Monday, August 1, 2011

Medication for Mental Illness: It's Not Just a "Happy Pill"

Hi, ETD community! My name is Lisa Sniderman. I've lived with a mental illness since 1983, and I've been a social worker since 2003.

I just finished a four-day training with David Burns, an expert in cognitive therapy. It was exhilarating! My colleagues and I practiced techniques for helping people with depression and anxiety. When it was my turn to be the "client" during these exercises, I sobbed real tears and felt real healing.

Like Dr. Burns, I believe that therapy is an important part of treating mental illness. Dr. Burns takes it even farther. He thinks the sole purpose of medication is to give people nasty side effects.

Each night after the training, I went home and took an antidepressant with nasty side effects. I respect Dr. Burns immensely, but I also respect my own story.

I am one of those folks for whom medication is crucial. I'm a wife, mother, and professional--and all of it hangs on three Sinequan a day. It's painful to recall the four years between becoming depressed and starting on Sinequan. I hated waking up. I dreaded facing people. Thoughts of suicide were a comfort. I was hospitalized eight times. 

So, did the right medication turn every day into rainbows and pony rides? I mean, isn't that what antidepressants are--"happy pills"? Hardly.

The term "happy pills" implies a quick fix for any misery--almost like recreational drugs. I get really angry at deceptive ads that perpetuate this idea. We've all seen these ads. They open with the image of a sad, lonely, unkempt person staring out the window. The person takes a pill and, bippity-boppity-boo! Now they're happily playing soccer with the kids on a spring day.

The result of these ads is that meds sometimes get prescribed to people who are very unhappy, but not mentally ill. Medications can't fix bad jobs, passive-aggressive relationships, or family conflicts. They can't speed the normal grieving process or help someone move on from a breakup. Support and therapy are much more effective for people having these kinds of problems.

The more serious issue with dismissing meds as "happy pills" is that they get stigmatized as a copout, an emotional crutch. That stigma keeps a lot of people with serious illness from getting the help they need. I resisted the idea of medication at first. I was convinced that I could--and should--think my way out of depression. I read philosophy books and sought new religions. It didn't work.

The futility of using a depressed mind to cure depression is pretty clear to me now, but it wasn't then. I considered it a moral failure when I wound up in the hospital again. Surely if I had been stronger and smarter, I could have beaten this thing.

As it turns out, taking meds was the stronger, smarter choice. It created a baseline from which I could do the work of recovery. And this, to me, is the proper role of medication. Pills alone don't effect the kinds of changes that help people stay well. But for some of us, they are a necessary pre-condition for change.

With my therapist's help, I became aware of the false beliefs that kept my depression alive. I learned that competing with others creates misery for me, because even if I win at something, it's lonely at the top. I discovered that I'm actually a lot like "other people"--no better, no worse. I found out that trying to be a perfect mother keeps me from being a good-enough mother. I saw that my self-acceptance benefits my children more than all the loudly chirped praises in the world.

Being true to my values is a tool for wellness. But doing that consistently is much harder than it sounds. Medication is just the starting point. My personal TV ad might say something like, "This hard work of being human is brought to you by Sinequan." That would be a disastrous marketing strategy, but it's true!

So what does my story say about the nature of mental illness? Is it a chemical imbalance, an adjustment issue, the fallout from childhood trauma? Is it as real as diabetes? Can "real" even be quantified?  

I don't know. But I do know that every time I've tried to go off Sinequan, my symptoms always come back. Within a few days, I lose the ability to recognize that I am depressed. The illness simply becomes my reality. It doesn't matter how much enlightenment or success I've gained up to that point.

That's pretty humbling, but it's also liberating. I don't have to figure out my illness. My job is simply to do what works, and to not do what doesn't work.

Current research shows that a medical model of mental illness, which emphasizes brain chemistry and medications, does not tell the whole story for most people. Each person's story of mental illness is a unique mixture of nature, nurture, and other factors that science may never be able to isolate. What's more, the medical model does not necessarily reduce stigma. What does seem to reduce stigma is shifting the focus from, "What's causing this?" to, "Who is affected by this, and how can we help?" That's why being part of ETD is so exciting to me. When "those weird people with mental illness" becomes "this one person who I know and love," stigma melts away.

The line between mental and physical illness is pretty blurry, anyway. Whether someone's heart attack was caused by extreme stress or by a clogged aorta, it's still a heart attack and they still need CPR. Treatment for chronic physical illness often involves stress reduction and social support, along with medication. All of this points to the mind and body being a connected system. From this perspective, mental illness is no more a measure of character than is high blood pressure, or osteoporosis. Wouldn't it be great if our culture could get behind that reality?

One last thing I'd like to say is that medication is, and should be, a personal choice. There are no magic bullets here. The same medication, or class of medications, does not work for everyone. There can be weeks or months of trial and error before finding the right one. A sizable minority of people with mental illness do not respond to any medication. Others decide that for them, the side effects outweigh the benefits. For some people, medication blunts aspects of their personalities that they'd rather hang onto. Others feel uncomfortable with Western medicine and prefer a different approach altogether.

Except in rare cases of court-ordered treatment, each person has a right to consider the costs and benefits of taking medication. The important thing is to consider all the costs, and all the benefits. It took me a few hospitalizations to conclude that taking my meds was the right choice. Thankfully, the people in my life were patient with me. They understood that unless the decision was truly mine, I wouldn't stick with it anyway.

If you are facing a choice about taking medication, remember that it is a choice. That choice should be based on personal experience, good medical guidance, and an honest appraisal of your present quality of life. In my case, I finally let go of the idea that I was weak for needing medication. What does "weak" mean, anyway? I could only access my inner strength once my depression was under control. From that point, I used my strength to build the kind of life I wanted-- the same hard work everyone must do. I feel proud of my decision to take medication. I hope you can feel that way, too, no matter what decision is right for you.

In love and recovery,

Lisa Sniderman, LCSW received her M.S.W. from the University of Chicago in 2003 and has been a licensed clinical social worker since 2005. She is also a member of ETD's Mental Health Advisory Board. Click here to read more posts from Lisa.


  1. Thank you for this post. It is the clearest description of the process of deciding about taking medication and how important it is for any person trying to figure out what is right for them that I have read. It is so important to be supported in making the choice that is best and to have that choice understood by both the therapist and your family/friends. I've seen the importance of dealing with this issue both as a counselor and as a parent of a young woman dealing with this issue in her life.

  2. I echo Janet's comment. What a wonderful post. Thank you for your honest and insightful description of the decisions we make to take care of ourselves! Your story is very moving and inspiring, and I look forward to sharing it with others.