A therapists rebuttal: Fighting medication stigma

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

By: Erika Belledent, Registered Psychotherapist

I was less than 20 pages into my new book (by a very well-known clinician in the mental health world) and there it was.  An undeniable, yet increasingly familiar scare tactic, suggesting it is a problem many people in North America are being treated with antidepressants, stimulants and anxiety medication.

There was that familiar undertone of medication abuse. Of course, the statistics in the book didn’t break down the nuances how one medication can be indicated for multiple concerns.

It did not talk about how many people are alive today thanks to their medication, how many babies were born, birthdays celebrated, graduations attended, jobs attained.

How many families get along better and have bonding experiences had because people have had the benefit of medication. 

No, it simply suggested that the world is overmedicated.

​The shame in the text weighed so heavy I needed to set it down.

I thought of my clients reading this book, I thought of my friends and family, I thought of strangers who don’t have the training I have to make sense of this stigma promoting content. Would they walk away feeling shamed and blamed for seeking treatment and taking the prescribed medication? Would this be just another roadblock in a person seeking treatment but finding themselves confused by the health care system?Each time I read this author’s fear mongering texts regarding medication, it became alarmingly clear what was powered by this author: Hello Anxiety.Anxiety drives a loud and shiny fast car, accelerating from 0-60 in less than a second, and riding shotgun is Assumption.

Each time I read this author’s fear mongering texts regarding medication, it became alarmingly clear what was powered by this author: Hello Anxiety.

Anxiety drives a loud and shiny fast car, accelerating from 0-60 in less than a second, and riding shotgun is Assumption. 

Let’s make sense of the anxiety around medication for mental health.

In cognitive behavioural therapy, we teach about “cognitive distortions”, the thinking traps ingrained in our psyche which skew our way of perceiving reality.

As I read the text I’m able to pick out a few,

  • Blowing things up – the assumption that simply taking medication is a terrible thing (note this molehill turned mountain is especially targeted towards mental health medication;  I’ve yet to see an article shaming people out of wearing casts, or taking chemotherapy.)​Fortune telling – assuming they know the future of what would happen if people continue to be treated, and assuming the worst (this is where they list all of the possible side effects of medication without mentioning the side effects of no treatment) and fail to explore the factors that contributed to a person’s negative experience of medication.​​​
  • Mind reading – assuming they know why a person chose to take medication and that they must’ve ignored or chose not to try something “natural” instead, without actually distinguishing what they mean by natural and unnatural, and without any scientific data to support their claim of what is better.
  • Should-ing – oh the pressure of the unattainable, this golden age or perfect human that simply doesn’t exist and never has.​​
  • Feelings as facts – I feel worried so it must mean there is something to worry about and that my fears are true!​
  • So how do we pump the brakes and slow back down?

Perspective

The truth is, life is messy and uncertain. At any moment there can be exciting, terrifying, life changing moments that we are not always going to be prepared for. That is the experience of being human. There are side effects of existing. When the authors of this particular book state “we” don’t know what the long-term side effects of all this medication, it would seem like they do know doesn’t it?
 
What do we know for sure?

Let’s take a condition near and dear to our hearts, attention deficit hyperactivity disorder (ADHD).

The global body of research demonstrates is ADHD is highly heritable, at a rate of 70-90%, which is almost as heritable as height (that means you are not the only one if your family with it, nor are you the first generation with it). Further, we know that unmedicated ADHD puts a person at greater risk of suicide, and that treating the ADHD first or alongside other comorbidities, is the evidenced-based gold standard.[i]

We know the trajectory of untreated ADHD can lead to symptoms of anxiety, which left untreated can develop into depression and increase the risk of suicide (impulsivity, emotional dysregulation, risky behaviour).[ii]

Common sense can prevail sometimes: for all the hand wringing about medication abuse, people with ADHD generally have trouble remembering to even take their medication daily (!).  We know people with untreated ADHD are at 2X risk for substance abuse and dependence (hit or miss dopamine availability, impulsivity, risky decision making, poor executive function and future planning), “ADHD medication was not associated with increased rates of substance abuse. Rather the results suggested a decrease in substance abuse up to 4 years after medication and that the longer duration of ADHD medication, the lower the rate of substance abuse.”[iii]

Then, what is the risk of NOT treating ADHD with the recommended medication? 

