes that the individual considering medication is not a threat to oneself 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 you are functioning, then begin with a medical consultation or counseling relationship. If you would like more time with your doctor than a diagnostic and prescription visit, then ask the receptionist if you can schedule an extended time with your physician for consultation on your symptoms and options.
Step One – Assess Life and Struggle
Most struggles known as “mental illnesses” 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 psychological problem has a biological cause is currently a diagnosis-by-elimination in most cases. However, an important part of this initial assessment should be a visit to your primary care physician. In this visit you should:
- Clearly describe the struggles/symptoms that you are experiencing.
- Describe when each struggle/symptom began.
- Describe the current severity of each struggle/symptom and how it developed.
As you prepare for this medical visit, it is also important to consider:
- What important life events, transitions, or stressors occurred around the time your struggle began?
- What is the level of life-interference you are experiencing as a result of your struggle?
- What relational changes would significantly impact the struggle that you’re facing?
Step Two – Make Needed Non-Medical Changes
Medication will never make you healthier than your current choices allow. Your lifestyle is the “ceiling” for your mental health; you will never be sustainably happier than your beliefs and choices allow. Medication can potentially alter some biological factors and perhaps diminish the impact of environmental causes of your struggles. But medication cannot raise your “mental health potential” above what your lifestyle allows.
Too often we want medication to make-over unhealthy life choices in the same way we expect a multi-vitamin to transform an unhealthy diet. We assume that the first step towards 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 our foundational guiding assumption.
Look at the lifestyle, beliefs, and relational changes that your assessment in step one would require. If there are choices that you could make to reduce the intensity of your struggle, are you willing to make them? Undoubtedly these changes will be hard, or you would have already done so. But they are essential if you want to use medication wisely.
As you identify these changes, assess the areas of sleep, diet, and exercise. Sleep is vital to the replenishing of the body’s energy levels. Diet is the beginning of brain chemistry – our body can only create neurotransmitters from the nutrition we provide it. Exercise, particularly aerobic exercise, has many benefits for countering the biological stress response (a primary contributor to poor mental health). Your first “prescription” should be eight hours of sleep, a balanced diet high in antioxidants, and aerobic exercise for at least thirty minutes three days a week (walking, jogging, swimming, bicycling, etc.)
A key indicator of whether using psychotropic medication wisely is whether you are (a) using medication as a tool to assist in making needed lifestyle and relational changes, or (b) using medication as an alternative to having to make these changes. “Option A” is wise. “Option B” results in over-medication and usually leads to the discouraging conclusion that “medication didn’t work either” as you try to compensate medically for volitional neglect of your mental health.
Note: See the next BCC post for the conclusion of Brad’s article.
 For more on understanding the choice about psychotropic 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.
 If you have been sedentary for a long time—and especially if you are over forty—it would be wise to consult with a physician before starting a regular exercise routine. Additional guidance on this kind of “life hygiene” can be found at www.bradhambrick.com/burnout.