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A recent survey from the National Center for Health Statistics (NCHS) and the Census Bureau showed that Seattle had the most adults report taking medication for mental health.
A Swedish psychiatrist helps us understand what it means to take medication for mental health. She also talks about the survey results.
There are alternatives and additions to medication that can help with mental health, including hobbies. A Swedish social worker explains the benefits of adding something fun to your routine.
When it comes to mental health, you’ve probably heard of prescription medications used in treatment. Maybe you’re taking or have thought about taking antidepressants, anti-anxiety medicines, antipsychotics, or mood stabilizers. Drugs can offer necessary and effective treatment for many mental health conditions.
A recent Household Pulse survey from the National Center for Health Statistics (NCHS) and the Census Bureau showed that Seattle has the highest number of adults who report taking prescription medications to help with mental health. So, what does that mean for the people of Seattle? Is taking medication for mental health a good thing? What prevents people from taking medication?
We spoke with Swedish psychiatrist Alicia Grattan Jorgenson, M.D., to learn more about the role medications play in mental health care. Dr. Jorgenson explains what medication does for some people, common stigmas around medication for mental health, and her thoughts on what the survey results say about Seattle.
What is a mental health medication?
A mental health medication is a prescription you take to help with your thoughts, emotions or behaviors. The most common types of mental health medications are:
- Antipsychotic medications. These typically are used for treating psychosis, bipolar disorder and treatment resistant depression.
- Benzodiazepines. These are sometimes (but sparingly) used short-term for stress and anxiety disorders.
- Mood stabilizers. These help treat bipolar disorder.
- Selective serotonin reuptake inhibitors (SSRIs), including sertraline or citalopram. These can help with both depression and anxiety.
- Stimulant medications. These are for attention deficit hyperactivity disorder (ADHD).
The type of medication and how long you take it depends on your situation. You may take some medication for a few weeks or months. For other severe mental illnesses, you may need to take medication for your entire life.
Common conditions that can benefit from medications include:
- Anxiety disorders, such as social anxiety disorder, panic disorder, or generalized anxiety disorder
- Attention deficit hyperactivity disorder (ADHD)
- Mood disorders, such as major depressive disorder, dysthymia, and bipolar disorder
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
How does medication help with mental health?
There are many reasons you might take medication to help with a mental health condition.
“It is always important to clarify with your doctor what the goals of treatment are with a mental health prescription,” says Dr. Jorgenson.
Many medications help balance brain chemicals like serotonin. For example, SSRI (selective serotonin reuptake inhibitors) medications can help people with anxiety disorders.
“Anxiety is a normal emotion. We all feel it to some degree during the day when we are worried or stressed,” explains Dr. Jorgeson. “Signs of an anxiety disorder would be if anxiety is so constant that it interferes with your life or changes behavior so much that you don’t want to do what you used to do anymore. For example, if you are constantly worrying or always thinking about worst-case scenarios, and it’s hard to function. It’s hard to focus.”
SSRIs enhance the transmission of serotonin in the brain. Serotonin is an important chemical for managing mood and anxiety. Usually, after serotonin does its job, neurons (nerve cells) reabsorb it. SSRIs prevent neurons from reabsorbing serotonin. This makes more serotonin available to the brain.
“By changing these serotonin pathways, SSRI medications can help people to turn down the volume on worry thoughts and move forward with what is important in their life,” says Dr. Jorgenson. “The medication can improve cognitive flexibility, like ‘hey brain, I’m at work right now. I need to think about my project, rather than worrying about the future.’”
Why doesn’t everyone take medication for mental health?
Though helpful for some, medication isn’t the only solution for mental health issues. How severe symptoms are is important to consider, as well as personal preference.
Dr. Jorgenson notes that for mild symptoms, sometimes talk therapy alone can help. And some people feel strongly that they either want talk therapy or don’t.
“We know that in adults, medicine and therapy, at least for depression, work kind of equally well,” says Dr. Jorgenson. “This gives people options about what treatment will suit their needs most.”
A strong relationship with your doctor is important for finding the treatment that works for you.
“Ultimately, trust your own instincts about what’s going on with you. You’re the boss of yourself and the expert on your internal experience,” says Dr. Jorgenson. “But I think, especially with a primary care doctor who has known you for a while, they can offer a unique perspective. So being able to listen to their advice and collaboratively explore all treatment options is ideal.”
Common stigmas about mental health medications
A lot of times, people discount taking medication for mental health because of stigma.
“There can be a stigma about mental health treatment in general – not just medications,” says Dr. Jorgenson. “This can stem from cultural factors, generational factors, or both. Stigma argues that it is a weakness to acknowledge negative emotions or seek help. Unfortunately, this attitude puts up barriers to fully addressing emotional pain and suffering. Pain and suffering can happen to both body and mind. We need to treat both.”
Medication for mental health is stigmatized in other ways, including:
- Guilt and shame for asking for help
- Concern about medication changing personality
Dr. Jorgenson admits that medication and psychiatry don’t have a perfect past. It also isn’t always portrayed positively in media.
“Our role moving forward is to be open and honest about what the data says about how medicines work and to be receptive to when there is resistance,” she says. “Or when there are questions about medicines. To be fair, sometimes medicines aren’t the right move for everyone.”
Importance of behavioral health tactics
Though medication can help turn down the volume on symptoms of a mental health condition, it doesn’t always solve every problem. Dr. Jorgenson says mental health takes a lot of self-work too.
