Mental Health Medications

A tough conversation to have

You’ve probably heard the phrase, “metabolic health is mental health” by now because it’s the topic of many books, podcasts, and social media posts. I’ve been stoked to see this because the role metabolic health plays in mental health is so important and the lack of this conversation is a big reason why more and more people are suffering from mental health issues and fewer and fewer are getting treatment that actually makes them better.

The role that metabolism plays in mental health is complex (here is a social media post explaining in more depth) and nuanced no doubt. Especially considering the wide range of mental health disorders that are now being identified. Regardless, it’s impossible to argue whether or not metabolic health plays a role as the body of research in support continues to pile up.

The part of the conversation that is much easier to argue about is what the hell we are supposed to do about it.

It’s one thing to have a good understanding of the root cause of a condition, which I believe metabolic health is the root cause, but it’s entirely another thing to be able to effectively target that root cause. Especially for certain mental health conditions, which in some cases can require immediate short-term relief or the outcome could at most be devastating and at least be debilitating or extremely uncomfortable.

This is a big reason why the use of psychiatric drugs has become so common. Of course, I’m sure there have also been some profit motives that have driven their widespread adoption and utilization in the mental health community, but I believe that a big driver of their use is the general human desire to treat symptoms and solve our problems with a pill. Especially when we are experiencing discomfort and especially when we are experiencing the discomfort that can be felt from mental health complications.

This is where the conversation gets even trickier.

Now before I go too far, I want to point out a few things:

1. I am not a mental health professional or practitioner. My knowledge is rooted in personal research I have done and through education from incredible mental health professionals like Dr. Christopher Palmer, Natalia Staniszewska, and other practitioner friends.

2. I have never suffered from a diagnosed mental health disorder. Outside of a couple of different short stints of incredibly high stress in my life, I have always had pretty stable mental health. Something I am grateful for but also something that prevents me from fully being able to empathize with people who have or are dealing with these conditions.

3. I am using the phrases mental health and medication/pharmaceuticals rather broadly and more focused on conditions like anxiety, PTSD, ADHD, and depression. There are many mental health conditions including those involving more severe forms of psychosis like schizophrenia and bipolar disorder as well as many different treatment options. I do believe that the underlying mechanisms involved in both are very similar across the board but in this article, we will be speaking more pointedly at anxiety, PTSD, ADHD, and depression.

So this is an opinion piece. An opinion that I have formed through talking to mental health professionals, and individuals dealing with various mental health disorders, and looking at the available research.

Now that that’s out of the way. Let’s talk about mental health medications.

Let’s start with the good.

The great thing about most mental health medications is that they do provide some form of relief. They help the person who is dealing with a mental health condition experience improvements that can dramatically improve their quality of life and in some cases even save their life.

Pharmaceuticals targeting mental health can help people who otherwise wouldn’t be able to hold down a job, fulfill their parenting duties, maintain personal relationships, or even simply enjoy life. In some cases, they can literally save lives, preventing dangerous behavior, irrational decision-making, and even attempted suicide.

For this reason, I am not against the use of pharmaceuticals for mental health. In the short term, I believe they can be extremely important and effective.

It’s the long-term use of these medications that has me worried. This is where we transition to the bad part of the story.

One of the ugly truths about prescription mental health drugs is that the longer we take them, the more we become dependent on them. Talk to someone who has been diagnosed with a mental health condition and prescribed a drug and you have a very high chance of hearing a story similar to my friend Alan.

Alan was diagnosed with anxiety when he was in his early twenties while making the transition from college to his professional career. A stressful period of life no doubt. He was prescribed an anti-anxiety medication that provided him with immediate relief and allowed him to better function in his day-to-day life and feel good while doing it. Over time he noticed the drugs stopped being as effective and when we would talk to his doctor about it, he would leave with either instructions to up the dose or a prescription for a new medication.

After a couple of years, Alan decided he no longer wanted to take the medication so he quit. He quickly experienced a rush of anxiety, depression, and other feelings that were far worse than he was ever experiencing in the first place. He immediately went back on the medication and when he told his doctor, he was scolded for trying to get off the medication. 7 years later Alan is still using the prescription and reports that he feels like his mental health is continuing to decline despite the continued use of the medication.

