Destigmatizing Mental Health Medication
by Melinda Lu
In the midst of unprecedented changes including periods of self-isolation that have shaped this unique COVID-19 experience, it is more important now than ever to prioritize our mental health and wellbeing. According to the CDC, Americans have reported a significant increase in symptoms and severity of mental health conditions since the beginning of the pandemic. By June 2020, the prevalence of depression had increased by a whopping four times since 2019. [1]
Although the topic of mental health is becoming increasingly normalized, there remains an overwhelming amount of stigma around mental health conditions, particularly in regards to medication. Individuals utilizing medication as a treatment for mental illness are often ostracized, bullied, and perceived as holding lower social status; they may even be viewed by peers as “different” or “dysfunctional.” [2] While common, these stereotypes surrounding mental illnesses and medication are unfounded. Here’s why:
The majority of mental health conditions are due to changes in brain activity. These alterations can be triggered by environmental circumstances, genetic predispositions, structural differences, or a combination of these factors. Treatments for mental illnesses—non-clinical interventions, psychotherapy, or medication—ultimately aim to regulate the negative changes in brain function.
Let’s take a look at depression: one of the most common mental illnesses. Non-pharmacological treatments, such as depression interventions recommended by neuroscientist and UCLA adjunct assistant professor Dr. Alex Korb, can include practices that we often don’t associate with depression (e.g. exercise, gratitude practice, and social interaction). Depression interventions and antidepressant medications both work to combat depression by altering neurotransmitter and hormone levels and regulating neural circuitry in the brain. The following chemicals are emphasized:
Serotonin - improves willpower, motivation, and mood
Norepinephrine - enhances thinking, focus, and dealing with stress
Dopamine - increases enjoyment and is necessary for changing bad habits [3]
Society lauds many intervention practices as staple components of a healthy, well-balanced lifestyle, yet continues to stigmatize medication for depression and other mental illnesses which aim to restore these healthy processes. Stigma surrounding mental health medication (however factually unfounded) often deters those suffering from seeking the treatment they need.
understanding depression
Depression, contrary to popular belief, isn’t just a pronounced feeling of sadness. Individuals suffering from depression often experience overpowering feelings of numbness and apathy, losing interest in the things they used to enjoy and feeling lethargic and unmotivated to the point where the smallest of tasks can seem daunting.
These sensations of numbness and emptiness have biological underpinnings. Scientists have attributed their effects to problems in the brain’s frontal limbic communication due to the dysregulation of neurotransmitters and hormones in neural circuits.
According to Dr. Korb, our behaviors play a large role in the dysregulation of our neural circuitry. The more we engage in thoughts or activities that make us feel depressed, the more “out of whack” our brain activity becomes. Consequently, we are more likely to engage in those negative behaviors. Dr. Korb dubs this snowball effect the “downward spiral.” [3]
depression interventions
In his book “The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time,” Dr. Korb details several “depression interventions”: small, everyday changes to regulate neurotransmitter levels in the brain, activating circuits to overcome negative habits and introduce good ones, breaking the “downward spiral.” Some examples of these interventions include:
Exercise
According to Dr. Korb, exercise “has many of the same effects on the brain as antidepressant medications.” In addition to increasing energy and concentration levels and improving sleep patterns, exercise increases levels of serotonin and norepinephrine in the brain. While finding the motivation to exercise can be difficult, the more we build physical activity into our routines, the easier and more enjoyable it becomes.
Exercise stimulates the release of dopamine, activating a reward circuit of pleasure and enjoyment that makes us want to exercise more. Working out with a friend, attending a group fitness class, or exercising outdoors are all ways of increasing motivation to get up and move. Although social distancing regulations have thrown a wrench in many people’s exercise routines, following virtual fitness programs or even video-calling a friend to hype each other up can improve the efficacy and enjoyment of home workouts.
Gratitude
Engaging in gratitude practices like keeping a gratitude journal, letting a friend know how much we appreciate them, or even just thinking of one thing we’re looking forward to every day can help activate a “gratitude circuit” in the brain. Practicing gratitude increases the activity of dopamine circuits and boosts serotonin levels, replacing negative thought processes with positive ones and combating depressive feelings of apathy and hopelessness in the process.
