MENTAL HEALTH TREATMENT AND THE ROLE OF MEDICATION
What is a "medical model" of mental health treatment?
There are different approaches to mental health treatment. One approach is a "medical model." Different doctors may have different definitions of what a medical model means.
We take the approach that mental health, like physical health, is influenced by our genetics and by our environment.
Genetics can affect brain chemistry related to emotions, thoughts, and behaviors. Doctors ask about any family history of mental illness, because there can be a genetic influence.
Environmental factors include life stressors, relationship strife, substance use, trauma, influences from childhood, and all other life experiences.
Considering all the factors that influence our mental health, the best treatment approach is a “whole person” approach, addressing biologic factors with medication and environmental factors with psychotherapy, physical activity, social involvement, and spiritual support.
The most important aspect of a medical model of mental health is to remove stigma, shame, judgment, and blame.
What is a "recovery paradigm" for mental health?
Older approaches to mental health treatment focused on "cure" of mental illness or "remission" of symptoms of depression, anxiety, or other emotional, cognitive, or behavioral disturbances. These approaches do not always reflect the reality of living with mental health conditions or the broader goal of living a productive and fulfilling life.
A more modern approach is the "recovery paradigm." The recovery paradigm focuses on the process of healing and restoring wellness.
For some people, recovery is the complete remission of symptoms. For others, recovery is the reduction of symptoms. For still others, recovery is the ability to function despite mental health challenges.
The recovery paradigm emphasizes the healing nature of hope, empowerment, and respect.
Will an antidepressant change me?
Some people wonder whether a medication will change their personality, impair their thinking, prevent them from feeling emotions, or create a false sense of happiness.
Antidepressants do not change who you are. They do not change your personality. They do not impair your ability to think. In fact, emotional symptoms can impair your ability to think, concentrate, and focus. Antidepressants can improve mental clarity by treating these symptoms.
Antidepressants do not prevent you from feeling emotions. Some people can experience mild emotional blunting when first starting an antidepressant, with less intense emotional highs and lows. For most people who experience this, it subsides as they adjust to the medication. If emotional blunting persists, often a change to a different medication will address the problem.
Antidepressants do not create a false sense of happiness. For people with Mood or Anxiety Disorders, they facilitate a healthy range of emotions. An antidepressant can be one tool used to help treat Depression, Anxiety Disorders, or other mental health conditions. Other tools may include psychotherapy, physical activity, social involvement, and spiritual support.
How do antidepressants work?
It is not completely known how antidepressants treat Depression, Anxiety Disorders, and other mental health conditions.
Most antidepressants work on a chemical in the brain called serotonin. Serotonin is one of many chemicals that brain cells use to communicate with each other. Most antidepressants lead to increased serotonin activity in the brain. It is not known exactly how this causes improvements in mood, anxiety, and other emotional disturbances.
It takes time for the brain to adjust to the medication. It may take weeks to begin to notice improvement in symptoms and months to realize the full effects. It is thought that increased serotonin activity in the brain eventually leads to new connections among brain cells, increased production of other chemicals that support brain health, and other changes.
The scientific understanding of the brain continues to evolve. As it does, so will our understanding of mental health conditions and psychiatric medications.
Why are you prescribing an antidepressant for anxiety?
Although we call these medications “antidepressants,” they are used to treat a variety of conditions, including generalized anxiety, panic attacks, posttraumatic stress disorder, obsessive-compulsive behaviors, eating disorders, and many other conditions.
Increasing the activity of serotonin in the brain can be a helpful tool for anxiety, panic, increased startle response, and other conditions involving elevations of brain activity, awareness, and arousal.
Can I just stop taking an antidepressant?
It is important not to abruptly stop taking an antidepressant.
Your brain adjusts to the increased serotonin activity from the medication. Abruptly decreasing levels of serotonin can be disruptive and can cause “discontinuation” symptoms, such as increased anxiety, insomnia, night sweats, tremor, and other uncomfortable sensations. Not everyone experiences discontinuation symptoms when abruptly stopping an antidepressant medication. Some medications tend to cause more discontinuation symptoms than others.
It is also important to monitor for relapse of depression, anxiety, or other symptoms.
The best practice is to slowly decrease the dose of medication in consultation with your doctor.
Are there long term health risks from antidepressants?
In general, most antidepressants are considered to be relatively safe overall, without serious long-term adverse health risks.
For some people, antidepressants can increase the risk of some adverse health consequences, such as abnormal bleeding, abnormal electrical activity in the heart, or other effects. Some of these are related to interactions with other medications. Some of these are related to age.
It is important to talk with your doctor about risks and benefits of medications.