Stories like this are too common. The reason is two factored. The first factor is related to the nature of these drugs and their ability to make us feel good and get us hooked. The dependency we develop becomes like addiction in nature.

The larger problem is that these medications do not address the root cause of the condition. They do not fix the problem. They are symptom-focused treatments meaning that no matter how long you take them, you are not going to just magically get better. You will feel better in the short term, and if you’re lucky longer term, but at no point will that medication be a cure for your condition.

My issue with this truth is that it is not always what is communicated to the patient being prescribed the medication. Often times a patient is told they will just be put on the medication for a few weeks and then they will be reassessed to see if they can come off it. The problem is that there is often no metabolic-based root cause combination therapy prescribed, or if there is, very little support is provided. Simply put, patients are not being put on a path for long-term success and potential cure.

Here’s the worst part of the story. Not only are these prescription medications not fixing the root cause while making us addicted, but they are also actively making the problem worse. Most prescription mental health drugs further damage metabolic health. These drugs aren’t fixing the problem. They are usually making it worse.

If this is the typical experience of someone diagnosed with a mental health disorder, of course, we aren’t seeing anyone get better so of course we are seeing 90+% of individuals prescribed medications still taking them 5 years later. Our standard treatment protocols aren’t set up for success.

Now if we agree that short-term relief from mental health is important BUT so is the long-term treatment of the root cause of the condition, then the first place to start is by instilling the practice of supported metabolic-focused combination therapy which could range from diet, exercise, and supplementation and supported cognitive focused combination therapy like cognitive behavioral therapy, meditation, therapist communication, and maybe even psychedelic treatment. In summary, the goal should be to use the prescription drugs for symptom treatment, the metabolic and cognitive therapies for root cause treatment, and get work like hell to get off the drugs as soon as safely possible.

The supported component of these lifestyle-based treatments is critical because you can’t expect someone who is dealing with a mental health complication to be solely responsible for getting themselves to exercise, eat well, and practice cognitive therapy. When you aren’t feeling well, these are hard things to stay consistent with. This is why we need a support system offered to these patients. This is why doctors should be working in harmony with other health professionals like dietitians, therapists, and performance coaches.

I believe that this is the quickest and easiest path toward improvement because most of the support is already there. There are more and more educated therapists, dietitians, and mental health professionals sitting on the sideline just waiting to be put in the game. If the support is there, the system just needs to be built around it.

This solution isn’t perfect though. Remember that prescription medications
still further damage metabolic health, the root cause of the condition. Thus, I think a longer-term focus for us is to create symptom-focused prescription drugs or repurpose existing medications that target metabolic health improvement or at the least, do not further damage it.

To be frank, one of the reasons why I think this approach is necessary is because if we keep pharmaceuticals, which can be helpful, in the conversation, we keep the players at the table who have big pocketbooks who if properly motivated may be able to actually help solve this problem. Maybe wishful thinking, but I tend to think most people are good and corporations when left unchecked are the real problem.

As I’m sure you can now see. This is an incredibly complex problem. It’s not as easy as saying we should or shouldn’t use prescription mental health medications. It’s not as easy as saying that mental health is rooted in metabolic health so we should just focus on eating better and exercising. The nuance, like most chronic conditions, is complex and critical to the conversation.

Regardless, we need to reshape the system. We need to reestablish our goals for mental health outcomes and tailor our treatments accordingly. An increasing number of humans are dealing with mental health conditions and very few of them are ever truly getting help or getting better. At the most, they are experiencing temporary relief that is likely to be followed by something far worse in the future.

The alternative to actively trying to fix this problem is not good. So why not give it a shot?

Thanks for reading,

Chris Irvin

P.S. Much of my recent knowledge on mental health has come from the incredible Dr. Christopher Palmer who is actively reshaping the world of mental health treatment. Check out the podcast we did together and the new book he just published called Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health--and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More. This book is an absolute game changer and does an incredible job explaining the role of metabolism in our mental health and even provides a ton of anecdotes from real patients Dr. Palmer has treated. This book has the ability to help a lot of people which is why I want to ensure as many people read it as possible. Click the button below to grab a copy. If you’re feeling it, grab 3-4 books for friends or family members who you think could benefit from it as well!