Why see a psychiatrist? What is psychiatry?
Psychiatry is the practice of medicine as it relates to mental health and therapy, but it’s not just about medication.
A psychiatrist is like a therapist, except they focus on evaluating your mental health from a medical perspective, consider the physical basis for mental health issues, can offer a refined diagnostic process, and can prescribe medication if needed. When done right, such as via integrative psychiatry and longer visit times, the consult also includes a discussion of your lifestyle, diet, exercise, supplements and more. Some psychiatrists also do therapy, but generally, you will see the psychiatric provider once or twice as an add-on to therapy, and they can collaborate with your therapist. If you choose the option of medication, it is helpful to have follow-up appointments quarterly to evaluate how it’s going.
What does a psychiatric provider do?
A psychiatric provider, whether that person is a medical doctor or a psychiatric nurse, will evaluate your mental health by asking you questions just like your therapist might. They will inquire about your family history, any substance use habits, lifestyle considerations, and symptoms or issues you are experiencing. Based on their evaluation, they may recommend medication, but only if needed and after an exhaustive review of the options: Diet, lifestyle, supplements, exercise, meditation, yoga and more.
Does medication have benefits?
Contrary to some opinions, medication can have significant and important benefits in the right application. There are many reasons why medication sometimes gets a bad rap: Unskilled providers who are rushing or not paying attention; the business model of many medical doctors (get you in and out in 15 minutes!), lack of follow up after prescribing, and relying too much on medicine and not enough on lifestyle modifications and supportive therapies. It is important to consider whether non-medical options exist and can be pursued for an issue. Sometimes, exercise, nutrition, counseling, supplements, and other approaches can help an issue enough. Other times, however, the ill effects of major depression or intense anxiety are more toxic than not pursuing medical treatment and call for the benefits of medicine.
The time to take medicine is when the side effects of your issue, like depression, stress, or anxiety, are worse than the side-effects of the medicine that could help, and when the problem is significant enough to disrupt your life. In those cases, letting the issue run untreated can have very significant health, mental, and lifestyle consequences, such as a worsening of the issue, losing a job or being unable to perform as usual, getting physically unhealthy in other ways, developing significant relationship problems, divorce, alcoholism, and being unable to enjoy your life, family life and social life in important ways. Keep in mind that the longer an issue, like anxiety or depression, goes untreated, the longer it will likely take to correct and bring back into balance. The brain starts to groove in pathways along the patterns of the issue or disease. Some mental health issues are also cytotoxic, and medication can protect your brain and body from disease and decay. Medication has three primary benefits:
When people are hesitant to take medication but qualify for the recommendation based on the criteria above, we remind them that the disease, problem, or issue they have is already creating massive toxic effects and side effects on their mind, body, health, and life. The first benefit of medication is that it can balance and treat the issue you have and eliminate some of the toxic side effects of the problem.
In some cases, such as when there is an underlying physical issue, family history, genetic susceptibility, or individual biochemical imbalance, medication sets the body right, puts it back in balance, and people feel better than ever. Medication can correct lifelong imbalances in our physiology and biochemistry that have been there and have never been addressed. You may not know that you suffer from a chronic physical issue or imbalance that is causing the issue you have, but we are physical creatures and highly complex. Just like someone may have a thyroid condition, or kidney issues, or a cholesterol problem, sometimes the physical parts responsible for producing neurotransmitters or parts of our nervous system just aren’t functioning up to par and need support.
The third important benefit of mental health medication that is often overlooked is that the medication can help your mind learn how to live free of that weight around your life. Some people worry that medication is a crutch, and that is spares your mind from having to wrestle with the issue itself, but the opposite is often true. It’s hard to wrestle with a mental issue, like depression, or anxiety, when you are crippled by it and don’t want to get out of bed or don’t have the motivation or outlook to do everything that needs to be done to combat it. If your body is involved in the issue, it may be an uphill battle for your mind to overcome and the issue can get worse as you try. Medication can alleviate your symptoms enough to allow your mind to experience what it’s like to live free of the issue, which reinforces the healing process. This is much like someone who takes a psychedelic and realizes ‘what is possible.’ Medications generally will not obscure an issue–just lessen the symptoms. You still have to do the personal growth work in therapy to wrestle with and understand how to fully conquer the problem.
What are the downsides?
There are pros and cons to everything, and an experienced professional can help you decide what is best for you, and what is worse–the issue you have, or taking medication for it. Some issues can improve without medical intervention. Others are likely to get worse without medical care. Not everyone responds to mental health medication, and it can take some time to get it right in terms of the best medication and at the right dose.
