A recent NY Times article, In Defense of Antidepressants, is one of several passionate articles about psychiatric medications, for and against. I stand firmly in the middle.

Not the wishy-washy swampy middle, but the place where scientific evidence, common sense, and holistic viewpoints all merge.

Correctly prescribed and correctly used psychiatric medications do help people. They can literally save lives. So, in what kinds of cases of mental illness (depression, anxiety, bi-polar disorder, schizophrenia, etc.) might psychiatric medications be helpful or even necessary?

It depends largely on the skill and medical philosophy of the prescribing professional. Still, most psychiatrists generally agree that:

Psychiatric medication may be helpful or necessary in cases where the individual is a danger to himself or others. That doesn’t mean we can rely on the medication to protect the individual (or others), from harm—it means that the medication is a useful piece of a comprehensive treatment plan.

Psychiatric medication may be helpful or necessary in cases where the patient’s symptoms interfere with their ability to benefit from psychotherapy. This doesn’t mean other approaches cannot be used in tandem with medication or even tried instead of medication. These other approaches might include the aforementioned psychotherapy, stress/anxiety management techniques, guided visualization, relaxation techniques, meditation, breathing exercises, nutrition, and so on.

Psychiatric medication may be helpful or necessary in cases where the symptoms of depression or anxiety or other mental illnesses cause the patient to experience chronic or intolerable suffering and pain.

Psychiatric medication may be helpful or necessary in cases where the symptoms of mental illness interfere with important aspects of a person’s life. For example, someone with bi-polar disorder might be able to hold a job while on medication.

However, if we take a big-picture holistic approach to the treatment of mental illness and addiction, too,we see that these illnesses are mental, physical and spiritual diseases—and that medication isn’t always the answer.

In the course of over twenty five years in the field, I can say that I have seen more than a few cases that simply broke the predicted mold.

At the anecdotal level…

I’ve seen cases where people with clinical depression and anxiety made sustained improvement after reframing their experiences by examining big-picture issues ala Viktor Frankel (Man’s Search for Meaning) or through the lens of belief in God and prayer.

I’ve seen cases where schizophrenia symptoms were lessened by radical changes in diet and exercise, including the complete elimination of some common foods.  I myself have encouraged that people with mental illness or in recovery from addiction to improve their diets and try eliminating sugar, gluten, and common allergens.

In fact, I believe that whether you are on medication or not, it might also be helpful to take various supplements to support your physical and mental health, such as fish oil or flax seed oil or other sources of Omega 3s, a multivitamin, calcium-magnesium, and so on. Naturally, if you are on medication, you must check with your doctor and make sure there are no potential interactions between the supplements and the medications.

Last Friday I met with someone I’ve known for nearly seven years (he’s not my patient but a friend). He was diagnosed with a pervasive anxiety disorder and depression several years ago and has attempted extraordinarily violent suicides, twice. He has been on major psychotropic medications since before I met him.

I hadn’t seen him in a couple months when he stopped me on the street. I didn’t recognize him. He was smiling. His flat affect was gone. His eyes were bright and clear, his skin was positively glowing. He looked ten years younger and he even told a couple jokes. Though he had some symptoms of his mental illness, the symptoms were so mild as to be unnoticeable unless you knew what to look for.

He told me that he felt the drugs were not helping him and so he decided, along with his nervous but supportive psychiatrist, to titrate off them. During this period which lasted a few months, he found an MD who was also a naturopath recommended vitamins, minerals, and even herbal supplements. He changed his diet and began an exercise regimen which involved walking quite a distance each day to a hospital. There he began to do volunteer work with patients which helped him gain a sense of meaning and accomplishment.

For this individual, it worked. It doesn’t mean it’s going to work for everyone. Medication has improved the quality of life for many people with mental illness. But, it isn’t the answer 100 percent of the time.

Do I recommend everyone do as my friend did? No way. Do I recognize that medication isn’t always the answer? Yes.