 SYCHOTHERAPY
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 and mania. 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.
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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. |
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Vitamins and Minerals
The daily diets of many
persons have nutritional deficiencies that affect mental health. Most persons aren’t
aware of this, and so, if they experience any mental health problems, they tend to believe
that their lives must be dependant on psychiatric medications.
So, rather than subject yourself to harsh medications that sedate and dull your mind (and
more often than not lead to substantial weight gain), consider this list of some vitamins
and minerals that can help naturally with psychiatric symptoms. Be advised that the therapeutic
dose may be higher than the FDA minimum daily recommendation, so a simple multivitamin
tablet probably won’t have much effect on psychiatric symptoms. You might want to discuss
this with a naturopathic practitioner, or see the book Nutrition and Vitamin Therapy by
Michael Lesser, M.D. (1980) for dosage recommendations.
Below is a list of vitamins and minerals along with the psychiatric symptoms that can result
from a deficiency of that vitamin or mineral. Taking daily supplements of a vitamin or
mineral may be helpful in alleviating the symptoms of its deficiency.
Vitamin A: anxiety / insomnia / depression / fatigue /
nerve pains
Vitamin B1: depressed mood / fatigue / apathy /
confusion
Vitamin B2 (Riboflavin): trembling / dizziness /
insomnia / mental sluggishness
Niacin: anxiety / suspicion / depressed mood
Vitamin B6: depressed mood / anxiety
Pantothenic Acid: depressed mood / fatigue /
quarrelsomeness
Vitamin B12: poor memory / poor concentration /
anxiety
Folic Acid: poor memory / apathy / slow intellect /
irritability /
“senility”
Note that antiepileptic medications can cause folate
deficiency.
Vitamin C: anxiety / insomnia / fatigue
Vitamin D3: anxiety / depressed mood
Calcium: anxiety / insomnia / depressed mood /
poor memory/ seizures
Magnesium: anxiety / insomnia /
hyperactivity / premenstrual depressed mood / grouchiness / irritability
Potassium: apathy
Zinc: apathy / lethargy
Iron: poor memory / depressed mood
For good mental and physical health, all of these vitamins and minerals
should be consumed daily, whether from food or as supplements. Note that in
today’s world our food chain has been so corrupted by over-cultivation,
fertilizers, and genetic modifications that most foods today are themselves
deficient in essential minerals. Thus, vitamin and mineral supplements are
actually a necessary aspect of modern life today.
Because many traditional physicians do not understand how vitamin deficiency
can be a cause of physical or mental distress, you may benefit from having a
naturopathic practitioner do a screening for vitamin and mineral
deficiency before going down the path of psychiatric medications.
Psychiatric
Medications
Psychiatric
medications 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.)
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And then you yourself
may be “prescribing” your own medications.
It may sound odd, but alcohol, nicotine, and “recreational” drugs
are psychiatric medications in so far as they blunt guilt,
anxiety, feelings of anger
or sadness, and physical pain. The use of any
“recreational” 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. |
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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 psychoactive chemicals that somehow manage to get some symptom
relief. If that seems vague, well, 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 some side-effects are 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, weight gain, 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; |
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• |
Talking honestly with your doctor
about your complaints; |
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• |
Working with your doctor to find
another medication that your body can tolerate. |
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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. |
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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. |
Use online resources to find information
about your medication. |
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.
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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. |
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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. |
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No
advertising—no sponsor—just the simple truth . . .
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Notes:
1.
American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric
Association, 1994.
Additional
Resources
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
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