Navigating the Stormy Seas of Mental Health, pt. 2

See part 1 here

I’d like you to remember that there are no medical cures for depression or anxiety disorders, only treatment to lessen or manage symptoms. Doctors or other healthcare providers who currently claim they have cures, whether scientific or pseudoscientific (aka “natural cures”) are being deceptive. With that in mind, let’s look at what you can really do to effectively manage your mental health. The three main modes of attack are through medication, counseling, and religion. And you may need all three for the best strategy.

Start with Your Primary Care

Your primary care doctor, PA, or NP is your gateway to better mental health—that’s actually the reason they’re called “primary care.” And these providers are well-versed in a wide range of medical knowledge that includes psychiatric treatment and medications.

For instance, they can start you on an antidepressant, a type of medication that, despite its name, isn’t meant to make you happy but instead help you get to a place where the things that made you happy can make you happy once more. Antidepressants are meant to take the edge off depression and really get you to a baseline of “meh.” I tell my patients, “I don’t want to change who you are by forcing you to be happy. These medicines just help you get back to letting you be you.”

Antidepressants can also help with anxiety disorders, OCD, and other psychiatric disorders. Specifically for anxiety, your primary care might also prescribe you “as needed” (not “as wanted” but “as needed”) medications called benzos that act quickly to relieve anxiety symptoms. Examples of this type are Xanax, Ativan, or Klonopin. Now whereas antidepressants take time to work (about 2 weeks for side effects to manifest, 4-6 weeks to see an improvement in your condition), the “as needed” anti-anxiety medications work within the hour. The drawback is that these quick acting medicines don’t last very long, along the lines of a few hours duration. But antidepressants, if taken daily and correctly, tend to take the edge off both depression and anxiety and keep it off. Most importantly, benzos aren’t really meant for daily or long-term use due to risks like addiction, development of dementia, or respiratory issues. In the low and limited doses we do prescribe them, though, these meds are generally safe to use. Antidepressants have the advantage that they are not addictive, so they’re safe for daily use at prescribed doses.

Seeing a Specialist

Finding the right medication or combination of meds can be complicated, a matter of trial and error, so I encourage you to keep working with your healthcare provider until a good combination can be found. Unfortunately, despite the popular view, medicine is more an art than a science. Although medicine is based on science, such as using medication and statistics rather than, say, bird guts and stone livers, there’s a lot we don’t know about how the brain actually works. But your doctor, PA, or NP is trained in what science does already know in order to make the most educated decisions for your treatment.

However, if your case is beyond the limits of your primary care’s knowledge, they won’t give up on you. Instead, they will send you to (“refer you to” in medical jargon) specialists like psychiatrists, psychologists, and therapists. In general, psychiatrists are medical doctors who specialize in psychiatry and, because they are medical doctors, they can prescribe medications—Psychiatric PAs and NPs also exist. Psychologists and therapists, on the other hand, generally cannot prescribe medications. However, they are much more learned and experienced in the study of the human mind itself through their hard earned Masters and PhDs, so they help you through practical and proven methods called psychotherapy, commonly called “talk therapy.” This isn’t lying on a couch and complaining about how much you hate your mom, though. You do get to talk about your issues—but you could do that over coffee with a friend, right? Difference is, with a counselor, you get useful and unbiased feedback and advice, which is what you really need to change your life rather than your friend saying, “Yeah, your boyfriend is trash, let’s go scratch up his car.”

It’s best to have both a psychiatric provider and a counselor of some sort, whether they are psychologist or not. I also recommend my patients seek out spiritual counseling from a pastor or priest, especially since these clergymen tend to also have counseling or psychology degrees themselves. This brings me to my final point: religion. Religion is not a bad word. It is our relationship with Christ. I’ll discuss more in part 3.