- Hey, everybody!
I am sitting down with my friend, Barry Lieberman,
who's a psychiatrist in Beverly Hills,
and we're going to talk about medication, so stay tuned.
(cheerful music)
Without further ado...
- Well, because I'm a person who will see anybody
who walks in my door, as I've told you before,
I'll do psychotherapy for almost everybody.
But about half the people that I see
really need medications.
And that need will vary from dramatically,
when they're severely depressed,
or having severe panic attacks,
or if they have a major mental illness,
such as Bipolar I disorder, manic depressive disorder,
or schizophrenia.
Most people don't have that, you know schizophrenia
is about 2% of the population,
bipolar is about the same kind of percentage.
People with major depression, or major anxiety syndromes
are more frequent, but with them,
you might only use medications for a chunk of time.
But it is really important to see that the medication
is part of the combination of psychotherapy
and medication, because even if it's almost essential
that they take medication, as in they're gonna do
very badly without it, they still need to address
other issues in their life, and how it's affecting them,
and so on and so forth.
- Yeah, 'cause nothing happens in a bubble,
like we don't, especially if we have Bipolar I disorder,
mania can cause a lot of strife in our relationships,
and a lot of other issues, even financial issues.
I have had a client, who used to,
when she was manic, go on shopping sprees.
- That's right.
- And so there are a lot of things,
and, like I've said before, to many, many of you,
and in many videos, like the two together,
with therapy and medication, gives the best outcome.
We know that through every research,
that's ever been done on that subject.
- But that makes the point, that of course,
that medication is one of the tools of treatment.
- Mmhmm.
- And with some people, it's essential,
and other people it's helpful,
and some people it doesn't help.
- Yeah. - And finding out
that it doesn't help is also
a very interesting thing to discover.
- So if you were starting someone,
you decided that they did need medication,
would you, how would you go about picking it?
- Oh well--
- And deciding how long?
I guess, based on severity. - Well, that's actually
one of the toughest, deciding how long, that I like,
I'll clarify that in a moment.
(laughs)
Well, the point of that is you decide on how long,
only if it's worked, and so if it's worked,
then you welcome that decision,
but it is not necessarily a life time thing.
It depends on the condition,
there are people, there are sometimes,
there is things called situational stress disorder.
- Yeah.
- Or something has happened in that person's life,
the breakup of a relationship,
the death of a loved one, the loss of an important job,
and people will not only have a grief reaction,
but that grief reaction may be prolonged enough
to really cause them to go to a lower level of functioning,
then we'll call it depression,
or anxiety disorder, or whatever.
And medications really help that,
but there you're usually, your intention is to
do a short term medication use.
Three months, four months, six months, whatever it is.
I'll always tell people, that if it's worked for them,
I'm going to try to get them to take it
for six months, at least.
- Yeah, and that's what I've heard too.
Many of my clients have said the same,
coming back, that six months is like a fair trial.
- That's right.
- 'Cause we wanna make sure that
we're taking the right amount,
which sometimes it takes a while to titrate up.
- Well, but that six months, is if it's working for them.
- Okay, we have to remember that, this is all based on
if it works. - Cause the newer medications,
the newer and better medications,
whether antidepressant, or anti-anxiety.
Anti-anxiety medications work right away, they're drugs.
You know, Xanax, Klonopin, Valium, etc.
They either work that day or not.
Or even stimulants, when you're using those.
They work that day.
Antidepressants, antipsychotics, or low-dose antipsychotics,
which we'll use to augment antidepressants,
which are an extremely effective thing,
and scare the hell out of people,
when they see the ads on television.
- The antipsych, yeah.
- When you see the ads for the antipsychotics,
I always tell people, either, I used to joke,
stop reading, or now stop watching television,
because the small print, especially when you hear it
recited on a television ad--
- Yeah, may cause death... - Scares the shit out of you.
Yeah, so you know, you think I'm going to die.
And that's a major problem for me,
because I'll say, there's a wide range
of these different medications,
from minimal side effects, to maximum,
and they have to report everything in that category,
so a lot of times, part of my use of medications,
is explaining to people that what we're going to do
is not going to kill them.
- Yeah.
- I've never had, in 43 years of practice, I've never had
anybody have anything really bad happen to them.
A lot of my medication work, is to reassure people
about what medications are, and aren't.
- Yeah, and I think it's important to
ask those questions when you see a psychiatrist,
if they aren't educating you enough about it,
or you still have concerns, because,
I feel like that's a really important part of
what Barry does, is letting you know
what the potential side effects are,
what to let him know about--
- And by the way, philosophically,
I don't think any patient should take any medication
that they don't understand why they're taking it,
what it will do, and what it will not do.
- Yeah, and so, if someone comes to see you,
you said only half are on medication.
- Yeah.
- What is, I don't know-- - Well, that's cause
I like to do therapy.
- Yeah, and I don't know if you actually have
the answer to this, but is there a deciding factor,
or something that you, is it like severity of the issues
that decide whether they're on medication or not?
- Well, good question, severity certainly plays a role.
You know if somebody's coming with mild syptomatology,
obviously, I'm less likely to use medication,
and if they're really suffering terribly,
I'm likely to do that.
But I still see people who are suffering
from very severe depressions,
and very severe anxiety syndromes,
or the secondary symptoms of those syndromes,
or all kinds of compulsive behaviors,
alcoholism, drug abuse, food abuse, etc.
- Yeah.
- And relationship abuse.
- Yeah.
- And that's of course, gets very interesting
and very subtle, because in fact,
I've had patients who I've given medication for
one targeted symptom, and I haven't even heard about
the other difficulties they were having in their life,
and they'll say, you know,
I was really surprised, I also find myself,
I don't know, much more able to be in traffic
without getting into road rage.
- Yeah.
- Or whatever else-- - All the other peripheral.
- And I didn't even know they were having that.
And so, and there are people who I intended
to take off of medications,
and talking about antidepressants, after a few months,
as they're doing better, and they say, I don't want to stop.
- Yeah, 'cause they're feeling so much better.
- Cause my quality of life is so improved,
and with antidepressants, there is no evidence
of any problem on long term use.
- And that's important to remember,
that depending on how you're doing,
depending on the things that are going on in your life,
you may come off, you may restart medication.
- Oh yeah.
- And there is no shame associated with doing any of that.
- No. - It's like I've always said,
recovery is a process, it's not perfection,
and it's having a team of people,
and professionals behind you, to help you know
if you're doing poorly, it's okay to go back on,
or to continue on.
If you feel like you've really improved
because of the medication, like my video I put out
with Paul Gilmartin, last, a couple weeks ago,
maybe a month ago, where he said
that he thought he was doing so well on his antidepressant,
and he felt so much better, he stopped taking it,
and then he got really suicidal.
And so it's important to know that if you're feeling better,
and you think it has something to do with the medication,
maybe you stay on it.
- That's right.
- So-- - That's right.
- There is so much we can talk about
when it comes to medication,
but this is just an intro for all of you,
so that you know kind of what to expect,
that not everybody has to be on medication.
You don't have to stay on it forever,
but it's something you should really talk with
your doctor about, and educate yourself,
so that you know how to better get the treatment
that you deserve.
Thank you so much, Barry, for sitting down--
- Sure, sure. - And taking time.
And thank you all for tuning in, if you haven't seen
the other videos I've done with Barry,
make sure you click here to check out another one,
and don't forget to subscribe,
and I'll see you next time, bye.