The twelfth pillar of recovery is medicines. One section of people is averse to taking medicines because of the various side-effects. Plus, medicines do not cure OCD, they only treat OCD. So, there is a large chunk of people which does not want to take medicines. The anti-medicine community may quote a lot of research which shows how psychiatric medicines impact a person’s physical health, how medicines are not as effective as therapy, and how there are significant side effects. All of that is partly true. But mental issues do not always have just a psychological component. They have a biological component as well. So, realigning what is out of alignment may sometimes require medication.
Being dismissive of medicines because they have side effects amounts to choosing ROCD over a few (and mostly temporary) side effects. It is like the poem ‘The Blind Men and the Elephant’ by John Godfrey Saxe. The six blind men go to observe an elephant and then describe it. Since each person is only focusing on one part, each describes the elephant differently.
One touches the tail and says the elephant is like a rope. Another touches the trunk and says that the elephant is like a snake. The third person touches a leg and says that the elephant is like a tree. The fourth person touches the ear and says that the elephant is like a fan. The fifth touches the sharp tusk and says that the elephant is like a spear. The sixth one touches the body of the elephant and says that it is like a wall. All of them were partly right, but they did not see the complete picture. I have added the poem as Additional Resource 4. Take a break, read the poem, and enjoy it.
Medicines are like that. True there are side effects, some worse than others. But most of the side effects abate. If they don’t, doctors can calibrate the dosage or the medicines to lessen them. If they still don’t, it is the choice you make – whether the side effects are worse than ROCD. Medicines may also take up to six weeks to start showing effect. Most people tend to give up taking medicines if they don’t seem to work in a week or ten days.
The other refrain is that medicines are habit forming. Again, this is an overgeneralization. The three most common types of medicines prescribed for OCD are SSRIs, benzodiazepines and anti-psychotics. SSRIs make sure that the serotonin produced in the brain and gut is available to the brain before it completes its function and gets reabsorbed. Dr. David Burns uses a wonderful analogy in his book ‘Feeling Good’. Think of it like needing to cross a lake over to the other side but not being able to because you don’t have a boat. So, an SSRI enables the serotonin molecules to be available as boats to transmit messages across neural pathways in the brain. SSRIs may cause some withdrawal symptoms with discontinuation but are not habit-forming (Fava et al., 2015).
The second type of medicine that is prescribed, often to relieve anxiety is a benzodiazepine. Benzodiazepines are believed to be habit forming, since they provide immediate relief and hence there is a possibility of abuse (Evans & Sullivan, 2014). Hence benzodiazepines are prescribed for a short duration only, or on an SOS basis.
The third type of medicine that may be prescribed sometimes is a mild anti-psychotic, to augment the efficacy of SSRIs and improve psychological insight, which is sometimes missing. Even SSRIs work to improve insight. But in some cases, an anti-psychotic may be added too. Anti-psychotics are also associated with symptoms of discontinuation (Brandt et al., 2020) but are not habit-forming either.
Sometimes, doctors may prescribe SNRIs or other anti-depressants. Or in the case of some co-morbidity, some other class of drugs. But whatever the doctors prescribe, you should put complete faith in and be compliant with the medication. Non-compliance is one of the major problems where medication for psychiatric disorders is concerned. If recovery is the core objective, medicines may be necessary sometimes.
This completes the twelve pillars of recovery and also concludes this section. In the next section, we shall get down to understanding concepts you need to understand to get better.
Read AR4 – ‘The Blind Men and the Elephant’ for fun