Wednesday, December 29, 2010

Magic Pill? *sigh*

Anyone who has been a client of mine has undoubtedly heard my soliloquy on "No Magic Wand." While there is no magic wisdom to impart, question to ponder, step to dance, or ceremony to perform for a quick fix to those thoughts, emotions, and behaviors that challenge our lives, there is also no magic pill. And on that point I am vehement.

Now, anyone who has been a client of mine would also undoubtedly know my stand on using psych meds. Absolutely, without a moment of hesitation, I believe that psych meds can be invaluable tools in our tool chest to help effect positive changes with people. I have seen adults who suffered for years since childhood and heard children themselves describe for me their tortured experiences until some psychiatrist happened upon the right medication(s) at the right dose for them and their particular difficulties. I have witnessed medications work what seems like 'magic' simply because the symptom relief may be so incredibly significant in the life of someone, but the danger lurking around the corner is the potential for someone to have tunnel-vision in his or her endeavor to get some relief from whatever is bothersome and rely solely on another pill.

While I would say that most of my clients took the long road and lots of repeating, cajoling, bargaining, and downright badgering to consider being evaluated for psych meds when I felt strongly they might be helpful, there has been the handful of others across my practice who showed up for their initial appointment, plunked down in a seat, and waited for the time they thought was 'right' to inform me that they didn't really think counseling would help them, but what they needed was a pill. Ummm. Well, that is not exactly the way it works. Yes, a pill may be a useful tool. I mentioned that already, didn't I? But it is like putting a bolt in without having a nut for the other end. Sort of useless in holding things together.

So when someone tells me that a pill is the solution for this or that I have to be careful not to either vomit on his or her feet, stand shrieking with fists full of my hair, his or her hair, a mix of hair, or a combination of vomiting and shrieking. The pill addresses a symptom. Under which is lying the cause. Which, if not taken care of, will not change and will be there bubbling away and waiting to potentially suck an assortment of innocent people along with the pill connoisseur into the mire when the timing is most sucky.

And let's face it, as much as I respect some of the psychiatrists I have known and feel confident that there is some good practice going on out there is it not completely obvious that evaluating for medications, prescribing medications, and then monitoring medications is their specialty??? And isn't it somewhat obvious that prescribing a 'helpful' medication is the solution a psychiatrist may recommend as front-line treatment? I do not think most doctors are above maintaining some measures of job security by suggesting their services are the best answer to the problem. Might counselors do this too? Sure. Most definitely. There must be slimy unethical professionals in every profession out there including counselors who might drag out treatment by scheduling session after session after billable session, but as I see it the chief difference in what a good counselor should be doing from what many psychiatrists are doing is that a counselor should be working from the first session to make himself or herself unnecessary to clients. If I am doing my job then my job is to get you to the point that you are ready to stop coming to see me. If a psychiatrist is doing his or her job then his or her job is to get you to keep coming to your appointments for medication monitoring.

So when someone I know told me today that his psychiatrist prescribed a psych med for being tired I was stuck somewhere between disbelief, dismay, and disgust. Eegads. Trying to keep the vomiting at bay and the shrieking under wraps I had a brief discussion about what exactly had transpired at the doctor's appointment this morning. Perhaps a little background information would be helpful first. This person has been going to appointments for over a year and a half with medication changes, dosage adjustments, and more changes and adjustments, and more changes and adjustments. Sometimes because the medication combination didn't seem to quite help mood and thinking, and sometimes because, as with many people struggling with mood and thought disorder processes, the patient had one of many new reasons to insist on a change. Oftentimes confusing, and sometimes making a shadow of sense, but nevertheless change it was. Then a good mix seemed to be found. More stable mood? Check. Less irritability and aggressive behavior? Check. Less distorted thinking and reactivity? Check. Both objectively and subjectively the reports were good that the psych med combo seemed to be what Goldilocks ordered. . . just right. And with this good result the person told me a few days ago that because the medications seemed to be adjusted so good at this point he was absolutely not going to have the doctor make any medication changes at this point; however, he did want to talk to him and get some ideas on what to do for the tiredness he was feeling.

During that conversation we discussed that, unfortunately, some of the unpleasant side effects of the medications that were working were tiredness, but the benefit outweighed the cost in this situation. We also talked about the fact that this person is in his late 40s and some of the tiredness that he may be experiencing may be the result of not being 20 years old anymore. And we talked about various things he had not been doing for his overall health that might help with feeling less tired such as diet, exercise, supplements, and nighttime sleep behaviors.

My belief was that he would be talking with his psychiatrist about his tiredness and desire to make no medication changes and hear similar ideas with, perhaps and hopefully, some interesting and useful other options we had not considered. To say I was taken aback when I received a telephone call saying that the psychiatrist had recommended addressing the tiredness BY ADDING A STIMULANT to the psych med combo is a nice euphemism (refrain from cursing in blog. . .refrain from cursing in blog. . .). Let me get this straight. The front line solution to feeling tired was to add a stimulant to a medication course for a patient with irritability, anger, and negative thought patterns. Ummm. . .

When I asked about the plan to not change the medication course the person tried explaining that this is why they didn't change any of the meds he was taking. They just added a new one. What? Apparently there is some alternate reality with which I am unfamiliar where adding a medication is not making a medication change. I did make an attempt to explain that "just adding a new one" did, in fact, change the chemistry of the combination and create a change with mood, thoughts, and behaviors. Perhaps for the better. Perhaps not. Either way, this change was going to effect not only this person but also significant people involved in his life. People who were beginning to be a little less gun-shy and a little more hopeful that there was going to be some consistency with the good changes that had finally happened after over a year and a half of appointments and adjustments. Now everyone was going to have to live with this adding-a-new-one-nonchange.


And my take on this -
A big jumble of inability to tolerate discomfort, self-focus, a desire for instant gratification, and laziness. Is it easier to swallow a pill than to exercise or eat healthier or take a vitamin, or stop the habit of drinking copious amounts of soda (so there are subsequent multiple bathroom breaks from sleep each night) and eating snacks in the middle of the night? Sure. But there is cost. Both with another prescription drug charge, more follow-up appointments with the psychiatrist to monitor this non-change, and, in my opinion most importantly, the impact on the relationships in this person's life if adding this pill disrupts the good thing they had going. So is it really worth it to just take one more pill rather than exert some effort? Wow.

Yes, psychiatric medications can be a positive life-changing tool, but by prescribing a medication for tiredness before looking at the bigger picture and considering the impact of adding more sludge to the mire is more suckiness. What a disservice we are doing to people if we are enabling them to maintain the illusion that there is a 'magic' pill so they can take the "easy road". . .to the mire.


  1. Oh my, someone needs to remind a psychiatrist of the primary goal "First, do no harm."


  2. JC,
    I am not sure how much can go on into that ten or 15 minutes a psychiatrist allows a patient for a med check, but that doesn't seem like a lot of time to discuss anything beyond a most superficial level. I am not sure how these type of interactions will ever be changed with constraints put in place by the push to book as many appointments into a day as possible.

    Thank you for sharing your time in reading and commenting on this topic.