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To Medicate or Not to Medicate

medsIn certain cases, it’s obvious that medication is needed.  It can even be a prerequisite for therapy (when people are too severely depressed, suicidal or hopeless to engage; when they’re floridly psychotic.)  But for others with, say, mild depression or non-debilitating anxiety, then the answer is not so obvious.

Of course, suffering is in the eye of the beholder (well, the experiencer, if I can coin a term.)  And it’s relatively easy to get psychotropic medication.  The vast majority of prescriptions for psychotropic meds are written by primary care physicians, often at the patients’ request.

But the decision of whether to seek medication can feel downright existential, and is extremely personal.

As a therapist, I have my own biases.  There are situations where people take antidepressants in lieu of therapy, and while it may provide short-term relief, I believe it can impede long-term growth.  For example, sometimes it can numb people when they should be feeling and processing their grief, or when they should work on their coping skills, or generating solutions but instead the problem is made tolerable by medication.

But there are also situations where problems are so intractable, so chronic, and so intolerable that medication is an understandable tool for emotional survival.  (For example, having a child with a severe substance abuse problem–which is extremely distressing and not subject to control.)

Sometimes the depression is mild but not responding well to therapy.  Or sometimes–and perhaps it’s anathema for me to say that as a therapist–it just doesn’t feel like the right time to engage in a therapeutic process, yet a person wants relief.  Sometimes, we want things to simply be easier, and medication offers that hope.

I say “offers that hope”  because it’s certainly no guarantee.  People may not respond well to medication, or it may actually take a long time to get the medication or dosage to a therapeutic level.  Antidepressants often take 4-6 weeks to work.

But the fact that medication does offer hope is, in itself, meaningful.  Often people start to feel better before the medication is actually kicking in, something of a placebo effect.  The mere expectation of feeling better makes it a reality.

However, many people fear the stigma of medication.  They worry what it says about them as people–does it say they’re weak and unable to manage their lives?  Are they “taking the easy way out”?

There are fears about the medication not working.  There are the fears about the medication working too well.  What if they feel better than they ever have?  Does that mean they’ll be reliant on medication for the rest of their lives?

These are all significant questions with which to grapple.  The answers are, I believe, deeply personal.

What I recommend to my clients who are suffering (and as I said, the degree of their suffering is not mine to judge) is to make an appointment with a psychiatrist and view it as a consultation.  Be an informed consumer.  Ask many questions about the risks versus the benefits.  And if they leave with a prescription, know they don’t need to fill it.  Or they can fill it and then think longer and harder about whether to take the medication.

But as I often say in this blog, one of the biggest causes of emotional distress is self-judgment.  So whatever you choose, be compassionate toward yourself.  Your pain is real.

Capsule image available from Shutterstock.

To Medicate or Not to Medicate

Holly Brown, LMFT

Holly Brown is a marriage and family therapist in the San Francisco Bay area. She has a private practice in Alameda ( ). She is also a novelist ( Her latest is HOW FAR SHE'S COME, a workplace thriller which received a starred review from Publisher's Weekly: "This provocative tale will resonate with many in the era of the #MeToo movement."

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APA Reference
Brown, H. (2013). To Medicate or Not to Medicate. Psych Central. Retrieved on June 2, 2020, from


Last updated: 24 Aug 2013
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