Six Steps to Wise Decision-Making about Psychotropic Medications (Part 2)

August 15, 2016

Brad Hambrick

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BCC In this post, Brad Hambrick continues with more compelling suggestions for thinking through the possible role of psychiatric medicines in addressing various types of mental suffering. In his first installment the two suggestions were:

Step One – Assess Life and Struggle

Step Two – Make Needed Non-Medical Changes

Step Three – Determine the Non-Medicated Base-Line for Your 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 psychotropic medications, other than cost, is because of their side effects.

If you are not careful, you will merely want to feel better than you do “now.” Initially “now” will be how you feel without medication. Later “now” will be how you feel with medication’s side effects. In order to avoid this unending cycle, you need to have a baseline of how you feel when you live optimally without medication.

One of the reasons postulated for why placebos often have an effect equivalent to that of psychotropic medications 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 you simply practice “good mental hygiene” is an important way to account for this effect. Thus, Dr. Charles Hodges writes, “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.”[1]

There is another often over-looked benefit of step three. 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 your answers to these questions will help you discern if you need to move on to step four and make the needed assessment in step five.

  • 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 Four – Begin a Medication Trial

If your struggles persist to a degree that is impairing your day-to-day functioning, then you should seek out a physician for advice about medical options. As you have this conversation, consider asking your physician the following questions:

  • What are the different medication options available for the struggle I’m facing?
  • What does each medication do that might affect this struggle?
  • What are the most common side effects for each medication?
  • How long does it take for this medication to have its full effect?
  • If I chose to come off this medication, what is the process for doing so?
  • What have been the most common affirmations and complaints of other patients who have this medication?

These questions should help you work with your doctor to determine which medication would be best for you. Remember, you have a voice in this process and should seek to be an informed consumer with your medical treatment in the same way you would for any other product or service you purchase.

In this consultation you also want to decide upon the initial period of time for which you will remain on the medication (unless you experience a significant side effect from the medication). In determining this length of time, you would want to consider:

  • Your physician will make recommendations based upon additional factors not considered in this article
  • A minimum of at least twice the length of time it takes the medication 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 three)

Once you determine this set period of time, your goal is to continue implementing the changes you began in step three while monitoring (a) the level of progress in your area of struggle and (b) any side effects from the medication.

Step Five – Assess Level of Progress against the Medication’s Side Effects

Near the end of the trial period, you want to return to the life assessment questions you answered at the end of step three. How well are you able to enjoy and engage life at this point compared to earlier? The questions you want 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 has been contingent upon continued use of the medication?
  • Are the side effects of the medication worth the benefit it provides?

The more specific you were in your answers at the end of step three, the easier it will be to evaluate your experience at the end of step five. At this point, try to be neither pro-medication nor anti-medication. Your goal is to live as full and enjoyable a life as possible, to the glory of God (1 Cor. 10:31).

Step Six – Determine Whether to Remain on Medication

At this point in the process there are several options available to you; this is more than a yes-no decision. However, any option should be decided in consultation with your prescribing physician. You can decide to:

  • Remain on medication because the effects are beneficial and the side effects are minimal or worth it.
  • Opt to start the process of coming off the medication because the benefits were minimal or the side effects worse than the benefits.
  • Come off medication to see if the progress you made can be maintained without medication, knowing you are free to resume the medication if needed without any sense of failure.
  • Opt to try a different medication for another set period of time based on what you learned from the initial experience.

Regardless of what you choose, by following this process you can have the assurance that you are making an informed decision about what is the best choice for you.

[1] Charles Hodges, Good Mood, Bad Mood (Wapwallopen, PA: Shepherd Press, 2012), 191.

Brad Hambrick

About Brad Hambrick

Brad is Pastor of Counseling at The Summit Church in Durham, NC. He also serves as an adjunct professor of biblical counseling at Southeastern Baptist Theological Seminary. Brad has been married to his wife, Sallie, since 1999.