Statistics show people with substance use disorder and ADHD are at an almost 5x increased risk of mortality, but that “pharmacological treatment of ADHD reduced risk of substance-related incidents by 35% in males and 31% in females”, and that “stimulant exposed adolescents were 73% less likely to develop substance use disorder vs unexposed”, and with fewer substance abuse relapses. [iii] 

It’s important to note, about 20% of people might not experience a benefit from stimulant medication (and it’s not the only form of treatment), but we should be very aware of what harm is brought about when we shame people for choosing to use medication.

Self-medicating behaviours have existing since the beginning of time, and in the case of ADHD, stem from a lack of treatment.  When the involuntary drive to self-medicate is addressed and a person engages in therapy and ADHD coaching to learn supplemental skills, they are able to treat their symptoms without having to search for risky alternatives.

​It’s worth repeating: when we treat ADHD and the symptoms of under or over stimulation, impulsivity, and emotional dysregulation, it decreases a person’s likelihood to search for their own ways of managing their symptoms that may be risky and often inconsistent. This allows them to treat not just the ADHD but the symptoms that developed from the lack of lifelong regulated support.

Our health care system – the patient as self-advocate 

Everyone likely knows our health care system is under immense pressure.  Everyone is doing the best they can, but in many cases, it still isn’t good enough. The responsibility to manage and navigate our care falls to us at our most vulnerable – when we are the patient.

​We’re vulnerable at the hands of our family doctor – who perhaps has known us since birth, or the psychiatrist (who might not be specialized in ADHD). And in the case of the book author, both a physician and widely accepted as an expert, it can be quite shocking to hear the healer themself shame us for taking a globally recommended and proven, yet stigmatized treatment.  With their opportunity to stand up for us, we are left standing alone. (When was the last time someone was shamed for needing glasses to read, or for taking insulin to regulate their blood sugars?)

Standing up for ourselves

We are learning new things about the brain every day (the human body’s least investigated organ), so it’s important to maintain wiggle room for growth, new science and new knowledge, taking into account the individual experiences of everyone’s brain and body. People with negative experiences deserve to be heard and receive support to find alternative treatments; their experience is valid. A person’s experience of medication is unique because it’s influenced by person-specific factors like diet, lifestyle, comorbidities, consistency, dose management, external support and access to regular follow ups with their doctor, to ensure their treatment is optimized. Not everyone gets the same level of care, even though everyone deserves it.

It’s important for all of us to practice critical thinking, look at the evidence (including tracking our own data!), follow the science, trust our own compass, and be able to distinguish between a fact and an opinion when it comes to managing our health care.

Regardless of our own individual experiences, let’s stop shaming people for taking medication and work to help support people in making a decision that is best for them, acknowledging the relationship between our physical and mental health.

Resources

References

[i] Faraone, Stephen V et al. “The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder.” Neuroscience and biobehavioral reviews vol. 128 (2021): 789-818. doi:10.1016/j.neubiorev.2021.01.022

[ii] CADDRA – Canadian ADHD Resource Alliance: Canadian ADHD Practice Guidelines, 4.1 Edition, Toronto ON; CADDRA, 2020.

[iii] Binder, S. (October 2, 2022). ADHD and SUD: A Case presentation. [Conference session]. CADDRA, St Johns Newfoundland, Canada

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Picture of Erika Belledent, BA (psych), MACP, RP (she, her)

Erika Belledent, BA (psych), MACP, RP (she, her)

Registered Psychotherapist Erika works with adults, couples and families, with a special interest in anxiety disorders, ADHD for individuals and family support, childhood trauma and family of origin conflict. Follow Erika on Instagram

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