Medication is one piece of the puzzle when it comes to treating mental illness, yet misconceptions around medications for mental health still exist. So, we spoke to an expert, psychiatrist Dr Michael Schirripa, to explore the topic further.
In 2024, we have quite a broad range of medications that are very effective in treating conditions where depression and anxiety are the core, presenting symptoms. When prescribed appropriately, after a careful assessment, these medications are highly effective in around 60 to 70% of people who experience significant mood and anxiety symptoms. It is generally the case that the more severe the symptoms, the more effective that medication can be.
Medication can also be tailored to the unique individual and to their specific symptoms . For example, sleep disturbance is common in depression and anxiety, and a different medication approach can be taken to a person who feels they are not sleeping enough compared to a person who describes feeling that they are sleeping too much.
Given that there are many options available, a change to an alternate medication can be very effective if the initial choice has not improved symptoms comprehensively enough.
What are some common misconceptions in the community around taking medication for mental health conditions?
I think the first misconception is how much medication can actually help. Often, medication can significantly improve symptoms and, more importantly, improve the quality of people’s lives and their ability to function as they want to.
One of the very common misconceptions is that modern-day medication used to treat depression and anxiety will cause harm and, more specifically, will ‘turn people into zombies’ or will somehow permanently change their personality. In reality when prescribed correctly, people feel better and are more able to function in their everyday lives.
Often, people also worry that they will become addicted or dependent on these medications, but that is not the case. Modern medications used for treating depression and anxiety are not addictive, and quite often do not need to be taken over the long term.
It is typically the case that once people improve and feel better, they can gradually reduce and stop their medication, especially if they have also learnt other strategies for managing their symptoms.
Do you believe stigma is still a factor that prevents some people from accessing mental health treatment?
Stigma has certainly improved and lessened in the past 10 years, which is wonderful, but there is still a way to go to further minimise its harmful effects. Unfortunately, there are still people who feel that they will be criticised or ridiculed for coming forward with their mental health problems.
Some people do still see mental health struggles as a question of ‘strength’ or ’weakness’ but we need to change the narrative around this language. These problems are part of being human and they are very common. People need to understand that they are not alone or somehow ’strange’ for having mental health problems.
It is very encouraging to see that the language spoken about mental health has changed to become more inclusive, more accurate and more understanding. This is vital to helping people to come forward. Each journey towards a mental health recovery starts with a conversation.
What things are important to keep in mind when considering beginning medication for a mental health condition?
Have a discussion with your doctor on what the medication is, what it is likely to do for your symptoms, how long it will take to work and what side effects it may cause.
There is evidence that the more a patient understands about their medication the more likely they are to take it and therefore get benefit from it.
It is also important to have a conversation about what to do if side effects occur and also how much the medication is likely to cost, as there can be some variations in the cost of mental health medications. Affordability is known to be a key determinant regarding whether or not a patient is willing to take a prescribed medication.
Is medication more effective when used in conjunction with talking therapy?
Yes, all of the research evidence suggests that the most powerful and effective treatment option we have is that combination of medication and psychotherapy or ’talking therapy’ rather than just relying on medication alone. There is evidence that medication is more effective if that person is also engaged in a type of psychological therapy. This is true for several reasons.
Medication and psychotherapy, although both attempting to achieve relief from symptoms of depression and anxiety, do work differently and as such their combined effects are more potent.
Talking therapy also allows for ongoing engagement with a treatment provider on a more regular basis and this allows for a closer monitoring of the effect of medications, including side effects.
Talking therapy also allows for a greater understanding of where a person’s symptoms may have originated from and what has triggered any recent symptoms. This can allow for a person to learn strategies to help manage these stressors and triggers, which can help greatly to prevent any future occurrences of depression or anxiety (whether medication is prescribed or not).
How important are lifestyle factors to support mental wellbeing?
Growing research evidence is telling us that lifestyle factors are a crucial piece of solving the mental illness puzzle, both in terms of understanding the causes of mental health problems and by offering solutions and treatments.
Lifestyle factors such as diet, substance use, socialisation, exercise and sleep all play an enormous role in supporting mental wellbeing.
Diet
It is increasingly recognized that a healthy, ’clean’ diet, that is lower in refined sugars and processed foods improves mental health, especially depression and anxiety. The link appears to be in the gut: healthy diets promote healthy colonisation in our gut of healthy bacteria and these bacteria then produce chemicals that are the precursors to neurotransmitters, such as serotonin which can improve our mood and reduce anxiety. A poor diet can kill off this healthy bacteria which can lead to problems with our mental health.
