Hallie Alpern is a physician assistant at Young Minds Psychiatry, a practice for all ages in Atlanta. Young Minds Psychiatry specializes in mental health evaluations, diagnoses and treatment plans for patients who struggle with conditions such as anxiety, depression, bipolar disorder, ADHD and schizophrenia.
In my daily practice, people ask me when to use therapy versus when to begin thinking about using medication for mental health conditions. I would like to start by emphasizing that mental health is not black and white. It is VERY grey. No single person’s journey looks the same as anyone else’s. I hope this brief outline provides some insight into the different roles of therapy and medication.
Therapy: When is it appropriate?
Anyone seeking ways to live a more fulfilled lifestyle is a good candidate for therapy. When someone is experiencing a mental health issue such as unmanageable stress or sadness for the first time, therapy often is suggested as a first-line treatment. Therapy also benefits someone who has a desire to open up and learn how to better express emotions as well as anyone who has endured a life stressor triggering emotional instability. Examples of stressors include loss of a family member, a new job and a difficult relationship.
Therapy is beneficial to those trying to gain skills to cope with unwanted mood changes and/or excessive worrying. Examples of coping skills include exercise (the most important coping skill in my opinion), journaling, music, meditation/mindfulness, and arts and crafts. When I think of a more specific coping skill that stands out to me, I think about what I learned from a 17-year-old patient who came up with a bracelet system. She described why she had been cutting herself on her wrists: She wanted to express how she felt on the inside by doing something to her body on the outside. During the course of her therapy sessions, she began using bracelets to describe her mood: green for good days, yellow for OK days, and red for bad days. This helps her to express her mood in a safe way when she doesn’t feel like opening up verbally.
Medication: When should I be evaluated by a psychiatrist to discuss medication management?
First, remember that medication should never replace therapy completely. Therapy, coping skills and exercise are all important in conjunction with medication. If you are experiencing any of the following, you might consider medication: thoughts of harming yourself, any suicidal thoughts (Yes, I said it. It is OK and important to talk about suicidal thoughts!), thoughts of harming anyone else, uncontrollable panic (especially if it includes any respiratory distress), hearing voices or seeing things other people may not (aka hallucinations, which are actually common among people struggling with depression and/or anxiety).
If you have tried therapy/coping skills and have truly put much time and effort into bettering yourself but still are not improving, it is OK to meet with a psychiatrist or physician assistant/nurse practitioner in the field of psychiatry to inquire about medication. If you are considering medication, genetic testing can be done to help determine how your body metabolizes it according to your DNA. Pretty cool, right?
Finally, please know mental health conditions such as anxiety, depression, bipolar disorder and ADHD are extremely common, and symptoms are especially easily triggered this year due to so much isolation during the pandemic. Remember, the most important aspect of treatment is to be open and honest, and to seek help if you need it.
Born and raised in Atlanta, Hallie has always felt lucky to be surrounded by Jewish culture and support. From Greenfield Hebrew Academy (now called Atlanta Jewish Academy) to The Weber School, from her childhood at Camp Barney Medintz to Sigma Delta Tau, her sorority at the University of Georgia, and more, she has always been comforted and enriched by her Jewish community and identity. She hopes this article serves as one small way to give back to that community.
Hallie volunteers for the Blue Dove Foundation and contributes regularly to our blog and printed materials.