When Doctors Use Psychiatric Medications and How Effective They Are

In psychiatry, medication is prescribed only when necessary. It is not prescribed for social suffering because medication does not change the harmful reality around people. Medication is prescribed when external changes create an internal imbalance, causing a person to lose joy and peace of mind, and the neurotransmitters responsible for them become unable to cope.

A person may also live in excellent circumstances with no external problems yet experience panic attacks, mood episodes, bipolar disorder, or schizophrenia. These illnesses are primarily biological and respond to medication. Sometimes 70% of the improvement is linked to medication, while talk therapy accounts for around 30%, depending on the nature of the problem and the doctor's understanding of it.

In discussing the doctor's understanding of the problem, we should note that many symptoms are shared by several psychiatric disorders. A patient may therefore see three psychiatrists and receive three different psychiatric diagnoses, along with a flood of medications that cause adverse effects or no improvement. This is what can result from a doctor's incorrect diagnosis of a mental illness.

Reasons Mental Illness Can Be Difficult to Diagnose

• The doctor rushes to make a diagnosis.

Each appointment is like one piece of a puzzle. In every session, the doctor discovers a new piece, and when the pieces are assembled, the disorder appears in its complete form.

• Disorders share many symptoms. 

A panic attack, for example, may be part of panic disorder, generalized anxiety, or a depressive disorder. A doctor may initially view it as panic disorder but later recognize it as another disorder. Bipolar disorder is the condition that appears in the greatest variety of forms. A patient may be seen during severe depression and prescribed an antidepressant, after which the patient disappears. A year later, the patient returns with a manic episode and may hear from one doctor that it is mania and from another that it is generalized anxiety or depression. It later becomes clear that the condition is bipolar disorder.

• The doctor fails to listen to the patient and ask all the necessary questions. 

If a patient presents with a complaint that began two months ago and the doctor does not ask whether the patient has ever experienced depression, heard voices, felt suspicious of others, or had other symptoms, that doctor may be more likely to make a mistake. This is the doctor who does not look back and ask these questions, focusing only on what is current and immediate. A doctor who asks these questions and inquires whether family members have experienced similar symptoms is conducting a comprehensive review and trying to assemble a picture of what the patient was like before.

• The patient moves from one place to another without giving the doctor a chance to see the other side of the picture. 

The patient does not give the doctor an opportunity to reconsider. Doctors are human, and certain factors can prevent them from seeing the complete picture. I therefore recommend returning to the doctor, providing all the information again, and explaining how the medications affected you and the different diagnoses you have received. Give the doctor an opportunity to reconsider what happened. A problem also arises when the doctor understands the issue and makes the correct diagnosis but does not make the effort to explain the medication-based treatment options to the patient and, when necessary, the family. Psychiatrists must recognize the importance of explaining these options to patients.

How Should a Psychiatrist Work With a Patient During Medication Treatment?

1. Some psychiatric patients believe that their symptoms are caused by external influences and are certain of it. Do not argue with them at length. If they are not sleeping or are thinking excessively, address these symptoms and help relieve them.
2. Some people strongly resist the idea that they have an internal problem. You must therefore find a shared understanding with the patient and begin working from there.
3. Do not debate the causes of the symptoms. Focus instead on the symptoms that are troubling the patient. Later, when patients begin noticing an improvement, you can return to their earlier beliefs and interpret and understand them differently.
4. The doctor should explain to the patient and the family why medication is the most appropriate treatment.
5. The doctor should help them understand that talk therapy is sometimes the most appropriate option.
6. The doctor should inform them that the problem may not lie with the patient, but with the people who brought the patient into the treatment room.
7. Doctors should be clear and candid and identify the problem with complete transparency.
8. The doctor should explain to the family and patient the medication's effects, the outcomes it may have for psychiatric treatment, and its cost.
9. The doctor should leave them free to choose the method of treatment.

Are Psychiatric Medications Dangerous?