“I tell teenagers that I see: medications can definitely help. But they do not automatically do homework assignments for you,” she says. “Behavioral change still has to come from you and the choices you make. The medications can make it easier to listen to your healthy self and start building healthier habits.”
It’s also important to try behavioral strategies that experts know work at the same time. This can look like basic healthy living, including meditation, exercise, sleep, and self-care. Self-care is about focusing on what is important to you. What interests you? Is it a new hobby? An event?
Q+A on hobbies and mental health
One important behavioral health strategy to help with mental health is hobbies – activities we do for fun. To learn about hobbies, we spoke with Darcy Wyatt, LICSW, a behavioral health provider at Swedish. Darcy is a licensed clinical social worker, who meets with patients regularly to support mental health. She explains the benefits of adding some fun to your routine.
Q: Why are hobbies good for us?
A: Generally, a hobby is a helpful way to promote social engagement, exercise, self-esteem, and mastery. Hobbies also promote brain health, strengthening our memory and focus. They can help with anxiety and depression and the intensity of these.
As humans, we need some outlets besides just work and home life. We need things that bring us joy and that we can look forward to. Hobbies can be a distraction from our day-to-day life – a way to be mindful while doing something in a focused state.
Q: How do hobbies help our brains?
A: Hobbies impact the reward system in our brain. We get pleasure from a hobby, causing our brains to activate. And when we get that reward, we want more. We’re more likely to want to do it again so that we can get that reward again. This cycle is helpful when it comes to positive activities. It also creates new neural pathways, so we can start to improve memory and focus and learn new skills.
Q: Are there ever times when hobbies become bad for mental health?
A: It’s all about balance. Too much of anything can sometimes cause a negative effect. It depends on the type of hobby and how much you do it. If we spend too much time doing certain hobbies, it can impact sleep, eating patterns, and even how we function at work, school and home. Our time spent on hobbies should be balanced, so we’re also taking care of our basic needs.
For example, someone might spend hours and hours playing video games or scrolling on their phone. That can trigger the positive reward system in the brain. This can be fine to a certain extent, but when it becomes all-consuming, then we don’t spend time on other important parts of life. The same could be said about activities that we generally view as really healthy. Working out is great, but if you’re doing it in excess, it can be detrimental both to your physical and mental health.
It’s also important not to push yourself too much to like a certain hobby. Notice how your mind and body respond to different activities. Remember, you’re doing a hobby for fun, not a job.
Q: In what ways has COVID-19 affected how we respond to hobbies?
A: It’s definitely an interesting time. During COVID, people have tried a lot of new things. We’ve had extra time, especially when we were in full lockdown mode. In certain ways, that was really positive – trying to cook, doing more puzzles, and art projects. But we were also really limited as far as what we could do, especially opportunities for social engagement (for example, group workout classes or sports). Many people use social activities as an outlet or way to cope. Travel also often helps people prevent burnout from work and break up some monotony. Not being able to do that impacts people’s mental health.
Q: What if I don’t have a hobby? How can I get started?
A: There are lots of ways to start a hobby. For patients who are feeling depressed, I tell them: Make a list of anything that may bring you joy or has brought you joy in the past. Schedule those things to look forward to. Journal to figure out what inspires you. It’s important to make time to think about that.
It’s tough during a pandemic. Some people are more comfortable in public than others, but community centers can be a great outlet. They have classes and different activities. Senior centers are helpful too, especially if you’re feeling isolated.
You can always start at the library when looking for a hobby. You can usually access some museums, the aquarium, and other activities for free with your library card. There also are tons of ideas online. Connect with people in a virtual space. Have a book club or paint together on video. Learn a new language with apps like Duolingo. Try a pre-packaged meal plan to cook. Seattle is a fabulous place to get outside and hike. Community colleges also have a lot of resources to help you explore options and see what you like.
So, what does the mental health survey say about Seattle?
Now that we have a better idea of the difference between taking medication and using behavioral techniques for mental health, let’s talk about the survey. Why is Seattle taking a lot of medication for mental health? Is that good or bad?
Dr. Jorgenson notes the importance of understanding the limitations of an online survey. But she also has a few guesses for why Seattle’s numbers are high:
- White people are more likely to get prescriptions for their mental health than minorities. Seattle has a higher proportion of white people than other metro cities.
- The people who took the survey had to have online access.
- Trends in mental health prescriptions are consistently higher in younger adult populations.
- People living in higher latitudes possibly have higher risks for depression – especially with seasonal affective disorder (which is more common in Seattle than California).
- Seattle is home to high-pressure jobs that may add to overall stress.
Ultimately, the survey doesn’t answer the big question: Why? Dr. Jorgenson isn’t overly concerned with the results.
“It does make me wonder – are people in Seattle more stressed? Or are people in Seattle more comfortable talking about their mental health and getting services (both medication and therapy)? Or both? I know there is a push in our primary care clinics to screen for depression. Maybe we’re doing well at helping people who may not have otherwise considered mental health treatment.”
Swedish continues to try to make mental health care a part of overall health care. Our behavioral health providers are part of primary care, which helps patients get easy access and reduce stigma. It’s important to normalize mental health concerns. They should be part of overall health, rather than separate from physical health. This makes people more open to treatment when they need it – whether it’s medication or some other form of therapy.
“Mental health is such an important part of overall health," says Dr. Jorgenson. “And our mission at Swedish is to provide the best care for the whole person – mind, and body.”
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