"Are you sure I really need medication?"
That is one of the most common questions I answer in my office as a psychiatrist and one that, quite frankly, makes a lot of sense in a culture that stigmatizes mental health. I am so used to answering it that I even have a bit of a canned response. I start with why I think medication could help someone, transition to discussing the risks and benefits, and because it always strengthens an argument, include supporting evidence from science about how medication plus therapy is the most effective treatment for depression and anxiety.
If my patient has not made up their mind either way by then, or more conversation is needed, I typically ask a follow-up question to understand why they are concerned or hesitating. I say something like, "What does it mean to you if you do (need medication)?"
What I didn't realize until recently was that I should have asked myself that question a long time ago. No matter how many times I've had conversations about why it isn't weak, a failure, or shameful to need medication for your mental health — and wholeheartedly believe every word I have said — it turns out it didn't protect me from internalizing the same negative beliefs about taking psychiatric medication myself.
Here is the truth: I have been on a stable dose of Wellbutrin (Bupropion) for 13 years, and despite being quite a public advocate about self-disclosure and mental health, I have never once said that out loud. If you have ever read anything I've written before this may seem surprising because I am really open about my own mental health. But, if you look closely, I've never mentioned having seen a psychiatrist myself or taking medication. It is a boundary I put up, even though it wasn't always a conscious one. Until now.
I first noticed that I selectively left out my medication history early in the pandemic, when a bunch of healthcare workers, professions that traditionally do not talk about mental health at all, shared on social media about their mental health treatment — I participated on Twitter, but only shared about my therapy. I read their responses and thought they were brave and vulnerable, and that mine didn't really say enough. It wasn't a lie, but it wasn't the whole truth.
Even as a prescriber who knows more than anyone how good and important medications are, I felt a need to keep quiet about using them. I started reflecting and wondered if I could even say it at all. I questioned why it was so hard for me to disclose that I took medication while also being such an advocate for medication whose literal job was to prescribe medication. Through conversations with many colleagues who also take medications, I also know I am not the only one. Knowledge and awareness do not make you immune to stigma. Either way, I started beating myself up about this double standard and truly feeling inauthentic.
At the same time, I also wondered why I thought I had to tell people at all. I knew I didn't owe anyone my story — no one does — and I was still being an advocate for mental health treatment by talking about my therapy and being vulnerable at all publicly. In fact, that was the model in popular culture for most celebrity disclosures anyway. When celebrities talk about mental health it isn't typically about medications, but they still have an impact in normalizing the conversation and helping people. I have seen that firsthand in my office when people talk about Demi Lovato's story, for example.
However, there is something special when celebrities actually do talk about the impact of medication. In a recent interview with The Zoe Report, Annie Murphy of Schitt's Creek said taking antidepressants saved her life. She said, "You don't have to be on drugs for the whole time, but they truly, truly saved my life in the sense that I was not a functional human being and I was able to be a functional human being." New York Times Best-Selling author and activist Glennon Doyle often talks about how Lexapro has helped her in her book Untamed and on her podcast. Perhaps because it is so rare to see, and/or because normalizing medications feels so needed, seeing celebrities talk about medications so openly feels so powerful when it happens.
The need for these conversations, and just how much more medications are stigmatized compared to therapy in our culture, makes me feel even more guilty for being someone who has felt unable to talk about it. You can even see in the Murphy quote that she knows people will be uncomfortable with the idea — while encouraging starting medication, she also lightens the pressure by telling people they don't need to stay on it forever. She attempts to calm another worry people have, and that patients bring up all the time before they start medications: the medication life sentence. But some people, like me, will need to be on it all of the time to feel their best and prevent themselves from ever feeling bad again. People take medication all of the time to prevent diabetes or hypertension from reoccurring, but it is hard to wrap our minds around preventing another episode of depression or experiencing worsening anxiety. This stigma is so pervasive that even outspoken allies to mental health treatment have a hard time breaking free from it. I have always wanted medication to be less stigmatized and be seen similarly to therapy as an accessible option for treatment. In actuality, I was contributing to the problem.
I brought my conflicting feelings to — where else? — therapy.
There, I figured out the meaning behind medication and me. As it turns out, underneath my psychiatrist exterior, I believed for myself, if people knew I took medication, they'd think I was sicker than I was. Even as I prescribed it for a college student just trying to get through the pressure of the transition from high school or a female executive who was trying to balance the added burdens of working from home during Covid-19, in my head, I associated medication with worsened illness. And if people thought I was worse off, needing more than "just therapy" to get better, then my colleagues or patients might think that perhaps I would be less good at being a doctor.
As I heard myself say those things to my therapist, I felt embarrassed, ashamed, and angry at the same time. I believe I said something along the lines of "That's f'ed up."
She paused and told me something she had never told any patient before, as a way to make me truly think, as she often does. She said that she, too, took medications, and asked me if it changed my opinion of her now that I knew.
Of course it didn't. Of course I still thought she was the best therapist I have ever had. I have never thought anyone was less good at their job for being on medications. I would never tell any patient they were less than for being on medication — in fact, I spend most of my time helping people find the medication that will help them be more: more content, more confident, more themselves. That is really what mental health means, after all.
Asking for help, including from medications, is a strength, not a weakness, and I believe in medication like antidepressants to help people get back to doing the things they want to be doing in their day to day lives, from socializing with friends and family, to truly enjoying their work. I believe in medication together with therapy as the holistic approach to mental health, the same way a doctor would recommend exercise and eating well for physical health. Medications can help people worry less and feel a range of emotions more. And, when I take my medication I am better able to show up for my patients and myself. It actually enhances my performance as a doctor and a human, it does not lessen it. I am another person that I can name that medications have helped — and keeping that a secret helps none of us.
It is about time I start believing that myself.
Jessi Gold, M.D., M.S., is an assistant professor in the department of psychiatry at Washington University in St. Louis.