“Do I have to take these pills in long-term? Do I have to depend on them for the rest of my life?”
This is one common question asked in the psychiatric clinic, especially during their first visit when they are prescribed with medicine, and again especially so in the Asians, who seem never quite keen to take western medicine (including myself).
I believe different consultant psychiatrists have different response to this question. More commonly, the answer is either, “not in long-term, but you will have to maintain stably for few months” (so before you are stable, it’s not taken into consideration), or, “yes, that will be better for you; though you should be able to maintain on a minimal dosage” (for some people, maybe just half a tablet of Lexapro 10mg).
And then they will continue to throw you with more questions… But today I just want to focus on this first question. And please take note that I have a background in clinical psychology, not medicine, and I had worked in a national forensic psychiatric ward (UK) for 3 years then in a private psychiatric outpatient clinic (KL) for almost 3 years too. (For differences between psychology and psychiatry, please see here)
I’d advise that you seek advice from your consultant. But if for any reason, you need a second opinion or some reassurance, these are a few points that you can consider…
- Are you in a stable state now? Do you and your closed ones around you think you are well? How functional are you compared to the time before you become unwell? (It’s obvious, if you are not even stable on the medicine, do you think you will be fine without it?)
- Is this your first episode? (I don’t think any psychiatrist would advocate long-term antidepressant treatment for people who have had a single episode of major depression; It may be different for people with anxiety or psychotic related problems)
- If this is not your first episode, how close is this episode to the previous one? How severe is this episode? Is it getting harder to manage, to return to your ‘normal’ state? (The general pattern was a decrease in the interval between episodes and an increase in the severity and complexity of the episodes, until finally rapid cycling set in. As time passes, it requires ever smaller stimuli (e.g. stress, a bit of change, an argument) to trigger an episode. The latter recurrences would typically include all the symptoms of earlier episodes, plus additional symptoms. So, if there has been a number of episodes, and it seems to get harder to manage and cope, you are strongly recommended to continue with the medication instead of withdrawing)
- Any early traumatic or stressful life events, e.g. physical/sexual abuse, separation from main carer, death of a parent, prolonged hospitalisation, marital quarreling, mental illness in a family member etc when you were young? (Those are not just memories, the incidents could also have altered your brain, leaving it more susceptible/vulnerable to stress, separation, rejection, loss etc. Click here for more details. Anti-depressant medications have been found to prevent further neural damage and block cell loss.)
- Are you someone who’s very sensitive and/or easily stressed? (It might suggest a vulnerability originated from the brain, please refer to 4.)
- Are you doing any psychotherapy? Are you responding to it? Does it help? (Not everyone responds well to psychotherapy. But as a psychologist and a psychotherapist I will have to add this point to the list! It is always good to learn more about the illness, to spot the early signs of relapse, to cope with stress and adversities in life etc. How can psychotherapy help after one’s stable with psychiatric medication? I have a post here in Chinese that explains it.)
Again I would like to emphasise the importance to discuss this with your consultant, whether you have financial difficulties, or maybe you think you are stable enough to stop or reduce, or maybe you think psychotherapy will help you in long-term. Sometimes it’s not a bad idea to have a second opinion, but that’s after sticking to one consultant long enough (a few months at least) and things still never improve.
A few readings that is related to the topic:
The need to maintain on psychiatric medicine (psychotic and related illness)
Is psychotherapy for me? (Well, if you are now stable and really are not keen to continue with medicine, check here to see if psychotherapy may be for you)
Anti-depressant & Anti-anxiety Medicine (Maybe you are thinking to try to reduce some medicine without the advice from your consultant? See this first)
精神藥物的角色 (The role of psychiatric medication, in Chinese. It also tells you the role of psychotherapy after you are maintaining well on medicine)
In the news: Mum killed for asking son to take psychiatric medicine (No, don’t force them. If they are not willing to take the medicine, try to get professional advice to see what you can do to help, but don’t make them take it…)
Psychology Today: 7 ways childhood adversity can change your Brain (How those adverse experience make you more vulnerable…)