Do I need to take medication for my mental health condition?

During our talk on “Navigating Mental Healthcare in Singapore” we received many questions about medication to treat mental conditions. Underlying these questions was the concern about the role medication can play in treatment.

We invited one of our speakers, Dr Daniel Kwek, to answer some questions from the audience about mental health and medication that weren’t covered during the talk

1. Is medication essential for the treatment of mental health issues? Medication can come with side effects that can affect one's functioning. What if they make me feel worse than before? 

This really depends on the condition one is suffering from, and the severity as well. Admittedly medication does come with some side effects in some instances. So it is ultimately a risk-benefit decision that the clinician and the patient decide together. The clinician would often go by what is beneficial and with less risk for the patient. That said, there are other options that would have to be considered. Even when a patient has started on medication, there would also be other things that could and should be worked on in terms of knowledge, in terms of social aspects, and also in terms of psychological issues. In the case of anxiety, for example, the patients could also be helped with ways of coping. An example of a condition that may be managed without medication would be a mild case of depression which may respond to counselling, therapy, and practical problem-solving. In the event that medication makes one feel worse, then an early review is needed to determine the nature of the "worse" feeling. Some medications can give a transient worsening of symptoms before one feels better. For example, some antidepressants can in the beginning worsen anxiety/sleep but when the full effects kick in, these would be alleviated. So a review would be helpful to evaluate the situation. 

2. How should I deal with bad side effects from psychiatric medications? What if it's difficult to reach the psychiatrist for a consultation or to bring forward the appointment?

This is an important question.

a. Make it a point to always ask the clinician about the known side effects and what response or recourse one has in the event one really experiences them, at the commencement of the medication.

b. If the side effect is bad but mild, e.g. bad nausea with antidepressants, but you are still able to consume meals to an extent, then you could persist a while since this would usually get better. If it gets much worse, then you should just stop the medication and call the hospital for advice.

c. Take note that there are, occasionally, some severe side/adverse effects that warrant an immediate consult at the Emergency Department. These would include a bad allergic reaction causing problems with breathing, or swelling etc. This would be applicable for any medication, not just psychiatric ones.

A couple of things can be implemented to manage this situation of bad side effects. You can ensure you have a communication channel e.g. a case manager you can call. Or you can schedule an early review appointment relatively soon after you start your new medication.

Calm Collective Asia hosted a talk titled “Navigating Mental Healthcare in Singapore”, where we received over 70 questions during our Q&A session. The questions above are questions that were not covered during the talk.

You can watch the replay here and check out the other questions answered by our speaker here.