Timothy Miller Ph.D.

Clinical Psychologist

Psychiatric Medication

Some of my clients are already taking psychiatric medication when they make their first appointment for counseling with me. Others start taking such medicine after they start seeing me for counseling, usually on my recommendation. Overall, about a third of my counseling clients take psychiatric medication at some point in their treatment with me.

Modern psychiatric medications, particularly antidepressants, are a kind of miracle. They save lives (from suicide) prevent disability, and alleviate misery. On the other hand, they are the pharmaceutical industry's "dirty little secret." Whenever scientists test an antidepressant medicine on humans, many subjects drop out because of unacceptable side effects. Even when people feel much better on an antidepressant, and don't have side effect trouble, most say they feel only partly recovered from their depression. In other words, they don't feel as well as they did before they became depressed.

The most commonly taken psychiatric medications are either antidepressants (such as Prozac, Zoloft, Welbutrin, Pamelor, Celexa, Serzone and others) or anti-anxiety medications (such as Ativan, Xanax, Klonopin, Valium, Buspar, and others). Antidepressant medication also relieves anxiety, although it takes longer to work, and side effects are more of a problem. On the other hand, antidepressants have the advantage of not being addictive or abusable. Most anti-anxiety medications can cause tolerance and dependence. Both antidepressants and anti-anxiety medications can help with sleep disturbance, a problem commonly associated both with anxiety and depression.

Most psychiatric medication is prescribed by primary care physicians, not by psychiatrists. In San Joaquin County, this is probably a good thing, because there is a shortage of psychiatrists. In straightforward cases, it's reasonable for primary care physicians to prescribe psychiatric medication. Psychiatrists should be consulted in complex cases that have not responded well to conventional treatment.

I am not a physician (psychologists have Ph.D. degrees, not M.D. degrees) so I cannot prescribe. I am familiar with most psychiatric medications, and I can advise my clients about the risks and benefits of various psychiatric medications. I will confer with a primary care physician or a psychiatrist, as necessary, if a counseling client needs medication.

Antidepressant medication is usually necessary in cases of catastrophic depression and other severe mental disorders. Even then, counseling combined with medication is more likely to produce good results than medication alone. For other less severe problems, some of my clients prefer at least to try medicine, while others prefer to avoid it, if possible. Either position is reasonable. Contrary to drug company propaganda, many mental disorders respond well to counseling alone.