How I Talk to Patients About Medication for Mental Health

Happy Sunday! I hope everyone had a great weekend!

This was my first weekend back home in 4 weekends. It felt so good to sleep in my own bed, cook food, and watch the Olympics.

P.S. Simone Biles, the G.O.A.T. of gymnastics, talking about how HER THERAPIST helped her stay mentally well and focused to help win a Gold medal was EPIC. Also, peep my comment 👀 

Today, I’d like to talk about how I navigate medication and mental health as a Psychiatry Resident Doctor.

I practice Integrative Psychiatry, which is a holistic approach that uses both conventional and complementary therapies in the treatment of mental health conditions.

Sometimes patients may mistake my treatment approach for one in which I only focus on “natural” approaches and don’t utilize medications. However I DO recommend and prescribe medication, when appropriate. Integrative Psychiatry combines the best of conventional medicine (i.e. medication) with complementary approaches (i.e. exercise, nutrition, etc.), always prioritizing evidence-supported practices.

BUT… if you’re hesitant about medication for mental health, I TOTALLY get it. I’ve been there. It can be scary to start a new medication. Sometimes you may feel guilt about taking medication. Medications CAN also have unwanted side effects. Plus, there’s a ton of misinformation on social media about medications, and it can be difficult to know who and what to trust.

Let’s break this down:

Understanding Medication Hesitancy

Medication hesitancy is common, and it's essential to explore the reasons behind it. Patients may fear becoming “dependent” on medication, feel that using it would be a personal failure, or have had negative experiences in the past. I always address these concerns with my patients with empathy.

For situation in which a patient is particularly wary of medications, and IF I feel that it could help the person feel less alone, I sometimes self-disclose that I have taken medication for my mental health too.

As many of you know, during my first year of residency, I reached a dark point. Despite my background in medicine, I was reluctant to seek help due to the stigma surrounding mental health treatment. It wasn't until I began taking a medication, alongside therapy, that I began experiencing significant improvement. This combination was pivotal in lifting me out of a depressive state. After about a year or two, I transitioned off the medication under my doctor's guidance. This journey taught me the importance of an open-minded approach to treatment.

Reframing Medication's Role

To help patients understand the role of medication, I use analogies that make the concept more relatable. (P.S. these analogies were described by Dr. Elana Miller, M.D., a Psychiatrist that I follow in California, and I don’t take credit for creating them - rather I’ve formed my own take on them).

1. RESETTING the Path: The Ox and Cart

Imagine a cart being pulled by an ox along a dirt road. Over time, the wheels of the cart create deep ruts, making it difficult for the ox to pull it out. The ruts represent entrenched thought patterns in conditions like depression or anxiety. Basically these thought patterns can make us feel “stuck”. For example, if you’re depressed - you know exercise can help you feel better, but you seem immobilized on the couch and can’t seem to get out of the house, no matter how much you want to. Medication can be likened to "filling in" these ruts, allowing the ox to move the cart more easily. Pave the road if you will… Once the road is smoothed, the patient can steer themselves towards healthier pathways.

2. Healing Support: The Cast and Broken Bone

Consider a broken bone. You wouldn't expect it to heal correctly without a cast, which STABILIZES the bone and allows proper healing. Similarly, medication can provide necessary support to stabilize mental health, creating a foundation for recovery. Just as the cast is temporary, medication may not be a permanent fixture but a vital tool during a critical phase of healing.

3. Managing Chronic Conditions: Insulin for Diabetes

This is the most simple of the analogies, and I sometimes use this one if the other two don’t seem appropriate. At the end of the day, mental health = physical health = HEALTH. If you had type 1 diabetes, would you avoid taking insulin? This metaphor highlights the importance of medical treatment for chronic conditions. Mental health is no different. Just as diabetes or hypothyroidism requires medication, so too can mental health conditions. It's not about weakness or failure; it's about managing health responsibly.

Bridging the Gap

As a resident physician training to become an Integrative Psychiatrist, my job is to discern when medication might be helpful for the patient and to dispel misinformation and misconceptions about its use. Education is key, and using metaphors can make these conversations more accessible. The goal is to empower patients to make informed decisions about their health, understanding that trying medication is not a high-stakes commitment. If the medication isn't a good fit, adjustments can be made.

My own journey has shown me that there is no one-size-fits-all solution. When I was depressed, I tried to exercise my way out of depression. I tried to eat healthy. I tried it all. It wasn’t working. Medication and therapy were the things that pushed me over the hump (IN ADDITION to my other self-care techniques) and allowed me to get my head above water.

The path to mental wellness often involves a combination of treatments, and it's important to approach each patient's concerns with respect and patience. That’s what I try to do every day. Whether through medication, therapy, lifestyle changes, or a combination, the goal is to help patients live fuller, healthier lives.

I hope these insights and analogies help you, as they have helped me, in navigating discussions around medication with clarity and compassion. Remember, the ultimate aim is to find the best approach for each individual's unique needs.

Disclaimer: These emails do not assume a doctor-patient relationship and my information is not intended to substitute for medical advice. I offer science-backed educational information aimed at empowering you to live your best life. Always consult your personal doctor before starting any treatment. My views and opinions are always my own and do not reflect the views or opinions of my employer. My newsletter will always be free.