Psychotherapy is hard work. It will often seem
counter-intuitive because it does not examine only what is on the surface
of your life. To be able to cure the pain and confusion of your life, you
really have to examine and change what motivates you to act in ways that
cause pain and confusion, and, for the most part, this motivation is
unconscious and under the surface of your life. Therefore,
your true motivation cannot be examined directly. It must be examined indirectly
by digging through all the dirt and filth hidden under the surface. It’s
no wonder, then, that most people fear
psychotherapy—and fear psychologists.
Consequently,
psychiatric medication has a special appeal to it, an appeal that is seen
more and more today in advertising. Rather than go through all the hard work
of constantly monitoring your feelings, thoughts, and actions, why not feel
better without having to do anything at all? Why change your lifestyle? Just
take some pills a couple times a day and go about your life as
usual.
Now, the truth
is, psychiatric medications are generally mandatory for the treatment of
disorders such as schizophrenia. For other
disorders
such as depression, PTSD, anxiety, or obsessive-compulsive disorder, psychiatric
medications can, under the proper circumstances, be a helpful adjunct to
psychotherapy.
That is, medications can suppress your anxiety or alleviate your depressed
mood such that you can then feel comfortable enough to do the hard work of
psychotherapy.
 |
Note carefully,
however, that psychiatric medications are not curative. The medications merely
suppress unpleasant symptoms for as long as you take the medications. If
you stop the medications, the symptoms will flourish again in full strength.
Only psychotherapy holds the possibility of a genuine cure by resolving the
deep unconscious issues that lie behind the
symptoms. |
|
Psychiatric
medication will usually be prescribed by a
psychiatrist,
although a general practitioner will sometimes prescribe psychiatric medications
in some simple cases such as uncomplicated depression or anxiety. Some specially
trained psychologists can also prescribe psychiatric medications. (Pain
medication will usually be prescribed by general practitioners or
specialists.)
|
And then, of
course, you yourself may be “prescribing” your own medications.
It may sound odd, but alcohol, nicotine, and illicit drugs are psychiatric
medications in so far as they blunt
guilt,
anxiety,
feelings of anger
or
sadness,
and physical pain. The use of any illicit substance, and the abuse of alcohol,
however, only set you on the path of social disobedience and self-indulgence,
and this defiles the very purpose of medicine: to improve your social
functioning. And
nicotine
is a case by itself, for it is nothing more than a deadly poison whose use
is a death wish grounded in
self-loathing. |
|
In any case,
your psychologist should be told of any medications you are taking—that
is, if your psychologist didn’t refer you for a medication evaluation
in the first place.
If you have been
prescribed psychiatric or pain medications, the following topics may be of
interest to you.
Side
Effects
Unfortunately,
modern medical science has not reached such a level of sophistication that
a drug can be directed to exactly the aspect of brain functioning responsible
for any particular symptom. Consequently, many medications simply saturate
the brain with specific chemicals that somehow manage to get some symptom
relief. I’m sorry if that seems vague, but that’s the way it
is.
The result of
all this lack of specificity is the problem of side-effects: a medication
given to relieve a particular symptom can also cause other unwanted
symptoms.
The good news
is that side-effects are usually mild and usually disappear (during the span
of a few days to a couple weeks) after your body has become accustomed to
the medication.
Being an Informed
Consumer
Some persons
develop side-effects that are just too uncomfortable or too much of a nuisance
to tolerate, such as drowsiness, constipation, or constant nausea. The best
recourse here is to be an informed (and assertive) consumer. This
involves
• |
Getting information about your
medication’s side-effect profile; |
|
• |
Talking honestly with your doctor
about your complaints; |
• |
Working with your doctor to find
another medication that your body can tolerate. |
|
If your doctor
will not work with you to find a tolerable medication, or is in any way
condescending, you have the right to seek another
prescriber. |
It can be quite
common, for example, to need to try several different antidepressants before
finding one that is both effective and tolerable. Today’s market certainly
offers many to choose from—although price can, unfortunately, be a
complicating factor for some people.
Getting Information
about your Medication
You have several
options here.
1. |
Talk to your prescribing doctor. |
2. |
Read the package insert from your
medication. |
3. |
Look up your medication in the
Physician’s Desk Reference (PDR). You can ask your doctor to
let you see his/her copy and to make a photocopy of the relevant pages, or
you can go to a public library to find a PDR. |
4. |
Use these on-line references:
PharmInfoNet allows
you to access drug information resources for drugs by generic or trade
names.
RxList—the Internet Drug Index,
allows you to search for drugs and retrieve a wealth of information about
usage and side-effects. |
Medication
Interactions
Always
remember that some psychiatric medications can be lethal in combination with
other medications or alcohol, and that some non-psychiatric medications,
taken in combination, can cause psychiatric symptoms. Therefore, stay
informed from your prescribing doctor, from your pharmacist, and from your
own research. |
Even herbal remedies
can interact with psychiatric medications and cause problems. For
example,
• |
Ginseng may cause
manic behavior, headache, and trembling
if taken with the antidepressant phenelzine (Nardil); |
• |
Kava should not be combined
with sedatives, sleeping pills, antipsychotics, alcohol, alprazolam
(Xanax), or drugs to treat Parkinson’s disease; |
• |
St. John’s
wort
may cause interactions if taken with the antidepressant sertraline
(Zoloft). |
Pain
Medications
There are essentially
three pharmacological modalities for treating pain: acetaminophen;
non-steroidal anti-inflammatory drugs, or NSAIDs (e.g., aspirin, ibuprofen);
and opioids (narcotics).