A common concern with mental health medications is that they might alter the brain in some undesired way. That concern makes more sense when medication is optional (meaning the issue you have isn’t already altering your brain in significant ways), and when the medication being proposed is a powerful one. Most mental health medications are fairly mild, however, have been on the market a long time, are well-understood in terms of how they work, and under proper supervision, pose little risk of unwanted effects.
The bad stories you hear (or read) about are generally due to poor psychiatric care. It is common that psychiatric providers don’t take enough time to really get to know their clients. It is also common that psychiatrists lean too much on their prescription pads and not enough on alternative or complementary options. It also happens that a provider is not careful with the dose, does not give the lowest therapeutic dose possible, or does not monitor to ease you off the medication as soon as possible. In fact, many issues you hear about with mental health medications are due to a lack of monitoring and follow-up, which are absolutely critical to proper care.
Mental health medications can have some side effects, but it depends on the medication–some have none. Also, the mental health issue you have likely has negative side effects, so often the question is–which are worse? We understand more now from neuroscience about the effects on the brain of mental issues such as anxiety, stress, and depression, and it is important to factor in that information when deciding on how to treat a problem.
What does neuroscience teach us about medication?
Modern neuroscience research has illuminated our understanding of the brain effects of mental health conditions and have informed new, updated treatment protocols for many issues. For example, we know that depression is highly cytotoxic to the brain, meaning that it degrades brain cells over time. We also know that the longer the brain experiences depression, the longer it can take to back the depression out of the mind and brain, because the brain adjusts to the depression and starts to physically groove in new communication lines between parts of the brain.
We know that anxiety attacks prime the nervous system to have more attacks in a vicious cycle that causes people to fear going out, being in groups, or getting too over-stimulated. It is important to guard against panic and anxiety attacks in order to protect the nervous system and help it heal.
Stress is also highly degrading to your body’s cells and to your immune system. Even a dysfunctional relationship can cause enough stress to predispose someone to illness.
Medication is not always the right answer, but when needed, it is part of a compassionate, intelligent response to what the brain, mind and body are dealing with, just like if your thyroid needs medicine to function optimally, or if you need insulin to keep you blood sugar at optimal levels so you don’t develop greater disease.
What is the right way to do it?
There can be a significant difference in the way psychiatry practitioners approach the process. Here is what we believe is important to delivering the best care:
- Longer consult times. Many psychiatrists wee you for 15 minutes, then hand you a prescription. That is not enough time to really get to know you, take a full history, and discuss options.
- Tracking and follow-up. Some doctors prescribe a medication and then don’t follow up with you. In psychiatry, it is important to stay in touch with your provider for the first few weeks to make sure things are working and feeling good, and to use follow-up appointments to shift the process if needed.
- Willingness to tweak as needed. Everyone’s biochemistry is unique, so it can take a little time, and sometimes tweaking the approach, to land on what works best for you. Some practitioners hope that what they give you initially will work and aren’t as willing to be in the discovery process with you. A skilled and attentive provider will pay attention with you to results and effects and tweak as needed until success is achieved.
- Get to know the person, not the label. Some practitioners move quickly to a diagnosis, then treat that label rather than the complexity of a human being over time. Diagnoses can be helpful, but is important is to get to know someone in all their complexity, and treat the totality of someone and their life. Issues such as trauma, developmental considerations, relationships, a sense of connection, stress, creativity, and grief are at play. Getting to know someone as a real human requires more complex thinking as well as building a real relationship with patients.
- Knowing when to cycle off the medication. Everyone is different, and every issue is different. Chronic, lifelong, imbalances of biochemistry or organic function may benefit from steady supplementation. Flare-ups of anxiety or depression may only need a 6-month course of a medication to support the body and mind’s healing. Whether the course is 6 or 12 months, having an exit plan from the medication is one way to ensure it’s only used as needed.
How do you know if you need medication?
If you think you might need, or could benefit from medication, schedule a consult with a psychiatric provider who can conduct a proper evaluation, or begin discussing the issue with your therapist. Here at Presence, we practice integrative psychiatry, an approach to psychiatry that utilizes all the best practices mentioned above. We always look to use the lowest therapeutic dose possible, and ease you off medications when appropriate so you’re only on what you need. We also discuss alternative and complementary treatment options with you, such as diet, supplements, exercise, meditation, counseling and more. To schedule a psychiatric consult, just call our main office number at 512-469-0535 or email us at admin (at) austinprofessionalcounseling.com.
Remember, meds aren’t always the solution, but letting serious issues like depression and anxiety go untreated is a recipe for developing more serious and chronic problems that are then much more difficult to correct. Let a professional help you determine the best treatment plan for you and let us help you get your full life back on track!