“Doctor, I don’t want to become dependent on medication.”
This is one of the most common concerns people raise when discussing treatment for depression, anxiety or other mental health conditions.
“Will I become addicted?”
“Will I need medication for the rest of my life?”
“What will it do to me?”
These concerns are understandable, but they can sometimes prevent people from receiving treatment that may significantly improve their quality of life.
Much of this hesitation is driven by misconceptions, rather than facts.
The reality is often far less frightening.
Let’s take a look at some of the most common myths surrounding psychiatric medications.
Like medications used to treat high blood pressure, diabetes or asthma, psychiatric medications are tools used to manage specific medical conditions.
Like all treatments, they come with potential benefits and risks.
Understanding what they can and cannot do helps people make more informed decisions about their care.
In clinical practice, most commonly prescribed psychiatric medications are not addictive.
Part of the confusion comes from the fact that the terms “addiction”, “dependence” and “withdrawal” are often used interchangeably, even though they mean different things.
Addiction refers to a compulsive pattern of use despite harm, often accompanied by cravings and a loss of control over use.
Dependence means that the body has adapted to a medication and may react if it is stopped abruptly.
Withdrawal or discontinuation symptoms refer to physical or psychological symptoms that may occur when certain medications are reduced too quickly.
For example, antidepressants commonly prescribed for depression, anxiety disorders and obsessive-compulsive disorder (OCD) are not considered addictive.
They do not produce cravings, intoxication or compulsive drug-seeking behaviour.
However, stopping certain antidepressants suddenly can lead to discontinuation symptoms such as dizziness, irritability, sleep disturbance or flu-like symptoms.
This is not addiction.
Rather, it reflects the body’s adjustment to the medication and is one reason why treatment should be reduced gradually under medical supervision.
Some medications, such as benzodiazepines, which are occasionally prescribed for severe anxiety, panic attacks or short-term insomnia, can lead to dependence when used for prolonged periods.
For this reason, psychiatrists are generally careful about when and how long they are prescribed.
Antipsychotics and mood stabilisers, commonly used in conditions such as bipolar disorder and schizophrenia, are also not addictive.
However, like antidepressants, they should generally not be stopped abruptly without medical advice.
In short, the risk of dependence varies between different medication classes, which is why treatment decisions should always be guided by a qualified healthcare professional.
One common misconception is that all psychiatric medications work in the same way.
In reality, medications are prescribed according to specific conditions, and treatment plans are tailored to each individual.
It is also important to have realistic expectations about how quickly improvement may occur.
For example, the full therapeutic effects of antidepressants may only be felt two to six weeks after treatment begins.
Other medications may have different timelines of action.
Benzodiazepines, for example, can provide rapid short-term relief of severe anxiety or panic symptoms, while antipsychotic medications may begin improving agitation, sleep or distress within days, although full improvement in symptoms often takes longer.
The recommended duration of treatment depends on several factors, including the diagnosis, symptom severity, previous episodes and risk of relapse.
For a first episode of depression, treatment is often continued for several months after recovery to reduce the likelihood of symptoms returning.
Conditions such as recurrent depression, anxiety disorders, bipolar disorder and schizophrenia may require longer-term treatment to maintain stability and prevent relapse.
When a medication does not work as expected, some people may feel discouraged and discontinue treatment.
However, finding the most effective medication may involve a process of trial and adjustment, and it is not uncommon for several options to be explored before identifying the best fit for an individual.
For this reason, comparing medications with friends or relying on self-diagnosis can be misleading.
Two people may experience similar symptoms, but require different treatments, depending on the underlying cause.
In short, the appropriate duration of treatment is therefore not determined by a fixed timeline, but by what is needed to help a person achieve and maintain long-term well-being.
Side effects are a genuine concern, but they are often misunderstood.
Many people worry that psychiatric medications will cause serious or permanent harm.
In clinical practice, most people tolerate treatment reasonably well, and many side effects improve as the body adapts to the medication.
For antidepressants, common early side effects may include nausea, stomach discomfort, headaches or dizziness.
These symptoms often appear during the first one to two weeks of treatment, and frequently improve before the medication reaches its full therapeutic effect.
Importantly, not everyone experiences side effects.
Even among those who do, the type and severity vary considerably from person to person.
A common mistake is to stop medication prematurely because of mild early side effects, without giving the treatment enough time to work.
If side effects occur, it is usually better to discuss them with the prescribing doctor, rather than stopping medication independently.
In many cases, adjusting the dose, changing the timing of medication or switching to an alternative medication can help.
Some medications do carry longer-term risks that require monitoring.
Certain antipsychotics, for example, may increase the risk of weight gain, diabetes, high cholesterol or high blood pressure.
A small number of psychiatric medications may also require periodic blood tests to monitor for rare, but important, side effects.
Psychiatrists will consider these risks when selecting treatment and will often recommend regular monitoring where appropriate.
Treatment decisions always involve balancing potential risks against the benefits of improving mental health and functioning.
One part of management
Medication is often one part of a broader treatment plan, rather than the entire plan.
Many treatment plans combine medication with psychotherapy; healthy lifestyle habits such as regular exercise, good sleep and a balanced diet; as well as regular follow-up to monitor progress.
For some conditions, particularly milder or situational cases, therapy alone may be sufficient, without the need for medication at all.
For others, particularly more severe or biologically-driven conditions, medication plays a more central role.
There is no single correct combination that applies to everyone.
The right treatment plan is built around the individual’s diagnosis, history and response over time.
Recovery’s the goal
The purpose of psychiatric treatment is to help people recover, function better and improve their quality of life.
Medication is one of several tools available to achieve that goal.
However, believing that medication is addictive, lifelong or guaranteed to cause unbearable side effects leads some people to avoid or abandon treatment that could genuinely help them.
The decision to start, continue or stop medication should always be made collaboratively with a healthcare professional, taking into account the individual’s symptoms, preferences, goals and circumstances.
In the final article of this series, we will focus on another important aspect of recovery: how to support a loved one who is struggling with mental health difficulties, while also taking care of your own well-being.
Dr Lim Poh Khuen is a consultant psychiatrist. This is the fourth in a five-part weekly series on mental health treatment and practical guidance in Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
