To be medicated or Not to be medicated – That is the question.

How to make an informed decision in an unstable time

Okay, I have a lot of thoughts about anti-anxiety medication. So, chances are that you found yourself at a really low point of either depression, anxiety, panic attacks or a combination of those. You finally got to go see a doctor and they labeled you “depressed” or “anxious” or both and prescribed you different types of drugs, including probably some anxiolytics and some anti-depressants. Because you are at a vulnerable point in your life and this authority figure ”THE doctor” that you probably trust is recommending those pills, you are thinking: “Damn, I might really be “depressed” or “anxious” then and perhaps there is something wrong with me that needs fixing”. And maybe that’s also how they phrased it: “You have a chemical imbalance in your brain that needs fixing or correcting”.

To that, I already want to say two things:

First, there is nothing wrong with you, not to mention that millions of people around the world have been at some point in their life “anxious” or “depressed”, wups I mentioned it. Those labels are not definite! Sometimes they don’t even ask you any questions before prescribing you those medicines (yep, it happened to me). And even if they ask standard questions, it still remains somehow subjective. I’ll give an example:  I was once labeled “depressed” after a 30 minutes phone call with a psychiatrist based on questions such as “do you sometimes feel like you are slow with people” “uh yes, but doesn’t that happen to anyone?” or “Have you lost interest in activities you used to do before” “uh yes, but I also settled down in a city and after a year naturally took a slower pace of life?!.” So anyway, those categories can be blurry. And also literally everyone in their life has experienced some episodes of depression and anxiety, but just because at that time they weren’t diagnosed, they were never labeled as such. So take those labels with a grain of salt, you know better than anyone else if you really are depressed or overly anxious. 

Second, yes, maybe there is a brain chemical “imbalance” in the brain, but that doesn’t entail that only a pill can fix it. Your brain chemical soup is always changing, when you wake up in the morning it is different than the day before, doing exercise, CBT, meditation or even having a really good conversation with a friend are all things that can “change” your brain chemical balance. A pill can change it, yes (btw, we still don’t really know exactly why the changes that a pill makes to the hormonal balance lead to fewer symptoms of depression and anxiety. Yep, the brain is complicated like that), but so are other things. And a pill has serious side effects to consider.

Take anxiolytics for example (like Xanax, Valium and other benzodiazepine types that your doctor might have prescribed when you have acute anxiety or panic attacks), they can be really addictive and can lead to side effects such as memory loss in the long term. Antidepressants, who are also almost always prescribed for anxiety and depression, are said to be non-addictive, but they have serious withdrawal effects that one needs to consider before jumping right at it. This is not to freak you out, there are people out there who’ve been able to overcome those withdrawal symptoms and got off antidepressants, but some people have remained on them longer than they had originally wanted. Staying on antidepressants means that you also have to cope with the side effects they have (e.g. loss of sexual pleasure for one, well, that would make me depressed). The point here is that those are things that are rarely discussed when doctors first prescribe anti-depressants, at least it wasn’t for me.

In addition, I think it reflects a broader “philosophical” point where as a society we have a weird relationship with pain and either try to avoid it as much as possible or indulge in it in a weird “tortured artist” fashion. I explain: In the first case, we try as much as possible to dull the pain. We’re taking (and being prescribed) countless medicines and drugs as soon as we have any symptoms of physical or mental pain, without really trying to understand where this pain comes from or if it’s a “necessary” pain in any kind of way. I’ve had an experience with a psychiatrist who prescribed me an antidepressant and 3 Xanax a day for 2 weeks “before the antidepressant kicks in”, arguing that “anxiety is useless”. There are so many things that are problematic with this but my biggest issue is that he thinks anxiety is useless and should be dulled at any cost, even if it means I am completely slowed and drugged for 2 weeks. Whereas I disagree and I think that anxiety is not ‘useless’ or clearly it’s not as simple as this (see here for why I think anxiety can be a useful wake-up call). On the other hand, I don’t want to completely indulge in anxiety and thrive in the pain of it because it might make me a better “writer” or “poet” “philosopher”, that’s what I called the “tortured artist” myth. So we come back to the difficult middle ground, it’s hard to strike it but hey! You have all your life to figure it out, so better start early.

There are no easy answers. I personally chose not to take medications for anxiety because I don’t believe it is a sustainable solution, It is likely that I’ll experience episodes of anxiety and depression all my life and if I only know how to revert to medication to ease the pain of those, I might make myself dependent on drugs that have side effects including the ones we know and the ones we don’t know. And at the same time, it sucks to live a life plagued by anxiety so I am turning to alternative treatments such as CBT or mindfulness-based meditation to equip myself with tools to deal with those for now and for the future.  

That being said, I am not there to judge anyone who is taking those drugs. Those can be really useful for some people to get you out of a really bad negative vicious spiral you might be in, or in order to get to a state where you have more physical energy to tackle your issues. I took antidepressants for some time at a point where I just wasn’t sleeping and got into a bad anxiety downward spiral and needed to get back to a “functioning” state. Antidepressants can also be a game-changer for some people who’ve tried all regular types of help (see toolkit here), CBT,  or others and there is nothing that is really working for them. But whatever is best for you, medication or not I’d encourage you to think about all of that and if you are yet, you might want to think about it before you have to take a decision in a time of crisis.