Many myths and misconceptions surround psychiatric medications. Some people believe that they cause addiction, change the brain forever, or can never be stopped. Patients sometimes come to every meeting with their psychiatrist influenced by public and conventional opinions that are not based on scientific information. They therefore arrive with barriers between themselves and the doctor and with preconceptions created by the media and general ignorance. Mental illness is invisible; when a person develops depression, for example, others may say that the person is lazy or dull. They do not accept solutions because the illness is invisible to them.

Popular beliefs claim that anything affecting the human psyche is caused by envy, magic, the evil eye, or weak faith. A newer view is that the person took a “trip” drug, although the person did not actually use drugs and tests show that they are healthy and well; the cause is instead attributed to an external influence outside the person. To preserve the ego, a patient may sometimes need to believe something of this kind. However, family members and friends who think the same way will not be able to help the patient out of the illness while they hold these beliefs.

It should be noted that a doctor cares for the individual patient and also works to limit the spread of illness. The same applies to psychiatry: a psychiatrist cares for the individual and tries to help with their problems, but doctors also have a duty to protect patients from ignorance, superstition, and possible exploitation. The belief that a “trip” drug causes a person to lose their mind forever is false and has no scientific basis. Every psychoactive substance has an onset and an end. It is true, however, that for some people who take this path, drug use reveals an existing illness, and they may have a family history and psychological vulnerability. If the patient continues defending against something strange, magical, and invisible, they will get nowhere. Psychiatric treatment begins by recognizing that something has affected the person, and change begins from within.

In addition to society's earlier view of psychiatry, another challenge is that its results are not as striking as those of other specialties. In obstetrics and gynecology, there is a baby to see, while surgery and organ-based specialties offer more visible results. Psychiatry, by contrast, is like a slow weaving process that can produce excellent results when both doctor and patient make an effort. The problem in our societies is that patients often seek help very late, after several years. Psychiatry achieves results when treatment begins no more than six months after the problem first appears. Fifty percent of mental illnesses appear before age 14, but people sometimes see a doctor much later, so the likelihood of improvement becomes limited. This does not mean that people should avoid psychiatric care when they are late; seeking help remains better than not going, because the condition may sometimes worsen with serious consequences.

What Steps Should a Patient Take Before Starting Psychiatric Medication?

1. Patients should have the courage to discuss the length of treatment and expected improvement with their clinician. They should ask when they can expect to improve.
2. Before seeing a clinician, patients should research the clinician's qualifications, what they are licensed to do, and the type of training they have received.
3. When patients see no progress, they should speak with the doctor, who may provide explanations.

The explanation may be that the illness is chronic and that some symptoms do not improve, although improvement may begin after three weeks or two months. The doctor may also identify external factors that work against psychiatric treatment, because psychiatric patients are psychologically vulnerable and can be swayed by people who lack knowledge of the details of what they are experiencing. The stronger the relationship between the patient and the doctor, the more likely they are to follow the treatment path safely.

Risks of Psychiatric Medications

Psychiatric medications can have long-term side effects, meaning that they do not appear quickly but emerge over time. Some psychiatric medications have negative long-term effects. Anyone taking psychiatric medication should therefore maintain a relationship with their doctor, even if appointments are widely spaced, so the doctor can continue checking for these long-term effects.

• Lithium

 is used after several medications have been tried. It is an excellent mood stabilizer, but it can impair kidney function in older people and weaken thyroid function.

• Modern Antipsychotics

 may cause diabetes, raise blood fat levels, and lead to substantial weight gain without adequate monitoring and exercise.

• Older Antipsychotics. They can cause involuntary movements in the facial muscles.

It is very important to remain in contact with your doctor because patients often do not notice a medication's effects, while a good doctor recognizes them from the beginning and stops the medication. If the effect is not identified early and the medication is not stopped, it may become permanent even if the medication is discontinued later, making the symptom irreversible. It is also essential to understand that side effects are not unique to psychiatric medications. They occur with all medications, and doctors always weigh the benefit against the potential risk. They prescribe medication only when the benefit greatly outweighs the potential risk.

