If I had a dollar for every patient who sat in front of me and said this, well….I wouldn’t need to actually see patients anymore (but I probably would, anyway!). The majority of people I treat are resistant to starting a psychiatric medication but have been referred to me because their therapist thought it was a good idea or their friends suggested they explore it as an option. I view medication as one part of mental health treatment or wellness. Therapy plays a big part as well.
The biggest part is what I call “life stuff”. I’m still working on a better term for it, but it encompasses everything from what you eat and drink to the relationships you keep and the work you do. I believe it is the most important determinant of mental health. Therapy and medication can help you make positive “life stuff” changes. Medication is a tool that can help you better cope with life and augment therapy. For some people, it is all they need to feel better.
The three most common questions women ask me about medications are: how long will I need to be on it, will it change my personality, and will I gain weight?
How long should I take it?
The majority of people with anxiety and depression will not require medication their whole life. However, if they are more comfortable on it or do need it to maintain mental wellness, it is not harmful to be on most medications for long durations. The World Health Organization and the American Psychiatric Association recommend you take medication for 9-12 months following a depressive or anxiety episode. People who have had more than 2 episodes in their lifetime may benefit from maintenance therapy that lasts longer than a year. Of course, every case is individualized. It’s important to have ongoing discussions with your provider about your symptoms. Often times, depression and anxiety are insidious. You may not feel sad, but you may feel empty or “blah”, you may be irritable all the time or feel restless.
Will it change my Personality?
Proper medication management will not change who you are or numb you. In fact, if you feel un-emotional on it, then its either not the right medication choice or its not at the correct dose for you. When psychiatric medications are working properly, you will feel like your best “you”. You will still experience the full range of human emotions, but you won’t be overwhelmed by your feelings. This means you will still have periods of sadness, boredom, and worry but they won’t interfere with your day to day functioning or relationships. You will feel in control. The idea of psychiatric medications is not to numb your life away. It is to help you better cope with your life.
Weight Gain?
Weight gain is a concern of many women. Fortunately, the majority of depression and anxiety medications are not associated with significant weight gain (more than 5 lbs). In fact, some may cause weight loss due to decreased appetite or nausea when first starting them. Typically, those side effects only last a week or two and can be mitigated by taking the medication at night. Decreased appetite is a common symptom of both depression and anxiety. Contrary to popular belief, it is more common to lose your appetite than overeat when depressed. I believe what happens in some people who gain weight is that they are simply gaining back their desire for food and experience a normal weight change due to that. Many of my patients, however, do not gain significant weight after starting medication.
What about sexual side effects?
SSRIs are known for the sexual side effects. These include lower libido (desire for sex), difficulty with arousal, or having an orgasim. Sometimes, SNRIs cause theses side effects, as well. Your provider will ask you about this and help find the right medication at the right dose to prevent this. Sometimes, we use a non SSRI or SNRI to treat your depression. This is known as an “off label” use. Additionally, we can use some medications to augment your tremante and counteract the sexual side effects.
Starting a psychiatric medication is a personal choice. Typically, people take them after finding therapy alone is not working. I work with a lot of women and find that most of them have great coping skills. They know about yoga and meditation. They feel less stressed when they exercise or have quality alone time. However, sometimes, you need more. Medication is a powerful tool to help you. We can work thought side effects and support you during this process.
Sharon P. Fisher, PMHNP, PMH-C, is board certified psychiatric nurse practitioner and founder of Nurtured Well, a boutique women’s mental health practice in Towson, MD.