Psych Meds: Beyond Black-and-White Thinking

10 Thoughts on the Bigger Picture

Though conventionally trained as an adult and child psychiatrist, I no longer prescribe psychiatric medication. The focus of my work (now holistic and functional) and my continuing education for the past 10 years has been to identify and address underlying root causes of brain symptoms.  I’m not opposed to psychiatric medication.  In fact, for some with severe symptoms who want to address root causes, they need to also be working with a psychiatrist who does prescribe psychiatric medications. 

I am glad that I’m no longer in the position of having to directly weigh the risks and benefits of these medications, especially when it comes to prescribing to children.  There are still many unknowns including how altering neurotransmitter activity might impact the developing brain.  I’m glad too that I’m not having to decide, for an adult or child, if the benefit of using an antipsychotic medication outweighs the risk of potential irreversible long term side effects.  A benefit, for example, could be saving someone’s life and the risk could be persistent involuntary movements of the mouth.

If I am prescribing a medication, it would likely be an antimicrobial (more often an antifungal), a mast cell stabilizer or a prescription binder. 

Still, the topic of psych meds comes up regularly, whether it’s understanding someone’s previous responses (which can inform me about potential root causes), or it’s a disagreement between parents when one is adamant about functional (root cause) approaches and the other is adamant about medication.  These treatments are not in conflict and can be used in parallel.

Now with that context -

1. Associations are not the same as causation.   The other day, I heard an integrative doctor say that those with Crohn's Disease (an inflammatory bowel disease) are 300 times more likely to be on an antidepressant.  She stated more than once, in a short video clip, that people choosing to be on antidepressants should be given this information.  She seemed to infer that antidepressants cause Crohn’s.  She wasn’t expressing curiosity about why there would be such a strong association..  She wasn’t expressing a recognition that those who have autoimmune disorders, which Crohn’s disease

   is, are more likely to suffer from depression, as both conditions share similar roots such as inflammation. The higher incidence of depression and anxiety would make it more likely those with Crohn’s would be on antidepressants. Lastly, there was no mention of the research showing a decrease in relapse rates in those with this inflammatory bowel disease.  

2. It’s easy to criticize and think something is all bad without offering other solutions.  That same day, I spoke with someone who told me their former holistic psychiatrist had them discontinue their antipsychotic and mood stabilizing medications -  the ones that brought them to a level of stability. Likely, because the root causes were never identified or addressed, their symptoms returned. Because of the severity of their symptoms, they had to be hospitalized for their safety and for stabilization.

   I would like to ask doctors who are adamantly opposed to psych meds, and really anyone judging or criticizing a person for being on meds, “What should the person do instead?”

3. While lifestyle changes and psychotherapy are very important, they’re often not sufficient when someone’s symptoms are especially severe.  Imagine you are psychotic, manic, severely depressed or have severe fatigue and/or brain fog.  Imagine trying to shop and cook “healthy” meals, maintain an optimal sleep and exercise routine and apply the tools you’re supposed to be learning in therapy .  Most of us, even when we’re feeling pretty decent, are unable to do this.

4. If medication can save lives, help relieve suffering, allow someone to continue to function (keep their job, care for their children, etc.) and even allow them, if possible, to address the root causes so that they can eventually be off (or on less) medication, why wouldn’t we want that?

5. Yes.  “Big Pharma” is a problem…but Big Pharma is also actually providing some benefit for some people.  And yes, there is over-prescribing, but that doesn’t mean that there aren’t some that actually need medication. Despite the insistence of our culture, we actually can hold two seemingly opposing thoughts at the same time. It doesn’t have to be that psychiatric medications are all good or all bad.   

6. What about the research that says psych medications aren’t helpful?   I would argue that certain psych meds are helping certain people.  We are biochemically diverse.  Research doesn’t account for that diversity. If you gave SSRI’s (Serotonin Reuptake Inhibitors) to 100 people with depression, those who are undermethylated are the most likely to respond.   When researchers are looking at a group of people with depression, that group includes people with undermethylation, copper overload, pyrrole disorder, mold toxicity, mast cell activation, autoimmunity, etc. ….and varying combinations of these

   If someone tells me that they have benefited from a medication, I believe them, even if I also believe that identifying and addressing the deeper root could be beneficial, and without medication side effects,....and would likely improve their overall health. Obviously, given what I do, I wish everyone could do this,....BUT ,that doesn’t mean that’s the right path for everyone.

7. Many people that I’ve seen who come to me on medication express concern that they can’t get off medication (even when appropriately tapered). The body and brain can become dependent; especially on benzodiazepines.  But more often, I suspect the same symptoms, for which the medication was started, are simply returning when a medication is discontinued. Again, because the root cause(s) are still there.

   Add to this the evolving understanding that medications may be helping for reasons that go beyond their original intent, which is to target neurotransmitter activity.  Most psychiatric medications have antihistamine effects.  High histamine, which is common especially in those with undermethylation and mast cell activation, can impact mood, attention and energy.  There is also evidence (in lab/not human research) that many SSRI’s and antipsychotic medications have antifungal effects.  This could be important, as candida and mold appear to be very common in those with brain symptoms. 

8. Getting to the root causes by seeing functional and/or holistic practitioners is not always:

   1. accessible (there are relatively few of us), 

   2. practical (there can be a number of treatment steps involved compared to taking a medication)

   3. financially possible, as it is relatively expensive.  

   So again, it can be easy to say, “You should try to get to the root cause,” but that’s not necessarily possible or even desired by everyone. Just as our biochemistry is diverse, so is how much attention we want or can give our health.

9. We can all benefit from resisting the black and white, all or none, good and bad thinking our culture prescribes….whether it’s about psychiatric medication, COVID vaccines or endless other topics.  We really can embrace the mantra, “It’s complicated.” Only then will we get somewhere, which in this case is growing a better understanding of brain related conditions, so that more doctors can provide more options.

10. I like to think that whatever the issue, most of us are all doing the best we can…given what we know, what we’ve experienced and our current circumstances.  As we weigh decisions about our health and our family’s, the best we can do is seek input from our doctors and try to be as informed as possible about our options. We can take that information to our own inner wisdom and consider what makes sense for us - what is possible and what fits with our deeply held values….all of which can change over time.  The more we can do this, the more the judgments and opinions of others can fade into the background. 

May you be surrounded by people who listen well, so you can hear yourself.

Until next time,