Are Psychiatrists like Carpenters?  Does every patient’s symptom look like a nail that should be approached by a hammer (or in this case a medication)?

Are Psychiatrists like Carpenters?  Does every patient’s symptom look like a nail that should be approached by a hammer (or in this case a medication)?

The answer is simple.  “No.”  Not all mental –  health symptoms should be treated with medication.  The decision to employ a new psychiatric medication is based upon a number of different variables, all of which are assessed by the psychiatrist during an evaluation / treatment session.  What are some of the variables that should be considered?

1. Is the symptom really a side effect from another medication that the patient is taking, that might improve by a reduction in dose of the other medication, or its discontinuation? For example, steroid medications can contribute to depression, mania and anxiety, and may not be the only type of treatment that is available to treat the underlying condition, such as asthma or skin rash.
2. Is the symptom a manifestation of a non – mental health medical condition that is masquerading as a mental health problem? For example, does the patient have an overactive or underactive thyroid gland which should be corrected with thyroid medication, not psychiatric medication?
3. Is the symptom the result of an identifiable stressor from work or friends or family that can be influenced or adjusted without requiring a new medication? For example, perhaps the patient has been assigned a higher work load at the office without being provided the resources to help get that work completed?
4. To what extent is a person’s social, educational, occupational or family (role) functioning getting adversely influenced by the untreated symptom, and would the use of medication shorten the time frame it would take to improve that functioning? For example, is a recent stressor interfering with sleep and causing daytime fatigue or concentration difficulties?  Is this interfering with getting the job done at the office?  Or, is the steroid medication prescribed for an acute asthmatic condition causing acute irritability in a parent who repeatedly yells at a young child for no apparent  reason? 
5. Is the “symptom” proportional in magnitude to its cause?  For example, sometimes things happen that do or should make someone angry and the cause does deserve some type of constructive response.  What happens if the anger is denied and ignored and translates instead into stomach aches or headaches. Could that anger be identified and relieved with techniques that don’t require medication?

These are just a few of the myriad of questions that might materialize in a consultation visit between a prospective patient and a psychiatrist.