Myths About Psychiatric Medications Persist Fueling Misunderstandings

Rohit was a middle-aged man and a senior officer at a bank. He experienced significant mental stress stemming from work-related pressures and domestic conflicts. Although he had scheduled multiple appointments with a psychiatrist, he did not attend any. After three months, he finally summoned the courage to visit the psychiatrist. Upon evaluation, he exhibited symptoms indicative of depression and urgently required medication for recovery. However, before proceeding, he requested, “Doctor, please do not prescribe any medication. Provide me with some alternative guidance.”

It is not uncommon for a psychiatrist to recommend alternative approaches such as exercise, yoga, dietary changes, or counseling to address a patient’s condition. Many patients seek validation of these solutions from their doctors. The psychiatrist treating Rohit, possessing considerable expertise, was familiar with such suggestions. However, he was taken aback when Rohit expressed reluctance about medication. He responded thoughtfully, “I understand your perspective. However, I would like to know your reasons for avoiding medication.”

Rohit’s response was unexpected. Regaining his composure, he replied, “I simply prefer not to take medication.” Unsure of how to articulate his feelings further, he added, “Let’s discuss counseling instead. Alternatively, if you prefer, we can schedule a follow-up appointment for a more in-depth conversation.” Rohit appreciated this suggestion and resolved to return for further discussion.

As planned, he attended his appointment with the doctor, having thoroughly prepared. “Doctor, once medication is initiated, it often becomes a lifelong commitment, and I am not in favor of relying on pills indefinitely,” Rohit stated.

The psychiatrist inquired, “What leads you to this belief? Has anyone provided you with this information?” He recognized that addressing misconceptions required a nuanced approach rather than a simplistic response.

“Doctor, my friend has been on medication for two years and is unable to discontinue its use. My uncle has been taking the same medication for his entire life and still is not well,” Rohit replied.

“Indeed, you have two pertinent examples,” the doctor remarked. “How long must one take medication for diabetes or hypertension?”

“Lifetime,” Rohit quickly replied.

“Why is that?” the doctor asked.

“Because diabetes and hypertension are chronic conditions,” Rohit answered.

“You are entirely correct,” the psychiatrist affirmed. “Treatment is tailored to the specific illness. Some conditions necessitate lifelong treatment, while others may require only a few months, such as tuberculosis or typhoid fever. Likewise, the duration of treatment for mental health disorders varies.

“Your uncle and friend may be dealing with different conditions than you, which accounts for the differences in treatment duration. Based on your symptoms, depression is indicated. Depending on its severity, you may need medication for at least a year. For a first occurrence of depression, a minimum of one year of treatment is advised. For a second episode, treatment may extend to two to three years. If depression recurs a third time, a five-year treatment period may be necessary.

“Some individuals require treatment for their entire lives. Similarly, conditions such as schizophrenia, bipolar disorder, or anxiety disorders may require treatment for two to five years or potentially a lifetime. Additionally, the manner in which each individual responds to treatment and the speed of their recovery can also influence the duration.”

Rohit said, “I understand now that it is a misconception that once mental illness medication is started, it must be taken for a lifetime. But many people say that these pills are just sleeping medications.”

The doctor smiled slightly and said, “If a patient needs sleep medication, it is prescribed for a few days or at most three months and then gradually stopped. But not all medications prescribed by psychiatrists are sleeping pills. They include antidepressants, anti-anxiety medications, or antipsychotics that address specific illnesses.”

Rohit replied, “My uncle just takes such pills and sits idle, doing nothing. It seems these pills dull the mind or make one insensitive.”

The psychiatrist responded, “Considering your uncle’s illness, it may appear that way to you. In some illnesses, especially schizophrenia, some individuals do not recover well and remain non-functional. However, the goal of treatment for any illness is for the patient to recover and remain active.

“In contrast, conditions like depression or anxiety make it difficult to work, causing a lack of energy and clarity in thought. But once treatment starts, these symptoms decrease, and patients regain enthusiasm. Many individuals with mental illnesses are active and work efficiently—some in banks, others in corporate offices, as teachers, doctors, police officers, or lawyers.

“On the other hand, untreated mental illnesses can reduce efficiency, just as physical illnesses can cause weakness or debility.”

Rohit gained clarity about some of his misconceptions. For the rest, he made another appointment to continue the conversation.

 Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being