On Ranking Mental Health Treatments.

I’m very happy that we are all learning to talk more openly about mental health. I do a little dance of joy every time someone casually mentions therapy. My openness here is not a farce, I casually mention therapy constantly and I don’t even go to therapy regularly anymore!

The problem that I have is that we – as a culture – are still framing Paths Other Than Medication as somehow better on the scale of treatment of mental health disorders. There’s still tons of commentary and personal testimony and memes which propose everything other than medication as better. Like, “I started exercising every day and now I don’t need my anti-depressant anymore!” Mental health is not like high blood pressure where most physical bodies react the same and can reduce medication uses with lifestyle changes. Anxiety and depression have different physiological effects in everyone and so there’s no consistent lifestyle changes that have the same effect in every human brain. And yet…we are still treating medication for mental health like it’s the less than option. Like it should be a last resort.

Listen…I applaud anyone who gets themselves out of the darkness in whatever way they can, but this idea that doing it “without medication” is somehow better, is one that is harmful to everyone on every path towards treatment.

If you are working with a trained professional to solve your mental health crisis…no one path to treatment is better than another. Now, some people choose to self-medicate in harmful ways, obviously…and those ways are not ideal. But if your doctor pushes you to try to change your diet and exercise more and it works, GREAT! But if it does NOT work and therefore your doctor pushes you to try medication…that is not a step down. You did not choose something less than. You did not fail. And that person who got better with the help of daily walks did not succeed in comparison to you and your Lexapro.

And if your doctor went straight to the medication as treatment? Then maybe your doctor listened to you and thought getting you out of the darkness was the top priority and it would be a waste of time to “try cycling to work every day instead for the next four weeks” when they felt your body chemistry was ideal for a medicinal treatment. They did not “take the easy way out” and neither are you. Yes, we all know there are bad doctors out there who have bad relationships with pharmaceutical industries, but we can not take those stories and use them to demonize medication as treatment for mental health.

And none of this even touches on the fact that sometimes your anxiety is so severe that even leaving the house is impossible, much less connecting with other people which is often written about as the reason we see so many more cases of anxiety now than we did before cell phones. HOW CAN I CONNECT WITH PEOPLE TO TREAT MY ANXIETY WHEN I AM TOO ANXIOUS TO GO FIND THE PEOPLE? Same with exercise treating depression…when my depression was at it’s worse I could move to do the things I felt life required of me: Work, Feed my kids, do laundry. But everything that seemed like it benefitted no one but me…got pushed away. I didn’t do my hair for weeks. I didn’t shave. I didn’t moisturize. And I sure as hell didn’t exercise. The fog was too heavy so that treatment? Was out of reach and therefor definitely not the better treatment option.

The person who was able to claw their way back into the light without ever filling a prescription for an antidepressant did not succeed at anything other than treating their mental illness. They do not deserve a pat on the back because they avoided Prozac. The person who journaled their way through grief with a qualified therapist did not somehow manage their depression better than the person who needed a periodic sedative. The person who found their anxiety lessened when they gave up processed sugar and red dye 40 does not deserve praise for never needing a Benzodiazepine.

I am thrilled we’re all talking more about our personal mental health journeys and we’re being more open about the struggles we all face, but media and popular writing on the subject still falls back to this framework that medication should be the last option, without any recognition that it could be the best option and why would you not want to find the best option first?

I worry about articles with anecdotes likes this:

I spoke with shared a story about how when she was in her early 20s and severely depressed, she made a plan to take her own life. The day she intended to go through with it, she went to the gym for one last workout. She dead-lifted 185 pounds, a personal best. When she put the bar down, she realized that she didn’t want to die. Instead, she remembers, “I wanted to see how strong I could become.” Five years later, she can dead lift 300 pounds.

Here’s how exercise reduces anxiety and makes you feel more connected

Because our response to anyone who makes a “plan to take their own life” should be to contact a professional. I mean, I’m glad for this person’s success but it’s very reductive of suicidal ideation to something that Lifting Heavy Things Should Be Able To Fix. If I’m currently in the throws of a depressive episode then the fact that doing something physical does not inspire me to live longer…just makes me feel like a failure and therefore reinforcing the lies depression tells me that I am not a worthwhile contribution to humanity.

I just think we all need take a closer look at these seemingly uplifting stories and memes we share. On paper it seems great that someone trained for a marathon and cured their depression. Or that someone started doing yoga daily and cured their anxiety. But unless every one of those articles also calls LOUD and PROUD attention to the fact that everyone is different and no treatment is the same for everyone and medication is just as good as exercise – then they are doing more harm than good. I still know several people who think they have somehow failed in life because they’re taking medication for their anxiety/depression and this upsets me so much because not all body chemistry is the same. Exercise endorphins and time in the sun and gatherings with friends are not enough for everyone. And if they are not enough for you, you are not a failure. You are not less than the person for whom all of that was sufficient.

In the end…the best treatment option is the one that works. Period.

4 thoughts on “On Ranking Mental Health Treatments.”

  1. Amen, sister! Our family has been going through some hard times, and when people ask how I’m doing, I respond ‘better living through chemistry’ or I say I’m letting Prozac take the wheel. The more we can normalize this the better!

  2. Agree. I’m considered to be clinically depressed due a heart attack a year ago. We (doctors, therapist and I) have it in partial remission. As of right now I will take it everything day by day. While we strive to make me better.

  3. BRAVO! Louder for the people in the back! I have come up with several fun responses for people who feel the need to comment on the fact that I take medication for my anxiety, which as you know I am very open about. Because I am a bigger person, exercise is generally insisted to be needed antidote. If I am in a good place, I listen for a minute, and then smile REALLY wide and say… “I’m SO GLAD that works for you.” If I’m feeling less patient, I respond with, “Oh hear ya, but people get really freaked out when you cry at the gym, so I think I’ll stick with what works for me.”

  4. So true. I quickly descended into the lowest place mentally about four months ago, and it completely reversed just TWO WEEKS after starting a new medication. Of course, this isn’t going to be everyone’s result, and I cant explain why mine reversed so quickly, but the point is, it helped. Sometimes medication IS the best option. I think it helped save my life.

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