Dr. Korb’s definition of optimism as “gratitude for the future”—not the belief that solely good things will come our way, but the faith in our own resilience to help us overcome whatever bad things might—is one that I always rely on to help me view the future in a more positive light.
Human Connection and Physical Touch
Engaging in social interactions and physical touch can boost levels of oxytocin, the hormone associated with love and trust—another chemical circuit that depression disrupts. Increased oxytocin levels help reduce the reactivity of the amygdala, decreasing feelings of anxiety, stress, fear, and pain. Many serotonin-producing neurons also have oxytocin receptors, so the release of oxytocin triggers a release of serotonin.
We don’t necessarily need to directly engage with others to reap the benefits of oxytocin. Even surrounding ourselves with strangers in a place like a crowded café can increase feelings of connection and make us feel less alone. [3] While quarantining during the pandemic has certainly put a damper on our ability to engage in meaningful social interaction, we can still take advantage of modern technology—consider using FaceTime or Zoom to catch up with loved ones.
antidepressant medications
Through a purely chemical approach to regulating neural circuitry, antidepressant drugs target many of the same neurotransmitters affected by depression interventions. There are several categories of antidepressants, including:
Selective Serotonin Re-uptake Inhibitors (SSRIs)
SSRIs—the most commonly prescribed antidepressant drugs—work to combat depression by increasing serotonin availability in the brain.
Multiple-Receptor Antidepressants
Due to the interconnectedness of neural networks, some antidepressants target more than one neurotransmitter. Studies have shown that serotonin and norepinephrine in particular exhibit linked interactions in the brain. Drugs such as serotonin-norepinephrine reuptake inhibitors (SNRIs) increase availability of both serotonin and norepinephrine. Other antidepressants also interact with dopamine. [4]
destigmatizing professional treatment
While there have been efforts to help change people’s views on mental health and mental health medication, it’s hard to correct centuries worth of misinformation and prejudice. Individuals suffering from mental health illnesses, although they may not buy into this stigma themselves, nonetheless internalize public stigma through negative opinions perpetrated by peer and social media networks. Because they often feel unheard, misunderstood, or invalidated, people struggling with mental illnesses are likely to experience feelings of low self-esteem and shame and discomfort and distrust around others. These feelings of self-disgust and isolation can cause them to feel the urge to hide their mental illness, withdraw from family and friends, and hesitate or decline to seek professional treatment. [2]
Medication is not the only stigmatized form of mental health treatment; therapy often gets a bad rap as well. Despite its criticisms, psychotherapy can be incredibly beneficial to both people who suffer from mental disorders or trauma and those who simply seek an expert perspective on their emotions and behavior. Psychotherapy can increase the number of serotonin receptors in the brain by helping individuals regulate their emotions and impulses and can reduce limbic activity by helping patients process trauma. [3]
Depression interventions, antidepressant medications, and therapy can all be effective treatments and are not mutually exclusive—many individuals benefit from a combination of all three. Studies have shown that combining therapy with pharmacological treatment can yield almost double the symptom improvement. [3] While medication is not a necessary or accessible option for everyone, it can be extremely beneficial for those experiencing high levels of apathy and lethargy. Non-pharmacological treatments can yield extremely effective results, yet many people suffering from depression lack the motivation to engage in depression interventions or apply coping techniques discussed in therapy. Antidepressant medication can help increase energy and motivation so people can better benefit from non-medicinal treatments.
final takeaways
Mental illnesses affect everyone differently; consequently, people respond differently to different treatments and one method should not be viewed as “better” or more effective than another. Ultimately, our brains seek balanced neurochemical interactions. While interventions, therapy, and medication present different routes to achieving that balance, they can all be effective methods of maintaining a happier, healthier you!
References
“Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24–30, 2020.” Centers for Disease Control and Prevention. (2020).
“Stigma experience among adolescents taking psychiatric medication.” Child Youth Serv Rev. (2009).
“The upward spiral: Using neuroscience to reverse the course of depression, one small change at a time.” Korb, A. (2015).
“Mechanism of action of antidepressant medications.” J Clin Psychiatry. (1999).
