|INTERVIEWING TIP OF THE MONTH
# 93 November 2007
"Medications as Tools: Patients as the Boss of Which Tool and When"
TISA Description of the Problem: In some instances the use of a medication can feel unsettling because a patient fears that the medication may be changing who they are meant to be - taking control of them. Sometimes a simple reassurance can be surprisingly helpful as described in the following practical tip provided by a psychiatrist from Nevada,
Angeline Lawrence, M.D.
Tip: I like to use the following approach when helping a patient process the meaning of taking a medication:
"Medication is a tool. It does not change who you are nor does it change the stresses of your life. But it can help take the edge off of your depression or anxiety in a way that can help you to engage in the work of taking care of your life the way you want to."
TISA Follow-up: The above approach by Angeline emphasizes to the patient that a medication is something that he or she uses as a way of returning their functioning back to normal. They are in control, not the medicine. Indeed, they have complete power to decide whether to use the medication or to stop it. The medication is a merely a tool.
Along these lines, in my primer written for prescribing clinicians, nurses, and case managers "Improving Medication Adherence: How to Talk with Patients About Their Medications (Shea, SC: Lippincott Williams & Wilkins, 2006)" I describe a method I like to use to address another common concern of patients that "somehow I should be able to get out of this depression without resorting to medications." I call this the "crutch myth" and find the following approach to be frequently effective in allaying this misconception:
"There is another common misconception that these medications are crutches, that somehow you should be able to cope with depression without medications. But if your brain is not making enough serotonin, it simply isn't making enough serotonin, and you can't just "will it" to make more, any more than a person with diabetes can will their pancreas to make more insulin. We would never tell a person with diabetes that their insulin is a crutch because it isn't. We are simply getting their insulin back to the normal level that everyone else has.
It is exactly the same with your depression. Your brain is not making enough serotonin, and we are just going to get your serotonin back to the normal level that everybody else has. It isn't a crutch. It is getting your serotonin level back to normal, so that you then have a fair chance to effectively cope with your stresses. Don't let anyone tell you it is a crutch, because it is simply not true."
I have had good-luck with this approach or variations on it, and it can be used nicely in tandem with the excellent tip provided by Angeline Lawrence.
Tip provided by:
Angeline Lawrence, M.D.
Northern Nevada Adult Mental Health Services