The Most Difficult Psychiatric Illnesses to Treat

We should remember that no psychiatric illness is inherently difficult. Even schizophrenia, whose causes involve heredity and genes, can develop in a person with no family history. If a father or mother has schizophrenia, there is an 8% chance of passing schizophrenia to their children.

This applies to almost all psychiatric illnesses, but hereditary factors are not inevitable, and genes alone do not determine whether an illness will develop. Schizophrenia is a serious illness; nevertheless, 70% of people with schizophrenia improve permanently. We can speak of the most difficult cases rather than the most difficult illnesses. A person may have a difficult personality, respond poorly, face challenging circumstances or difficult social and economic conditions, and have a severe illness, creating a difficult case. The illness alone is not what makes the case difficult. Rather, it is the combination of an unsympathetic environment, severe illness, difficult economic and social circumstances, and a complete lack of institutional support.

For example, persistent depression may occur in people whose personality tends toward depression, or it may be long-term depression in which some symptoms remain despite attempts at treatment. Something in the person's personality may prevent them from responding to helpful interventions, whether talk therapy or medication. Their past may also include traumatic events and an unhealthy upbringing that left long-term marks on them.

Every psychotherapist has a toolkit containing many approaches to psychotherapy. There are also many medications for treating depression and stabilizing mood, as well as effective psychotherapies such as cognitive behavioral therapy, psychoanalytic therapy, and other treatments that may help with depression. Treatment-resistant depression can also be treated with electrical stimulation while the patient remains on antidepressant medication. Several electrical-stimulation sessions may increase the permeability of brain cells and their receptiveness to these medications, potentially producing better results. We do not turn to this treatment readily.

A Psychiatric Patient's Responsibility for Their Actions

Some mental illnesses eliminate a patient's awareness and ability to distinguish right from wrong, but these illnesses are rare and affect no more than 7% of psychiatric patients. It is very important for doctors to be honest, avoid rushing, and not generalize excessively. Before determining that a person lacks capacity, a doctor must examine the case carefully. Someone who appears to lack capacity now may, one month later, be able to manage their money and make important decisions about their life.

Lack of capacity is not a permanent, indelible characteristic. It must be assessed carefully, and people's capacity should not be removed lightly. In countries with sound systems, lacking capacity gives a person additional rights: the state provides care and adequate allowances. A person who has responsibilities at work but whose illness causes an impairment that prevents them from performing those duties is exempted from them. In a country where rights are protected, the person is exempted and compensated until recovery. If recovery is not expected, the person is permanently exempted and compensated.

We should understand that psychiatric patients are more afraid than others when they seek medical care while experiencing tension, distress, and depression, so their ability to tolerate truthful information from the doctor is lower. We should also remember that chronic illnesses or illnesses with limited improvement are not unique to psychiatry. Eighty percent of adult illnesses are chronic, including high cholesterol, diabetes, high blood pressure, many skin diseases, and most rheumatic diseases. This limitation in improvement exists, and the doctor does not sell false hope. The doctor instead tries to be honest and serve you faithfully, so listen and learn; psychoeducation is extremely important.

Everyone with an illness wishes to recover forever, but not every wish comes true. A wise and realistic person accepts limitations, works with the doctor to reduce symptoms, and understands the highest level of improvement they can reach. Many people recover with a complete absence of symptoms, particularly when they begin treatment during the first few months. Some people's symptoms may disappear completely, but they do not want to remain on medication. They want to improve quickly, recover 100%, and stop taking it. Not all these hopes are achievable.

Very few illnesses improve with age. Borderline personality disorder, for example, improves as a person grows older. Most illnesses, however, become more severe and dangerous with age if left untreated. With bipolar disorder, for example, if it is not treated at the beginning, episodes that once occurred every four years will occur ten times in a single year.

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