Before I share my thoughts on the use of psychiatric medications for mood disorders, let me first clarify my lack of credentials.

Some people think the terms psychiatrist, psychologist and counselor are basically interchangeable, but there are some distinct differences. A psychiatrist is a medical doctor who is an expert in mental health and prescribes psychiatric medications. A psychologist is an expert in mental health with a Doctorate degree. A counselor is an expert in mental health with at least a Master’s Degree. All can provide talk therapy, but only a psychiatrist can prescribe medication and has extensive training in brain physiology, chemistry and the like.

I am a counselor.

So, when I share my opinion on psychiatric medications, it is from the perspective of someone who believes in the power of insight oriented solutions, a belief that changing circumstances and thinking is a means to make changes in a person’s mood and life. My opinions come from observations, rather than education and detailed understanding.

Many of my clients also make use of psychiatric medications, either prescribed specifically by a psychiatrist, or often by a primary care doctor. I have learned a lot from their experiences and insight, as well as by seeing the effects in their lives.

Some people are eager to find the relief they need in medication. Others are very resistant to using medication. I would say my initial attitude on medication was similar to those people who want to solve their problems on their own, by their own will power. Other people are afraid of becoming addicted, dependent or having side effects. It is an unfortunate fact that I have met some people who have ongoing suicidal thinking, depression or other lasting side effects from bad medication reactions.

But the research I have seen suggests that counseling and medication are more effective together than either one separately. I tend to simplify the matter by thinking of medication as something that can make the emotions less raw, and counseling helps people make real changes to their thinking and behavior. If you just take medication, you may feel better, but may not make any real changes. However, for some people, counseling alone is unlikely to be productive if the emotions are just too overpowering. For some people, medications may be like a scaffolding that is put in place while a structure is being built, but then can be removed when the building is complete.

However, for others, there is a legitimate ongoing chemical imbalance that needs ongoing treatment. I witnessed the reality of chemical imbalances when I saw my wife go through post-partum depression. Here was a woman just blessed with a beautiful new baby and she knew she was supposed to be happy, but every night she found herself weeping when it got dark. The doctors predicted it might happen because she had been producing chemicals for two and now suddenly she was getting all those chemicals just for one. And as the doctors also predicted, the depression went away after a few weeks. I saw the very real mood effects of a chemical imbalance. It was not due to external circumstances, my wife’s thinking or anything she had done wrong. She was aware of what was happening, but the feelings were still just as real and just as painful.

If someone had asthma, would you expect them to run a race without an inhaler? Thyroid conditions, blood pressure issues and many other medical conditions require ongoing medical treatment to manage symptoms, so should there be any shame in needing medication when there is a legitimate chemical imbalance? Do we expect people to just will power themselves through slipped discs or vertigo?

So, sometimes medications are in order for long term chemical imbalances and sometimes they are just temporary aids while people make the necessary underlying changes via counseling. Sometimes people are unsure which is the case. I usually just trust each person’s judgment. I have seen cases where people weaned off of medications as they made progress, but I always suggest this be done under advisement of a medical doctor. I have also seen some people start without medications and when they have thoroughly addressed their thinking, behavior, beliefs and circumstances and they still feel depressed or suicidal despite no discernible reason, then they usually feel satisfied that they have done their due diligence and a medical approach is in order.

At the end of the day, I just generally encourage people to stop worrying about the stigma and pressure about what others think they should do, and instead trust their own judgment about what they need.

Today’s post comes from an anonymous guest writer who has figured out how to thrive after decades of being stuck in depression. I hope you enjoy these insights as much as I did.

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Ways that a life living with years of depression has left me with challenges in
my new life.
When you live with depression, you spend all day everyday in your head. The only
person you talk to is yourself. The internet and tv and Netflix are your only
inputs.
The result is a state of living in fantasy. When you come out of this state of
arrested development, there are challenges that I framed as fantasy versus
reality.
In fantasy, there are no consequences. You don’t hurt anyone’s feelings if you
don’t interact with anyone real. Fantasy people say whatever you’d like them to
say. These imaginary people in your head offer no feedback and no advice. When
you talk, your words mean nothing, they’re just words. When you talk to real
people, they usually assume your words mean something. Your promises are
expected to be binding.
There’s no making plans in fantasy, you can just leap to the best part. There’s
no reason you can’t just say you’ve slain the dragon and now you’re here to
marry the princess. In reality, there are steps in between where you are and
what you want.
Like tv, fantasy has no progress. Every ‘episode’ ends happily, and the next one
starts with a new fresh start. All is forgiven and forgotten. In reality you
have to push and push and keep up the effort to reach a worthwhile goal. Only
simple goals can be finished in a half an hour. And when depression keeps you
from finishing a plan, you have to start over when you get the gumption to get
back to it, if you get back to it at all.
Fantasy is like a single play in football, where every play ends in a touchdown.
There are no ‘plays’, no strategy. In life, you have to persist over many, many
plays, struggling for every yard. You don’t shoot for a touchdown every time.
You try for a first down, and then another and then another as you creep toward
the goal. You don’t learn strategies in fantasy, they aren’t needed.
Not only are there no steps in fantasy, there are no rewards. When the fantasy
is done, that world evaporates. In reality, whether you win or lose you get a
result. You will get a lesson. Fantasy offers no lessons.
There’s no time in fantasy. Things can take as long as you want, good times last
as long as you focus on them. In reality you have to put up with movies that are
over, and ushers that tell you it’s time to leave the building.
Fantasy has no friction. The world is like a smooth sheet of glass. You can fly
and glide and teleport across time and space. In reality the rubber has to meet
the road. The road provides the friction to move you forward. You have to have
friction, it’s the grip of the tires on the road.
In fantasy you can have perfection. The princess is flawlessly beautiful. The
castle is strong and well-built. In reality perfection is not only impossible,
chasing perfection will always get in the way of getting what’s ‘good enough’.
In reality you need to get things good enough and move on to the next thing. If
you don’t, you find yourself always far behind where you want to be because
you’re waiting for the ‘perfect’ opportunity. In reality the best way to move
forward fast is to get things good enough and then ask, “what’s next?”.
Fantasy is a road trip, and reality is moving and having a life.
– Anonymous

One of my most memorable counseling moments occurred this year. I write this blog with permission of the person I was seeing.

A gentleman who had spent a year making incredible personal progress was reflecting on how far he had come and how much he had learned, when he made a comment that I felt was profoundly raw and I think common for all of us if we are honest.

He said,

“Sometimes I ask myself why I have to deal with depression all the time. I start to wonder, why do I have to work so hard to be happy…”

And as he said that, it reverberated with my own tendency to groan at how adulthood and life in general always requires so much effort. Even if it isn’t a struggle with full blown depression or bipolar issues, don’t we all wish that we could just do enough so that we could finally be done? Taking out the trash, self grooming, yard work and paying bills are tasks that may be completed for a time, but always come back. There seems to be no way to avoid doing the work it takes to have the life we want.

But, as he continued without me saying anything, I realized he wasn’t complaining.

“…but then I stop myself and think, I’m burying the lead here. If I know the secret to happiness, that is pretty epic. That’s what everyone is looking for. So what if it takes some work.”

And that my friends, is the simplicity and the power of a new perspective.