Substance use
Substance use, such as excess alcohol use, can also impair our mental health as not only is alcohol a depressant, but it can also impair medications from working correctly or efficiently. Excess alcohol use can also lead to a range of other relational, occupational social problems that can also worsen our mental wellbeing.
Exercise
It is now very clear that exercise also improves our mental wellbeing as our bodies and minds are intimately linked. Regular exercise also leads to improved sleep quality which is also shown to improve our mental wellbeing. Regular, quality sleep functions as an antidepressant and can reduce daytime anxiety markedly as our brain carries out ‘maintenance’ and ’repair work’ when we are asleep.
Connection
Regular socialisation with family, friends and colleagues is also very important for mental wellbeing. Isolation and a loss of connection with others can be risk factors for depression and anxiety, especially as we age. Keeping regular contact with loved ones appears to function as an antidepressant and provides us with that much needed human outlet and attachment. Our neurological system is wired up to ’attach’ to other people and certain hormones and chemicals are released when we are in the presence of loved ones that can help to prevent feelings of isolation, sadness and anxiety.
You mention that exercise is important for supporting people experiencing mental health challenges, or to support mental wellbeing in general – can you tell us more about this?
Our bodies and our minds are intimately connected and are not separate entities. They both work at their best when we are engaging and employing both of them, not just one or the other. As such exercise (and in particular, ongoing movement) is vital to good mental health.
Exercise is very effective for helping to prevent mental health problems and for treating mental health symptoms once they have occurred. There is strong evidence, for example, that if someone is experiencing symptoms of depression then exercising for 30 minutes per day for at least three days per week is a highly effective antidepressant if that can be maintained for at least 12 weeks. It is believed that there is a more efficient use of oxygen in the brain during exercise and this can improve mood and reduce anxiety,
The great thing about exercise is it can take many forms, can be done alone or with others, and also has a cumulative effect: even 10 minutes here or there all adds up! Exercising with others can also improve social isolation, build social connections and these factors can also function as an antidepressant and promote reductions in anxiety symptoms.
Exercise undertaken in the first part of the day can also lead to better sleep at night, and it is well established that better sleep can improve mental health symptoms the following day.
If someone is concerned that either they or a loved one might be experiencing symptoms of a mental health condition, what next steps would you suggest?
The very first step is to have a conversation and start speaking about how you feel. This may begin with a loved one: a spouse, a family member, a friend or even a close work colleague and certainly your general practitioner or health provider.
If you notice that another person is experiencing symptoms then it is about encouraging them to speak up by taking a caring, non-judgemental approach and simply asking them how they feel or relaying your own observations about them. Letting them know that you are there for them, even just to listen, is very helpful. Again, it is all about encouraging them to speak and find their own language for how they feel and what is going on for them. It is true to say that “a problem shared can be a problem halved” and so those initial words and conversations are vital and can be therapeutic in themselves.
From there, it is about having that person become aware that there is help out there and that these days that help can take many different forms (and does not just instantly mean medication). Getting online can be less confronting initially and can be a great place to start to find services that may provide further information and links to other help.
As always, speaking with your general practitioner (or health care provider) is also an excellent step and that can lead to a discussion with a professional about how you are feeling and, importantly, what can be done about it.
Many workplaces now also offer an EAP (or Employee Assistance Programs) which can provide quite rapid and meaningful support and advice, so enquiring about what is available in your own workplace can also be another avenue to get help.
Why do you think we need to push for better mental health in Australia right now?
Mental health conditions are among the most prevalent health conditions affecting Australians. They can begin or become present right throughout the lifespan: from childhood to old age. 1 in 5 Australians will experience a mental health condition at some point in their life. If left ignored or untreated, these disorders can lead to severe reductions in quality of life, and at its most extreme, can even shorten the lifespan of people who experience them.
The World Health Organisation lists a table of health conditions that, if not treated, can lead to significant disability. For Australia, they specifically list depressive disorders as number three on that list, which tells us that untreated depression is the third most disabling health condition currently impacting on Australians.
Aside from the quality of life and health ramifications, there are significant economic costs to all Australians as well if mental health disorders are left unchecked. This can cost billions of dollars each year, for example, in lost productivity in Australian workplaces. It can also lead to harmful secondary problems, such as substance abuse.
But the situation is very different with treatment. We need to push the idea that you do not need to suffer in silence and that safe, effective treatments are available right now. The push needs to be on to get more people coming forward, talking about their experiences and getting some help or treatment.
Check out our Stories section to read more mental health-related articles.
If you or someone you know is experiencing mental health challenges, Lifeline offers 24/7 crisis support on 131 114.