All patients
on opioids will experience dependence, which means that uncomfortable
physiological effects (withdrawal) will occur on stopping the medication.
This is a basic physiological process and is nothing to be embarrassed
about.
Addiction—which
commonly refers to a compulsive use of a substance despite the physiological,
psychological, or social harm to the user—rarely happens in pain patients.
Ignorance of this fact can cause many physicians to under-medicate pain patients,
thereby actually prolonging the pain.
|
The use of
longer-acting opioids and constant dosing at the acute phase of pain is usually
the best form of treatment to prevent the pain from becoming chronic and
to allow other aspects of treatment, such as physical therapy, to be
tolerated. |
|
Therefore, as
long as pain medication serves to decrease pain in order to increase functioning,
there should be no problems, even with opioids. And, unless the pain is due
to a degenerative disease, the ultimate goal of pain medication should be
to discontinue the medication eventually in favor of healthy psychological
coping.
Note:
The above common-sense definitions of addiction and dependence
are often confused with the
DSM-IV [1]
diagnoses regarding Substance-Related Disorders:
Substance
Abuse refers to a maladaptive pattern
of substance use leading to clinically significant impairment or distress
characterized by such things as
|
• |
Recurrent substance use resulting
in failure to fulfill major role obligations (e.g., work, school,
family); |
|
|
• |
Recurrent substance use in situations
in which it is physically hazardous (e.g., driving an automobile); |
|
|
• |
Recurrent substance-related legal
problems; |
|
|
• |
Continued use of the substance despite
having persistent problems caused by its use. |
|
Substance
Dependence refers to a maladaptive pattern
of substance use leading to clinically significant impairment or distress
characterized by such things as
|
• |
Tolerance (a need for increased
amounts of a substance to achieve the desired effects, or diminished
effect with continued use of the same substance); |
|
|
• |
Withdrawal (see below); |
|
|
• |
Taking the substance in larger amounts
or over a longer time than was intended; |
|
|
• |
Persistent desire or unsuccessful
efforts to cut down the substance use; |
|
|
• |
Spending a great amount of time in
activities necessary to obtain the substance; |
|
|
• |
Giving up or reducing important social,
occupational, or recreational activities because of substance use; |
|
|
• |
Continuing the use of the substance
despite knowledge that its use is causing problems. |
|
Withdrawal refers to
|
• |
The development of a substance-specific
syndrome due to the cessation of, or reduction in, substance use that has
been heavy and prolonged; |
|
|
• |
The substance-specific syndrome causes
clinically significant distress or impairment in important areas of
functioning. |
|
|
No
advertising—no sponsor—just the simple truth . . .
|
|
DID MY WORK help you? Have you found
insight into your behavior? Have you found information unlike anywhere else?
Then why not make a Quick & Easy donation to this freewill website
to express your gratitude for my labor in creating something substantial,
something that can change your life for the better?
|
|
 
Additional
Resources
References:
1. American
Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition. Washington, DC: American Psychiatric Association,
1994.
Drug interactions:
Alternative Medicine — Known or Potential Drug-Herb
Interactions from WellnessWeb
Herbal-Drug
Interactions from HealthCastle
Medication
information:
The best source for such information is the Physician’s Desk
Reference, but it’s not available as an on-line data base. So check
out these links:
Drug
Information from the FDA/Center for Drug Evaluation and Research
(US).
Drugs.com provides
“Information, Side Effects, Interactions” for prescription drugs.
RxList —the
Internet Drug Index allows you to search for drugs and retrieve a wealth
of information about usage and side-effects.
Pain:
American Academy of Neurology for multispecialty
consensus on diagnosis and treatment of headache (migraine).
American Family
Physician for an article on guidelines for the treatment of
nonmalignant chronic pain.
American Pain
Society
Arthritis
Foundation
Imagery
and Pain Control by David Bresler, Ph.D.
International Association
for the Study of Pain
National Headache
Foundation
Neuropathic
Pain
Postgraduate
Medicine for the article Why is chronic pain so difficult to
treat?
Smoking cessation:
Alcohol and Tobacco from athealth.com.
Assessing
Nicotine Dependence is an article from the American Family
Physician.
Blair’s
Quit Smoking Resource Page is a resource guide for help with
quitting.
Do
I Want to Quit Smoking? is a patient handout from the American
Family Physician.
Does
Cigarette Smoking Cause Stress? is an article from the
American Psychologist.
Health
Impact details the health implications of smoking; from the
Tobacco Free Initiative of the World Health Organization.
QuitNet provides
help with quitting, a library of resources, news items, links, and an online
support system for people who want to quit smoking.
Treating
Tobacco Use and Dependence: Quick Reference Guide for Clinicians from
the U.S. Public Health Service.
Related pages within A Guide to Psychology
and its Practice:
Medical Factors
Affecting Psychology
Psychology and
Psychiatry
Questions and Answers
about Psychotherapy
Reasons to Consult
a Psychologist
Trauma and PTSD
Types of Psychological
Treatment
CONTACT ME
INDEX of all subjects
on this website
SEARCH this
website
A Guide to Psychology
and its Practice
www.GuideToPsychology.com
Copyright © 1997-2008 Raymond Lloyd Richmond, Ph.D. All rights
reserved.
San Francisco, California USA
All material on this website is
copyrighted. You may copy or print selections for your private, personal
use only. Any other reproduction or distribution without my permission is
forbidden.
|
|
