What is it that holds so many people back from taking medication to treat their mental health? There is no simple answer, and it’s never just one thing. If you asked a dozen people this question, they would all give you a different answer, but none of their answers would be “I don’t want to feel better.”

For some, it’s just that they’re too deeply depressed to find the energy, motivation or desire to take the steps necessary to begin treatment. When you’re this depressed, even the smallest task can feel like an insurmountable hurdle. The same can go for anxiety – when you’re experiencing intense anxiety, the last thing you want to do is dive into a fresh new situation, full of unknowns, an environment that’s foreign to you, social interactions, and healthcare providers. Anxiety can be paralyzing and trap you in a place where regardless of how uncomfortable you feel, standing still feels safer than making a move. Luckily, most providers now offer telehealth which can soften at least some of the burden of taking next steps. While the benefits of face to face interaction are invaluable, sometimes being able to skip the drive and remain in the comfort of your own home is what it takes to make taking these next steps possible. 

It’s much easier to avoid things when we aren’t really sure they’ll actually help, or when we’re pretty sure they won’t. Most of us have at some point heard a horror story about an antidepressant from a friend or family member. Us humans are funny in that we’re much more likely to talk about a negative experience than a positive one. If we go to dinner and have a terrible experience at the restaurant, we often make it a point to warn everyone to stay away and rant about how disappointed we were in the food or the service. We’re less likely to share a positive experience unless it happens to come up in conversation. 

Some have actually have had their own personal negative experience with medication in the past. Sometimes, it just wasn’t the right medication. Sometimes, what they were being treated for wasn’t actually the correct diagnosis. Sometimes they had no idea what to expect and the side effects caught them off guard, they didn’t realize that the medication required several weeks to take effect and figured it just wasn’t working, or the prescribing practice of their provider was just too aggressive. 

I was prescribed Lexapro back in high school – it made me feel so nauseous and crampy that I wanted to curl up into the fetal position and hide under the covers. At that point, I couldn’t imagine how any potential benefit was going to outweigh having to experience that on a daily basis. A decade later, I was looking through some of my old medical records that my mother had saved and saw that my pediatrician had instructed me to start at 10mg daily and then increase to 20mg (the max dose!) within the first week or two. For reference, the way that I typically prescribe Lexapro is 5mg daily for a week and then increase to 10mg daily until the next visit, typically about 1 month later. If I know that someone is sensitive, side effect prone, or if their body is having a tough time adjusting during that first week, I’ll either keep the dose at 5mg or increase only to 7.5mg daily. ANYWAY – unsurprisingly, I stayed far away from even the thought of trying another medication for depression and anxiety for years after this experience. 

Another common barrier is the big ugly hairy stigma. It’s not uncommon that I hear people say, ‘I don’t want to have to take medication, I should be able to handle this myself, I’m not weak! If I have to rely on medication, that must mean that something’s wrong with me!’ These are the times that I think it would be helpful if everyone walked around with the mental health medications that they take plastered on their forehead. Of course that would be unreasonable, but then we would realize how common it actually is for people to take these medications. People don’t tend to announce it and it doesn’t always come up during small talk while waiting in line at the grocery store. I think that if we really knew how many others take these medications, it would be easier not to see it as a personal flaw or weakness, and to see it more as a tool that many utilize to feel like their best self. I know the whole cliché where people say ‘you wouldn’t deny insulin if you were diabetic, or an anti-hypertensive medication if you had high blood pressure’, and I hate clichés, but this one is true.  If you are willing to seek help, work with your provider to find a medication that does not cause any significant side effects (yes, it’s possible!) and helps you feel and function as your best self, this is most definitely a strength and not a weakness.

The fear of dependency is another common concern. ‘If I start taking this, I’ll have to take it forever and I won’t be able to survive without it’ or ‘I’ll get addicted to it’ or ‘I’ll have terrible withdrawal symptoms if I try to stop taking it’. These are completely valid concerns – but luckily, the majority of the medications that we prescribe for mental health are not addictive and do not cause dependence. Of course there are medications in the mental health world that do, and unfortunately they’re often the ones that we hear about more (i.e. Xanax, Valium, Adderall). Even those medications are safe when prescribed responsibly and taken as prescribed, but the majority of antidepressants, anti-anxiety medications, and mood stabilizing medications do not lead to dependence. It’s typically best to slowly taper off if you decide to stop taking a medication rather than just stopping ‘cold turkey’, but this is just for the sake of being gentle on your body. Think of cutting down on caffeine intake little by little instead of going from several cups of coffee daily to none at all – that’s a headache, literally. 

In fact – while you are taking medication, your symptoms are stabilized, and you choose to see a therapist regularly and/or work on creating better habits because you actually feel well enough to do so, your brain is developing and reinforcing new neuronal pathways and connections. ‘If you don’t use it, you lose it’ applies to the way your brain works too. When you begin to have the energy, motivation, and desire to make positive changes and you neglect those old habits or behaviors, the strength of those connections weakens and eventually withers away. When I say those connections, I mean a cue such as feeling depressed and hopeless sending a signal through a synapse in your brain that triggers a negative behavior like self harm, or even something like binging a whole Netflix series until 4am and eating 5 ‘happy’ meals (lol) and then feeling like crap the next day. Or a cue such as feeling ashamed and embarrassed when the waitress says ‘enjoy your meal’ and you say ‘you too!’ and then spending the entire afternoon beating yourself up about it. 

Taking medication can help get your brain to a level playing field where you can meaningfully participate in therapy and identify ways to improve your daily life. It can help you replace those negative ‘automatic’ thoughts or behaviors with positive ones, continue to strengthen those new connections, and allow them to become your new normal. You may be better able to recognize, ‘this day sucks, I’m over it’ and just brain-dump in your journal to get all the yuck out of there, and call it an early night so you can get adequate sleep and start fresh the next day. You may be able to recognize, ‘oops, I made a mistake and said the wrong thing, that was embarrassing. I feel a little silly, but I’m human and it’s not a big deal.’ The waitress probably didn’t even notice and if she did, there’s a better chance that she thought it was cute than that she thinks you’re a giant idiot.

For some, this opportunity to work hard on re-training their brain has lasting effects, and will continue even if the medication does not. It is true that some do need to be on medication long term, but that doesn’t mean that they’re addicted or dependent on the medication, it just means that they feel and function better with it.

The decision to begin taking medication is a very personal one and should never be made from a place of feeling pressured or coerced – not by a family member, not by a partner, not by a medical provider, not by anybody. The decision should be made if/when you feel comfortable with it, and it should be accompanied by trying to keep an open mind, being given realistic expectations, and asking/receiving answers to all of the questions you need to in order to feel confident in your decision.