Why patients should take psychotropic medications.

There has been some debate on whether psychiatric patients should take medications. Are these just "happy pills"? Are we changing someone's basic personality? Are we trying to make patients be someone they're not? While I don't believe every patient who comes for treatment needs to be medicated, I do believe medications are necessary for many patients. Not all patients who call themselves "depressed" meet the DSM-IV criteria for major depression, but many who do may be making a tragic mistake by not taking meds. Major depression is often self-limiting, but how many lives are lost because someone with this illness couldn't tolerate the psychic pain, and felt suicide was the only solution? We know there are chemical changes in the brain when someone has clinical depression, and we know this is a treatable disease. We no longer encourage people with physical pain to work harder to tolerate this symptom even if they have a low pain tolerance. Our knowledge of pain has progressed to the point that we know pain is a truly personal experience and that letting patients suffer with their pain by encouraging them to bear it is counterproductive. Why, then, should we do this with people in emotional pain? Some people who have diabetes mellitus or hypertension can control these diseases with only diet and exercise, but many cannot. In the same way, depressed patients can't "pull themselves up by their bootstraps" or "focus on something else" so they'll "forget" about their depression, as well-meaning friends and family may encourage them to do. They can't on their own change the chemicals responsible for depression any more than someone with a physical illness requiring medications can change the chemicals responsible for these illnesses. This isn't to say I believe medications are the sole answer for clinically depressed people. Therapy also is essential and might be compared to the diet and exercise component in diabetes or hypertension. Unfortunately, though, patients with a significant depression may not be able to focus on therapy or use the therapy sessions in a helpful way when they're in what many have described as the "black hole" of depression. Medications can be useful in alleviating the depression, enough so they can work successfully in therapy. Obviously, depression isn't the only illness we see as clinicians. Many patients come complaining of anxiety and want something to help them feel more comfortable. As is true with depressed patients, I don't believe everyone who complains of anxiety should be given a pill. I see this as a matter of degree. For some patients, the best solution is to tolerate the anxiety and work in therapy to find the cause so that they can eliminate this symptom. Other patients, however, may suffer from anxiety that is so intense that they are unable to work in therapy or even sit in the session. Once the anxiety has been decreased to a more tolerable level, they are able to work with a therapist to find more permanent solutions. Obsessive compulsive disorder is one of several examples where this may be true. When we talk about psychotic illnesses or mania, though, I can't think of any circumstances where medications aren't essential. Although manic patients may complain that they feel too subdued while taking mood stabilizers, in my experience the alternative is truly frightening. Bipolar affective disorder is a treatable disease; with proper medication management, patients with this disorder are able to continue their work and relationships. …