Common Questions, Myths and Misconceptions About Psychiatric Medicine

By Richard S. Schloss, MD, copyright 1999

Psychiatric Medications, sometimes called psychotropics (literally, "mind-growers"), have become a powerful tool in the treatment of mental illness. However, much ignorance remains about their uses and effects, resulting in undertreatment and stigmatization of patients, In this article, I have endeavored to address the most common questions and misunderstand-ings surrounding psychotropic medications.

What kinds of medications do psychiatrists prescribe?
The six main kinds include:

1. antidepressants (sometimes incorrectly called "mood elevators")
2. anxiolytics (often referred to as "tranquilizers")
3. antipsychotics (sometimes referred to, for archaic reasons, as "neuroleptics"). These are effective in the most serious psychiatric disorders, such as schizophrenia and bipolar disorder (formerly "manic-depression").
4. antimanics (also referred to as "mood stabilizers;" chiefly lithium and anticonvulsants)
5. sedative-hypnotics ("sleeping pills''), some of which are chemically related to the anxiolytics.
6. stimulants, which are used to treat everything from attention-deficit disorder to sleep-wake cycle dysregulation, such as that found in narcolepsy.

It should be emphasized that drugs from every category have found uses outside of their original applications.

How do psychotropics work?
All psychotropics work by altering levels of one or more naturally-occuring chemical messengers in the brain known as neurotransmitters, or by blocking or enhancing their actions.

If my doctor prescribes a psychotropic for me, does that mean that I have a chemical imbalance? Shouldn't I be tested for a chemical imbalance before I start taking medication?
"Chemical imbalance" is an imprecise term which is based on the theory that most mental illnesses have a component of dysregulation of one or more brain chemicals. Since this theory is based on indirect findings, there is no reliable test to screen for a "chemical imbalance." Your doctor's decision to prescribe for you is based on multiple clinical findings which are reproducible in many hundreds of patients.

Won't psychotropic medication change my personality? I don't want to feel like I'm being "controlled."
Medication works to correct what is wrong. It won't alter your personality or change who you are. And it is the illness itself that leaves patients feeling they are not in control of their lives; medication is an important step towards regaining that control.

Aren't psychotropic medications highly addictive?
With the exception of the anxiolytics, stimulants, and hypnotics, psychotropics cause little if any physical dependency, although any medication taken for a long time should be tapered rather than stopped abruptly. Even anxiolytics, stimulants, and hypnotics can be safely tapered under a doctor's supervision with no lasting effects.

Aren't psychotropics just a crutch for weak people who can't deal with everyday problems?
Psychotropics are not "stress -reducers;" they correct genuine disorders. Far from being a sign of weakness, it takes a certain degree of strength to admit that you have an illness that may need medication.

A friend of mine stopped taking her antidepressant when she was feeling well, and her depression came back after a few weeks. Does this mean she's addicted to the medicine?
If antidepressants are discontinued too early in treatment, such as when the patient first begins feeling better, relapse is common, After some period of time (usually six months), the doctor may suggest weaning off the antidepressant. However, many depressions are chronic or episodic, and a recurrence of symptoms several weeks after medication is discontinued may be an indication maintenance therapy is required. 

I've heard that some antidepressants can make you violent or suicidal.
A few scattered anecdotal reports were picked up and sensationalized by the media. The Food and Drug Administration, after careful review, found evidence that suicidal thinking (but not behavior) may occasionally be increased in some children and adolescents in the first weeks of antidepressant treatment. Suicide is always a risk in severe depression, arguing all the more for early and aggressive treatment with careful monitoring.

Don't psychiatrists just push drugs at everyone who walks through the door? I just need someone to talk to.
Psychiatrists are the only mental health professionals who are trained to evaluate all the biological, psychological, and social factors involved in an episode of illness. They are trained in various types of psychotherapy, as well as in assessing the need for medication, Most psychiatrists are fairly conservative about prescribing medications.

Why do I need to see a psychiatrist? Can't my family doctor prescribe for me?
The prescribing and monitoring of psychotropics is complex and requires assessment of many different aspects of a patient's history and current symptoms. The psychiatrist is a specialist in mental illness and in the medications used to treat it. You wouldn't expect your dermatologist to prescribe your cardiac medication; nor should your internist or family physician be expected to know everything about prescribing and monitoring psychotropics.

Psychotropic medications are more effective than ever, but they are not "magic bullets." Recovery from serious disorders such as depression often takes weeks or months, even with psychotropics...but the results are worth the wait.