Mental health medications: The double-edged sword

This morning, 40 million Americans woke up and, somewhere between putting on the coffee and walking the dog, headed to the medicine cabinet and took a mental health medication. Most breathed a sigh of relief, thankful that their anxiety or depression would feel manageable for another day. At the same time, many worried about the potential side effects of the medication and whether they’d be able to cope if they had to stop taking them.

Meet three people who have to navigate this tricky dilemma on a daily basis: Maria, Jelani, and Chantel. They are our coworkers, friends, and family, looking for the most effective mental health treatment that’ll enable them to excel in the workplace and at home. We’ll follow their stories to take a human-centered look at the advantages and downsides of the most common medications for anxiety, insomnia, and depression.

The double-edged sword

Mental health medications can transform a person’s life. There’s no doubt that these medications can lessen the disruptive symptoms brought about by anxiety, depression, or insomnia. Research shows that when someone takes a mental health medication it can improve their life satisfaction, increase productivity at work and reduce the risk of suicide.

It’s also true, however, that medications come with a host of potential risks and side effects. Side effects for the most common mental health medications range from undesirable — weight gain, sexual dysfunction — to downright dangerous, such as increased risk for seizures, accidents, and serious injuries. Plus, some mental health medications have a risk of dependence, meaning that tolerance builds over time, they can be difficult to stop taking, and discontinuation can lead to potentially life-threatening withdrawal. These risks may be part of why 75% of people prefer a non-drug intervention for their mental health (pssst… read an entire blog on this topic).

Side effects for the most common mental health medications range from undesirable — weight gain, sexual dysfunction — to downright dangerous, such as increased risk for seizures, accidents, and serious injuries.

Mental health is often treated in primary care

Medications are the most common intervention for mental health — 82% of people who present for mental health care are prescribed medication. A main reason for this is the dearth of trained mental health providers, contributing to long waitlists and difficulty accessing care. A recent New York Times piece summarizing survey results from 1,320 therapists revealed that “75% reported an increase in wait times [during the pandemic]. Nearly one in three clinicians said that it could take at least three months to get an appointment or that they didn’t have room for new patients at all.”  

Nearly one in three clinicians said that it could take at least three months to get an appointment or that they didn’t have room for new patients at all.
‍NYT writers Tara Parker-Pope, Christina Caron, and Mónica Cordero Sancho

With nowhere else to turn, people in need of mental health support go to their primary care provider (PCP) — which is where nearly 60% of all mental health medications are prescribed. PCPs are not experts in prescribing and monitoring mental health medications. But in an overburdened system without enough mental health providers, PCPs have little choice but to prescribe, especially when their patients want relief immediately. This reality means that many people who receive mental health medications never get the opportunity to access other forms of care.

But in an overburdened system without enough mental health providers, PCPs have little choice but to prescribe, especially when their patients want relief immediately.

Medications are a one-size-fits-all solution

While for many, mental health medications are a path back to healthy living, for others it’s a long, arduous journey of trial and error. Imagine trying multiple medications, with no way of knowing how much time or money you’ll have to invest to find one with adequate efficacy and manageable side effects — all while wondering whether your mental health will actually improve. Medications are a one-size-fits-all solution to a highly individualized problem.

Even if Maria, Jelani, Chantel each take the same medication at the same dose, each may respond differently. This is due to genetics, biology, age, and other health conditions or medications they’re already taking. There is no way to reliably predict who will have more or fewer side effects, or which specific medication will be more or less effective — even genetic testing doesn’t always offer a clear picture. As a result, many patients cycle through different medications or may need to change their dose multiple times. Everyone hopes to be among the lucky patients who finds a great fit on their first try, but many mental health medications have a remission rate of less than 50%.

We need scalable, effective non-drug alternatives

Individuals and employers hoping to achieve good mental health are left with a conundrum: Take the risk of experiencing side effects from medications and trying different medications to find the right one; or forgo what for many, is the only form of mental health treatment available. That’s an unnecessary dilemma. We can reach more people in need of mental health support if we transform our system to offer more scalable mental health treatments — including safe and effective alternatives to drugs.

Together, we’ll follow Maria, Jelani, and Chantel to take a closer look at the real experiences of people grappling with the benefits and downsides of the most common mental health medication: Benzodiazepines, SSRIs/SNRIs and Z-drugs. Their stories will give us a human-centered perspective at the urgent need for innovation in mental health care.