Just saying no!..To the WRONG drugs

It seems so much easier. I never have any trouble try to get patients take antibiotics or medicine for their blood pressure or diabetes. Patients almost never turn down pain meds–especially addicts. Clearly addicts have the hardest time saying no when it comes to drugs that in any way resemble those chemicals which live in the same neighborhood as their substance of choice. But tell an addict that you are going to give them a drug to treat their anxiety or depression or bipolar disorder (unless of course it is a Benzo) and you have a whole new fight on your hands.

It is not just addicts that have an aversion to psychiatric or psychotropic medications. Everyday, not some days, everyday; I have a conversation with someone who is reluctant to take a medication to treat their psychiatric symptoms. People believe that they can control their own thoughts. That they have control over their emotions. That unlike their pancreas or kidney or liver they actually have control over their brains. That is simply not true.

As a patient imagine how many times you have woken up and said that this will be a day when you will not feel depressed or you will not have a panic attack. And yet it happens anyway. The centers of your brain responsible for emotion (depression, anxiety, fear, happiness, etc)lie in your limbic system; miles from from your prefrontal cortex. It is the prefrontal cortex that you do have control over. It is there that you can scratch your head or memorize a poem. It is a whole different world in the limbic system however, and you have no more control over that region of your brain than any other organ in your body. Medications allow us to change the dynamics of the limbic system in a way that we can’t otherwise do consciously. And they can do it quickly. When combined with psychotherapy they can do it more thoroughly than any other treatment modality.

Perhaps most importantly, when you say no to medicine you may be guaranteeing that you will stay on a path or psychiatric illness with no hope of recovery. Recent studies show that when untreated, illnesses such as depression can cause irreversible anatomical, hormonal, endocrinological, and physiological changes to the brain and the adrenal gland. These changes not only attenuate recovery but also promote increased incidence of heart disease, diabetes, and stroke.

Today the United States leads the world in very few areas. One area where we are miles ahead of the rest of the world is psycho-social illness. The numerous reasons for this will be a topic for another day. One thing is clear. If we want to change this dubious distinction then we must stop saying “no” to the right drugs! Take your medicine!

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